SNUD Committee Meeting

SPECIAL COMMITTEE ON NON-MEDICAL USE OF DRUGS

COMITÉ SPÉCIAL SUR LA CONSOMMATION NON MÉDICALE DE DROGUES OU MÉDICAMENTS

EVIDENCE

[Recorded by Electronic Apparatus]

Wednesday, November 7, 2001

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[English]

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

This is the committee that is following the order of reference adopted by the House of Commons on Thursday, May 17, 2001, consideration of the factors underlying or relating to the non-medical use of drugs.

We're very pleased to have with us today, from the University of Toronto, Dr. Eric Single, a professor of public health sciences in the Faculty of Medicine there.

Professor Single, you'll be very happy to know that we have some students from the University of Ottawa, who are studying here in the criminology department, to hear from you as well.

Dr. Eric W. Single (Individual Presentation): Thanks for having me here today.

I'm here, I understand, as an individual researcher, not as representing any particular organization. Since we want to maximize the time for questions and give-and-take around a whole lot of issues, I thought I'd just start by giving you a little shopping list or menu of some research or information products I've been involved with that might be of interest to the committee and that seem to be relevant to your mandate.

I'll spend most of the remarks, though, talking about how the drug policies have been managed in Australia compared with the United States particularly, and the implications or lessons to be learned from the past—from Australia and elsewhere and from the mistakes we made in Canada's first drug strategy, the one that sunsetted in 1997.

I'll start with the research and information products I was referring to. First, there's the Canadian profile. I brought with me and gave to the head of your research team, Carol Chafe, a bilingual compilation of all available—readily available, at least—national data on alcohol, tobacco, and drugs. It's big. We're hoping we can get copies to everyone.

I have been involved for the last eight years in editing this. It's intended for policy makers, for the media, for researchers, for law enforcement officials—basically anyone dealing with alcohol, drug, or tobacco issues—and it's just a convenient way to pull together the available information from a variety of sources. It's organized into 12 topics, and each one typically has a large number of tables. But there are also narrative summaries and even bullet point highlights covering three or four major points for such purposes as briefing policy makers who don't have time to read more than one page. I understand that problem. So it's pretty user-friendly, I think.

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It was updated every two years from 1993, but there hasn't been any addition since 1999, and none are planned, because of lack of data. The feeling was we'd just be ripping off the consumers to charge them when there hasn't really been sufficient new information on the substance abuse situation in Canada to warrant a new edition.

A second information product—the research I've been involved with—involves a broad area: estimation. It's my major interest. It's the estimation of morbidity, mortality, and economic costs attributable to substance abuse. In 1996 I headed up an interdisciplinary team of people who attempted to do the first major study estimating economic costs of substance abuse. The data referred to the year 1992 because at that time it was the most recent year for which data were available.

In order to do economic cost estimates, you have to first produce estimates of deaths and hospitalizations caused by alcohol, tobacco, and drugs. That's a major part of it. Your economic cost estimates are only as good as the morbidity and mortality estimates that are sort of the raw input to it.

This work has not been updated, so we have information estimates only back to 1992. Three weeks after releasing the results, the CCSA research unit that conducted the study was disbanded because of budget cutbacks. The whole line of research hasn't received any sustained federal support, and there's no new information available on economic costs at this time.

I should mention, too, there are summaries available, I understand, in your briefing books, in French and in English. I brought with me some of the spin-offs. This is an article in Addiction, summarizing the results, which I'll leave with your research staff; there's one in the American Journal of Public Health on morbidity and mortality, attributable for 1992; and a more recent update that some colleagues and I did, updating the estimation of deaths and hospitalizations attributable to drugs to 1996. This was published in the Canadian Medical Journal. It was done, by the way, without funding support. I just want to mention that, too. We basically did it on our kitchen tables on Saturday mornings because there was no funding support for it.

Another information product that should be of interest to you contains the new international guidelines for estimating costs of substance abuse. Actually, before we did the cost study we had the luxury of calling together the economists from around the world who had done cost studies. The feeling was that the estimates available had widely varying results because they were based on different economic models.

Our first two international symposiums were run with funding support from a variety of national, provincial, and international agencies. We've held three of them now. They've all been held in Canada; we've sort of led the way in developing an international consensus around appropriate methodology in the area. It's not that we've resolved the problems, but we're getting there. And they have become the basis for cost studies now in the U.S. The recent U.S. cost study, our study, and the Australian studies have all been done using these guidelines.

The guidelines are also being used now in eastern Europe for studies, and throughout North and South America, because CICAD, the inter-American agency on narcotic drugs for the Organization of American States, has now agreed to include estimates of costs of substance abuse of drugs in their routine monitoring—so they're going to have to be trained. I've given training seminars in Chile and Colombia, but a lot of work will have to be done to do it. The last symposium actually focused on the special problems involved in estimating the cost of substance abuse in developing countries and drug-producing countries.

We're coming out with the second edition shortly, which will be on the CCSA website with the new international guidelines.

So that's very much part and parcel of the economic cost. We're not doing this on our own; we're doing it in collaboration with researchers really around the world, so that we have results that will be more comparable. There are many, many problems, and the people doing these studies are very much aware of the methodological problems. We probably led the way ourselves in pointing them out to people.

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But my feeling is it's a good movement. I think it's where GDP was 35 years ago. At that time, people disparaged the idea that you could come up with a single measure of the total value of goods and services in societies. The methodological problems seemed insurmountable, but it has turned out to be one of the most useful tools for economic analysis. I think 20 years from now it will be pretty routine that countries will be able to monitor costs associated with substance abuse and use that to evaluate the effectiveness of policies and programs.

Not finally, but penultimately, there's an analysis I did with two colleagues from Australia, a comparative analysis on the impact of marijuana decriminalization measures in the two countries. The experience in the two countries indicates that the removal of jail sentences as a penalty for cannabis possession doesn't lead to increases in rates of use, as many people had, and I think quite recently, feared it might, but it does result in significant cost savings to law enforcement and also reduction of other social costs.

However, there's a continuing need to fine-tune the implementation. In Australia particularly there were many problems with the implementation, even though the public perceived it as a total success.

In the American situation there were no problems at all, and by all objective measures a huge success, but the public didn't perceive it as a success. It shows you how much research plays in public perceptions.

It's not like it's unqualified success. There's going to be a continuing need for fine-tuning. You have to design a research plan to monitor impacts, and you need to have a communication strategy to make it clear that a reduction in penalties doesn't signal less public concern over cannabis use.

Finally, there's the evaluation of Australia's national drug strategy. In 1996, just when the research unit was disbanded, I was offered a contract by the Australian government to evaluate their national drug strategy. I did that in collaboration with Timothy Rohl, director of their police college.

The report is available. It's on the Internet. It's also available in hard copy, but they're out of them now. I can't give you my only copy, but I've given the Internet address to the research staff. It details the accomplishment of their strategy, and it notes concerns voiced by stakeholders. We had a very extensive consultation process involving focus groups on specific issues, public hearings in all the state and territorial capitals, and so forth, and we heard a lot of concerns from stakeholders during this process. We addressed those concerns in a set of seven strategic recommendations to rejuvenate the strategy and to provide it with a better sense of strategic direction in the next phase.

I haven't been able to monitor all the developments since then, but I've been back a few times, and it's quite gratifying. They made a commitment to renew the drug strategy for five years. At the time we presented the report, the commitment was only for three years. They've almost doubled the funding for it. They've set up a specialized national drug strategy unit to manage it more effectively. It was very poorly managed in the past, even though it was sort of a success despite its management, and action plans have been developed with regard to the other recommendations in the report.

So this is meant as a little menu of things that you might want to ask me questions about. I'd be happy to talk about them in more detail.

I'd like to spend most of my remaining time talking about the experience in Australia as compared with that in the U.S., and some of the lessons that can be learned from mistakes in the past year by looking at the experience in other countries if we are to have a new national drug strategy, which is in the red book and I understand the government has committed to.

There are a lot of similarities between Australia and Canada. A lot of people tend to look to the U.S. as to how they handle a particular social issue or maybe to the experience in European countries, but I personally think if any country comes closest to our experience with regard to drugs, it's Australia. There are similar rates of use and very similar issues. The morbidity and mortality and the costs are the same. In Australia, exactly as in Canada every year, there are hundreds of deaths, thousands of hospitalizations, and significant economic costs that can be attributed and have been documented.

Both Australia and Canada inaugurated major special-funding national drug strategies in 1987, for ten-year periods. Like Canada's drug strategy, a goal of Australia's national drug strategy was cast in terms of harm reduction. To reduce the harm associated with drug use was its primary goal.

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As in the Canadian strategy, it encompasses both legal and illicit substance abuse problems. It doesn't include tobacco, also like the Canadian strategy. It's a comprehensive approach attempting to deal with both of these things under one policy umbrella, and there are some cost efficiencies in that.

