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37th PARLIAMENT, 1st SESSION

Special Committee on Non-Medical Use of Drugs

EVIDENCE

CONTENTS

Monday, February 18, 2002

0915

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

0920

Dr. Patricia Erickson (Senior Scientist, Centre for Addiction and Mental Health)

The Chair

Dr. Patricia Erickson

0925

0930

The Chair

Mr. Alan Young (Associate Professor, Osgoode Hall Law School)

0935

0940

The Chair

Dr. Diane Riley (Canadian Foundation for Drug Policy and Harm Reduction Network)

0945

0950

0955

The Chair

Dr. Robert Remis (Associate Professor, Department of Public Health Sciences, University of Toronto)

1000

1005

The Chair

Dr. Peggy Millson (Department of Public Health Sciences, University of Toronto)

The Chair

Dr. Peggy Millson

1010

1015

The Chair

1020

Mr. White (Langley--Abbotsford)

Dr. Patricia Erickson

Mr. Randy White

Dr. Diane Riley

1025

Mr. Randy White

Dr. Diane Riley

Mr. White (Langley--Abbotsford)

1030

The Chair

Mr. Randy White

Mr. Alan Young

The Chair

Ms. Libby Davies (Vancouver East, NDP)

Ms. Davies

1035

The Chair

Mr. Alan Young

Dr. Patricia Erickson

The Chair

Dr. Diane Riley

1045

The Chair

Dr. Peggy Millson

The Chair

Dr. Robert Remis

The Chair

Ms. Davies

The Chair

Mr. Lee

Mr. Alan Young

Mr. Lee

1050

Dr. Patricia Erickson

The Chair

Dr. Diane Riley

1055

The Chair

Dr. Robert Remis

1100

The Chair

Dr. Robert Remis

The Chair

Dr. Patricia Erickson

The Chair

Mr. Alan Young

The Chair

Dr. Diane Riley

1105

The Chair

1115

Ms. Hedy Fry (Vancouver Centre, Lib.)

1120

Dr. Robert Remis

The Chair

Dr. Robert Remis

The Chair

Dr. Robert Remis

The Chair

Dr. Peggy Millson

1125

The Chair

Mr. Alan Young

Ms. Davies

Mr. Alan Young

Ms. Davies

Mr. Alan Young

Ms. Libby Davies

Mr. Alan Young

Dr. Diane Riley

1130

The Chair

Dr. Patricia Erickson

1135

The Chair

Dr. Robert Remis

The Chair

Dr. Peggy Millson

1140

The Chair

Mr. Alan Young

The Chair

Dr. Diane Riley

The Chair

Dr. Diane Riley

1145

The Chair

Mr. Randy White

1150

The Chair

Dr. Robert Remis

The Chair

Dr. Patricia Erickson

The Chair

Dr. Diane Riley

The Chair

Ms. Libby Davies

The Chair

Dr. Robert Remis

The Chair

Mr. Alan Young

1155

1200

The Chair

Dr. Diane Riley

The Chair

Mr. Lee

The Chair

1205

Diane Riley

The Chair

Alan Young

The Chair

Mr. Alan Young

The Chair

Ms. Hedy Fry

CANADA

Special Committee on Non-Medical Use of Drugs

NUMBER 022

1st SESSION

37th PARLIAMENT

EVIDENCE

Monday, February 18, 2002

[Recorded by Electronic Apparatus]

¿ (0915)

[English]

The Chair (Ms. Paddy Torsney (Burlington, Lib.)): I'll call this meeting to order. We are the House of Commons Special Committee on Non-Medical Use of Drugs. We were struck in May 2001 to study the factors underlying or relating to the non-medical use of drugs in Canada and to bring forth recommendations aimed at reducing the dimensions of the problem. Following the Auditor General's report in December, which reinforced the message that things need to be done in Canada, we have also been hearing in Ottawa from people from across the country, and we met with some people on the ground in Vancouver, which added some interesting dimensions to our work.

We're here in Toronto until Thursday, and in the greater Toronto area, including Burlington, on Wednesday, and down into the border at Niagara Falls on Wednesday as well.

We have with us this morning members of Parliament from three parties. As witnesses, we have, from the Centre for Addiction and Mental Health, Dr. Patricia Erickson, who's the senior scientist; from York University, Alan Young, who's an associate professor at the law school; from the Canadian Foundation for Drug Policy and Harm Reduction Network, Dr. Diane Riley; and from the University of Toronto Department of Public Health Sciences, Dr. Robert Remis, who's an associate professor, and Dr. Peggy Millson.

I'm sure our wonderful clerk and researchers have briefed you, but I think we're expecting about five to ten minutes worth of testimony and then we'll open it up for questions and answers. We will keep track, and at about nine minutes I'll give you the one-minute finger, meaning you really should start wrapping up.

Uunless there's been prior agreement among all of you, I'll think we'll start with Dr. Patricia Erickson. Welcome.

¿ (0920)

Dr. Patricia Erickson (Senior Scientist, Centre for Addiction and Mental Health): Thank you.

The Chair: Also, interpretation is available in English and French, and the people who are here will make sure the microphones are turned on, so you need not fight with them.

Dr. Patricia Erickson: Thank you. I'm very pleased to be here and to have a chance to speak to this important committee about an issue that I think is truly a non-partisan one in this country.

It has been almost 30 years since I first went to ARF, as it was then, in the wake of the Le Dain commission. We've been through several changes and discussions of different drug laws and changes in members considering drug law, but what I thought of today when I considered my presentation was, in a sense, how depressingly the same things are today as when I started at ARF in 1973.

In that intervening period, I've been very fortunate to do quite a bit of research on illicit drug use in Canada, particularly focusing on users' perceptions of the laws and the impacts of the laws. This has resulted in books, one of which is Cannabis Criminals, which is one of the few studies that actually focuses on users who went to court. I've also studied cocaine users in different studies, looking at middle-class users, street crack users.

So in five minutes or so I can't really say too much. I really look forward more to the questions and answers, where I can get a sense of what is particularly on the minds of the committee.

Let me just highlight three or four major conclusions from this body of work, both my own and from colleagues around the world.

First of all, I think I would have to emphasize how little deterrent effect has been demonstrated from the use of the criminal law against users of drugs. Users in numerous studies, whether they're users or non-users or users at different levels, basically find that the law is quite remote, and this low perception of the likelihood of punishment means that the law has very little input on decisions about using or continuing to use.

It's not surprising when you think about it because after all drug use is a voluntary activity for the most part, engaged in in secret among willing people who don't want to call the police and report the activity. It's very difficult to make deterrence work when you can't rely on complainants. It's difficult to make it work when the values around the activity are far from being a consensus, when the evolution in my 30 years or so is to see more and more people question whether drug use is a seriously wrongful activity. They may not want to do it themselves, but a lot of people over time I think in the mainstream have become more and more ambivalent about the use of the criminal law against drug users.

