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]

Thursday, October 25, 2001

• 1534

[English]

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

We are very happy to have with us today, from the Canadian Centre on Substance Abuse, Michel Perron, who is the chief executive officer, and from the Canadian Community Epidemiology Network on Drug Use we have Dr. Colleen Anne Dell. We welcome both of you as the very first non-governmental witnesses we've had on the issues before us. We know you both do great work, so we're really looking forward to what you have to tell us.

Mr. Michel Perron (Chief Executive Officer, Canadian Centre on Substance Abuse): Thank you. Good afternoon, and thank you very much for the opportunity to be here today.

Just to give you a sense of what I'll be speaking to you on, I was asked to provide an overview of the Canadian Centre on Substance Abuse, which is referred to by its acronym the CCSA, for approximately 30 minutes, and my colleague Colleen Dell will be talking about the Canadian Community Epidemiology Network on Drug Use. I will wrap up for two minutes with some thoughts on direction specific to the committee's mandate with respect to this issue.

• 1535

I have a power point presentation, but you also have handouts in your package and they are bilingual, so please, use whichever is the easiest way to see what I'm talking about.

I'm representing the Canadian Centre on Substance Abuse. It states here that our mission is to provide a national focus for efforts to reduce health, social, and economic harm associated with substance abuse and addictions.

The CCSA was created in 1988 by a federal act of Parliament. This was a time when we had a national drug strategy, which was created in 1987. The CCSA was created to be Canada's national non-governmental organization on addictions, to provide a focus for addictions issues, and to provide a means whereby we would bring together credible, scientifically based, objective information on the issues of addictions to policy-makers and decision-makers.

As you start to get into this whole area, you'll see the issue of addictions is fraught with ideological and philosophical extremes, and there is a lot of mis and and disinformation out there. Our role is very much to try to weed through that—no pun intended—to get through what we think is a lot of noise to what we think is probably the best course of action. We are not an advocacy group. We are promoting what we think is the best evidence available for the course of action that should be taken.

I am the chief executive officer of the CCSA. I'm governed by a board of directors, six of whom are named by the GIC, nine of whom are at large. It was specific at the time we were created that we would have a plurality of non government-appointed directors. The position of CEO is also a GIC appointment. I report within the portfolio of the Minister of Health. So we are a bit of an odd creation in the sense that we are not civil servants, we are at arms length, yet we have this conception through government.

When we were first created in 1988, we were to facilitate a lot of the relationships with the provinces, the not-for-profit sector, and the private sector. In addition, we were provided an annual federal grant at that time of $2 million per year, which was reduced in subsequent years to approximately $1.42 million, at which time, in 1997, through program review, it was reduced again to $500,000.

Our current budget exists at $500,000; however, we undertake a number of projects to keep the centre afloat. The size of the centre is approximately 20 professionals—addictions experts, epidemiologists, statisticians, and policy researchers—and the bulk of our work is now conducted under contract to government. We work for the federal government as well as the provincial governments.

I should mention the contract arrangements we have in place today, while they have allowed us to survive since the cuts of program review, were very much a short-term measure and a short-term fix to the situation. We're hoping we can re-establish a stronger core funding base, given the resources and the mandate that is provided to the CCSA. You should note, as well, I've included in your package a copy of the act. And I think that's what sets us apart from any other NGO in Canada, that we actually have an act of Parliament that sets the specific roles, mandates, and responsibilities we are to adhere to.

The partners we work with are varied and very diverse. We certainly work a great deal within the federal government with Health Canada, and you'll have noted that within Health Canada there are a number of players. There's the hepatitis C division, AIDS, first nations, drug policy, drug regulatory—a plethora of partners within Health Canada that we try to work with.

We also work with the Department of the Solicitor General—the department itself—the RCMP, Correctional Services of Canada, the Department of Foreign Affairs, and the Department of Justice. We work a great deal with the central agencies, and in the lead up in recent months, given the liberal government is committed to creating a new national drug strategy, we see it as appropriate for us to provide our views on what a new drug strategy might look like and how we can best leverage the $420 million investment that was committed to in the red book for a new strategy.

We also work a great deal with provincial and municipal governments, Canadian NGOs—and there are approximately 2,000 in Canada that work in the area of addictions—the private sector, U.S. and other governments, and international organizations and NGOs.

• 1540

We have five business lines. I'll run through them fairly quickly for you to give you a sense of the type of work we undertake. Under our policy formulation business line, we have.... I think one of the strengths of the CCSA is that we are meant to broker situations. We are meant to bring together diverse interests, multidisciplinary and multisectoral groups, to the table to try to find and reason our way toward a common resolution to common problems.

The national policy group is a group we chair that develops policy that is ultimately adopted by my board. This policy group brings together representatives of the federal, provincial, and municipal governments, as well as academia, research, and policy. They take on fairly ticklish issues, those which perhaps one federal department or one provincial government might not want to take on on their own. This forum allows for a means of airing views and suggestions as to how we might best tackle a particular issue, such as cannabis, for instance.

In 1998, the national policy group elaborated CCSAs policy on the possession of cannabis, what we might want to do with it, and how we might deal with this issue.

The CCSA also monitors and produces policy papers, again, not as an advocate—we are not saying you must decriminalize, you must legalize, you must have harm reduction—but rather by looking at the issue and trying to rise above a lot of the rhetoric that is out there on these drug issues, getting to the nub of the issue and where we think the evidence best points us. We also monitor research on an ongoing basis.

One of our key business lines is information development, not unlike—you might have heard the term already in other countries—“observatories” of drug information. The CCSA pulls together a great deal of information from a variety of sources, collates it, analyses it, and tries to breathe life to it.

The Canadian profile is a compendium of all the statistics related to drugs and alcohol in Canada. It was put out by the CCSA and the Centre for Addiction and Mental Health, our Ontario partner, every two years. It's a fairly thick document, but it is invaluable to researchers wanting to know anything that's going on with respect to addiction issues. Unfortunately, we have not been able to produce another one, both because of financial restraints and because we have no new data to report.

You've heard previously that we have not had a prevalence study in Canada since 1996. This obviously severely limits the ability we have to report and comment on new drug trends.

The Banff symposium and the Canadian cost study are two issues that are linked. You'll have heard also that the cost of substance abuse in Canada is $18.4 billion. In fact, that figure came through work done by the CCSA, where the CCSA brought together a number of economists from around the world to try to determine a common means by which we could estimate what the cost of substance abuse is to society.

We sat down and developed a common methodology that has now been applied around the world—the U.S., Colombia, Chile, and Europe—and we came up with this number of $18.4 billion. You'll note, within that $18.4 billion estimate, tobacco was the number-one cost; alcohol was the second; and illicit drugs, at $1.4 billion, the distant third.

With that being said, when we quantify the cost of substance abuse in Canada, the illicit drug cost did not have a handle on the drugs-and-crime aspect; therefore, we had to rate it as zero. We have since undertaken research that is going to be coming forward in the very near future whereby we are trying to attribute a fraction on the types of crime and their link with drugs that would be defendable at a scientific level.

In other words, if we know we had 40,000 break and enters in Canada, we could reasonably attribute x amount of those to drugs, and know what types of drugs and what types of drug activity. That would certainly help us in the context of a new cost study in the future, pointing us to where the cost might lie.

Just knowing the cost, however, is not that helpful. Knowing the cost is one aspect. The next thing is to ask where those costs can be avoided, and how we can best invest our programs appropriately and strategically to reduce the costs and measure them over time. The attribution fractions are in the document I referred to with respect to drugs and crime.

We also did a fair amount of work with respect to injection drug use, a comparative analysis of injection drug use policies in Europe and in Canada. This is, of course, another issue of particular concern to many people here. Member Davies, from Vancouver, has a particular interest, I'm sure, with respect to what is happening in the downtown east side there, as well as other areas across the country.

The CCSA also has undertaken work with respect to gambling, particularly the nexus between gambling and substance abuse—where do the two intersect, and how, in fact, are they linked? There is a tremendous amount of revenue being garnered by provincial governments in this area, and we are of a mind to see what the problems are—la problématique—in this area. The Whistler symposium is a means by which we are trying to quantify the cost benefits of gambling as well, using the page we took for the drug side.

• 1545

I should mention also that my presentation is by no means exhaustive. If it were, I'm sure it would be well beyond the time available and the interest level of most people. Nonetheless, it gives you a sense of the highlights of some of the stuff we've done.

We also do a fair amount of work in the area of best practice development, and I know that's a term that has come under some criticism. Some people say you should call it best guesses, or best efforts. At the end of the day, it is looking at the many wheels that have been created to find the best wheels—i.e., programs, determining the factors that make them good programs, and therefore identifying the exemplar-type ingredients to a best practice.

We've done this with respect to youth prevention programs, in a document we did on contract for Health Canada. In this exercise, we identified 40 exemplar-type youth prevention programs. Of these, one was Canadian and 39 were international—U.S. and others. That speaks to the fact there's been a tremendous disinvestment in the area of addictions since 1997, since the sunset of the national drug strategy.