They stress very much the same things we do, such as the importance of partnerships and a balanced approach. By that they mean a balance between different levels of government, geographic balance throughout the country, a balance between supply-and-demand reduction strategies, and a balance between research, prevention, and treatment.

Finally, despite their many accomplishments—more so in Australia than in Canada, perhaps—both strategies were falling off the political agenda in 1997 and plans were being made to end them. I think in both cases that was due to a lack of leadership and poor accountability in the management of interventions.

I think there were a lot of similarities up to 1997. At that point, the similarities really end. Consider what the Australians have done and what we've done in the meantime. The Australians hired an external expert who had no stake whatsoever in what recommendations might come out of an evaluation and who had a background in substance abuse and substance abuse policy. The report was very critical of their management of the strategy and of the lack of accountability—a number of things.

Despite those problems and the critical nature of the report, they acted on it. They renewed their drug strategy for a longer term than they were committed to at that point. They increased the funding, and they created a special unit dedicated to the management of the strategy and so forth.

In contrast, in Canada, we hired a private consulting firm, without expertise in drug issues, to conduct a process evaluation; in Australia, we look at outcomes. There's a companion volume that actually monitors the identified performance indicators for the drug strategy over the five-year term of the evaluation and gives it a score, basically, on all of those things. The Canadian evaluation only looked at processes. It didn't look at one piece of evidence about the outcomes or what impact it would have on drug-related harm; we don't know.

Furthermore, that evaluation was commissioned and conducted after a political decision had already been made to end the strategy. I was having to fire my staff and disband the unit, which was costing maybe a small amount of money—much less than the evaluation cost. It was kind of frustrating. Why bother conducting an evaluation if you've already made a political decision to end it? As far as I know, no change has ever occurred with regard to policy or program as a result of that evaluation.

I think Australia chose to build on its strengths and to renew and reinvigorate the drug strategy, and the Canadian government decided to allow the strategy to expire. No special funding has been allocated to drug issues in this country since 1997.

At the same time, the CCSA, the Canadian Centre on Substance Abuse, an arm's length organization created by Parliament in 1988 to conduct research, develop networks among addictions agencies, and be a focal point for national efforts to deal with drug problems, was cut back to the point where it had to dismiss virtually its entire staff. To this day there are only two full-time employees, the CEO and his secretary. This was despite the very positive evaluation it received at that time, an evaluation that they had no control over.

In contrast, the Australians created two world-class research institutions from virtually nothing, and they continued to support it. Here in Canada cutbacks in funding at the federal and provincial levels have damaged and almost destroyed the research infrastructure on drugs in Canada today.

Nearly five years later we're paying the price for the decision to end Canada's drug strategy and the failure to adequately fund addictions research or the national agency created to provide a focal point for efforts to deal with drug problems.

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Our information base for dealing with drug issues is woefully inadequate. We know from provincial surveys and some regional surveys that drug use is increasing among our youth in particular, but we don't have the basic information about levels of drug use at the national level.

Interventions continue despite a complete lack of evidence about their effectiveness. The only major sustained drug education program in Canada has been the DARE program in schools, which is run by the RCMP. We don't know if that's reducing drug use or having no effect. It might actually be increasing drug use, given the results of some American evaluations of the same program.

We don't know the impact of drug enforcement on the availability of drugs, the rates of drug use, and the level of problems. We have the figures about seizures and arrests, but what's the impact on the community? We don't even know how many people are using drugs in Canada today. We have no information on that. No national drug surveys have been carried out since 1994, and to my knowledge none is planned at this point.

These are some figures around that. Ten years ago, in 1992-93, Canada spent an average of 12¢ per capita on research on alcohol and other drugs. In the same year the Australian government spent 27¢ per capita, more than twice as much, and the U.S. government spent $3.33 per capita, about 30 times as much. Since then the CDS funding has ended, and the U.S. and Australia have increased their research spending.

Despite the fact that the federal government receives more than $3 billion a year from alcohol and tobacco taxes alone, the U.S. government spends significantly more on substance abuse research in Canada—this is the substance abuse problems of Canadians being researched by Canadians. The U.S. government spends six times as much on research on our drug problems than the Canadian government does.

These cutbacks have led to a tremendous loss. We've lost almost all of our major senior scientists. I'm feeling quite lonely. Young, promising researchers have been driven to work in other countries or other fields. This was detailed in a submission to the CIHR last year, with names and such things.

There's very poor coordination of research on addiction issues across the country, because it's done in such a fragmented fashion, resulting in a lack of standardization and other cost inefficiencies. We were a leading country in addictions research in the 1970s and 1980s, maybe the leading country in the world, and today we're really a third world country when it comes to additions research.

We led the way in creating an arm's length agency to act as a national focal point, and from all accounts it did an excellent job. I know I'm a little biased in that regard, because I had a role in the CCSA. But the government reneged on the promised funding levels. Parliament at that time indicated that the minimum funding level would be $2 million a year. It never reached that, and it's only $0.5 million a year now. I think it's just amazing how much they still manage to do. It's a testament to their board and management that they're able to do it with that incredibly low level of funding. Internationally, it's embarrassing.

There are some promising signs of change. I think the problems of drug use haven't gone away. People recognize that, and there's a growing consensus to reconsider and revitalize our efforts to deal with these problems. The government has announced its intention to create a new national drug strategy.

In the remainder of my time I'd like to make some recommendations about how we might learn from the past and the Australian experience and give the next drug strategy a better sense of direction. It really lacked that in the past. One of the reasons it lacked it was that it was based on the notion of harm reduction. That was the explicit goal of Canada's drug strategy for ten years, and yet there was no agreement on what harm reduction meant.

Harm reduction is often used in two difference senses, which sort of conflict with one another. There's the traditional sense of use-tolerant interventions, such as needle exchange programs and safe injection sites, which is a hot issue now, those kinds of things aimed at getting drug users, who can't be expected to stop using drugs at the present time, to use in a safer way. So they're less likely to become infected with AIDS or hepatitis C, less likely to cause problems for themselves, their partners, and the community.

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That's the original concept of harm reduction as opposed to policies focusing on reducing drug use, per se, a zero tolerance or war on drugs kind of approach.

There's another conceptualization, which was the conceptualization underlying Canada's drug strategy. It's an all-encompassing meaning of harm reduction. It came from an understandable sentiment on the part of people oriented towards abstinence-oriented approaches, such as drug enforcement and therapeutic communities. They're saying, well, we're doing things to prevent harm, too, because we're preventing drug use. So the all-encompassing meaning basically says it's harm reduction if a policy or program is aimed at reducing drug-related harm, and chooses to do it by reducing use, per se.

Well, that has its advantages for a national strategy. In effect, that's the same resolution they had in Australia with regard to the term “harm reduction”. But it has distinct disadvantages. If any drug policy injuries and drug-related harm is harm reduction, then what isn't? I don't know of any drug policy or any intervention in the drug field that doesn't aim at reducing drug-related harm. It leaves you with no sense of what gets priority and what doesn't.

But there's a third option as to how you might look at harm reduction, and that's the empirical conceptualization. The empirical conceptualization basically says it's not enough to be aimed at reducing drug-related harm; it's only considered harm reduction if there's evidence that it actually does. It's dependent on evidence of effectiveness. In other words, let's look at the evidence of effectiveness and then determine whether it's harm reducing or not. Let's not say, a priori, this is harm reduction and this isn't.

It has disadvantages to it. It's not the way a lot of people think of harm reduction. So you need a strong communication strategy to it. It could become a barrier to innovation, because it takes a while for new and innovative interventions and strategies to be implemented and evaluated and assessed. If you had a strict requirement of evidence for everything that you gave priority to, you would have no innovation. So you have to have special mechanisms to deal with that.

Probably the major disadvantage is that it entails an enormous investment in research and evaluation. I know I'm a researcher, so it's a little bit self-interested to say that. Nonetheless, the advantages just simply outweigh the disadvantages. One major advantage is that it doesn't say, a priori, you're harm reduction and you're not; you get priority and you don't.

Harm reduction with an empirical conceptualization would include drug enforcement. It would include therapeutic communities. It would include safe injection sites, drug maintenance programs, needle exchange programs, and so forth, insofar as the evidence indicates that they reduce drug-related harm. So it doesn't exclude anything a priori. That's a big advantage, to my thinking, at least.

That would be my first recommendation. If we want to have a really new and different strategy and one that has potential for being sustained and more effective in the future, we should base it on harm reduction. I think there's a strong consensus for that. We don't want a war on drugs, because a war on drugs always becomes a war on drug users. What we want is a harm reduction strategy based not on a priori notions about what's the right thing to give high priority to but on the evidence of effectiveness.