The second point would be that, again, over several decades, drugs have been very widely available in this country. The police have confirmed that in their annual reports. Users confirm that they can get drugs very easily if they want. People who don't use drugs can usually find people in their friendship networks if they want to use them. And I have teenage kids myself, so this has been an issue, you can imagine, that has concerned me over the last 20 to 30 years, as I've gone through this process with them.

It's very clear that if a concern of our original harsh policy was to protect youth, it hasn't done that. I think in many ways it has aggravated the problem by marginalizing adolescent users by making them feel they're part of the out group or the delinquent group. It hasn't kept drugs out of their hands, but I think it has interfered with finding appropriate ways of getting them to make good decisions about not using, or delaying use at least and not getting involved. We haven't protected youth by our criminal laws at all, I'm afraid.

The second thing I've observed over my nearly 30 years is that there's been little impact on drug availability. Again, though it's harder to study drug dealing, it's fairly clear that the low entry costs to become a drug seller...even if you're pretty uneducated or under-employed, there are low entry costs and lots of money to be made. So it's not surprising that studies that have interviewed actually detected or convicted drug sellers find that they just kind of thought it looked like an easy thing to do to make money. And of course they're very easily replaced by the next level, the low street-level, low-rung dealers, who are of course the ones the police are more likely to catch because they're the ones who are more hands on and have the drugs on them. It's very difficult, as we know, to reach to the top of the black market pyramid.

A third point I'd make is that what again comes out quite consistently in a lot of studies is that what really is effective in making people think about use--not to use, use less, or stop--is their own concern about their health. Health messages are clearly what are most important, when you can get studies that look at the effect of the law versus how harmful do you think that drug is, what effect will it have on you. This shouldn't be any surprise. We see similar things with alcohol and tobacco. It's a concern about your health.

When we've had the very few long-term studies that have actually looked at young people, say before any of them started using, they show pretty dramatically that the kids who end up in trouble later with drugs are generally the ones who show early evidence of stress and social and family problems.

¿ (0925)

So in a sense I think there's a real chance you're doubly penalizing young people if you exclude them from school, take them to court, treat them like criminals for behaviour that is probably in some sense an adaptive or coping mechanism for them--not all of them, but I'm saying the kids that.... Most kids experiment and they don't get involved. For kids that are psychologically healthy, it's almost a bad sign if they don't experiment. The studies also show that the kids who never use are the ones who are most likely to display some problems on mental health indicators. So you have these two extremes.

Healthy kids might experiment, but for the most part they don't get into the problems. I think we should really be worried about the kids who get into heavy drug use at early ages. Something other than a police response or an exclusion from their peers or their family surely is what to think of first.

I'm not sure if the committee has familiarized itself with all the testimony from the Senate committee. I didn't want to repeat myself, because I spoke there quite a bit about my cannabis research, but I thought I would just highlight a major finding of the cocaine research, which has also been a large part of my research program. Again, there isn't as much research on cocaine, but there is quite a bit internationally. We haven't a whole lot in Canada, but it's pretty clear that the effects of the drugs are the same in any country: the pleasure and the attractiveness of cocaine as well as some of the pitfalls don't change when you cross a border.

What really determines outcome--problem outcomes, harmful outcomes--has a lot more to do with the individual and their characteristics, why they're using, how much they get involved in use with peers and so on, and what cocaine is meaning for them, along with the social context of cocaine. When I was fortunate to go to a conference in Sao Paulo a few years ago, I was quite struck by how the depictions of coca paste smoking in the ghettos and among prostitutes and among poor people parallel the relatively minor upswing in crack use we had in this country. So there are, I'm suggesting to you, the beginnings of a fairly good basis to say that if we want to have good drug policy we probably have to have good social policy. We have to reduce the vulnerability of the people in our society for whom cocaine might be an obvious route to filling their time or employment or simply a cheap way to get high.

The environment is clearly very important in determining the outcome of drug use. I would suggest this is why we didn't experience nearly the extent of crack epidemic as our American neighbours did. I would argue that in relation to Dutch and Australian studies as well. We simply didn't have as large and as vulnerable a population. I interviewed many of them in Toronto, in the Sherbourne and Dundas area. We had a vulnerable population who took up crack, but because of our then fairly reasonable support of social welfare and housing problems, the group wasn't as large.

I'm just again sort of flagging the committee to think about not just those powerful pharmacologic agents, but the user and the setting and social environment of the drug in order to think about what interventions and outcomes you might look at.

Thank you.

¿ (0930)

The Chair: Thank you, Dr. Erickson.

Professor Young.

Mr. Alan Young (Associate Professor, Osgoode Hall Law School): Thank you.

Dr. Erickson, I'm pleased to have this opportunity to participate here, but frankly I'm still a bit saddened by the fact that we've gathered here today to continue discussing the merits of a criminal justice policy that has dismally failed, and which I think everyone knows has failed. We have different reasons why we believe that.

I'm here really to tell you a couple things from the point of view of criminal justice administration. I think the important thing that has to be mentioned, which this committee and the House would know, is that criminal justice is a blunt instrument. The Law Reform Commission of Canada said that in 1976. The Government of Canada released a document called The Criminal Law in Canadian Society in 1982 and they reminded us that criminal justice is really an ineffective tool for advancing social policy. I find it funny that the governments have said that and not recognized it in the context of drug law reform.

In my mind, criminal justice, if it's to maintain legitimacy in the modern era, is to be a system for maintaining security and order. It should only be called into play when there's a serious breach of the social order and it should never have been called into play to tell people what psychoactive substances they could ingest. Threats and prohibition never have worked to curb the human appetite, and we have to realize that. It's ancient wisdom. We all know the story of Adam and Eve and the forbidden fruit, and my position has always been that that story tells us that if God could not control the curiosity of the human spirit, it borders on the height of arrogance for a secular state to think it can do so.

So I come here based on two different types of experiences that I bring to the table. One, in my younger years I had a great deal of experience in the drug subculture, growing up in the early 1970s. Second, in my professional life, when from a conventional point of view I matured, I started to study drug policy and to challenge authorities in regard to drug policy because I came out of a drug subculture where most people who were using drugs were what I would call law-abiding, productive citizens. I couldn't understand why the criminal sanction was being triggered.

I think if anything good is to come out of this committee and if it is not to be the same as all other committees, certain realities have to be recognized and confronted that governments have failed to do, because drug policy is being maintained largely on the basis of misinformation and propaganda. There's a lot of bad information out there.

The couple of points I want to make that I think are the realities of drug use and that have to be recognized are as follows. First, most people--or many people, I don't have a percentage--have very strong desires to seek intoxication. Some people call it a fourth instinctive drive. I actually highly recommend reading Dr. Ronald Siegel's book, Intoxication, to see how animals intoxicate themselves. So really what you have to understand is people will get high regardless of what state policy is. The consumption rates in this country for drugs in the 20th century have ebbed and flowed regardless of the state of our laws. Draconian criminal sanctions don't influence people.