We've also done a lot of work in the area of fetal alcohol syndrome best practices. We're working on how to train practitioners and front-line professionals in the area of fetal alcohol syndrome. We're working on concurrent disorders, where you have mental health problems as well as addiction problems, and how to best tailor our services for those people. We are monitoring the entire field of best practices.

One of the very exciting aspects of the CCSA's responsibilities is network development. For those of you who have thought about the drug field or have been around it in recent years, one of the worst and darkest days for us was during the harm reduction conference in Toronto. It was an international harm reduction conference and we had the police, the health people, and the harm reductionists there. We thought it was going to be very much a consensus-building event, when in fact it was nothing but. It was very divisive.

From that point on we saw there was an opportunity to go to the health and enforcement people and ask how we could bring these groups together and work together in a very integrated fashion. We've tried to do that with a number of groups, and our networks are based on the notion of bringing together very diverse interests, trying to leave our ideology at the door, and putting issues on the table that we know are right.

Among the various networks we coordinate—there aren't that many, admittedly—one is a network of heads of Canadian addiction agencies. These are agencies that are responsible for addictions in a province, for instance, British Columbia, Alberta, Manitoba, Ontario, and Quebec, with

[Translation]

the committee on the non-medical use of drugs.

[English]

In the past year I put this group together and asked if the CEOs of these organizations would be interested in forming a group to ensure that we, as CEOs, look at the strategic requirements of the field of addiction, how we can best work together, and how we can leverage our investments and work on this issue at the same time.

The heads of agencies and I met yesterday in Winnipeg. They had some specific issues they would like me to bring, on behalf of the committee, to this committee. I will touch on those a little later.

One of the other networks we lead is HEP, or Health and Enforcement in Partnership. You may have heard of this acronym in the past. This is a national network with a national steering committee co-chaired by myself and the chair of the drug abuse committee for the chiefs of police. We bring together interests from treatment, the RCMP, AIDS, and a variety of groups. At HEP we try to look at developing a policy forum by which we can address issues of common interest.

A very easy example is needle exchange programs. When they first came about, at a chief of police level—I'm not talking about a police officer's level—they thought they certainly supported drug use and didn't want anything to do with them. If anything else, they were rather good places to do surveillance because they were target-rich environments, as they might call them.

Of course, the health people said that was completely not helping them. So we got the chiefs of police and the health people to sit through the HEP forum, and we have come to the point where the chiefs of police now endorse them, and have adopted a resolution among their constituent body supporting needle exchange programs. It doesn't mean to say there's not a lot of work to be done, but it's really moving the issue along and coming to a common understanding of the issue.

CCENDU is another very comprehensive and solid network we have the pleasure of chairing. I will leave my colleague, Dr. Dell, to speak to that at the end of my presentation. I'll just pass on that right now.

• 1550

We also have a network that is funded by the Department of Foreign Affairs called the Virtual Clearinghouse on Alcohol, Tobacco and Other Drugs. If you go on the Internet and try to search for cannabis, you will learn how to smuggle it, smoke it, eat it, and do everything you need with it, but you won't find the information you might require as a committee member. It is difficult to weed through all of these websites. The virtual clearinghouse is a single portal that is accessible to all, but contributed to by few. Those who contribute to it are recognized organizations that provide credible information in the area of addictions. It's a French, English, and Spanish site. Approximately 31 countries are members of it. It is governed by an international committee. It is very much a means of moving forward on the Internet, trying to get away from all the difficult information, and focusing on issues that are of most interest to policy researchers and decision-makers.

Finally, through partnership with Correctional Service Canada, we have created a national researcher database that has just come online. Those who are working in the area of addictions can find out who is doing what and where the expertise lies. If we want to do a project on fetal alcohol syndrome in Whitehorse, we can go on this site and identify who, among the Canadian researchers, are working in that area.

We are also undertaking a content analysis of the site to see where the primary interests of researchers in Canada are, where the gaps might be, and where that might lead us in investments for the long-term capacity-building of researchers in this country.

Finally, the information and reference service is another of our business lines, and speaks to the national clearinghouse on substance abuse information. We provide information to a variety of sources, agencies, and governments on addictions issues. We have a very extensive collection of what they call fugitive or grey literature, which is literature that has not been published in peer-reviewed journals. They are difficult-to-obtain documents that researchers typically like to look at and draw from, as they go about their research.

The clearinghouse has always been at the forefront in making these documents available on the Internet. Our interest in this area is to have not only information management but knowledge management, and to disseminate that information across the board to all those who require it.

We also maintain a fetal alcohol syndrome andfetal alcohol effects information line. It is funded in part by the Brewers Association of Canada and the Association of Canadian Distillers. We very much embrace the opportunity to work with those in industry, particularly those two, given the fact they have a responsibility in this area. It has been a very effective partnership over the years.

We also provide what's called customized information services. In other words, if you want to know something about drugs, these organizations actually hire us to provide the support to their people. The International Labour Organization in Geneva has us on their payroll, so to speak, so when their people require information on addictions they call us. We do the same work for the Alberta Alcohol and Drug Abuse Commission in Edmonton.

I will end here and turn the floor over to my colleague Dr. Dell, to speak about the CCENDU network. At the end of her presentation I'll have some specific recommendations or thoughts that the committee might want to consider, on the field of addictions and where you might want to focus your effort.

Dr. Dell.

Dr. Colleen Anne Dell (National Research Adviser and Director, Canadian Community Epidemiology Network on Drug Use): Thanks, Michel. I would like to highlight some of the key aspects of CCENDU, because I have ten minutes here, I believe.

I believe we all recognize that there's currently a dearth of literature and research in this area. So I'm going to give you information on CCENDU, and I think you will see there's a lot of shared investment in CCENDU. There's a lot of collaboration in the community and at different departmental levels. I think that's one of the strengths of CCENDU, and I'll highlight that.

Essentially, CCENDU's vision is a partnership to monitor drug trends and associated factors. There are two parts to that vision. One, which I think really captures CCENDU, is the idea of partnership. As I just said, there's partnership at the local, national and international levels. The other part is to monitor drug trends and associated factors, and that's essentially the data part.

In CCENDU, we're in pursuit of valid and reliable data. A lot of people define CCENDU as a pulse of the city, to see what's occurring at a local site we have in a certain city, in terms of drug and substance abuse. People also refer to it as an early warning system to see what's occurring, for example, with Ecstasy, or what have you.

We have, at the national level, some data sets. What we don't have though.... If you have a national representation of data sets, you have a national surveyor, and so forth. Sometimes that's not applicable to places like Charlottetown, P.E.I, for example.

• 1555

I was just talking with one of the site coordinators from St. John's. What's occurring is that the number of people who die from injection drug use, such as from injection drug use related to hepatitis C, is very small. There are two people. How is that representative when you have a national population survey?

What CCENDU does is address that. The background of CCENDU is that it was spearheaded by the CCSA and is guided by a steering committee. It began in 1996. It's a counterpart of the Community Epidemiology Working Group in the United States, which has been around for 25 years. One similarity with the CEWG rests in the fact that a lot of the work is done on a volunteer basis. Very few of the site coordinators are paid. Some are even from the academic community. There are also some resources from, for example, the Addictions Foundation of Manitoba and AADAC.

What is not common between CEWG and CCENDU is the funding. There are large data sets within the U.S., as I'm sure you are aware, with DAWN for the treatment databases and so forth, and we don't have that at any level in Canada.

CCENDU is a collaborative project involving federal, provincial, and community agencies with intersecting interests in drug use, health, and legal consequences of treatment and law enforcement. Again, key to this is partnerships, putting data to use.

As to the CCENDU steering committee, you can see here the idea of partnership. There is diversity, intersectoral representation, and partnership on this committee. We have the Canadian Society of Addiction Medicine, the new CSC Addiction Research Centre in P.E.I., the Federation of Canadian Municipalities, various divisions from Health Canada, Ottawa Hospital, and the RCMP. Substance abuse, as I know you're aware, is a very multi-dimensional issue, and therefore you're going to need a multi-dimensional response. That's one thing we address at CCENDU.

Currently we have 15 sites across Canada. They're at really different levels of development. For example, in Whitehorse there are not the resources at this time, but we do have a member who is a site coordinator in Whitehorse and who is able to provide the pulse of the city and what is actually happening there. Right now, this year, we have eight site reports coming in from Edmonton, Regina, Winnipeg, Toronto, Ottawa, Montreal, St. John's, and Vancouver. Again, these are available on our website, and I also have some copies if people would like them.

The primary goal of CCENDU is to coordinate and facilitate the collection, organization, and dissemination of surveillance information on substance use among the Canadian population at, again, the local, provincial, and national levels. We do this though local site reports. Once a year our sites collect data—and I'm going to tell you the indicators they collect it on—and provide this in a written report. From that we do an overall national report to try to compile this information. One of the problems we have is the standardization of data. What is collected in, say, Winnipeg as compared to Vancouver may not be the same; it's not collected the same way and so forth, so you have a harder time comparing. But again, it is necessary to have that type of deal because each of our individual sites has different problems specific to the locality.