A second recommendation I'd make is that adopting a goal of harm reduction in an empirical sense, I think, is a good long-term strategy for determining priorities. But you have to recognize that in the short term we won't have the required information to know which interventions are the most effective.

Another recommendation is that in the short term we should develop a broad consensus at the outset of a strategy about what the guiding principles should be, to guide program development and policy development. That should be a consensual process involving not just all the ministries within government but all the levels of government and all the key partners—the NGOs. I'll discuss shortly a little bit of how that might be done.

The kind of strategic principles I have in mind...and these are just suggestions. This is something that should come out of this consensual process. It should not be dictated.

This first is do no harm. We recognize that because it's part of the Hippocratic oath, but it's also a key underlying principle of harm reduction in the original sense. It holds that a primary goal of any policy or program should be to avoid exacerbating the effects of the problem. That's the first and foremost thing.

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So the ultimate criterion of success isn't some idealized state, like abstinence; it's just what's going to be your impact on harm indicators. It entails in practice an awareness of unintended consequences that can result from interventions. And we know a lot of our attempts to reduce use have unintended consequences—for instance, promoting unsafe methods of use, or creating barriers to treatment for drug users.

A second kind of principle that might be considered is to focus on harms, not use per se. The harm reduction measures that are use-tolerant, such as needle exchange programs and so forth, may well involve reductions in use, but they're a means to an end; they're not the end in themselves. But they do bring users into contact with health authorities.

Most harm reduction programming like that—not all of it, but most of it—when it was tried in Europe, as I think you'll learn when and if you travel, has had very positive results in the sense of reductions in the spread of infectious disease without leading to increases in rates of use in the general population, as many people might have feared, and many people did fear. And I think that was a reasonable fear. The reason this happened is that it brought a lot of dependent drug users into contact with health authorities and started them on a road that lead to abstention.

So harm reduction strategies can lead to reductions in rates of use, even though it's not their primary goal.

A third kind of principle is to maximize intervention options, and for anyone, I think. It doesn't refer just to drug policy. We really should be always thinking about trying to provide a maximum range of options for front-line health care workers and law enforcement officials when they're dealing with drug-dependent persons, people with drug problems, or drug problems per se.

Law enforcement people should have the options of diversion at the maximum possible, using drug courts or other options for diversion. Physicians dealing with the drug-dependent person should have a wide variety of treatment options, such as drug substitution or maintenance, and interventions that help drug users adopt safer measures of use, that are less likely to impact, not just on themselves but on their communities, in those situations where you can't reasonably expect them to cease their drug use at the present time.

Another potential guiding principle might be to choose appropriate outcome goals, giving priority to effective programs that are practical and realizable. Risk reduction measures are often the first measure towards reducing and even ceasing drug use. So there's no conflict here with an eventual goal of abstention.

Another one is to give priority to innovative and new programming. As I mentioned, if you adopt an empirical concept of harm reduction, you could create inadvertently a barrier to innovation, and so you have to have special pools of funding for that sort of thing.

Finally, another guiding principle that might be considered in a consultation process—to see people's reactions—would be respecting the rights of people who have drug-related problems. An underlying principle of harm reduction is that drug users should be treated as normal people and not marginalized and treated as criminals. People experience those problems as a result of their use. And whether they're alcohol-dependent, smokers, illicit drug users, they should be accepted and dealt with as part of the general community. That's the only really effective way of dealing with the problems in the long run.

I think it's best typified by the Dutch, who don't refer to “drug users” in the Netherlands but to “Dutch citizens who use drugs”.

Not everyone would necessarily agree with these. I don't claim they would, and I don't claim the list is complete by any means, either. It's meant to be just suggestions. I think it's very important that if we have a new strategy, we should start out with a consensual process and a clear set of guiding principles, something that was really lacking in our last strategy.

Finally, if you go to the next overhead, the third and last way I'd recommend enhancing a future drug strategy would be to ensure that there's meaningful participation by all partners. One of the reasons the earlier Canada drug strategy failed to sustain itself was that it had no sense of strategic direction and it was essentially a top-down strategy. Representatives of provincial governments were consulted, but decision-making was placed in the hands of one ministry, basically in the federal government. I know there were coordinating committees, but essentially the real funding decisions and program priorities were made in one ministry. So priorities among interventions competing for funding weren't made clear. NGOs and other interested parties, provincial governments, the municipal level, weren't really meaningfully involved. They were more or less informed and asked for ideas, but they weren't given real decision-making power.

It doesn't have to be that way. Other countries have done it differently.

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The Australian drug strategy is run by a set of committees, a committee structure. The highest one is the Ministerial Committee on Drug Strategy. It's actually the health and law enforcement minister from each state and territory and the commonwealth government. They make the key decisions. Their secretariat, in a sense, is called the National Drug Strategy Committee, and it's at the deputy minister level. It's a police commissioner and deputy minister of health, or the equivalent, using the Australian terminology, dealing with drug issues for each state and territory and the commonwealth government. So the two key decision-making committees that make the major decisions for the national drug strategy are funded by the federal government there, but the majority of votes are not held by the federal government. So there's a real sharing of power there.

Another thing that's done in Australia that we really might learn from is that they share decision-making in other ways. They kick off each five-year phase of their national drug strategy with a big national conference, and they draft and then agree on a document that lays out the goals, the strategies to achieve those goals, the guiding principles for program priorities, and the specific performance indicators to know whether or not they've achieved those objectives five years later. Then they design a research plan in order to monitor those performance indicators. I think that certainly suggests to us that we might consider something like this.

There hasn't been a national conference bringing together health and law enforcement people dealing with drug problems since 1989, and a good way to kick off a national drug strategy would be to do that. But it shouldn't just be a show and tell, this is what we're doing, aren't we doing a great job. Let's give them a real task. Let's get an agreement on what the guiding principles and priorities should be and what the performance indicators should be, because how are we going to know five years later whether it really had any impact?

I don't want to take any more time with these remarks, because I know you might have some questions about this or the previous information products.

I will summarize by saying I think we need a renewed political commitment in Canada to a sustained effort to deal more effectively with drug problems, one that's based, much more than it has been in the past, on sound research. Based on my experience in evaluating Australia's drug strategy, I've presented three recommendations. I think that would give us a new and different drug strategy from the one we had in the past, one with the potential to be more effective and to be more self-sustaining.

I think we should adopt the goal of harm reduction but make it based on an empirical concept—that we agree on a set of guiding principles right at the outset, with all the partners, and that we design the next strategy to have meaningful participation by all the partners.

I've seen the results in Australia and I think we could do a lot more to ensure a better and more effective drug strategy in the future for Canada.

The Chair: Thank you, Professor Single.

Mr. White.

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

I apologize for being late, Dr. Single. We were at another meeting.

I hear from academics so much these days that we should study, study, study. The drug problem is getting worse in this country, and we've studied, studied, studied. I'm wondering, at this point, what you see the primary role of the federal government being in this whole exercise, where you basically can go into any one community and find community services doing, from one community to another, any one of zero to ten different programs on drugs and alcohol abuse. The provinces may or may not be into it. They're all over the place as well, I would suggest. As to the federal level, I am just at a loss as to where they are at all.

What is the role of the federal government? Is it providing money? Is it providing money for research? Is it setting up establishments that take effective action? Is it to study it?

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Dr. Eric Single: That's a good question, I think.

I know academics tend to say study, study, study, but in the case of substance abuse, I don't think you can make the case that we've studied it enough. We don't even know how many people are using drugs in Canada today. We have interventions of totally unknown effectiveness.

The amount of money spent on a big bust.... For example, there have been busts that have cost as much as $10 million to investigate, and resulted in things that involved dangerous and difficult work by the law enforcement people. I don't see them as adversaries in this whatsoever, but as partners. You see the guns, and the drugs, and the money on the table, but the real question is, what happened to drug problems in that community? What happened to HIV infection rates, hepatitis C rates? What happened to the victims other than drug users?

If the only impact is that another supplier came in very shortly and replaced them and temporarily there were higher prices of drugs, leading to increased crime, you have to ask if we perhaps need to have a re-emphasis on where we're putting our balance of effort.

So I don't quite agree that we've studied, studied, studied this. I think the information basis is incredibly woeful at this point.

To get to your main question, on what the government's role should be, in Australia...there's a subtitle that says “Mapping the Future”. I was attempting to drawn an analogy of what a drug strategy should be. I was trying to draw an analogy to a mapmaker in a period of exploration. When the first explorers came to Canada, Cabot and La Salle, they would gather information in one particular place. But it wasn't until that information was collected in a central place, put together by a cartographer, a mapmaker, that they could see where the unexplored territory was and where they could properly plan out the next phase of the exploration and see what information was needed.