Therefore, in the 1980s, when the Americans tried and were successful in indoctrinating us into a “just say no” policy', we made a horrible, horrible mistake--coming out of the 1970s, when it looked as if we were going to become progressive. “Just say no” is not valid social policy. Really, it's ludicrous. It's the same as if you were to go through a psychiatric facility to a ward of clinically depressed people and just tell them to cheer up. That's how valuable “just say no” is as a policy.

Prohibitions don't work well in the area of human instincts. They work well with instrumental crimes like fraud and income tax evasion, but they don't work well with conduct that is an expression of our individuality. We will never have a drug-free zone; that has to be recognized. North America is the largest drug-consuming continent in the world. We'll never have a drug-free zone, so we shouldn't be teaching abstinence; we should be teaching responsible drug use.

The second reality I want to mention--which is considered heretical, but I stand by this--is that all drugs are harmless if used responsibly. There's not a drug on the planet that's going to destroy you from incidental use. Those are poisons. People don't take poisons to get high. There's some degree of sensibility in our choice of how we intoxicate ourselves.

Why this is important to understand is that we've made a mistake by focusing on what we consider to be the evil pharmacological properties of a drug as if it had some sort of design on us to destroy our lives. Drug use and the effects of drugs are all about sets and setting--the circumstances of use and the mindset of the user. If we start focusing on the individual, we can come up with the same drug policy that deals with compassion and the medical complications that can come from drug use, because even though I say it's harmless if used responsibly, I know that for every drug there's a certain percentage of people who will abuse it and suffer, and their suffering will be spread to other people. With cannabis, which is my main area, we're talking probably 1% of users; with alcohol, we may be talking as high as 15%. I've never, ever seen a study--and maybe my social scientist friends can help me--where more than 20% of a user population are abusers. I've never seen that. So we know that more or less one in five people use drugs responsibly.

¿ (0935)

The third proposition I wish to advance is that I think it has to be recognized that by the year 2002 we're not in the area of sound social policy. A drug war is a crusade. I say that because sound social policy is evaluated by the efficacy of its results. When government sets a policy, every once in a while they're going to revisit it to see if it's working. Every time you revisit this policy you know it's not working, but we don't care because it makes the crusaders feel good. That's the definition of a crusade. We don't care that we're wasting our time because the idea of a crusade is, hey, we may be losing the battle but we're fighting the good fight.

That's unacceptable in contemporary society. Even if you don't agree with me that drug use is part and parcel of a larger right of self-determination, self-actualization, even if you don't buy that, if you think it's frivolous and a silly thing to do, you could forget the political philosophy of liberal ideology, but just look at the cost of this war and what the impact is. Start looking at what it's doing. Don't keep hoping for good results in the future.

Let me give you a few quick examples of things I've been involved with. On December 1, 1999, the police raided a birthday party of children and shot a dog in front of ten screaming children. That is the cost of a war on drugs. It escalates violence. There's more violence endemic in drug law enforcement than in any other area. When they do a search warrant raid on an armed robbery, they don't go in the way they do on a drug raid.

Second, junkies are dying on the streets of Vancouver. It's not because of the pure properties of heroin. It's because of the black market impurity. There's no quality control. We have to help these people.

Third, junkies across the country are robbing stores. They are causing secondary crime, because there's no safety net for someone who is a junkie, there's no way of accessing drugs legally, and there's no way of maintaining yourself. The only dangers, in my opinion, that come from drugs are from the small percentage who abuse it and may become dependent or addicted, because then their behaviour becomes skewed.

I've represented hundreds of people who are law-abiding, productive citizens with good jobs who contribute to this country, and they walk around now with the mark of Cain and a criminal record because of their choice of intoxicant. That's not acceptable.

In the course of my work, I also discovered how often the police violate the Constitution and how much corruption rears its head in our policing as a result of drug law enforcement. These are side effects we have to start taking into account. The policy is not getting us anywhere, and we have to see what sort of damage is being done to society at large.

I'll end on this. If the drug prohibition truly was leading to some constructive, tangible result--if we saw a healthier society, a more law-abiding society, whatever the goal is--then maybe I could overlook the Pandora's Box of evil that's triggered by having the police investigate consensual crimes where they have to be proactive. But not seeing any tangible, concrete results in the last 30 years of our drug policy, in my mind, all we're left with is a black mark on the administration of justice.

Thank you.

¿ (0940)

The Chair: Thank you, Professor Young.

Now we'll go to Dr. Riley.

Dr. Diane Riley (Canadian Foundation for Drug Policy and Harm Reduction Network): Thank you very much.

Like my colleagues, I would like to express my appreciation for being invited to speak here today on such an important topic. Also like my colleagues, I think there's a sense of déjà vu. Many of us have been involved in similar committees before.

I've been working in this area of drugs and drug policy now for thirty years, in a number of countries around the world, and as others have mentioned, what never ceases to amaze me is the similarities in the situation in these many countries in terms of the human need to seek out intoxicants and the human need to alter consciousness. But what differs, and this is what I'm going to talk about a little bit today, is the way in which the society responds to those activities and therefore the way in which the harms, which can be attendant but don't need to be attendant on drug use, vary from society to society.

I would like to make some suggestions about the ways in which, in Canada, we could alter our drug policy so as to be more effective and more humane.

As had been mentioned, I'm with the Canadian Foundation for Drug Policy, but I'm also with the International Harm Reduction Association, an association that I started, along with several colleagues, in 1996 as a result of demand from around the world to look at ways of reducing drug-related harm. In doing this work, I've been able to look quite in depth at the ways in which different countries and different regions of the world respond.

I also work with and I'm on the board of several organizations, including the United Nations AIDS program, and today I would like to bring some of my concerns from that platform to you as well.

I am submitting a brief to the committee, so I am just going to highlight a few points today. I would like to also mention that I have prepared a very long paper on this topic for the Senate. Several years ago I was asked by Senator Nolin to prepare a background review paper for what became and is now the Senate Committee on Drugs, and also to write the terms of reference for that committee. That paper is available on the Senate site, and in my written documentation I've given you all the links to those papers.

In terms of my main concerns, I would like to say that globally, I think we all realize now that the illegal drug industry is one of the most profitable industries in the world, next to arms and legal pharmaceuticals, bringing in over an estimated $400 billion U.S. a year. But in addition to that, I think what concerns us, and should concern us more and more, is that this is fuelling organized crime, it's fueling terrorism, and it's also leading to the spread of infections such as HIV and hepatitis. It's also leading to very miserable conditions of lives for people who are caught up in the misguided approach of prohibition that is used to try to control what is already something that is driven by a black market. It's not going to improve it; it only serves to make it worse, and only serves to ensure that you have very large populations of people in prisons.

It is in prisons that I have done a lot of my work as well, and there we see, I think, the worst possible outcome of our prohibition system. We see people who are sent into incarceration for simple possession of a minor drug-related crime, put into a system where their likelihood of infection from hepatitis and HIV is greatly increased, and where we do not provide the means for people to protect themselves from such infection.