We collect both qualitative and quantitative data, and again, I'm going to tell you what the indicators are. Quantitative data might be, say, the number of deaths or morbidity determined through hospital separation data. Qualitative data is what I like personally because, again, I think it gets at the pulse of what's going on in the city. For example, if we want to know what is occurring in a specific city with OxyContin, we can go consult focus groups using emergency medical personnel: doctors, nurses, and so forth. Then we can get an idea of what is occurring without relying on media reports and anecdotal information.

Next, as we look at the secondary goals, number one is networking at all levels: local, national, and international. On each of our individual sites there is partnership. You will have various people on a site: a chief medical officer, an RCMP or other police officer, site representatives from, say, a community agency, and so forth.

Number two is data development and evaluation. We recently had a meeting of our national coordinators here in Ottawa. We started to look at our indicators—which I'm going to tell you about in a second—and also at this idea of standardization: how can we get a better national picture in Canada of what's going on in terms of substance abuse?

And third is data surveillance. Again, this is what I've talked about in terms of the reports. With regard to the reports and who's comprising the committee at the local level, once these reports are produced, people can put this into action and that can filter down to local practitioners.

• 1600

We'll now look at our indicators, and there are seven of them.

Number one is prevalence, because we want to know the proportion of the population using alcohol or drugs.

Number two is treatment, looking at all aspects of treatment programs in Canada. Unlike the States, which has the DAWN database, Canada does not have a national database on treatments, so it's very hard to collect data on successful treatment, the number of people going through, and so forth.

Number three is law enforcement. We collect data on the number of drug offences, court procedures, seizures, and so forth.

Morbidity looks at the burden of disease related to alcohol and drug use, and this is at the time of hospital separation.

Mortality is the number of deaths directly attributed to alcohol and drugs.

As to HIV/AIDS and hepatitis C, as you may well be aware, a lot of it is laid to injection drug use; a lot of that data comes from Health Canada.

The last one is prescription drugs, and this is a new one we're starting to look at now through some data from IMS and other data on drug-dispensing activities in Canada.

Just to close in terms of CCENDU, I think we can describe CCENDU as having an observatory function similar to what Michel described with respect to CCSA. It's an important, vital function to find out what's happening across Canada in terms of drug and substance use. It's also important to have this early warning system as part of it as well. It's severely under-resourced, but I think this is typical of the field of addiction as a whole.

Mr. Michel Perron: Thank you, Colleen.

As I mentioned earlier, I thought I would finish with some suggestions with respect to the mandate and scope of interest for the committee. I do hope that this is not seen as presumptuous on my part, but I did detect a common theme about this type of question in previous evidence I read from your previous witnesses.

I've been working in the drug field for a number of years, and frankly, just when you think you have it, it becomes very elusive. It is a very complex field, and its horizontality is as much a strength as it is a liability. It affects so many different parts of the machinery of government and the fabric of Canadian society that it's hard to encapsulate it. Nonetheless, I've tried to do this for you on this next page just to give you a sense of what it is you have to deal with and what the environment is that you are looking at. I hope this actually makes some sense to you.

What I've put before you on the slide here is, on the left vertical axis, three types of interventions—that is, what the field typically looks at as types of prevention: primary prevention, secondary prevention, and tertiary prevention. These are in increasing order of use. In other words, primary prevention is aimed at those who do not use drugs, namely younger children or people who do not use drugs at all. Secondary interventions primarily concern those who are using and using in a dangerous way, where we're trying to reduce use or promote use in a safer manner. Tertiary intervention is typically referred to as treatment.

If you look at the bottom line, I've gone from in utero to seniors, and it's basically the life continuum of Canadians. If I can encapsulate this in one page, this is in fact the totality, as I would suggest and the CCSA would suggest, of the arena you have to look at and work in.

Where we situate ourselves on this grid.... I really hesitated to use dotted lines, and I was wondering what kind of lines would be best there. I don't want to pigeonhole; I don't want to compartmentalize. This is in fact a very fluid type of chart, yet it allows you to be rather specific where there is a need for specificity. For instance, if you look at adolescents and treatment, they would be about halfway up the line here. That would be where they would be on this chart, and you can ask yourself, who's working in this area and what is it we need to do for this group?

Similarly, if we have seniors who abuse alcohol and are on medication—they fall down, they break their hip—they in fact are fairly costly to the Canadian health care system. They aren't necessarily in need of treatment per se so much as education on safe practices with respect to drinking while on pharmaceutical products.

By the same token, if we talk about a healthy pregnancy, something that is of interest to everybody, what are in fact safe levels of use—if there are any—when you're pregnant? What do you tell a pregnant mother if she says she's just had three drinks of wine and has just found out she was pregnant? What if she asks whether she can have one drink of wine a week and so on?

I think plotting—and without getting too academic, because I'm not an academic—gives you a sense of where things might lie on this. If you look at injection drug users who are young, they could be right up in the secondary panel there as they're using in a very dangerous way and might be in need of treatment, and so on and so forth.

• 1605

The question then is what do we do with these boxes? This is what the next slide looks at. You can look at this matrix from different points of view. You can look at it as to what is the federal government's responsibility or by substance. If you go back to the previous slide, you can say let's look at this for alcohol or for OxyContin. Let's just look at this for different orders. You can look at it along the lines of harm reduction. Who's doing what on harm reduction in this area? Who's doing what in enforcement?

Suppose we're looking at healthy pregnancy. The question you might ask Health Canada as a committee or if you're in charge of the federal government is who's the lead on this and who else is involved? That would suggest not only within your department but also in other departments. Who's doing what? I'm assuming we have objectives for this particular program. You would find out what is being duplicated, what is counterproductive, and where the gaps are. So you would get a sense of what is going on. There is a tremendous amount of activity at the federal level, never mind at the provincial and municipal levels and other sectors in each of these boxes, and I think it would be helpful to get a sense of what that activity is.

The next question is how does this box fit in with and relate to the overall environment? Where does that fit in as you move up the scale from primary to secondary or as you move into your lifespan?

Where does a national drug strategy fit in with regard to overall government initiatives? In other words, if we create a drug strategy, where would the drug strategy fit with regard to organized crime, terrorism, homelessness, and crime prevention? These are some of the environments you might want to consider.

As you go forward and you have to look at this very broad sweep of activities and areas, you might want to ask yourself these questions in order to frame it. I'm not suggesting that you'll have all the answers. I'm suggesting that the committee might in fact raise the questions and ask the government to come back with the answers. I think it would place a tremendous burden on the committee to think that you're going to come up with all of these answers. In addition you have a very short timeline, and I don't think you can do a lot of these things in the time you have available. With that being said, you can certainly set forth the mechanisms by which these might be looked at.

You have already started, obviously. You're asking what are the nature, extent, and consequences of substance abuse? We don't really know what those are in Canada. We don't know about the use of cannabis or other drugs in Canada. We know what the costs were in 1996 based on 1992 data, but we don't have anything very current. What have we been doing at a federal level, and what impact has that had?

What should be the federal role? I think this is critical. Frankly, we don't need a federal drug strategy. We need a national drug strategy that involves every order of government, the not-for-profit sector, and the private sector and that leverages the investments of each of those orders together. The leadership of the federal government is critical in making this happen, but defining what that federal role would be would be very interesting. Certainly, it's a point that the heads of addiction agencies raised with me when I met with them in Winnipeg yesterday. They said, please ask the committee if they could define that federal role.

The next question you might want to consider asking is where do you want to invest? How do you operationalize this? These speak to the issues of machinery, organization, leadership, and coordination.

I would imagine you might want to ask, did we get it right? It's that cyclical process of coming back and adjusting and building on the information we have.

If I could sum it up, you will be pulled in many different directions, given all of the various interests that apply to the area of addictions. If I could ask one thing of you it would be to bear in mind the need not to get too much into the details. Everybody will pull you into the details. It's important to know them, but the value added of this committee, in my opinion, is to look at the big picture. There is not the view within government today of where the big picture is, where it all hangs together, or where this hangs with other orders of government.

I'll stop there, Madam Chair. I think our time has elapsed.

The Chair: I'm sure all the committee members will agree that it's fascinating. You've definitely given us lots of food for thought.

We are going to have some time constraints in terms of everyone's schedules. It's always a problem with Thursday afternoons in particular. I believe there is some arrangement over here so that Ms. Davies would go first. Perhaps Madam Allard can ask a question, and then we'll go back to the regular order.

[Translation]

Is that possible?

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Because people take the plane?

The Chair: Yes. The next time you fly, you will find... [Editor's note: inaudible]

Mr. Réal Ménard: We had asked that meetings not be scheduled for Mondays, but nevertheless, there have been some Monday meetings.

The Chair: There have.

Mr. Réal Ménard: That's right.

• 1610

[English]

Ms. Libby Davies (Vancouver East, NDP): Thank you very much. I appreciate the other members allowing me to go first. I'm just dashing off to a Literacy Day event.

Thank you very much for coming today. There are a tonne of questions I would love to ask you, but I won't be able to. So I'm going to focus my remarks on what I consider to be the critical elements of injection drug use in particular. You mentioned the downtown east side, where the body count is quite awful. It's now the leading cause of death in B.C. for men and women between 30 and 44, over heart attacks, car accidents, coronaries, the whole bit.