The analogy was that we should think of a drug strategy, in a sense, as having the role of mapmaker, planning out the next phase of the exploration, assessing the information, and coordinating it with other pieces of information and things like that.

I think the major role of the federal government...since most of the costs are not borne by the federal government other than the specialized drug enforcement, most of the costs are borne by the provinces through health care services and ordinary police forces and law enforcement agencies. I think the best role the federal government can play is to provide national coordination and leadership and a research base to avoid the inefficiencies of people duplicating effort throughout the country, standardization of measures, things like that, and basically identify where the next things should go. A drug strategy should focus specifically on new and innovative programming. It should be the rudder that steers the ship. It's not the ship itself.

Mr. Randy White: To what extent would you say that is being done today? We haven't had a national study since, I think you said, 1992 or 1994.

Dr. Eric Single: Yes, 1994, with CADS. I was one of the authors of the technical report, so I should know.

Mr. Randy White: To what extent are we in Canada providing that national leadership?

Dr. Eric Single: It's not being provided in any meaningful way; I'd put it that way at this point in time. I mean, the CCSA is choked off to the point where it actually voted to close its doors for six months. It only managed to barely stay alive because staff were willing to work on a part-time basis and supplement it with income from other sources. I get half my income from overseas.

It shouldn't be that way. We need that information. We need that research desperately.

The Ministry of Health is making attempts, but there's no special funding. I don't see the leadership coming and I think it's desperately needed at this point.

Mr. Randy White: When we asked the Department of Health, I believe they said.... Wasn't it $400 million they said they get per annum? It was $200 million or $400 million. But I didn't get the impression that they actually had a wonderful program going whereby they could say, here's what we're doing. It was kind of like, well, we have this money and...[Technical Difficulty—Editor].

I got that same impression from Corrections Canada—oh, they had $200 million—and they, I would suggest, does the worst job of drug prevention, or drug rehabilitation, in the country.

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Dr. Eric Single: That's a fair indictment over the past, yes, but in their defence, I'd say they've turned around. The creation of this new research unit in P.E.I. is an excellent move, I think. It's going to inform their efforts a great deal in the future. They've made some serious mistakes in the past, and they've owned up to that, but I think they're making an attempt to redress it now.

Mr. Randy White: To encapsulate my opinion of it, I think we not only need a decent strategy—not some rhetorical document that says we should follow these pillars here—but also something that works at the street level, that can actually do some good. In that regard, I think we're batting less than 5%.

Dr. Eric Single: You won't get it by asking the bureaucracy to write that document. You won't get it by hiring a consultant like me to write it. You'll get it by talking to the NGOs, the municipal officials, the provincial officials dealing with it, and the drug user groups. Drug users are the best people to consult when designing drug policies and programs. They do consult with them regularly in Australia. They wouldn't think of having a drug committee without a representative of the user groups on it, because they'll tell you right away whether something is going to work or not work. They'll tell you right away. They know. They have the street smarts. They have the motivation, too, because these are mostly people in methadone programs who no longer use drugs. Their interest in being there and being at the table is to save the lives of their friends who are still out on the streets.

So they're very strongly motivated, and we shouldn't be pushing them aside. I think you're identifying exactly what's needed, but to get it, we're going to have to cast a much broader net than we have in the past.

Mr. Randy White: Thank you.

The Chair: Just to clarify, Mr. White, my notes say $33 million from Health Canada.

Mr. Randy White: I think I had them confused with Corrections Canada.

The Chair: Right. And it wasn't clear exactly what they were spending money on.

Mr. Lee.

Mr. Derek Lee (Scarborough—Rouge River, Lib.): As I approached this committee exercise over the weeks or months—perhaps, in my case, it was years—I thought I knew what harm reduction was. I didn't think it was that complex. But now that we're all here, you know, harm is relative, and it depends on who's defining it. Now I don't even have a good focus on what harm reduction really is, and now I'm very cautious about using the term, because I don't know how my listener is going to perceive it. He or she may have a completely different conception of it.

Fortunately, you have made a gentle suggestion that we try to define harm reduction—define it, focus it, or articulate it in some way, by using....

You go ahead and jump in here. It was empirical...?

Dr. Eric Single: Empirical concept, yes. “Empirical conceptualization”.

Mr. Derek Lee: Yes, “empirical conceptualization”; that's even tougher for me than “harm reduction”, but I understand. From the letters and the words, I have at least a sense of it.

Now, your advice here, I'm sure, will be very good. How can we latch onto more down-to-earth concepts, words, and phrases so that when we describe what we think we should be doing in terms of public policy change, we have a concept that people can sink their teeth into?

For example, would the street person who is either still on the drug problem or off it know what all of these terms mean?

Dr. Eric Single: I'm sure they don't, and I'm sure they don't care.

I'm not a communications expert. I rely on colleagues to help me get across some of these things sometimes. I know I can use three-syllable words at times, but I think the empirical concept of harm reduction can be explained very simply: We'll consider it harm reduction if the evidence shows it reduces drug-related harm. It's not simply that it's aimed at reducing it but does it really reduce drug-related harm. So you can't say, a priori, something is harm reduction until you have some evidence that it really is working.

That shouldn't be too hard to communicate in lay language, I would think.

Mr. Derek Lee: I'm a legislator, and at least once a year I have to vote and approve the expenditure of billions of dollars for various very important public purposes. Initially I had a sense that there was harm if there was an insupportable, unsustainable cost involved to society or to government, but is that a viable conceptualization? Should I abandon cost measurements as an empirical conceptualization vehicle?

• 1630

Dr. Eric Single: Oh, I wouldn't abandon that at all.

“Unsustainble”—I'm not sure what that means, just as you're not sure what “empirical” means in that context.

There are key things the policy-maker would need to know. First, how much does a problem cost? What are we doing to reduce those costs? Are those investments cost-effective? Are they good investments? Are they paying back? Are they reducing the costs more than they cost themselves?

That's exactly the kind of information we need to underpin our drug strategy in the future, whereas now we're basically flying in the dark. We don't have any idea whether what we're doing is having any good whatsoever. And we're doing virtually nothing in the research area in order to answer those questions.

Mr. Derek Lee: So did the Australians pick a harm, define it, and then develop a mechanism to reduce it and show the reduction by measuring dollars?

Dr. Eric Single: Right. Exactly that.

Mr. Derek Lee: Is that what they did?

Dr. Eric Single: Well, some of the performance indicators involved dollar figures that could be translated. Some of them involved intangibles, so they'd be expressed in terms of number of deaths, hospitalizations, and so forth. So they had morbidity, mortality, those kinds of indicators. It would be very articulated. They'd produce every five years a document that would lay out their performance indicators.

Mr. Derek Lee: Have you a list of some of these harms so that I don't have to fish for them? They're probably in the materials you've brought with you.

Dr. Eric Single: Oh, yes. I'll direct your research staff exactly to them.

Actually, this is one you could take along and pass on to the research people afterwards. That has a specific listing.

Mr. Derek Lee: So the written product you've just shown us here, coming out of Australia, actually isolates and defines particular harms?

Dr. Eric Single: Right.

Mr. Derek Lee: So they've decided they want to reduce it.

Dr. Eric Single: They might have a specific goal of, say, a reduction in the incidence of HIV infection caused by injection drug use. That would be a specific goal. Did they reduce the HIV infection drug use over the period? They mark, year by year, the trend in reduction in hepatitis C infections, etc., or the proportion of people entering treatment who successfully complete treatment by certain standards, outcome standards, and so forth. They have very specific performance indicators.

Mr. Derek Lee: And it's your view we don't have a lot of these in Canada now?

Dr. Eric Single: The treatment area is not good. There's a lot of work there. We can borrow a lot from our rich American friends. But that's probably better than most. We have virtually no idea about our major intervention, which is drug enforcement. We really don't know what the impacts are. I mean, we have hints; we haven't seen a reduction in price we haven't seen a reduction in availability, by all accounts. But nobody's ever really researched that in a systematic way.

We don't really know about school education programs. We don't know what works and what doesn't work. I don't know what they're spending the $33 million on in Health Canada, but I haven't seen a summary of education programs around the world—what appears to be effective, what the key characteristics are, and perhaps we can fund the design of a pilot program, etc.

We haven't had an outcome evaluation of our own DARE program, the only program for the last decade that's been sustained and aimed at Canadian youth. We don't know whether it's working. I think there's a reasonable fear that it might be increasing drug use among Canadian youth.

I don't mean to pick that one out in particular. The people running it are really well motivated, and good people. I'm not criticizing them, because it's not them. Naturally, you have to have faith in what they're doing, but I worry that perhaps it's not having the effects.

One problem with all drug education programs is that you stimulate interest when you show needles, when you show new drugs, and when you start talking about effects.