I think we can also see, turning specifically for a moment to Canada, some of the problems writ very large in our own very wealthy country. What I must say is when working overseas so much, when I return to my home country--and very glad I am to come back--I am so often appalled and ashamed to see us, as one of the richest countries in the world, with such severe problems. We have the highest rates of HIV/AIDS among drug users in the western world. The situations in some of our inner cities that relate to drugs, and of course more directly relate to poverty and lack of social support, such as in Vancouver, can match many of those within the developing world.

What's more appalling to me are the conditions we see in our native population. Alan Young mentioned that you rarely see rates of drug misuse over 20%. Yet I think one example that goes against that common rule is in native populations, where you will see rates of misuse of alcohol and other substances as high as 60% or even 80%. This should alert us to the fact that there are terrible problems of inequity and of social dislocation going on in these communities.

The other thing that more generally concerns me about the conditions in our indigenous populations is the suicide rate: the fact that in some populations of native children we are seeing suicide rates 27 times the rate of the average Canadian population of the same age.

¿ (0945)

Other concerns I have pertain to all of our cities with regard to strict use. I think we're seeing, especially in a province like Ontario, that as our social safety net erodes and we become more draconian in our approaches, our problems of street use are exacerbated. In all of these cases, including correctional services, we are exposing our populations to a very high risk of infection from hepatitis and HIV, as well as overdose. The rate of overdose for heroin and cocaine in Vancouver is extremely high, and it's something that, if we looked at other countries, we could be doing something about.

That's the other thing I would like to mention briefly at this point, because of my experience working in other jurisdictions. Too often we look at the United States for guidance. I would like to suggest that the only reason we should look at the United States in this regard is to see what not to do. They have an appalling situation with regard to drugs and drug-related problems. Those in prisons are largely there for so-called drug-related crimes, which is greater than under the Soviet gulags.

So we should look elsewhere to more enlightened countries, such as some of the European countries and Australia before the system started to erode. The system has gone backwards in the last three years because of the new prime minister who was put in place. But I think we have very good examples of what works. I know that the committee is planning to make some visits to those countries.

One thing that is common to many of these jurisdictions is that they have based their approaches on the principle of harm reduction. I'm not going to go into those principles in detail here. I've written extensively about them elsewhere, as has Dr. Erickson, and we'll make sure that you get copies of those papers. But I would like to say that the approach has proven to be a very effective one, and now worldwide we have a great deal of sound scientific data to show that harm reduction works, that it works well, and that it can be done very cheaply. I think the fact that we can see such amazing results in the developing world done on a shoestring should make us realize that we can do it well here.

Having said that, I think we have a so-called harm-reduction strategy in Canada in name only. I think it is dangerous to believe that we have real harm reduction here. A little harm reduction is a dangerous thing, because it makes us complacent. We don't have real harm reduction. It must be thoroughgoing.

I think we need a new drug strategy, one that is fully funded. Our old drug strategy, as you know, sunsetted in 1997 when the policy and research team that I worked with was closed down because of the ending of the funding. I would very much like us to have a fully funded drug strategy and one that is fully coordinated with our HIV/AIDS strategy. At the moment there is no coordination whatsoever, and many things are falling between the gaps.

In terms of recommendations, I would say that we need to look elsewhere for guidance, to countries that have policies and programs that work. I would also say that we need to move away from prohibition, because prohibition is driving the problem, including the multi-billion-dollar industry of crime and terrorism that we see at the moment. I would also suggest that we look to base our system very much on the principle of harm reduction, but only in terms of thoroughgoing, comprehensive harm reduction.

This will involve some very controversial measures. It will involve putting in place safe injecting facilities. But they work. This will involve putting in place the prescribing of not just the opioids, including heroine, but also stimulants, such as amphetamines, because so many of our problems now are based around stimulants and we are not attending to this.

¿ (0950)

Most importantly, I would recommend that we need to strengthen our social safety nets and to provide for the well-being of people. That will include such things as housing, job training, and sports programs, because drug use is, above all, a human need to alter consciousness. That is what we need to be looking at, the need for human beings to take such routes to alter their consciousness and also the need for human beings to guard against misery. We are not providing very well in this country, and indeed in a number of others, for saving people from the misery they face every day.

Thank you.

¿ (0955)

The Chair: Thank you, Dr. Riley.

Dr. Remis.

Dr. Robert Remis (Associate Professor, Department of Public Health Sciences, University of Toronto): Thank you very much.

To change gears somewhat, what I would like to do this morning is primarily focus on some of the implications of injection drug use from the point of view of blood-borne infection and also to speak briefly about the epidemiology of injection drug use in particular.

I have left a brief with you, which I guess will be distributed to the members. You have it? Okay, great.

IDUs, as we've heard, are at particularly high risk of both HIV and viral hepatitis infections. This has enormous implications for the users themselves as well as for their families, the community, and society as a whole. These are serious, potentially fatal, infections.

HIV without treatment progresses to serious immune deficiency and AIDS from within three to 20 years following infection. New treatments can mitigate some of these effects, but at great expense and with many difficulties, including irregular adherence, side effects, and the emergence of resistance.

HIV is also transmissible to sexual partners, with infectivity being greater immediately following infection and in the later stages. The probability of such transmission is about 5% to 10% per year or two on infected partners, although I have noted that the actual monetary costs of these infections are enormous, actually hundreds of millions of dollars a year. We have actually tried to quantify this in some other work we've done.

Hepatitis C virus has a slower course, but over the long term it leads to potential consequences such as cirrhosis, liver insufficiency, and lymphatic cancer. These infections are acquired through injection with needles used previously by another IDU.

Rates of sharing in the previous six months of 30% to 50% have been observed in most studies in Canada to date. Cocaine injectors appear to be at particularly high risk of HIV and HCV related to their higher frequency of injection and greater social disorganization associated with its use.

The degree of sharing of needles is in part related to the availability of clean needles such that a new needle is used for each injection. An evaluation we carried out in Montreal in 1996 revealed that less than 5% of the number of needles were in fact being distributed.

Now I'll speak briefly about the epidemiology of injection drug use. Precise data on the extent of injection drug use in Canada is lacking; however, a recent study in which I participated estimated that the number of active IDUs in Montreal, Toronto, and Vancouver was 12,000, 13,000, and 12,000 respectively. Extrapolating these results to the rest of Canada yields estimates of approximately 90,000 active injection drug users. These estimates must of course be considered tentative.

It's also important to realize that these are estimates of the number of persons actively injecting, which we took as meaning having injected in the previous year in our study. In addition, there are a much larger number of persons who injected with varying degrees of frequency and duration in the past. In this context, we estimate there are about twice as many so-called ex-IDUs as active IDUs. Many of these persons may have acquired blood-borne infections and be at risk of their long-term sequelae, of infecting their sexual partners, as well as of relapse of drug injection.

We estimate there are approximately 35,000 active IDUs in Ontario. In a situation report we prepared in 1997, we estimated the overall proportion of IDUs in the Ontario population varied by geographic region but was in the range of 0.2% to 0.6%.