I feel that in Vancouver we've come a long way in the debate. When we were first talking about things such as safe injection sites or heroin maintenance programs, it was very controversial. I was out on a limb, as were other people. Now the debate has gotten very broad. With the mayor of Vancouver, the previous provincial government and hopefully the present provincial government, and even within the police department, there has been a very solid debate about what we need to do.

I don't know if your organization was involved in the federal-provincial-territorial advisory committee on population health. I was very pleased to see that they were coming to the same conclusion, that we need to look at safe injection sites. Firstly, I want to ask you if you are endorsing that. How do you feel the debate in the rest of Canada is going? You say that you have these pulses across the country.

Secondly, just picking up on something you said in terms of what you do in your particular centres and monitoring what's happening on the street, I've tried several times to get the RCMP, or even Health Canada, to look at the issue of providing information to health care providers about what is available on the street. There's no question that the high overdose death rate is as a result of people basically not knowing what they're taking. There are very pure substances out there. People are dying. Sometimes we get a whole string of deaths. So I believe that as part of harm reduction, we need to have public disclosure so that people will know when something really bad has hit the street. I just wondered whether or not you had ever tried to take that up in terms of monitoring or public disclosure for the groups you network with.

Mr. Michel Perron: Thank you for your questions, and thank you for your leadership in this area. I know that you have been very active in it over the years.

You raised a lot of points. With regard to safe injection sites, if we want to focus on that specifically, as you know, the debate has raged and continues to rage in Canada that in order to have a safe injection site, that has to be part of an overall comprehensive drug strategy. Others are saying we can't wait until the whole thing is rolled out before we get a safe injection site; we need to act right away.

How is it that we approach this issue? The CCSA has not taken a policy position on safe injection sites per se. Therefore, I'll speak from a personal perspective.

Certainly safe injection sites should be considered as part of an overall approach to addressing injection drug use. I think we have to be careful that we don't automatically assume—and I'm not suggesting you do—that a safe injection site or a heroin maintenance program of any sort will solve the issue of injection drug use. In fact, when you ask a lot of injection drug users whether they want legal heroin, they often say they'd rather just get off heroin.

When we look at Zurich and countries where they have heroin maintenance programs, you will know yourself that these are for the aged chronic addict who has repeatedly failed at conventional treatment methods. I'm not sure that our addicts in Canada have had the chance of repeatedly failing at conventional treatment methods, because I don't think they have access to treatment many times. So that's one point.

With regard to safe injection sites, certainly they should be considered. I was part of the FPT committee on IDU.

In Canada we often focus on the very-high-profile issues. I think it's important, particularly for the committee, that we also look at prevention. We have to look at the stuff that doesn't make the papers as much. Harm reduction is one aspect, but so are prevention, treatment, and law enforcement. How do we have that intersect in each way? I truly believe that's the only way we can move this thing forward.

So yes, safe injection sites make sense, given where the issues are today.

• 1615

With respect to testing substances—I remember Mr. Turvey had recommended this many years ago—if you could provide us a copy of the analysis certificates, we can tell you if there's a hot load on the streets. I won't speak on behalf of the government departments; that's not my position. Certainly that type of information would be helpful, but I'm sure you'll appreciate there might be some problems with respect to testing the wrong load, if there is a hot load.

How is it that we get all types of information to drug users, rather than just about purity? I think that is an element CCENDU could be looking at—at least monitoring the purity—

Ms. Libby Davies: Right now there's really no information. Usually when the information gets out there, it's too late, and we've had very preventable deaths. I think this is just a tragedy. Sometimes the information people are getting is just lacking, and the body count goes up.

Mr Michel Perron: On a final point concerning safe injection sites, I've been a member of the drug abuse committee for the chiefs of police, and while I don't speak for them either, one of the things they say is “Fine, let's have a safe injection site. But we also need a prevention program in schools for kids. We also need resources for parents.” If the government is going to place its attention on the addictions issue, as it has stated in the red book, then let's make sure we hit all the important points rather than just the safe injection point, respecting absolutely how important it is in the area of Vancouver.

Ms. Libby Davies: Thank you.

The Chair: Thank you.

Madam Allard.

[Translation]

Ms. Carole-Marie Allard (Laval East, Lib.): Good afternoon, Mr. Perron. Thank you for coming. Your centre was established 12 years ago.

Mr. Michel Perron: That's correct.

Ms. Carole-Marie Allard: I have been working with this committee for the past two months and I'm astounded by the testimony I have heard. You talked about prevention. Do you believe enough is currently being done in terms of prevention? Shouldn't we be focussing our efforts on this area? You seem to be saying that in our schools... If we were to properly fund a prevention campaign, do you think we might make some headway in combating the youth drug problem?

Mr. Michel Perron: Absolutely. Just look at the results of the strategy aimed at getting young people to stop smoking. Admittedly, smoking is on the rise among young adolescent females, but generally speaking, consumption is down in the general population. As a result of an extremely effective campaign to stop impaired driving, young people no longer find this behaviour acceptable. According to the results of a survey conducted this week in Manitoba, young people consider driving under the influence to be unacceptable behaviour, but see nothing wrong with getting behind the wheel after smoking a joint. Prevention education is an absolutely critical area. It's one of the best ways of spending money.

Ms. Carole-Marie Allard: Do you have statistics comparing drug prevention strategies with smoking prevention strategies in Canada?

Mr. Michel Perron: No. I can tell you that very little is being done in terms of a drug prevention strategy. If any action is taken, it's more on an ad hoc basis. There is no national drug prevention program. We haven't assessed any one program to see if it is working as it should.

I would have to say that prevention efforts are sadly lacking at the federal level. However, prevention is also a provincial and municipal responsibility. The federal government role in this field needs to be clearly identified. Considering the effort consigned to smoking prevention, why isn't the same effort put into drug prevention strategies?

The Chair: Go ahead, Mr. White.

[English]

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

I want to thank you for coming today, both of you, because you have put into perspective something I've been wrestling with, and that's the scope of this committee. I like what you've got up there. In fact I think some of it is exactly what we have to start looking at, which is what the federal government role should be. When I look at all the research documents I have from over the years, there's an unlimited number of opinions. I find the research so extensive I just can't get through it. In fact most of the time I find I just muddle through it nowadays.

• 1620

One of the things I would like to see from this committee is this. I don't know if you've got a study done on it or not, but you hear about “RITE” commissions: rehabilitation, intervention, treatment, enforcement. Under those categories, I would like to see the recommendations made by the various organizations out there in the country. There are so many of them, but I'd like to get a grasp on what organizations are saying about enforcement, what they are saying about rehabilitation—what, specifically, their recommendations are.

Are there 40 recommendations out there from credible organizations in this country that say we're far too short on rehabilitation facilities, perhaps not in detox, but maybe in intermediate or long-term care? I just don't know, and it seems to me that inventory is missing. Do you have such a thing?

Mr. Michel Perron: No, we don't, not as you characterized it. We have bits of it. Let me clarify.

Last year, the heads of addiction agencies and I got together and said we haven't had a national conference on addictions in Canada for years. Who knows when the last one was? We said let's have one. Let's have the start to what might be a new drug strategy. Let's at least ask the practitioners what it is we need to do.

Coming out of this meeting in Winnipeg, we came up with a list of critical and essential elements of a drug strategy—what we need to do in particular areas. They touch upon the items you referred to, Mr. White, and I can certainly make that report available to the committee.

One of the recurring recommendations you will hear a lot, I would imagine, if you go back to the chiefs of police and ask for all their resolutions—and to the police associations and the Canadian Medical Association and so on—is for more resources, leadership, coordination. Where that gets you, I'm not sure.

With respect to what it is we need to do for treatment—is it access, availability?—if this is work that would be of interest to the committee, certainly we can do some more digging for you on it.

Mr. Randy White: What I'm looking for is to know under each of these categories of treatment what all the recommendations are by all of these groups, and exactly where they are headed. They'll differ from each other, I'm sure, but perhaps if there's enough of a consensus out there that 20 or 30 credible groups are saying this is what you have to do—that is, recommend this—at least it might provide some focus.

I have a couple of further questions. Are you a medical doctor, by any chance?

Mr. Michel Perron: No.

Mr. Randy White: Ecstasy seems to have come onto the market today with a splash, so to speak, and we don't have much good information on it. I believe it may replace marijuana, because it avoids the smoking for one thing, which a lot of young people just don't do. Can you tell me, is Ecstasy more dangerous than marijuana?

Dr. Colleen Dell: First I'll comment on what actually exists across the country in terms of Ecstasy use. A lot of what we see in the media on use of Ecstasy sometimes concerns other types of drugs that are used in combination with it. When we see “Ecstasy death!”, was it specific to Ecstasy, or is it something the media have taken upon themselves, saying “This is Ecstasy”?

Ecstasy used to be used by a 13-to-18 age group at raves and so forth. Now the rave group ranges from 12 to 24. Now we have a much larger group, and with the older group there's also been the introduction of alcohol. So now you're seeing Ecstasy used in combination with alcohol and other things as well.

At our CCENDU sites across Canada, again you see the same thing; you see very different pictures of what actually the prevalence of Ecstasy use is.