There are some kids who are going to learn about things they otherwise might not. So you have what are called “boomerang” effects in educational programs, and you have to be worried about that.

• 1635

I'm not saying it's happening; I'm saying we don't know. To keep on doing it without finding out whether it works just doesn't seem to make sense to me. Research is expensive, but I think it's a lot less expensive than investing year after year, for a decade, in something of unknown effectiveness.

The Chair: Thank you, Mr. Lee. Did you have one follow-up or are you fine?

Mr. Derek Lee: No, I'm okay. I have some more, but there are other members.

The Chair: Mr. Sorenson and then Mr. LeBlanc.

Mr. Kevin Sorenson (Crowfoot, Canadian Alliance): I apologize for being late.

I was one of those guys who was at a meeting that was scheduled last April. We had the opportunity to grab a date with an individual who was hard to get hold of. I really feel badly that I missed the first part, because what I heard I really liked and appreciated.

A lot of what you say we've heard. One of the things you say is that the war on drugs becomes a war on drug users. You caution us to come out saying that we're involved in a war.

When the lady who gave the Canadian drug strategy was here, and it was definitely $33 million, she said the very same thing you said. There was no way of knowing whether we were winning or losing. There was no evaluation process. There was no accountability.

You feel you can be accountable to anybody, because is it going up or is it going down? How do we judge whether we're winning or losing?

I came into this whole drug committee without realizing, first of all, that there was a terrible problem there. I didn't realize the scope of what it might have been.

We talk about safe shoot-up sites and we talk about places where people can go, about harm reduction, or whatever. The police aren't allowed to come in and prosecute at some of these safe shoot-up sites, otherwise it just becomes a place where they can go and make their arrests.

We have a problem—and I don't know if you touched on it or if it's even in your area—with a prison in my riding. I go to that prison and I see drug use inside the prison. I talk to people who say they weren't drug users when they came in, but they are when they leave.

We've talked about this before, and Dominic has brought it up as well.

When you talk about harm reduction and all the plans and so on, what about these guys who are incarcerated? Some of them come in with the habit. They're shooting up hard drugs. I've seen people going through withdrawal, and some of these methadone treatments don't seem to work for them.

What about the whole prison thing? Is there a place for allowing these guys to shoot up heroin? My gut feeling on this is no, it's illegal, it's wrong, you keep it away. But then when you see the anguish of these guys....

What do you think about drugs in prison?

Dr. Eric Single: I myself have never conducted research on drug use in prisons, so I don't consider myself as expert as, say, Brian Grant and his colleagues at that P.E.I. centre. I think they have a reasonable handle on the problem, too.

Definitely, you're right, the situation in prisons is just incredible. I do know that for a late adolescent—say, someone between the ages of 15 to 25—the single strongest risk factor in their becoming drug-dependent is going to prison, even if they hadn't used drugs before they went to prison. It's remarkable. How can that be, with strip searches, video monitoring, and everything like that? And how can you expect the police to deal with it in the streets, in general society, if it's impossible to control within a prison situation? I'm just astounded by it.

But there is one thing we do know. There's a good menu of potentially effective strategies, looking at the experience of other countries. I think the people in the P.E.I. centre are very well aware of those things.

• 1640

One thing I think they have already done is people who are on methadone maintenance continue to be when they go into prison. There are more extreme harm reduction measures that might be considered as well.

It's clearly not working to simply try to control drugs. It would require so much manpower it couldn't happen. These people are in prison. To them getting high is the only relief they have from their situation during their terms, and the motivation is just too strong to realistically think you can stop drug use in prison.

Given that it is not going to be stopped, what do you want to do? Do you want them to use it safely? Do you want them sharing needles? Do you want them going out into the community infecting their girlfriends or boyfriends and spreading it to their children through neonatal transmission?

As a practical thing, you have to look at what can be done. I think there are a wide variety of measures that can make us more effective. We can do a lot better if we adopt some of those measures. To some extent, though, there are always going to be limits because of the drug use in the general society from which they come.

Mr. Kevin Sorenson: One of the phrases you used was “the goal is abstinence”. But prohibition is quite another thing, isn't it, in your mind?

Dr. Eric Single: Well, the goal of prohibitionists would be total abstinence, a drug-free society. That would be wonderful, of course; we all agree. But we have a cough here, and right over there. Some people here are going to have a cigarette after.

So what does it mean, really? It's being free of the drugs that are officially disapproved of. It's a hard sell.

Mr. Kevin Sorenson: We are in a time in society I think when the first answer to a huge problem like drugs is to say, what can we legalize and what can we decriminalize. So then the numbers drop down, and it doesn't look like the problem is there any more. In fact, if it's not a criminal offence to be involved in it, then you take a look at the rate of crime, and it's even taking a drop, because we're talking about not just legalizing but legitimizing.

Thanks.

The Chair: Do you have any comment?

Dr. Eric Single: Yes, that's the fundamental conflict here. You can probably deal better with problems, but to some extent you're going to be legitimizing use. And it's a balance. There's no question that those are reasonable fears and concerns.

In some situations it has worked out that harm reduction programming led to actual reductions in rates of use, because it brought dependent people into treatment and a portion of them—not all of them—eventually became abstinent. That offset any increase it might have had in creating a climate of acceptance around the use.

In other cases, some harm reduction measures haven't worked. Tolerant zones have been universally a failure wherever they've been tried. In some cases, like Vietnam, they declared a victory and left. They've said, well, we've dealt with the problem by providing services and moving them out to the suburbs.

Still, I find it very telling that not a single case of a drug tolerance zone has succeeded, or maintained or sustained itself. So that probably isn't one that works.

The Chair: Thank you, Professor.

Mr. LeBlanc.

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

Like my colleague, Derek Lee, who worries about voting estimates and expenditures every year, I worry about the election coming in three years. One thing that I have found difficult—I have a riding that contains a big part of rural New Brunswick—is to try to take the discussion and what I've learned at this table and from some of the documents and make it relevant to constituents who come from a different world than some of these “tolerant zones” or other phrases I've learned about at this table.

Your expertise is vast, and your advice in finding a way.... For example, I'm intrigued by a supervised or a safe injection site. I'm struck by your comments on the lack of research. I think it's a very valid revelation that for the money that has been spent and some that should have been spent and the work that is done, there may not be the empirical research that we should have. That is worrisome.

How do you take, for example, the discussion of a supervised injection site, and in very simple terms how would you explain that to a constituent of mine as an important research initiative? They see drug addicts sitting around. It is supposed to be illegal, and yet we're all looking the other way.

I'm convinced of the need for some of these measures and the validity in some of the research and some of the harm reduction strategies. I've convinced myself of that. But it's a bit of a hard sell in the Tim Horton in my riding to explain that we should have needles available in prisons. I mean, the Solicitor General is a friend of mine, and to see him answering a question from Randy about giving out needles in prisons.... It's hard to get past that test.

• 1645

So what advice would you have for those of us who think about the electorate? In very simple terms, how do we explain some of these things? Start, for example, with a safe injection site, and in your view the validity of that, if you think there is some validity in using that as a research project. How do you explain that harm reduction to the guy in the Tim Horton?

Dr. Eric Single: You start from a presumption that there are some people who are going to use drugs and who are going to shoot up regardless of whatever you do. You're not going to be able to stop them all. You may be able to arrest a bunch of them, but there will still be some. Now, do you want them to shoot up in an alleyway, leaving the needles around where they might be picked up by a kid who might prick himself and get HIV or hepatitis C, or they're sharing needles with other people and infecting other people? A teenage kid comes to downtown eastside Vancouver to experiment with drugs and, bang, he winds up with hepatitis C the very first time he injects drugs. This happens. It's not hypothetical.

I acknowledge the concerns that this might lead to increases in drug use and facilitate drug use for people. Those are real and I think very legitimate concerns. You have to look at the situation and see where the advantages are of providing a safe site, which would make it less likely to infect other people and be damaging to the community. Was it worth that compared with the disadvantages—that is, did it lead to a climate of acceptance and more kids using drugs, and things like that?

You have to measure those things and compare them. It's not a quick and easy answer. That has been done in some evaluation studies, but only, to my knowledge, in Switzerland and Germany. So it's applicability in Canada isn't that known. It's promising. It may on balance be a good move, but I'd openly recognize that it's not a priori going to be a success. It's not the answer. It's only one of many strategies that have to be done. It shouldn't be in the absence of other strategies.

Mr. Dominic LeBlanc: Thank you. That's a concise way to put something that I had wrestled with. I appreciate that answer.

Kevin had talked about some of the problems in federal penal institutions. I have a prison in my riding. I visited it this past summer with the Solicitor General and was struck, as Kevin said, by the drug use problems there.