Injection drug use is substantially more common among men than among women, with the male to female ratio varying from two to four to one, and thus 20% to 35% of IDUs are women. The problem of injection drug use is primarily in the early adult years, from 18 to 45 years of age, with the peak use in the 25- to 35-year category. By 45 years of age, most IDUs have either died or have burned out. In that vein, although it's not included in my brief--and this has been referred to before--the mortality rates among persons who are injecting drugs are extremely high.

We did review literature in the study we did, and we found that mortalities vary from 1% to 4% per year. This applies to Canada as well. This is about 20 to 30 times the mortality rate for persons of the same age who do not inject. So the consequences of injection are enormous both in terms of cost and the morbidity and mortality among those who inject.

We'll talk briefly about HIV infection, which is a new problem in the world dating from the late seventies or early eighties. Canada was relatively spared for the first decade of the epidemic of HIV in the world but soon caught up, starting in the late eighties in Montreal and subsequently Vancouver. Ottawa has known explosive outbreaks of HIV in their injecting population.

Health Canada estimates that as of the end of 1999, approximately 10,000 persons were infected with HIV through injection in Canada, of whom about 2,300 live in Ontario. In Ontario the overall prevalence of HIV infection is in the range of 5% to 10%, but this varies by region. Annual incidence may also vary, although only limited data are available. In Ottawa in the mid to late nineties there was an explosive epidemic of HIV. We estimate that in Ottawa approximately 3,000 to 4,000 persons are actively injecting. Measured incidents were as high as 20 per hundred person-years, which is an annual rate of 20%, though I believe that estimate is probably not totally representative. Nevertheless, they were very high and probably still are elevated.

HIV prevalence is also high in a number of smaller communities in northern Ontario. This has been made evident by our diagnostic data, where high rates of positivity are observed among those persons who undergo HIV testing, particularly, as I said, in Ottawa, but also in several smaller communities in northern Ontario.

This has implications for secondary sexual transmission as well. Actually, there have been some patterns whereby areas with higher injection drug use also have higher rates of HIV through heterosexual transmission, which is not surprising.

Hepatitis C is also probably not a new problem, but it is newly recognized, although it's hard to know when it actually swept through our country. It has become a big issue in terms of public health, although few data are available on HCV prevalence and incidence.

A few studies have been carried out, especially prevalence studies, and they have found that from 50% to 90% of IDUs are infected with HCV. The overall prevalence in Canada among active IDUs is probably in the range of 70% to 80%. At least two studies have looked at HCV incidence and found rates of from 15% to 25% annually. Thus it appears that IDUs become infected with hepatitis C relatively rapidly after beginning injection. Combining the estimate of prevalence and the number of IDUs in Canada yields an estimate of 60,000 to 80,000 active IDUs who are infected with hepatitis C. It's almost double that for those who have never injected. That yields an estimate of close to 200,000 persons infected with hepatitis C due to injection, accounting for in the range of 80% of all those infected with hepatitis C in Canada.

Several collaborators, such as Dr. Shimian Zou and Leslie Forrester, along with others, have looked at the issue of incidence and tried to quantify that, and we have some ballpark figures. We estimate that currently from 3,000 to 8,000 persons are becoming newly infected with hepatitis C every year in Canada, with a midpoint estimate of about 5,000. The vast majority of these are likely related to injection.

Finally, I'd like to speak briefly about the epidemiology of HCV/HIV co-infection. Because they share the same risk factor, the sharing of used needles, it's not surprising that they co-exist in a relatively large number of persons. We carried out a study under contract from the hepatitis C division last year. This is an important issue, because there are particular challenges to treatment related to the other infection. In particular, persons with hepatitis C who are also HIV infected have a far faster rate of progression to liver disease than those who are not HIV infected.

We concluded that overall approximately 11,000 persons are infected with both HCV and HIV in Canada and that 70% was related to injection alone and 15% among persons who had injected and had sex with other men, accounting for overall about 85% of co-infections in Canada.The majority of these persons resided in Quebec, British Columbia, and Ontario. Those three provinces account for about 90% of co-infected persons in Canada.

À (1000)

We were also asked to look at co-infection among the aboriginal population and incarcerated persons. We found that among prisoners there were 600 prisoners infected with both viruses in Canada and that almost 90% of them were injection drug users.

Finally, in another vein, in terms of research needs, as I suggested earlier, there is a lack of good data on the epidemiology of drug use and of serious blood-borne infection in Canada. Routine surveillance provides some insights in this regard, but its utility is extremely limited.

Historically, research funding agencies have been hesitant to fund large and often expensive studies that are extremely important for public health purposes but do not necessarily have original scientific merit. In particular, cohort studies are currently operating in Montreal and Vancouver, but have had great difficulty in obtaining funding and also in maintaining their ongoing funding. Toronto has never had a cohort of IV use for the study of blood-borne infection. I believe these studies are exceedingly useful in understanding the extent and reasons for injection and the acquisition of blood-borne infection in this highly vulnerable population.

Incidentally, I have some of these source documents I've been referring to, which are available to the committee.

Thank you.

À (1005)

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

Dr. Millson, do you have anything else you wanted to add?

Dr. Peggy Millson (Department of Public Health Sciences, University of Toronto): I have prepared some comments as well, if you'd like.

The Chair: Perfect, no problem. I wasn't sure, when I saw your group.

Dr. Peggy Millson: I guess it's because we work at the same place.

Like Dr. Erickson, I have an interest in what questions will be asked. Perhaps I can be more responsive in that area to specific interests the committee has. So I just thought I would tell you a little bit about my area of work and give you an idea of what I might be qualified to answer questions about, and a few points particularly following on some of what Dr. Remis has said about data availability and research funding. Those are issues with which I am familiar.

I've basically been involved with research related to HIV and injection drug use since 1989 and I've been involved in a number of studies, including an evaluation of the needle exchange here in Toronto, several cross-sectional surveys of injection drug users and their behaviours in Toronto, and more recently a regional comparison of users around the province of Ontario. I'm currently involved in an evaluation of a low-threshold methadone program--actually two, one in Kingston and one here in Toronto. I'm also involved in a study of crack injection in Toronto, and a study we've called “Understanding Drug Use in Toronto”, which involves very extensive qualitative interviews with injection drug users about their use and behaviours, about their use of services, about the barriers they encounter in seeking services, and so on.

I'm obviously not going to be able to talk about even a fraction of that at the moment, so I thought I would focus on some of the very specific issues that I identified in terms of the questions the committee had listed on the website, particularly related to data sources and information.

As a researcher, I have serious concerns about the issue of data sources and information on drug use in Canada. This was also identified, as you said, as a concern of the committee. Most of the data currently available about the hardest to reach and most marginalized groups in Canada, who are generally those most at risk for both injection drug use and other problems, such as HIV/AIDS, is provided by research studies whose funding is often difficult and tenuous. Most of these studies are of several specific types--and I'm simplifying here. I apologize to people; I'm sure there's a lot more nuance in research than this, but I've lumped things into several specific types:

--surveys, which may or may not be repeated, using questionnaires and statistical analyses, frequently along with anonymous testing for HIV and possibly for hepatitis B and C;

--cohort studies, already mentioned, which undertake similar types of surveys but try to follow the same individuals at regular intervals over time so that they can see what happens to those same people;

--various types of qualitative studies in which the content of the investigation is usually less directed by the researcher and more open to new and unexpected information. These may involve personal, in-depth interviews with open-ended questions. They may involve focus groups where a group of participants are asked to discuss a series of questions, and they may involve various types of field studies involving direct observation and usually accompanying questions.