Mr. Michel Perron: Speaking just on the specific point, because we can't rely on national data—since there are none—I'll rely on Manitoba data that just came out last week. Five percent of high school students in grades 9 to 12, I believe, used Ecstasy in the past year. That's up from 2% the year before. So there's definitely an increase.

The use of Ecstasy also is very much related to a social movement involving raves, as you know. By the same token, 38% use cannabis. What does that mean? I think, at the end of the day, the frequency of use, the purity of the drug, how you use it, whether it's a pharmacologically more dependent drug or more dangerous—I can't tell you, frankly. Probably somebody could, and we could find that answer for you. I wouldn't want to pronounce specifically. The question, I think, is what it is that we see as an acceptable level or not of risk for the kids on these drugs.

• 1625

Mr. Randy White: I don't think the percentage use is indicative of the growing problem, because marijuana has been around a lot longer than Ecstasy has. I think you'll find Ecstasy is more of a clean drug, if you know what I mean, because you don't smoke.

Dr. Colleen Dell: There's a whole culture around Ecstasy.

Mr. Michel Perron: With respect to raves, parents think it's great to drop off kids at raves because there's no alcohol.

Mr. Randy White: Yes.

Mr. Michel Perron: Well, that's not very helpful sometimes.

Mr. Randy White: I just want to ask you one quick question. There are so many organizations in Canada involved in the drug industry—whether studying it, whether as proponents of safe injection sites, or needle exchange groups, and so on. You have a number of CCENDU sites across the country, and I often wonder how many of these organizations work at cross purposes to each other. If you go downtown to the east side of Vancouver, it's almost an industry down there. There are more social groups down there working for every project and getting grants from every level of government.... I just have this feeling that across the country it's not focused. Can you give me an idea of that?

Mr. Michel Perron: Yes, you hit the nail on the head. It isn't focused. It isn't coordinated. There is a tremendous number of groups out there doing what they think is appropriate and right. I personally start from the assumption they're all trying their best and think this is in fact very important to do. When you look at VANDU, what they're doing in Vancouver is quintessentially important to them. I think to say they're wrong or another is right—and I'm not saying that's what you're implying....

The fact is, if we step back and ask what is it we want for Canadian drug policy in Canada—what is it we stand for...? What is Canadian drug policy? How do we want to make efforts to go ahead? Or if we recognize that drug policy is here or drug use is there, how do we organize ourselves to minimize these duplications—minimize the fact that we've probably created 48,000 manuals on the same thing across the country because of the nature of the work we do, because of the nature of the funding organizations...? It is, I think, the role of the federal government to step back and say “What is that central leadership and coordination role that we play?”—recognizing that they can't do it all, I agree. I think by starting from within, certainly, we could attract the others as well.

Mr. Randy White: Do I have more time, or am I out?

The Chair: You could ask another quick question.

Mr. Randy White: Oh, a quick one.

The Chair: You could come back on another round.

Mr. Randy White: Yes, I'll let somebody else have some time.

[Translation]

The Chair: You have the floor, Mr. Ménard.

Mr. Réal Ménard: Thank you. I have three brief questions.

The briefing book that we were asked to read this summer—a 300-page document that our research staff kindly put together to increase our knowledge of the subject, as we are not as knowledgeable as you, although we do know some of the basics—contained a limited review that you yourself had done of the impact of drugs on Canadian society, as well as an attempt to evaluate the impact of drug use on Canada's GDP. I'd like you to go over the main points of this review and the methodology used. Do you have any figures indicating productivity losses linked to drug use and the extent of drug use?

I'll ask my three questions all at once.

One of your comments took me somewhat by surprise. You claim that yours is an advisory body - not exactly a Crown corporation, but a recipient nevertheless of a modest amount of government funding, considering the task at hand. You seem to be saying that you have not taken a very clear position on various drug issues and that surprises me somewhat.

For example, one member of the Canadian Alliance that you probably know is Keith Martin. A debate on the marijuana legislation is scheduled to take place in the House either next week or the week after that. My colleague Bernard Bigras had also tabled a bill calling for the legalization of marijuana for medical, not recreational, purposes. We're talking about people who need the drug and would be allowed to consume it for medical reasons. Do you have any views on this subject?

• 1630

Therefore, my questions relate to your centre's specific mandate, to the use of marijuana for medicinal purposes, and to the cost of drugs to Canadians and Quebeckers.

Mr. Michel Perron: When I said that we weren't taking a stand, perhaps I wasn't making myself clear. When research shows that a particular course of action is the right one, then we do take a stand. We don't always sit on the fence. We take a stand every time we possible can.

For example, in 1998, we argued in favour of the decriminalization of simple possession of cannabis and maintained that offenders should be fined instead. However, we also called for prevention programs, among other measures.

Therefore, we do take a stand, when the appropriate course of action is clear to us.

If I understood your question correctly, you wanted to know where we stand on the use of cannabis for medicinal purposes.

Mr. Réal Ménard: That's correct. That's where the debate started.

Mr. Michel Perron: Indeed. Again, we have not made a final determination. There are three aspects to the marijuana question: legalization, decriminalization and medicalization. These expressions are commonly used by many people under a variety of circumstances.

On the subject of the medical use of marijuana, we at the CCSA believe that the new drug approval process must be followed. If it can be scientifically proven, through trials in Montreal, among other places, that a particular drug has therapeutic properties, we would not object to its use for therapeutic purposes. It's a matter of whether the drug is medically approved.

Mr. Réal Ménard: Something is wrong here. In order for a company or anyone else for that matter to obtain a notice of compliance and subsequently the go-ahead to market a drug, the drug in question cannot be an illegal substance. Health Canada cannot approve a toxic substance.

Mr. Michel Perron: In fact, Health Canada has approved the use of heroin. Heroin is available by prescription.

Mr. Réal Ménard: No order of compliance was issued. I see, it was approved under the Emergency Drug Release Program.

Mr. Michel Perron: Correct, but it is nonetheless available. Hospitals can prescribe heroin for the treatment of severe pain, for example, to terminal cancer patients. Physicians can prescribe heroin. Obviously, it's an illegal drug. If it can be demonstrated that cannabis can be used for similar therapeutic purposes, it would then fall into the same category, in our opinion The issue for us is not whether cannabis should be used for recreational or medicinal purposes. The issue is what kind of drug prevention policy we want in Canada. Do we want people to use the drug? What are we trying to achieve by bringing in the legislative changes on cannabis? Are we trying to reduce socioeconomic costs? I'll get to that in a moment. Are we trying to resolve some of the problems associated with having a criminal record? Are we trying to reduce the harmful effects of a drug like cannabis on human health?

We feel it's important to target very clearly the problems we're trying to address. If fairly convincing evidence exists that marijuana could be used for therapeutic purposes, fine then. Canada's drug approval system is quite clear on that score. The difference with cannabis is that it is used quite commonly. There is the whole question of the acceptability and commonality of marijuana in Canada. That's where we stand on the therapeutic use of this drug.

As for the socioeconomic costs associated with cannabis use, in order to arrive at an estimate of sorts, we brought together various international economists and asked them about the specific costs associated with the use of a particular drug. If we start with the premise that 70 per cent of accidents are caused by drug use and that there are 100 such accidents in Canada, it's easy to do the math and come up with a figure.

• 1635

Using data for 1992, we estimated the cost of drug abuse in Canada in 1996 - and this includes alcohol, tobacco and illegal drugs - at 4.9 per cent of GDP. This 4.9 per cent loss in productivity, which is equivalent to about $4.9 billion, is a loss that can be recovered fairly easily through prevention programs, perhaps in the workplace. The costs are tied to productivity losses, and absenteeism resulting from accidents and drug use.

Mr. Réal Ménard: Thank you.

Mine were straightforward questions and you answered them very clearly.

Mr. Michel Perron: Thank you.

The Chair: You get a star.

You have the floor, Mr. Adams.

Mr. Peter Adams (Peterborough, Lib.): Thank you, Madam Chair.

[English]

I was very interested in what you both had to say on the networks...your points about Canadians' strengths and weaknesses of the situation. For example, having the pulse of a great variety of communities is immediately a big advantage. Having some indication of drug use in very, very different environments from downtowns of large cities up into the territories is very useful.

I think you both mentioned standardization somewhere. I wonder about this basic matter of data. I can well see that for alcohol and tobacco, there are all sorts of ways of doing calculations in addition to interviewing people and asking, “Do you use tobacco?”, or whatever. You do calculations on consumption and so on. But for illicit drugs, it seems to me it's a very different matter. For example, we have been told that the amount of illicit drugs caught at the border has gone up. Now, that's very interesting, but unless you have some idea of use in the country, you have no idea what percentage that might be of the total.

With respect to illicit drugs and data collection and standardization of the data, can you truly say to us that the use of a certain illicit drug is increasing? Are your data sufficiently accurate and standard to be able to show that there's a trend of some sort? That's the general framework of my question.

The other question then is, are things improving in the area of data collection? Should they improve? What should be done? Do you understand my point?

Dr. Colleen Dell: Yes.

Mr. Peter Adams: Because if you're going to tackle a problem, you need to know the magnitude. My impression is we don't really know the magnitude of the problem in some of these illicit drug areas.