Again, in very simple terms, if you were addressing somebody who wasn't exposed to some of the research or some of the information we've seen, in the brief time we've been at this table.... First of all, if you were the Solicitor General, do you think it would be a good idea to have, for example, a needle exchange program in a federal prison?

I was shocked by the number of people—exactly as you said—with hepatitis and HIV/AIDS in the federal prison system. Because they're an addict or a drug user it doesn't mean they have to be condemned to a life of illness and disease like that. How in your words would you justify...? My understanding is in some cases they get bleach kits now, but that may not be uniform across the prison system, or a needle exchange system. Is there some validity in your mind to that in a federal prison system?

Dr. Eric Single: Oh, very definitely. I think we should have needle exchange programs in prisons. Bleaches help, but it's not as completely effective. They are developing new needles now that can't be reused. A major problem is that they might reuse them and then share them.

When I say I'm in favour, I'm in favour of trying it and monitoring it and seeing if the advantages outweigh the disadvantages.

Mr. Dominic LeBlanc: That's a good balance.

A final question, sir. The media and the people in the coffee shop seem to focus on the idea of legalizing marijuana. That's the knee-jerk reaction of this committee. When the whole issue comes up, it focuses on decriminalizing or legalizing—and there's a big difference—marijuana.

• 1650

What do you say to the person who says—and I'm not sure this is true, but this is the knee-jerk reaction you get from people—that if you legalize marijuana, or, say, decriminalize marijuana...? My own personal view is that there's some merit in looking at the latter. The argument you hear is that somebody who starts using marijuana in college or in school, or in a recreational way for their own use, is more likely to end up in one of those alleys using injection drugs.

I'm not sure that's true. What are your views on that?

That's the obvious argument: If you start with marijuana, you'll finish with heroin. Or you're more likely to finish with heroin. Or every heroin user started with marijuana.

I don't know what to say to these people.

Dr. Eric Single: Yes, that's the escalation theory and controversy that's been around since the.... Oh, I've actually been involved in that, commenting on it for 30 years now. This issue has been around a long time.

Mr. Dominic LeBlanc: I was three years old then.

Dr. Eric Single: Basically there's no doubt that the use of marijuana is related to the use of other drugs and subsequent drugs. They're correlated. But whether there's a causal connection is a completely different issue, and the evidence for that is extremely weak. It doesn't really exist, and there's a lot of contrary evidence that it's not causally linked, that they really share common underlying determinants.

I've looked at one study, for example, of high school students who had gotten involved in hard drug use, who had progressed beyond marijuana, but it was only the ones who got involved in buying and selling who did. The higher your level of marijuana use, the more likely you were to use LSD, heroin, and cocaine. But if you controlled for getting involved in buying and selling, other than just buying for your own need—so you're buying quantities and then distributing to your friends or actually selling for profit, which a small number of kids do—it's only the kids who get involved in buying and selling who are more likely to move on to harder drugs. Even at the high levels of use, the kids who don't get involved in buying and selling, who simply buy for their own use, don't get involved. That suggests that the criminalization of marijuana, by driving users into the illicit market, is actually promoting drug escalation. So that's one piece of evidence.

The other thing we've done is what's called scalogram analysis. It's basically a technique to see if there's an underlying unidimensionality, one underlying set of causes, and basically the same phenomenon to the use of different types of substances. Marijuana use scales with the use of harder drugs, but also what scales with the use of hard drugs is alcohol and the use of pharmaceuticals.

So if there's a drug progression, it doesn't start arbitrarily with marijuana, with the first illicit drug. It probably starts with taking a lot of pills. It probably starts from trying to change your mood by taking an aspirin and things when you were a little kid, or it being given to you by your parents.

So it's not a simple matter of marijuana causing it. It's part of a progression that can happen in some people, where they just keep taking drugs and are prone to becoming dependent. So they are related to one another, there's no question, but there isn't good evidence that it's a causal relationship at all.

The quick and easy answer to give to a constituent who raises the issue is, sure every heroin user started with marijuana, but actually they had potatoes before they had that. They drank alcohol, and they had this and that. Correlation does not mean causality. Or potato chips—whatever.

Mr. Dominic LeBlanc: It's an important distinction.

Thank you very much.

The Chair: Thank you very much.

That was very interesting. For those parents from potato country....

Mr. White.

Mr. Randy White: As I take another pill.

The Chair: That's right. I have to eat some chocolate.

Mr. Randy White: I have a couple of comments. I did discover the initial pilot project of bleach in a prison. It happened in my community, and I brought it to the public's attention.

What bothered me more about the bleach project was the contradiction in terms. We have a prison here with zero tolerance, but here's some bleach and we'll turn our backs. That's the message sent to the individuals. I'm in here for breaking the law and I know you have zero tolerance, but if you turn your back, I'll have some bleach. So I disagree with that concept.

You say some people will use drugs regardless. I would agree with that, and I don't think there's any stopping a certain number of people. So let's cut to the chase, and let's package up our marijuana and our Ecstasy. Let's have safe shoot-up sites and needle exchanges, and we'll just accept the fact that 1% to 2% of the population is into that sort of thing. We'll throw some money into Health Canada and into the provinces and say, fix them up when they get too bad or overdosed, or, as we do in Vancouver, put them in a hotel and wait until they die. Because that's in fact what happens there.

• 1655

I'm almost of the opinion that's where some people are headed. If you go to downtown eastside Vancouver, or Walley in Surrey, in fact....

I understand where Derek is coming from; I thought I knew what harm reduction was until I talked to various people on the street and to the individual who's making a living off drugs—that is, a bureaucrat, for instance, who's running a needle exchange centre, who's the director of needle exchange, who has assistant directors and supervisors and needle exchange people and basket handlers, and so on and so forth. They think, yes, that's the way we should proceed, and I'm half convinced the reason is that they make a living off it.

Given what I've just said, why not cut the losses here and just say, let's legalize it, and for those who want it, we'll put on a cigarette package, “Don't smoke Mary Jane, because it's not the best thing to do and you may go further in addiction”, and cut out all this policing and all the rest of it? I'm convinced that's where some people come from.

Dr. Eric Single: I understand your frustration. I share it too. I just would be worried about throwing the baby out with the bathwater. Some parts of our strategies may be effective.

As well, I don't see the need to jump all the way to legalization. Why not try incremental measures and see how they work, and if they work, go to the next step, and if not, go back? Don't make policy changes that can't be reversed if they don't work. That's one thing to avoid, too.

So I wouldn't advocate selling marijuana on the street corners in packages with health warnings, but I think the evidence is overwhelming that reducing jail penalties will not lead to any more problems and will entail tremendous cost savings and that the advantages far outweigh any disadvantages, and that's just a modest step. It's sometimes called decriminalization, but you're not removing a possession offence; you're just reducing the penalty to a fine.

It could actually lead to an increase in deterrent effect, because the police right now, as we know, are very reluctant to prosecute and to pursue crimes that are widespread, and it would affect their ability to work with the community if they really made a major crackdown on something that's done by millions of Canadians.

So when you reduce it to a fine, sometimes, as happened in Australia, you have a great increase in police activity. They detect more offences because it's seen that the punishment is more suited to the crime.

So I don't think we have to jump into legalization. Let's first try things in incremental steps and see how they work and do it in a way where we could always retreat and try something else if it isn't working.

Mr. Randy White: As a final comment, we heard here that in, I think, 1997, approximately 1,000 tablets of Ecstasy were seized. Last year there were over 2 million tablets. And this was seized; this wasn't what's floating around. I read this morning that in Great Britain alone it's about 500,000 tablets a weekend.

This is where I would agree that there's research lacking. If we're seizing that much, there's that much growth, it scares the hell out of me to think about what we're not seizing and where it's going on the weekends in this country, and I worry that by the time this committee gets through doing its study, we'll still not have any idea of how big the problem is and even what Ecstasy is. Is it addictive? Because it can be made in basements, literally, it's of different strengths and quality, and so on.

Dr. Eric Single: Yes, and no quality control when it's illegal.

• 1700

Mr. Randy White: I'm not an advocate of legalization, but I am afraid that in the run of a week there are a hell of a lot more than 2 million tablets out there of any strength, size, or proportion, and we just don't know what the numbers are. I don't know. I guess I'm just a little frustrated that we don't have the research done, and nobody seems to be actively pursuing this.

Could we have your comments, please.

Dr. Eric Single: The Canadian centre has something called the Canadian Community Epidemiological Network on Drug Use, which I think you might have heard about. It attempts to do that, and they get law enforcement people, epidemiologists, and health people together in cities to triangulate in and get a picture of what is going on to identify newly emerging drug trends.

At this point it is still largely based on soft evidence: impressions, press reports, and information on people who come to the official attention of police or health authorities in emergency rooms.