Each of these types of studies has its strengths and weaknesses. None can provide all the information needed but all can contribute to overall understanding required. Cohort studies in particular are expensive to mount because of the relatively large number of personnel generally required to conduct repeated interviews and especially to follow up persons who are difficult to locate. They frequently involve additional costs not usually covered by funding agencies, such as the provision of storefront research facilities or other means to establish a presence and a degree of comfort within the community that enables the research to occur.

Funding of such studies has been a difficult issue within the research funds of the HIV strategy for some time.

I should interject here that I was the chair of the research review committee for NHRDP for HIV/AIDS public health research from 1994 until it was rolled into CIHR last year, so I've seen a lot of the issues related to these studies coming forward.

Two such studies can easily consume the entire budget allocated for public health research and HIV/AIDS at the federal level, a situation that seems unacceptable since it prevents the funding of other very important epidemiological studies, or we don't fund the large cohorts studies.

Two major Canadian injection drug user cohorts, the one in Vancouver and the one in Montreal, in fact received their principal support in recent years from an American funding agency, the National Institute on Drug Abuse. This isn't a problem in itself, but it does indicate the vulnerability of these studies if they are no longer regarded as able to supply new information relevant to American policy needs and interests.

To my knowledge, there isn't any mechanism within the new CIHR that will alleviate this problem. Since these studies have become a principal source of information, not only about HIV issues but about a variety of other factors related to drug injecting in their respective cities, this is a serious concern.

There are also potential pitfalls for such studies. For example, the individuals willing to enter such a study may differ from the overall injection-drug-using population in a variety of ways. Obviously the more you're able to attract the bulk of the population within a given area, the more protection you have against this selection problem. If you are not able to maintain very high rates of follow-up, important biases can be introduced so that the people you continue to follow become less and less representative of the whole population you wish to study.

Finally, participating in the study over a period of time can in fact itself affect behaviour, or at least the reporting of behaviour, so that over time it becomes less clear what you are actually representing in terms of the situation. I'm not saying any of this to say that these aren't worth doing. I'm just saying they're worth doing in a context where you support them and you support other types of research together. We shouldn't be in this invidious position of choosing to do one or the other at the expense of needed research.

There are also many cities and towns in Canada where information about drug injection in particular, which, as I mentioned, I know best, would be valuable but where for a variety of reasons cohort-type studies have not been undertaken or may not be appropriate. There is a problem with relying on cohort studies within a few major urban centres to provide a relevant picture for the whole country. The downtown east side of Vancouver is a specific situation--very important to understand, very important to do something about, but it doesn't represent what's going on in Halifax or St. John's, or a variety of other places across Canada.

There's a problem with relying on cohort studies within a few major urban centres since there is this contextual piece that needs to be there, as well as the common concerns, which these studies have been very good at illuminating. In Ontario, we've chosen to undertake repeated cross-sectional surveys as a more efficient way to use our very limited research infrastructure to examine the current picture, particularly in communities where the current rate of infection appears to be low, where mobility of users, and hence poor ability to follow up specific individuals, appears to be a major issue.

When the rates of new infection are low, the number of persons who must be followed to examine factors leading to infection in a cohort become too large to be feasible. It has been apparent in Toronto, for example, that there's no one single major drug scene, but rather a number of different scenes, making the development of a single focused cohort study problematic.

However, funding support is also required to undertake repeated surveys. Without stable support, each new survey must be undertaken as a new research proposal, subject to all the uncertainties and delays of research funding. It appears evident to date that research review committees, even those attuned to funding public-health-oriented, policy-relevant research, become resistant to funding what they perceive as surveillance activities rather than innovative new research ideas. This is very apparent, in my view, in the new CIHR structure, where, despite the very good intentions that have been expressed, the actual evidence of research funded to date in the HIV/AIDS field suggests a much greater receptivity to biomedical research and a lack of acceptance of the compromises necessary to carry out research where designs such as random sampling, randomized trials, and the like are not feasible.

À (1010)

In short, I feel that an already bad situation with regard to key policy-relevant reseach is likely to get worse. If you consider the presently available data to be insufficient, there is no reason to believe it will improve without timely and targeted support.

One option might be to provide specific funding for research surveillance support within Canada's drug strategy in the same way as has been done for HIV/AIDS. This could be a combination of investigator-driven research proposals and the issuing of specific research RFPs for areas where policy development requires specific research. If such a program already exists, I'm certainly not aware of it.

Indeed, the funds could be added to the HIV/AIDS funding as well, provided it was done in such a way that there wasn't duplication and it was accepted that the proposals that came in might cover a more holistic range of drug issues. Right now you have to target your proposal to the specific interests of the funding source you are going for. So if you're going to do something related to HIV/AIDS, you emphasize that and you don't talk about the fact that you're also going to examine drug overdose or other things.

If you're going to somebody who is interested in funding drug work, that's a different set of priorities. Researchers can waste a lot of time going after small pots of money here and there to try to fund these large proposals, which require a significant amount of support.

It's also important not to lose sight of the need to fund researchers as well as research. In my view it is particularly difficult to build an academic career in this field. As I previously indicated, obtaining the research funding itself is a struggle. Doing the research is a struggle, with political and logistical issues that do not plague researchers working in more conventional environments or with simpler issues. There may still be an element of stigma attached to the researchers as well as those being researched. Research staff, the people who actually carry out the research under the direction of senior researchers, are frequently working under considerable stress and are in danger of burnout. Because we operate with individual research proposals with individual amounts of funding for each, we don't have an infrastructure that will allow us, for example, to keep good staff employed while we are busy applying for the next little pot of funding. This means that expertise can be lost as people go to other areas where they have a better chance of ongoing salary support and easier working conditions.

I wish to elaborate on the type of structure to support data gathering that I think might be useful. I think a federal role in this process would best be seen as one of coordination of funding and of dissemination. Direct data gathering is best done at the local level, with the support provided from elsewhere, where individuals understand the context, have relationships with providers and the IDUs themselves, and are in a position to work with the application of findings once the research is done.

Obviously, a lot of the issues being expressed involve provincial matters. Hence, their partnership and involvement is necessary, certainly if it's going to be applied in policy. It's essential that there be better means for communication at all levels and between government departments. It seems that the departments concerned with health, education, social services, and corrections all have a portion of the information needs and the information sources. They all have difficulty arriving at any holistic understanding of what is going on. This fragmentation, in my view, impedes policy development and implementation.

I'm going to stop there. I could say a lot about some of the substantive issues my colleagues have addressed, but they've already provided excellent coverage of those.