Dr. Colleen Dell: Definitely, one thing with CCENDU sites and what's provided.... When we talk about standardization, when we looked at CCENDU, you had this little bit of information from Charlottetown, Winnipeg, and Vancouver. You can't compare. So we looked at national data sets in Canada and what could be disaggregated to an individual level and what we could compare it to. Say there's a national population health survey, which is done by Health Canada, with a specific question on alcohol abuse. Can we bring that down and compare that for Vancouver, say, to Winnipeg and Charlottetown, whatever? That's in alcohol.

There's going to be an illicit drug question on a second round of that survey coming out in 2003, I believe. But that's one survey. You see the inherent difficulties with the survey.

Mr. Peter Adams: That's for alcohol, where you've got the figures.

Dr. Colleen Dell: Yes. With illicit drugs, they do have one question that is coming out on one of the surveys through Health Canada. So that's just one question and that's a survey.

What happens, though, when we look at seizures, for example, of a certain illicit drug in Winnipeg? When we look at a CCENDU site, if we have the RCMP, we have local RCMP on there; we have people from community groups; we have the Addictions Foundation of Manitoba, and so forth. We're able to take what that information is so it's not just solely a number, because maybe there was a change in reporting practices or whatever. We take that number and we're able to contextualize it for that city. Does that make sense?

Mr. Peter Adams: Yes, I understand.

Dr. Colleen Dell: So yes, we're able to contextualize that. We are able to provide that snapshot of that city in that way.

• 1640

How much we can do that in terms of standardization across the country is harder to answer. However, if we did have national data sets with which we were able to work, the better it would be. The last one we had, as Michel said, was nearly a decade ago.

In terms of improvement, we're looking at not just the quantitative data and the numbers. If you're going to look at illicit drug use, methodologically you would want to do some triangulation; you would want to look at data that were more qualitative, finding out what is happening on the street and so forth. That way, can you compare it across the country? One of my areas of expertise is qualitative methodology, and I would say that you can. There are certain ways of doing interviews, going into the street, or doing focus groups in emergency rooms, and so forth. So you would be able to do that.

The CEWG, the Community Epidemiological Working Group from the United States, which has been around for 25 years, did a really interesting study, an ethnographic study of illicit drug use in 10 major centres in the U.S. They put some funding into that and there was some standardization in being able to see what was going on with a certain substance.

Mr. Peter Adams: So you go back from the use to the quantity of the drug. Let's take cannabis, which, as Randy said, has been around a long time. Obviously it's illegal. People will give you some information about it, but you don't have a great deal of information about the actual circumstances. So for cannabis, with what level of confidence could you say to us that cannabis use has increased by so many percent this year, decreased by so many percent, or stayed the same? Then I would ask the same question for Ecstasy, which, as Randy said, is new out there.

And when you answer that, do I have to assume that you go from interviewing people—as you implied in the case of Manitoba—asking, “Have you used Ecstasy lately?” to then somehow elaborating that back to a population? You try to get the total use in the population.

Dr. Colleen Dell: I don't think you can go from individual site to individual site and say this is a national average for Canada; this is what's occurring in Canada. For that, you would have to do something that was standardized across Canada so it was implemented the same way in each of these individual sites or sentinel sites, or what you want to say.

What we're doing is providing a snapshot, and that's the best we can do. If we had the resources and money were put into that to get a real understanding of what is occurring in Canada with Ecstasy use or with OxyContin or what have you, that would be a different story—if you could put the money in that way.

Mr. Michel Perron: Perhaps I can just add to that. Your question was can you see a trend rise, decrease, or otherwise in cannabis—

Mr. Peter Adams: Can you state confidently there's a trend—that's really the question.

Mr. Michel Perron: The short answer is yes, there is an increase in cannabis use among high school students in grades 7 to 13 in Ontario, and that trend is also seen in Manitoba. I'm being very specific because those are the only two places where there is in fact information that has been collected on a similar population as they move through the ages. You'll see that the age of onset is actually decreasing in some areas, or increasing in others. We can't tell you that on a Canadian scale because we haven't had that information. We can rely on provincial data because they have in fact been collecting it.

But it's more than just the one time, as you mentioned. You need to have a trend. You need to be able to compare this year over year. So given provincial data in Ontario and Manitoba, we can say that with a fairly high degree of certainty, given their methodological uses of surveying in schools, yes, cannabis use is going up, as is Ecstasy.

Now, there are all sorts of qualifiers. What kind of cannabis are we talking about? What is the purity of the cannabis? What is the purity of the Ecstasy? What is included in Ecstasy and all sorts of other club drugs? That's when it gets a little bit murkier.

With respect to the committee and where you might want to go on data collection, whatever we do in Canada has to be sustainable over the long haul. We cannot keep jumping in and out of the drug file, hoping to get a glimpse of the picture and then coming back in ten years and figuring out what it is again.

Mr. Peter Adams: Each of the points in the trend has to be of known value. You can't just put points this year that are not very good and points next year that are very good and then put a line through it.

About what you said on the role of the committee—I wasn't being critical, by the way, in any way, because I greatly admire, particularly with the volunteers, the amount you've been able to do—I was trying to get an example. If there was another type of disease—we hear a lot about that sort of thing nowadays—in order to set up a federal strategy, which is really what we're thinking here, you actually have to have some indication—

Mr. Michel Perron: What the problem is.

Mr. Peter Adams: —that the disease is getting bigger. I mean, if the disease is getting smaller and it's disappearing or something, then that affects greatly what you're going to do about it. That's what I was trying to get at, and the point about data collection and the quality of data collection. So I thank you for it.

• 1645

Dr. Colleen Dell: If I could add to that, we get really excited when a new study comes out or a new survey comes out and says this is what's happening in Manitoba, and we kind of accept that as is. I think what we need to do, as well, is to be critical of that survey, not specifically the one in Manitoba, but if a new survey comes out we should ask, what is the methodological soundness of this? What are they really representing? How representative is that population? If it was a school survey, you only have kids in school. What is it? So we get really enthusiastic when there's new data coming out, but we must qualify that or contextualize it, as well.

Mr. Peter Adams: Thank you very much.

Thank you, Madam Chair.

The Chair: Thank you, Mr. Adams. It was like the professor talking to the professor. It was great.

Mr. Sorenson.

Mr. Kevin Sorenson (Crowfoot, Canadian Alliance): This is not like the professor talking to the professor; this is like—

The Chair: The father talking.

Mr. Kevin Sorenson: Yes. This is perhaps from someone who does not understand the problem to the degree that others who sit on our committee do. I'm new on this committee, and I haven't done a lot of reading on the background of it, like the report. I'm looking forward to getting a copy of that report.

I have a question for you. Last week we came to committee and I made a statement that my children have never tried drugs, never experimented with drugs, and the crowd broke into riotous laughter. They thought I was very naive. Then I think they were quite satisfied when they found out that my children were still under the age of ten. In Canada, have we thrown up our hands with this problem, whereby it's beyond the realm of belief to think that any young people haven't experimented with these kinds of drugs? Are we kind of defeatist in our attitudes? Is it true that we would never talk—as the senator said last week—about prohibition, we would never talk about anything that would mean basically no drug use, but we talk about things like harm reduction, minimizing drug use, minimizing illegal drug use?

In my riding, drugs are not a big problem. It's predominantly a rural riding. I wouldn't be naive enough to suggest that this is only an urban problem in our country, and maybe it's the availability of drugs in the urban area, but certainly urban areas are where the congregation of users and misusers and abusers gather. In my riding, I don't see a lot of misuse of it. There is marijuana use and some of those kinds of things.

Are we defeatist in our attitudes? When we had the head of Canada's drug strategy here, I asked her: “You have a $33 million budget. Are we winning in this strategy? Do we have a winning strategy?” Her answer was that there's no way of judging whether we're winning or not. I would look at it and I would say that obviously we're having a committee meeting here because we aren't winning. You have a job because there are concerns and we aren't winning. Maybe the first part of winning any kind of battle is forgetting the denial and saying yes, we're losing so badly that it's time we start looking at why we're losing so badly. Many of the people coming here wouldn't suggest we're losing. I find that unbelievable. We look here at what is the nature, extent, consequence of substance abuse. So how are we doing?

Mr. Michel Perron: Are we winning? It's an excellent question. As difficult as it is to answer and as much as I want to just really get into this—

Mr. Kevin Sorenson: And could you also speak a little bit about harm reduction?

Mr. Michel Perron: Sure.

Let me start by saying the whole discussion—and I might ruffle some feathers with this, but it's not meant to be that—of legalization, decriminalization, and harm reduction is frankly a red herring, which is in fact distracting from the real issue, which is what is it we want for our population in Canada? What do we want for our kids?

• 1650

Are we defeatists? The question is do we accept that there will likely be a level of experimentation among children who grow up and go to high school and that there will be pot circulated at a party or what have you. Yes, there will be experimentation. The question for us is that we understand that there will be risks of use among those kids, and how is it that we minimize the risks—not harm reduction necessarily, but how do we minimize the risk of drug use, problematic drug use, among all Canadians?