We can do a lot better. That's a volunteer network; it's not really funded. We get a little money from Health Canada for a national meeting once in a while, but as to those people's time, let me point out that their meeting together, getting together, and networking are all done on a volunteer basis, this by people who just feel we have to get a handle on this. They have that same sense of frustration you do. We really need a concerted national program to monitor those things and measure them in the best possible way. We don't have that right now.

The Chair: Thank you, Mr. White.

Mr. Lee.

Mr. Derek Lee: I noticed in one of the Australian reports references to alcohol and tobacco, and earlier this committee saw some of the costs associated with abuse of and addiction to alcohol and tobacco.

My first reaction was, my gosh, we're wasting our time on the drug thing. The harm costs and social costs of alcohol and tobacco addiction are way beyond what we appear to be absorbing as a result of illegal drug use or drug addiction. Have I got that right? And if I do, tell us that we're not wasting our time by focusing on this to the exclusion.... Well, it's obvious we're running in tandem with anti-tobacco and alcohol abuse strategies as well. Are we placing our emphasis in the right envelope here by focusing on the drug issues as opposed to those of tobacco and alcohol?

Dr. Eric Single: You wouldn't be wasting your time as long as those other issues were being dealt with somewhere by government. Then the question becomes, is it more efficient to have a comprehensive approach, where you look at all problems of substance abuse under one policy umbrella, or is it more efficient to have them dealt with separately? There are advantages and disadvantages to both.

In some situations, like prevention programming, it doesn't make sense to have a school education program for alcohol problems and a separate school education program for other problems. They are covering so much of the same material that both should be integrated into a general health promotion program anyway. It doesn't make sense to have separate programming in some areas. In treatment, drug treatment and alcohol treatment are often merged together because the majority of people who present for drug problems also have alcohol problems. Certainly, a high proportion of alcohol-dependent persons have used illicit drugs. They often go together, so there are cost efficiencies.

On the other hand, there are sometimes disadvantages to dealing with them together. It's not clear. I tend to like to think of them under the same...and I personally have always worked in all three areas, alcohol, tobacco, and illicit drugs, sometimes more in alcohol, sometimes more in others.

Mr. Derek Lee: That takes me into the second part of my inquiry, which you may be able to help with for the record. To the extent we see a linkage between tobacco, alcohol, and other drugs, I have also been struck over the last number of years by the apparent moralization about and the moral stigma attached to the use of certain drugs as opposed to other drugs. Tobacco may not be seen as evil. You can be addicted to tobacco, but it is not as evil as being addicted to something else.

• 1705

There's a moralization that's going on here, and I'm frustrated by that. I personally have been able to demoralize the whole thing—a drug is a drug is a drug. But as Mr. LeBlanc points out, it may be that there are lots of segments of Canadian society that are just not able to do that. They see the world differently.

Can we, should we, or might we be able to comprehensively demoralize the whole spectrum of drugs in what we may report on? Can we do it? Have other countries done it successfully? Is it necessary for us to do it in order to get a good handle on it? Do we have to demoralize it comprehensively?

As a bit of a corollary, are we treaty bound or stuck by international treaty in some way that would prevent us from demoralizing the drug issue, wanting to delink the morality? For example, suppose we wanted to back off from a total prohibition of everything and just stick to heavy, intense regulation rather than criminal prohibition. Then if you wanted to carry around a bag of heroin, you could do it, but you'd have to have a licence. That wouldn't be a problem, but if you did it without a licence, you'd be history. It would be because you didn't have a licence, not because you'd broken the criminal law. I think you see what I'm getting at.

Dr. Eric Single: Yes.

Mr. Derek Lee: There were about three or four questions there.

Dr. Eric Single: They're getting at the core. That's a real core issue. That's why I have as one of those guiding principles the suggestion to treat drug users as normal people. I don't think we should make such a big distinction between illicit versus licit substances. We should really focus on the harms and the best way to manage those harms. There are always going to be advantages and disadvantages to almost any approach. Let's not charge it with so much emotion.

In a way, it's because of that moralization of illicit drug use that you sometimes get a disproportionate amount of government effort and resources being put into one problem when the evidence is that other problems deserve at least as much attention. I don't mean to minimize drug problems one bit by that, but I found it striking that the economic costs for tobacco use are far greater than they are for illicit drugs. Yet the government spends least on policy costs, research, and prevention programming for the substance that causes by far the most deaths, hospitalizations, and costs to the economy.

That's one of the advantages of an umbrella approach and of a less moralizing approach. Some moralization is inevitable in human behaviour. There are always going to be judgments in everything.

I think one thing we've done right in Canada is the way we've dealt with the medical use of marijuana as a separate issue from the non-medical use—and it is a separate issue. No matter what you do for making medicinal marijuana available—and I recognize it doesn't necessarily have positive medical effects, as the jury is still out on it—you can make that available for people regardless of what policy you have in place on the non-medical use. We should keep that separate.

In the U.S., the drug reform movement has more or less latched on to the medical marijuana issue. What I don't like about that is that it portrays to the public the idea that there are two kinds of drugs, good drugs and bad drugs, where marijuana is a good drug. The real world isn't that simple. There are a lot of bad things about legal drugs, and maybe there are some benign or even beneficial things that come from illegal drugs.

We shouldn't be thinking of it as a dichotomy of good versus bad in terms of the public interest, but we should be thinking of it in terms of, what are the harms and how can we best manage those harms?

As for international treaties, I've actually looked into that to some extent for the Victoria government in Australia on another job. There's a report I can pass to your research staff that summarizes the available evidence on what impact the treaties have on the various legislative options for the control of cannabis.

It's very interesting. The Vienna drug convention was originally designed to deal just with supply-side issues. The ministries of health weren't even involved in the delegations, just law enforcement. It was meant to be that way. The Americans were putting very heavy pressure on third world countries to have all kinds of monitoring and supply-side restriction, and my understanding is that the South American delegation, headed by Mexico, basically rebelled a bit and said, well, for every transaction, there's not just a seller, there's a buyer too, and you have to do something in Western countries. They put in a stipulation requiring that it be a criminal offence to possess this schedule of drugs, which included cannabis.

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The interesting thing was, though, it wasn't drafted very clearly. It wasn't a case of great legal draftsmanship. Even the United Nations drug control program, which is sort of the official interpreter of the international treaties, recognized that it could be interpreted that it only applies to possession for the purpose of trafficking and not necessarily to possession for the purpose of personal use. The Dutch chose to interpret that way.

So the international treaties do require that it be a criminal offence, but not one that requires imprisonment. It is very openly stated that treatment and prevention and education should be given priority over criminalization if possible. That is very much encouraged.

There are other ways around it in any case. Countries can withdraw from particular aspects of a treaty without withdrawing from the treaty altogether. There's the Dutch solution, which is to keep the law on the books and ignore it. I don't think that's a very good one, for the kinds of reasons you were just giving. I don't think it's a good idea in general to let policy go on that way, in an ad hoc fashion. It's almost contradictory to talk about ad hoc policy like that.

There are other options, but I think the realistic policy options facing Canada at this point would all be.... We have no problem with international treaties, and I think those are the removal of jail sentences but maintaining a criminal offence and still having a penalty of some kind. Maybe I'm not reading the political situation correctly, but I don't think people are really suggesting complete removal of the possession offence.

So the treaties don't really represent a problem at this time, I don't think.

Mr. Randy White: Thank you.

The Chair: I have a couple of questions.

Members, we're due to go until about 5:30 I know some people might have other things to get to, but we have a serious budget problem that we have to discuss before we all leave this room—serious as in “We don't have one”.

Leave your money on the table for that coffee, Professor Single.

Some hon. members: Oh, oh.

The Chair: I'm just kidding.

Perhaps we can use the last five minutes or so to talk about some strategies.

You talked, Professor Single, about the focus on harm, not use per se, and I wonder if that helps. You were talking about different classifications of drugs, and perceptions, and moralizing, and everything. It would seem to me there are a great many people who think, well, if I got it on a prescription from the doctor, it must be okay. And yet there's so much prescription drug abuse.

If you read the Globe and Mail on Saturday, “pink panther”—a hair spray I didn't even know about—is currently the number one choice in some parts of Saskatoon. It wouldn't be listed under any international treaty as a drug, but the harm is the same—or worse, in fact.

I wonder if you have any comments about that. Does that focus on harm really help deal with all the other kinds of drug use or substance abuse?

Secondly, you talked about giving priority to new and innovative programs. I guess I wondered whether that, then, precludes somebody saying, look, I think I figured out why this particular program in that town didn't work—they didn't have these other conditions around it. Or it's a northern climate, or it's happening in the west, or it's happening in the east.

Are there community differences to some of these things, and would research show what the conditions are that you need for a program to be successful, to be replicated elsewhere? Could it be that there are some things that are not new and innovative but are applied differently in different circumstances? And how do we account for that in terms of research?