À (1015)

The Chair: Thank you, Dr. Millson.

We will now turn to questions.

I should have introduced my colleagues more formally. Randy White is the representative of the Canadian Alliance and vice-chair of the committee. Randy is from Abbotsford, British Columbia. Libby Davies is the representative of the New Democratic Party. She is from Vancouver East. Derek Lee is the representative of Scarborough--Rouge River and a member of the Liberal Party. I am the member of Parliament for Burlington, Ontario, just down that highway. I am also a representative of the Liberal Party. We could have others join us as well.

Why don't we go with ten-minute rounds first. If the question is directed to you, obviously we'd like you to answer first. If you would also like to answer, just give me a little sign and I'll keep track of who else would like to answer. We'll try that ten-minute thing and see where we get.

Randy.

À (1020)

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

Welcome to all of you. You've taken very interesting positions. It's also interesting to hear the frustration, I suppose, of making presentations year after year, and studying, and yet governments so often seem to drag their feet on these kinds of issues.

The last time a government of Canada studied this issue, I believe, was the Le Dain commission in 1972--hardly what I call keeping on top of things. Here we are in 2002, looking at some recommendations, and really, I think everybody in the nation understands that things have to change. Which way it changes and how fast is the question, but certainly we can't say it's been changing very fast up till now.

The Senate committee is actually studying more the cannabis issue, I think. I believe this committee is hearing a lot more about what one would call hard drugs--heroin, cocaine...and one doesn't know where Ecstasy is any more; even up to this point, people can't even say whether or not it's addictive.

I wonder, Dr. Erickson, if you could tell me whether you think it's necessary to study cannabis in one group and so-called hard drugs in another group. Why the separation?

Dr. Patricia Erickson: Well, from a researcher's point of view, it's somewhat deceptive to have a study of cocaine, a study of heroin users, and a study of cannabis users, because they're all illegal and they can all be obtained through similar channels. Most of the hard drug users are poly drug users and have exposure...in my studies, I think crack was about the thirteenth drug people usually started with. Very few people end up using hard drugs, of course, who have never used tobacco, alcohol, or cannabis. So I think there's good reason, if you're trying to understand the processes and trajectories of drug use, to try to see how they fit together.

By the same token, I think cannabis has been used by so many more people and has a much higher degree of social acceptability and a lower perceived risk of harm. Even when you interview people who have used it and cocaine, you'll find that they view cannabis quite differently than they view cocaine; they're much more cautious about cocaine--in the research I did.

I think you can look at different policies for cannabis that can reflect its much wider diffusion. I think the health impacts and the addiction issues around the opiates and cocaine are more intense and are associated with much more harm to users; our response is associated with more harm. With cannabis it's much more in terms of the criminal record and the life-long stigma that could be associated with it. I think if you're looking at them without trying to divide them too rigidly, that would be my kind of encouragement.

Mr. Randy White: Thank you.

Dr. Riley, it's interesting, you said that what we need is a fully funded drug strategy. I'm interested in...[Editor's Note: Inaudible]...all along that what we needed was a drug strategy.

Dr. Diane Riley: Yes, well, I'd agree with you there, although we do supposedly have a drug strategy. I think it's just in name only. Essentially it's in no sense a real drug strategy. It's appalling. As you know, we did have two periods of a fully funded drug strategy--five-year periods--and then it sunsetted, as they called it.

I think we need to go back to that, very much so, because it's one thing to have a strategy--which we don't have--but it's quite another thing to fund the research and all of the support that needs to go with that strategy. As my colleagues have said, we don't have money for research in this country. The Americans spend far more in Canada doing research on our drug situation than we do. So these are things we have to address.

By “fully-funded drug strategy”, I mean that money would have to go to the different partners. The partners would have to work together, and this is where we obviously need coordination. At the moment the so-called drug strategy sits with Health Canada, and I think Health Canada's record over the last few years on the drug issue has been appalling. It's got a lot worse than it was. I think things have fragmented. I know from my own experience directly that there is a tendency of the people working within the drug division not to talk to the HIV-AIDS division, and vice versa, which, for those of us who work at the juncture of those things, is absolutely appalling and is of course a completely immature situation to have. I think that's one of the reasons we do have the worst rates in the western world when it comes to HIV and drug use.

À (1025)

Mr. Randy White: Tell me about a drug strategy just a little further here. What if we had a national organization to coordinate drug strategies, provincial organizations? How would you describe the strategy? Right now we have provincial governments with various departments spending money on drug issues. We have the federal government spending money in certain departments--the Solicitor General, Health Canada, customs, and so on--on drug issues. We have municipalities, community service organizations. They're all spending money to some extent on these things. Would you describe a national drug strategy for this lay person who has yet to define it in his own mind?

Dr. Diane Riley: Yes, briefly, and of course we can have longer discussions of these and also there is a lot of very good documentation to go to on this.

I would suggest that we would use models of good strategies such as the Australian model that was initially introduced at the end of the 1980s and which worked extremely well until recently, when there was something of a lack of political will, shall we say, with the new leadership. That strategy works through looking at the main issues that need to be addressed, which bodies at the federal level.... I think Australia is a good one to start with, because, like us, it's a federation, so it has a federal level, a state or provincial level, and it has a municipal level that looks at the responsibility.

What's so important and what I like so much about the Australian strategy is that it had goals, very specific goals in terms of reducing the spread of HIV, reducing overdose, reducing the number of accidents or violent incidents with broken glass, reducing initiation into injection--that kind of thing. And it went through it with all of the partners--customs, police, street groups, and so on.

In order to put together the strategy, they met with community groups. They met with each of the--I hate the word--stakeholders. They met with drug users, with parents. They went around the country, and every year they had an annual review of this--a major national annual review--and assessed where they were and moved around the goals and strategies as was needed. As I said, it worked very well. I think that's what we need here.

The essential thing about the Australian strategy was that it was a coordinated drugs and AIDS strategy. I'm afraid what we have in Canada is this tendency to polarize so that we're not getting effective collaboration on issues. We'd have to overcome that somehow.

Mr. Randy White: Can I have one other question?

À (1030)

The Chair: You have sixty seconds.

Mr. Randy White: I'd like to ask Alan Young, if I could, whether it is possible to legalize drugs in Canada.

Mr. Alan Young: I'll just say yes, but the actuality is this. Legalization is probably the progressive move to make, because it falls into what I call the failure to dramatize an evil. I think the mistake we've made in our drug laws is that we've created an evil. We've dramatized it and made it very alluring. So a legalization policy would have two components, as I see it. One is that government should never have been in the business of prohibiting plant products. If you actually think about it, it's very strange and surreal to have laws against plants. With synthetics, you will need to have laws. You can't have pure legalization, because of quality control, so it would be moved into a regulatory process, with very draconian penalties for people who distribute without licences, because of the inherent risk of having adulterated products.