In your discussion you said illicit drugs. When we did our cost study of tobacco, alcohol, illicit drugs, we found that alcohol is a hugely important and very costly drug in Canada. People say it's legal. It's not illegal. The fact of the matter is it is very much part and parcel of when our kids go to their parties, or when you go sit in the gravel pit with your two-four of beer, where you start off, and then you get in the car and you drive, or you get drunk and you have risky sexual behaviour and you come down with an STD or HIV. It's the whole use of illicit and psychoactive substances by Canadians that I think is what is most important to us. Recognizing there will be some use, how is it that we minimize the negative impacts of that use?

With respect to war.... I use the word “war” in terms of are we winning the war on drugs and this sort of thing. I know you didn't use this term; CBC national news used it with me last week when they asked me if we are winning the war on drugs. Frankly, that's a U.S. term. I don't believe there is a war on drug use in Canada. A lot of people will say there is. At the end of the day, Canada has always approached the issue from a social health perspective. The U.S. has approached it from a national security perspective. Therefore, it's two different kettles of fish.

I don't think we're defeated. I think we have to accept the fact that there will be some use and we have to minimize those costs. How do we do that? We have to know where the costs lie. We have to know the extent and prevalence of certain use. We have to know where the negative impacts of that use occur and how we reduce it.

Harm reduction is a very interesting fashion. There is no common definition of “harm reduction” as well. Something I would suggest for the committee, as you go about your work, is that in the absence of a common definition you make up your own, or use your own, because at the end of the day there are those who believe A is the actual definition, and those who believe B, and then they go all over the place.

Harm reduction in its purest form is reducing the immediate consequences or harm related to a substance abuse. This means you use a clean needle instead of a dirty needle, that you drink whiskey instead of rubbing alcohol, that you open your LCBO, your liquor outlets, at nine o'clock in the morning so that those who are on the street don't go drinking rubbing alcohol at nine o'clock in the morning—they have access.

It's a variety of issues. Frankly, I know we talk about pillars of a drug strategy, and we talk about harm reduction, enforcement, treatment, and prevention. I would like to see Canada come up with a new drug strategy that uses these as the tools by which we have a strategy, but not necessarily as the pillars of a strategy.

I think we should look to try to create something that is new for Canada. We should build a drug strategy on innovation and integration, by which we're looking at making Canada a healthier place. We can use harm reduction, we can use prevention, but what is it that we want to establish as our own drug policy? What is it that we feel is the best for our health policy for Canadians? That applies throughout the systems, from harm reduction to enforcement and onward.

I'm not sure if I got you your answer.

Mr. Kevin Sorenson: No, you did, and I appreciate that. I think of harm, and I'll tell this little story of harm reduction. I have a very close friend—I wouldn't say very close friend, but actually a relative—

The Chair: That would be very close.

Mr. Kevin Sorenson: I have more than one friend and acquaintance. But this person grew up in a home, was very straitlaced, and went to one party. At that party she was tempted. The drugs were available. She didn't want to do it, but the peer pressure pushed her into it. She'd never experimented with drugs, but tried it once and got bad drugs. She went from a top-of-the-class student to basically—I don't even know how to term her now—just a social misfit, with obviously huge problems, emotional instability, everything. And it all goes back to the bad drugs.

So we have two different ways. How do you reduce harm? I'm not saying I'm a prohibitionist, but as a parent I would tell my children that story, saying “Just say no”. There are others in the committee who might suggest other ways of making sure that we have a safe drug supply, that therein lies two—

• 1655

Mr. Michel Perron: I'll give you an in-between, if I may: just say no to drugs, but say yes to what? I think that is a different way of looking at it, and one I think the committee might want to look at. Saying no to drugs is great, but what do we say yes to? What do the aboriginals in northern Labrador and the Innu in northern Labrador say yes to? Abject proverty, absolutely no hope of getting out of this cycle of poverty and abuse and what have you.

Ideally, we would like to say yes to theatre, employment.... This is where I think the drug strategy has to fit into this broader umbrella of where this fits in for employment, where it fits in for innovation, for computers, and so on and so forth.

So to say no to drugs is one area, yes, but the alternative doesn't mean to provide drugs either.

Dr. Colleen Dell: May I add to that?

I always think on the macro level. Being on this committee, I'm sure one thing to think about is the embeddedness. When you ask if we are winning, look at the embeddedness of illegal substances in our everyday lives, in our culture, the media culture. I teach a course in addiction, and the one thing we're looking at is the media and watching the commercials on TV. Yoy have people lining up for Trident gum and it looks like they're standing in a rave. You have small kids, if you've seen the commercial, sitting around the table and this one is saying “I never did it and I started and I was hooked and I couldn't stop”, and they're talking about reading.

So this is becoming embedded somehow in our culture, and we need to look at that. What is acceptable? Why are we using analogies to drug abuse for reading? So putting it in that broader context that Michel is talking about....

Mr. Michel Perron: Can I just make one point, Madam Chair?

The question is are we winning. In Winnipeg, 38% of high school students use drugs. The reporter asked me, “Michel, why is that?” I said, “Why don't we ask why 62% don't?” Less than one percent of Canadians use heroin, so 99% of us don't. So when we talk about the winning formula, it's not necessarily a function of yes, there are some tremendous problems. I think we have to recognize what those problems are and try to reduce those problems where we know we can. But by and large, Canadians don't choose to use drugs.

Licit drugs like alcohol have a much higher prevalence, there's no question, because they are available and legal. Therefore, you see that 80% of Canadians might use alcohol on a regular basis. But to say that among those, how many are using the harmful...? I think it's more than saying that 50% of Canadians believe in legalizing cannabis. What does that mean, exactly, if that is in fact a true figure? I just pulled that out of the air.

The question is, what are the impacts on drug use? I think that's what we're getting into: how does that affect us as families, as parents, as educators, as parliamentarians?

Thank you. Sorry for the run-ons, but we wanted to specify that.

The Chair: Mr. Sorenson left one issue on the table, but Mr. White has to get a plane, so we're going to go to Mr. White, and then I'll tell you what issue was left on the table that I'd like an answer to.

Mr. Randy White: Thank you. I apologize, I do have to leave for a plane. I suspect that's why there are some empty seats here. Thursday evening is a bad time for us.

Is it time in Canada to consider—I was going to use the word “drug czars”—a federal organization similar to yours that looks after the drug issues, with funding going to that organization, not through all these departments, and then redistributed to similar agencies, one in each province, as opposed to the diversification we have across the country as it stands?

Mr. Michel Perron: If you look at other G-8 countries, they certainly have a much more centralized leadership and coordination approach to the drug file than we do. You have a drug czar, you have the home office that is responsible, and so on and so forth. And there are some budgetary ties to it.

I used to work for the Canada Drug Strategy Secretariat, when we had a drug strategy in the second phase. One of the greatest challenges to the secretariat—we were responsible for coordinating the strategy—is that we didn't have the tools, responsibility, or mandate to do that. So we would go with moral suasion, go and talk to so and so—“Would you please let us know what your budget is?”, and “Oh, gee, you're lapsing money; you might want to shove it over to another department”. That doesn't happen, and we know that.

I think if we look at what it is that we need, Health Canada is our lead department in Canada for the drug strategy. The first question I would ask is if that is the appropriate department, do they have the tools, mandate, and the resources necessary to do that work? Whether we need one central agency that holds all the purse strings, that has all the money, I'm not sure.

I think we can have a much more effective strategy than we currently have by having a high level of accountability and coordination among perhaps the three departments that are very key to this—Solicitor General, Department of Justice, and Department of Health—not unlike the national voluntary initiative, where you have this number of ministers working together.

• 1700

I would love to see the federal government have memorandums of understanding with the provinces with respect to their roles in a drug strategy. I think that would be very effective. We could say “you're responsible for treatment, we're responsible for providing you money through the alcohol and drug treatment rehabilitation program, and we're also providing you with transfer payments to the provinces; here's what we hope for from you with respect to drugs.”

I think there is a need for a higher level of coordination and integration. It could be within a central agency, certainly, but right now, before we jump there, you might want to ask Health Canada if they have the right tools to do what they're doing.

Mr. Randy White: Thank you.

The Chair: Thank you.

On that point, from the presentations we got from the various departments it sounded like the thing most of us cared about, which was prevention, was being done by the RCMP, and not by the other departments.

Mr. Sorenson had asked whether drug use was a problem in his riding, since it is very rural. I was looking for some kind of answer on that. I would think that it's not so much a rural-urban split, that it could in fact be demographics—what the age of the population is—and that would also be somewhat about the kinds of drugs we're talking about. Certainly there are parts of the country traditionally where lots of people use Valium or use sleeping pills or whatever, and they may be technically legal, but it's still substance abuse. I wonder if you could comment on that.

Mr. Kevin Sorenson: I have just one other little question that ties in with this. Does this substance abuse as you see it in Canada...? I don't know if it's ever decreased, but does it increase or decrease relative to alcohol? I know alcohol is one of the substances, but when we're talking about harder drugs, is it relative to alcohol increases and decreases, as we see, for example, marijuana or heroin use? Is there any way of...?

The Chair: Do you mean if they use heroin, do they not use alcohol?