You mentioned something you are writing for the CIHR. Where are they in terms of funding research into substance abuse? Are you in the application process? Are you hopeful? Is there something going on? Perhaps you can tell us about that.

The last question was, what happened in 1997 in Australia that they got so hot on this? Was there something specific?

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Dr. Eric Single: Let me deal with the last one first, because it's quicker.

They have a commitment, every five years, to do a major evaluation of what they've done over the past five years before they go into the next phase of the strategy. What a novel idea, to actually consider—

The Chair: We do that in a lot of things, but it doesn't always....

Dr. Eric Single: Not here. Not in this area.

So in a way, it was a routine, scheduled check-up for their drug strategy.

The other thing that happened, I have to admit, was just the week the report came out there were about two dozen overdose deaths in Parramatta, a suburb of Sydney, their equivalent of our downtown eastside Vancouver, with a huge drug problem. So it was a bit of a political accident that there was a huge amount of public attention placed on this report, with these recommendations for change. It was a tragedy, and I don't mean to minimize those deaths, but it was fortunate for getting the report implemented.

On the application to new drugs of the focus on harm, new drugs represent a problem no matter what, whether you're focusing on use or harms resulting from use. It's a problem that will happen, in any case. The designer drugs are such that there are new ones coming out monthly, virtually, and some of them get popular quickly. Whether you have a kind of zero tolerance approach or harm reduction approach, it's going to be a problem.

I think the prospect for a harm reduction approach is maybe better, because it can be more immediately implemented and we can find out things immediately, like the pharmacological effects and the ways to counteract them. If we had known right away about the dehydrating effects of Ecstasy, we probably could have saved some lives and instituted harm reduction programs at raves, and things like that. Eventually that did happen, but there's always a time lag in the response and everything like that.

So new drugs and emerging drugs are a constant problem, and they're going to be a problem regardless of the major type of strategy you have. I think focusing on harm probably has a little better potential for positive impact, but that's just a guess; I can't say it's based on firm evidence.

The Chair: Sorry to interrupt you, but pink panther is a hair spray.

Dr. Eric Single: Or...there are all kinds of things people will get high on. You have the inhalants, you have—

The Chair: Glue, solvents—the whole bit.

Dr. Eric Single: Kids were using Midol to get high in Halifax, at one point. They had to take a whole jar of it, I guess.

The Chair: It would probably burn your stomach.

Dr. Eric Single: It's sort of the nature of things that people will find ways to get intoxicated.

Mr. Kevin Sorenson: How would you find ways to get...?

I'm sorry, Paddy.

The Chair: His last question is on programs, and then you can ask questions.

Dr. Eric Single: On the community differences and how to account for them, it's true you don't know for sure very often if a program that was successful in one community will be successful in another. If you try it out in the other, it may be successful but not as successful, or not successful. Then you have the problem of determining why. What characteristics of the community accounted for its success in one place versus another?

One thing that's important is to have good well-designed research. A lot of evaluations—maybe even the majority for a certain kind of programming—start out as outcome evaluations. There are two basic types of evaluation, outcome and process. In outcome, you focus on specific outcome indicators you agree to in advance. In process, you just look at the processes used. Did they consult? Did they do this? Are the people who had the program happy with it, etc.? But there's no specific outcome.

Process research is largely not worth the money, in a very general sense. It may be useful for some purposes. I really dislike that it often becomes an excuse for real research on outcomes. At the end of a five-year phase of a strategy, you do a widespread consultation.

If you ask people you gave money to if it was a good idea for us to give them money, they'll all say it was a wonderful idea; they consulted with the right people; they did this. But that's not sufficient for me. So good research is the first answer to that question. A lot of these community studies are based on process evaluations. We have to get more of them based on outcome evaluations.

You also need to build evidence. You often need a lot of studies. Then you can do sort of net analyses or after-the-fact analyses of these different situations.

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You may find the key factor in that community was that they had built a network, or whatever, whereas this other community hadn't. If you get evidence from eight or ten communities, you may have enough. You have to build up a body of evidence to get at these underlying things. You're never going to completely answer the question, but you can do it with a certain degree of probability if you build up enough evidence.

The CCSA funding is still up in the air. There's a memorandum to cabinet to increase the funding to something like $2.6 million—it's only $0.5 million now. That would allow them to at least have some staff.

The Chair: Did you apply to the Canadian Institutes for Health Research, as well?

Dr. Eric Single: First of all, I'm not an employee of the CCSA.

The Chair: I didn't think you were.

Dr. Eric Single: I do some work for them on a contract basis, because they can't afford me. That's basically what it comes down to. I really shouldn't act like I'm speaking for the organization, in that regard.

I'm on the board of one of the institutes of the CIHR, so I'm quite familiar with them. I made a proposal and got a grant. I proposed to the CIHR a stand-alone institute dealing solely with addictions. They didn't accept that. They included addictions with neuroscience and mental health. But a lot of addiction issues are actually spread out in the other CIHR institutes.

The CIHR institute I'm on the board of—neuroscience, mental health, and addiction—is making a very sincere effort to address all these terrible problems of the current research situation regarding addictions. They have a large mandate. They also have to cover mental health, neuroscience, vision problems, and hearing problems. I'm the only member in the substance abuse area on the 15-person board. I'm surrounded by neuroscientists and mental health people. We have to give them a period of time, see how much they accomplish, and then revisit the idea.

I still haven't given up the idea that maybe at some point, not far in the future, the next time they decide to rearrange the makeup of the CIHR institutes they will consider a stand-alone institute on addictions. I think the scope of the social and health problems associated with substance abuse alone merits that. It's the approximate cause of one in five deaths in Canada, and it's the reason why many of the underlying determinants of health relate to low levels of population health.

The lower longevity of low-income Canadians today, which is often cited in the population health movement, can be accounted for almost entirely by their higher smoking rates, for example, just to give you an idea of how important substance abuse is to overall levels of population health.

Those are the reasons why I am still holding out and thinking that unless the problems are really redressed—and I just don't see them being able to do it this way—they will at some point have to have a stand-alone institute on addictions. But we'll see. They are making a sincere effort to do as good a job as they can.

The focus right now will have to be on professional development and training. We don't have the people. There's a huge generation gap between people my age and our students from the University of Ottawa over there. There are very few young people in this field now. There are a few old people like me still around, but we've lost a generation of addiction researchers because of what's happened over the last five years.

The Chair: Since we'll be focusing on addictions, maybe all the money that's raised by all the provinces on gambling could fund the centre, as well. Clearly, there is a relationship between that kind of addictive behaviour and drugs.

Dr. Eric Single: I keep trying. I'm doing a gambling study myself now. We keep trying to tap into that money. But gambling has its own problems. There aren't many gambling researchers. It's a new and emerging thing, so you don't have the infrastructure in place yet.

What I dislike most about gambling is that any research money available now is largely controlled by the gaming industry or provincial governments who have a vested interest in maintaining high levels of legalized gambling. So you really have the potential for impinging on scientific integrity.

The Chair: Good luck with that.

If you have a quick question, Mr. Sorenson, we can entertain that.

Mr. Kevin Sorenson: I guess I was just wondering where these new substances are coming from, as our chairperson—

The Chair: How people figure out that gasoline is addictive.

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Mr. Kevin Sorenson: Yes, and how many different hair sprays they tried—

The Chair: They all work.

Mr. Kevin Sorenson: —or how many different paints they got before the plastic wood.

But Ecstasy is a little different. It's not a product, it's a drug. Is that something that's developed by organized crime?

Dr. Eric Single: It could be, but I doubt it.

Mr. Kevin Sorenson: Is Ecstasy a pharmaceutical that is used for something else, or is it specifically an illegal drug? With a lot of these other things, I think a lot of these kids are looking for a cheap high, a quick high.

Mr. Randy White: Something they don't have to smoke.

Mr. Kevin Sorenson: Yes, maybe, that they don't have to smoke.

Dr. Eric Single: When I was younger, in the sixties, they were smoking banana skins. I mean, who would even have thought of that? The human capacity to find new methods of intoxicating themselves is endless.

I don't know the origins of Ecstasy, but I'm not surprised it came about. It's very predictable that something like it's going to come out again and again and again.

The Chair: Well, Mr. LeBlanc was quoted in an article on his vices, so perhaps we can add to this discussion privately.

Professor Single, thank you very much. It's been absolutely wonderful to have you here today. You've given us lots of food for thought, and we might have to have you check in again. We'll certainly be looking at the Australian situation, as well. It's been really great to have you here, and I hope it's been a worthwhile trip for you as well.

So thank you very much.

Dr. Eric Single: Thank you.

To turn this into an in camera meeting, I need to suspend for a few minutes so we can clear the room.

[Proceedings continue in camera]