Mr. Kevin Sorenson: No. My question is do the increases or decreases in use increase or decrease relative to the increase of alcohol?

Mr. Michel Perron: That would be presuming that we actually know what the prevalence of use is in Canada, which we don't.

Mr. Kevin Sorenson: Which we don't.

Mr. Michel Perron: Sorry, I'm not being cheeky.

Mr. Kevin Sorenson: No, that's a good....

Mr. Michel Perron: For where we do know some numbers in the provinces, there is no correlation per se with the use of alcohol or other use. In fact, there is no matching trend—I think that's what you're suggesting—between alcohol and other drug use, and if alcohol use goes up, then cannabis or other use will go up.

What you might see is substitution, in the sense that kids say we can't drink and drive, but we should smoke cannabis and drive, because we know the police don't have a roadside breathalyser for cannabis. Most kids interviewed in Manitoba last week said they drive much better when they smoke cannabis. So how that shifts over to a different type of drug is interesting.

I'll let Colleen answer the other parts of the question.

Dr. Colleen Dell: For the rural-urban dichotomy, I don't think it is a dichotomy in that way. You have to look at the broader social context of that, social economic status and so forth.

When you look at the States and the use of OxyContin, they termed it a hillbilly drug because it started in a small rural community. I think it's a myth, that it started urban and filtered out to the small rural communities.

I was just speaking with someone last week who came in from health treatment programs in Halifax. She was talking about the very same thing. They have a small rural community, and it filtered the other way. I can't remember at this point what she was talking about, but it was an illicit drug and it filtered into the city. It started in the small community.

That's another one of the myths we might have to fight against.

The Chair: You have mentioned several times that we don't have a study and you've mentioned what kind of study you'd like to do. I guess the question is how long would it take and how much would it cost, and how frequently does it have to be done to be relevant?

Dr. Colleen Dell: If you want a national survey, the cost relative to that, and if we had a longitudinal study, which would be best, so you could do trends over time, that would be ideal if we could do that. That would be ideal for Canada, for a national picture. But someone like our site coordinator in St. John's would say “Yes, but that doesn't capture my population here in St. John's, because it's not representative of everyone”.

The indicators we look at through CCENDU.... There are different ways of collecting the data, as I said. In the States they have DAWN, which is a large national survey. But if you talk about federal leadership, if we had some type of standardization, even if there were just more sharing of information, treatment data or what have you.... A lot of data exists out there. How readily it is shared, for example, through CIHI or what have you, on morbidity or mortality data, is very hard to get access to. It's very expensive as well. A lot of the data is there, but the cooperation and so forth is not there as much.

• 1705

We need leadership in that way, in terms of getting first what is there and then maybe doing an environmental scan that way, which we have been doing through CCENDU, and then starting to fill in the gaps and being more realistic in what we should be doing in terms of collecting more data.

Mr. Michel Perron: I think what we might want to do is triangulate information. A national prevalence survey every year might be overkill. Every two years might be more reasonable. Once you regularize it, depending on schools and so on and so forth, then the cost would come down over time. And it would not be an exorbitant amount of money, given what it is we're trying to do here.

The Chair: Exorbitant to whom?

Mr. Michel Perron: I have no idea. It costs you maybe $100,000 to do a national survey. I'm guessing. For a representative survey that we can disaggregate to provincial levels, not necessarily to city levels, call it $100,000 to $150,000. But say that's a telephone survey. Well, there are a lot of people who are using drugs out there who don't have a phone, so how do we access that population? I think that's where we have to have very specific and other ad hoc types of information-gathering mechanisms. CCENDU could be one. You might want to have special thematic investigations: street youth, homeless people, employers or employees in the workplace; we might want to look at women, or we might want to look at seniors.

I'm not saying do all of these every month, but rather triangulate and build it over time and bring in different sources—bring in the qualitative side as well as other indicators that sort of paint a bigger picture for you.

So do a national survey every two years, at maybe $150,000 per time. Then you could regularize that with having a cost study every two years. Ideally, when you start building in a cost study every two years you know where your costs lie—you know if they're going up or down; you're refining your methodology on estimating those costs; you're seeing if your investments and target investments are reducing the costs and if in fact you're being efficient. That's a thought.

The Chair: Okay. To triangulate the information, how long would something like that take? Are we talking months, years, or a couple of weeks?

Dr. Colleen Dell: In terms of sentinel sites and so forth and you want to get qualitative and some quantitative data in there, that wouldn't be difficult at all. You can have that. You could do a snapshot study, which would say everyone in every site go in and do the exact same thing, collect this data for a three-day period. Analyse that data and you can have something within say three months.

Mr. Michel Perron: We did a project with the chiefs of police where we collected data on arrestees for one month in 26 cities. It didn't cost us anything. The chiefs of police said they believed in the project enough that they would collect that data for free. Now, it might not withstand the most minute scientific rigour and examination, but it gives us a sense of where we're at. So there are different ways of doing it.

As to how fast you can get out there, it does take some time. I think this is where the committee might be feeling a real sense of rush: got to get it, got to move it, got to do it. Frankly, if you could build something that's going to last twenty years from here, that would be a very valuable contribution of the committee, as opposed to having to get it all done in this year, because that is very difficult for this mandate.

The Chair: Obviously you know that we're going cross-country. If there are specific people or sites or interesting projects that you want us to pay attention to, we'd be more than happy to have your input. We do have a travel agenda that we've worked out; we just have to get it funded.

Mr. Michel Perron: On that, Madam Chair, the heads of addiction agencies also asked me to suggest to you that as heads of their respective agencies they would be most happy to appear as witnesses before the committee, but that they would also like the opportunity of speaking with you or the committee informally, as the six of us sitting around the table. You can sort of pick our brains and ask what it is we should do, how we should do it, and so forth.

I would imagine these agencies would also be very helpful with respect to local consultations that you might want to have and facilitating your approach in those areas. I'm sure they'd be more than happy to help you and your researchers in that regard.

The Chair: Okay, thank you.

• 1710

Finally, you talked a little bit about the benefits or drawbacks of a central agency or someone being able to force everybody else to fulfil their responsibility. When you were talking, Dr. Dell, about the education advertisement, which obviously has been done because it works—it gets people focused, people are paying attention to the ad, they're very concerned for these children, and the kids even seem to understand the benefits and the drawbacks of peer pressure—really, aren't you talking in some ways about what Mr. Perron was talking about, in terms of what we want for Canada and how we want to approach it and integrating all that we do? You know, kids are going to have risk-taking behaviour, so what's a healthy risk? What are good things to take a risk on—running faster, jumping higher, sports activities versus doing drugs? How do we integrate a healthy Canadian population type of approach?

If you go back to your slides with the different boxes and people in primary and tertiary and secondary—which would be in the wrong order—where you are at various points in your life, maybe you're ten and you're not doing drugs, but if you're in the next school and your little buddy is, then you might be, and what happens. Or you have a crisis in your family or you go to the wrong party, or whatever happens.

You move in and out of these things, and if the supports aren't there, or if it's a one-shot dare program in my grade schools versus real pressure when you get to university, that's not really helpful. We need to be having all kinds of supports and approaches. It's really adopting a philosophy for the nation, which seems to be a bit contrary to where everybody is going with let's just legalize drugs.

Dr. Colleen Dell: On the whole, I think you said the words there: a healthy lifestyle. If we ask kids why they don't use it, why they don't succumb to peer pressure and so forth, it's self-esteem, people around them. Some people may not have a strong support network at home in their families, with mothers or fathers or what have you, but they might have it in a teacher. There are those types of things, those networks that are around individuals, youth to older people as well. I mean, you can go in the university: which ones are deciding they're going to use in university or not; which people are starting to smoke in university or not. Where are those supports and things around you, and older adults as well?

Mr. Michel Perron: You make the point of the philosophy versus legalization. I'm not convinced that there's an overwhelming majority of people who want to legalize. For those who want to, I would suggest that you ask them to be very specific in what it is they want. More often than not, they would likely fall into the category of they want to make some small changes to cannabis law, rather than all drugs for everybody, anywhere, anytime.

Again, as the committee goes forward, now that it's at the end of my time here, I would urge you to be very specific with your witnesses, and ask them to be specific as to what they're recommending. Legalization is a term that's tossed out by a lot of people. Frankly, I'm not sure they're using it the right way, or at least the way you might interpret. What they're really talking about is some change, and 99% of the time, on talk shows and whatever I attend, everybody comes back to the issue of cannabis.

Cannabis is playing a disproportionate role with respect to the attention given and is sort of clouding what we're trying to do with addictions generally in Canada.

The Chair: Right.

Did anybody...? Dr. Adams? Mr. Sorenson?

Mr. Kevin Sorenson: I'm ready to go.

The Chair: You're ready to go?

Well, thank you very much. We certainly appreciate you coming to this committee on fairly short notice and putting up with our attendance issues on a Thursday. The good news is that transcripts are available for everybody. We will probably talk to you at different points in the process, because you are a wealth of information for us. You've certainly given us lots to think about, and we really appreciate that. Thank you very much to both of you, and we all wish you very much luck with what you're doing. Thank you.

Mr. Michel Perron: Thank you.

The Chair: The meeting is adjourned.