So I do believe it's possible. I do believe it is not something that's on the table as we speak. I believe government will only look at that when it's seen as a revenue device, in the same way they moved to gambling when they felt they needed revenue. The first step might be a pull-back of criminal sanctions, decriminalization, ultimately leading to legalization. The biggest fear, of course, people have when you talk about legalization or an open market is that Canada is going to be inhabited by 20 million junkies. If that were something I believed in, I wouldn't be recommending the type of proposals I recommend, and I think my colleagues can support me on this. With cannabis, which is maybe a slightly different drug in this regard, in every jurisdiction that has moved to liberalization and a progressive change to decriminalization their consumption rates don't go up; in fact, their consumption rates tend to be lower than North American consumption rates, where we have the prohibition.

I don't want it to be thought that I'm being cavalier and simply saying legalize, don't dramatize the evil, knowing that would lead to horrible results for the country. I would never advocate a position like that. I actually believe it would be the same experience as in Denmark when they outlawed or disbanded their obscenity prohibition in the 1960s. Everybody started buying porn for two years, and every home in Denmark had porn. Now if you go to Denmark, it's a non-issue. There is a satiation that sets in. Once you remove the sanction, people indulge, and then they wonder what was the big deal in the first place--I prefer to play golf.

The Chair: Thank you, Professor Young--a surprising ending.

Ms. Davies.

Ms. Libby Davies (Vancouver East, NDP): First, thank you very much for coming. You've all presented really excellent information.

I just came back from east Vancouver, where we're dealing with the enormity of the fifty women who have been missing. There's a very high correlation between what's happened to those women and the drug laws, and also prostitution laws. Most of those women are drug users, many of them aboriginal. There are many questions I could ask you, but the question I want to get at is really a class issue. It seems to me that we have this incredibly strong stereotype about a drug user. It comes from the police education programs in schools, and it's not a stereotype of your affluent stockbroker or professional person who's using for recreational use, it is a stereotype of a hard-core user on the street and so on.

I have a lot of concerns about not just the criminalization of drug users and the marginalization that comes from that, but how these laws are even applied. You talk to any officer on the street, anybody, and it's mostly the low-level users and dealers who are being harassed, picked up, sent through the system, and so on. It strikes me as ironic that it's so easy to get drug courts and it's so hard to get safe injection sites. We've had very good reports in Vancouver from John Miller, who is the former chief provincial medical health officer.

I don't know if there's a similar report in Ontario recommending heroin maintenance, the health approach, and so on. We've got the reports stacking up all over the place, very good reports. It's not even clear what the jurisdiction is for safe injection sites. Then you've got drug courts, and the reason I want to ask you about the drug courts is that we're going to be hearing about them later on today.

Of course, we just had one open in Vancouver in December. You have more experience here, but I feel very skeptical and am opposed to them, because I feel they're just a continuation of criminalization, and rather than providing low-threshold interventions before people get caught in the justice system, we're waiting for people to be charged, and as a consequence of conviction, they have these so-called choices, which is all based on the premise that somehow people are refusing treatment. I don't know the situation in Toronto, but that's certainly not true in Vancouver. In fact, it even raises questions as to whether that means if you go through the court system, you get to jump the line, so some poor slob who's been trying to get into detox or treatment for months and months can't get in, but somebody who's gone through the court system does get it. It raises all kinds of questions.

I wonder if you could comment on how you've seen the drug courts, because they are often presented as a moderate, almost social policy. I was very interested in Dr. Erickson's remark that good drug policy equals good social policy, and often the drug courts are being held up as a social intervention, a social policy. I really question whether that's the case. I think it would be useful to hear your opinions on that.

À (1035)

Rather than arguing on principle, I have to say we should wait and see what the research shows out of the Toronto court, and I was involved in some of the earlier phases of that. But I also think it's important to be reminded.... I think there are people who are really involved with drugs, with the street life, who have chaotic social histories and relationships, who really are seeking help, who would like help, and it seems a very kind of cumbersome and roundabout way to have to go through the judicial system to get it to them.

I think the issue is that in the drug court there may be a subgroup of this population who might really benefit, and there are probably others who would benefit from other interventions.

Perhaps what I picked up on what you said, Ms. Davies, is that whenever you have an overall umbrella of a prohibition and a criminal justice response, it tends to kind of trump everything else, and it tends to override safe injection rooms, good HIV prevention, and a reasonable response to cannabis education. That's the problem. It gets in the way of saying, well, maybe we can just offer treatment and help in other ways that don't invoke such a coercive approach.

I think when the Toronto court started, at least, there was a commitment to try to fast-track people into treatment who wouldn't have got it otherwise, to have a lot of community supports. Perhaps in Vancouver this was already in place, but I think it's early days yet. But in Toronto I think it's clear that there are some people who have benefited, some who have left, and some who have been forced to leave. It shouldn't be the only thing we think of. The Americans have tended to say, well, if you don't go to prison, it's drug court and forced treatment. I think we could construct that differently. If the given is that we're still going to criminalize for quite some time, then there might be a use of the judicial machinery that would improve the outcome for some people.

So I have an open mind that there could still be a benefit for Canadians through drug courts.

The Chair: Any of you. Alan Young.

Mr. Alan Young: When I take my students to drug court, I have a program where they get placed there. I send them there because I think it's a good education, but I don't think it's a good program.

Drug courts operate on a premise, and in my small presentation I tried to establish that the premise is mistaken--that is, if you use drugs, you abuse drugs. That's the problem with drug court. Everyone who goes to drug court gets a concession, the idea being that they won't bring the criminal sanction to bear against your behaviour if you get treatment. Well, people shouldn't be forced into treatment scenarios if they don't need treatment. That's the problem with drug court: it works on the assumption that everybody before them, every user, is an abuser. I think that's wrong; it sends the wrong message, and just widens the net of social control in a way that I don't think is very manageable.

Now, if drug court were some sort of social institution that dealt with people who are messing up their lives and their partners' lives and their families lives as a result of rampant drug use, I'd be for it. I'd be for a welfare model, because I'm not naive and I recognize some of the horror stories that are associated with drug abuse. But my position still is that for the vast majority of drug users, they are simply users, and there should be social control mechanisms put on them--whether you call it drug court or whether you call it just a regular general division court or whatever. That's the problem that I see.

The second point, very quickly, because you start off on something else entirely, which is sort of the hidden secret, of course, in drug policy, is the racial profiling and the targeting of the lower socio-economic class. Everyone knows the history of drug legislation, that all drug legislation was created on the basis of racial fear--we know that, and it's a tired story. But what people don't know is that because we have a discretionary justice system where both crowns and police really get to call the shots with their own discretion, we do find that the lower socio-economic class is being targeted.

For the best example, just go to the States, which is really just us but extreme: you don't see any more prosecutions for white powder cocaine; it's all crack, because crack is the choice of the inner city and cocaine is the choice of the suburbs. So that's something that has to be taken into account too.

Dr. Patricia Erickson: Well, there's been a lot of controversy over drug courts, and I think we should remember that they were basically a U.S. invention, where the prison sentences have become so long that there was a cost-effective argument to get people channeled into treatment, and the stick for the offender was that they would perhaps go to prison.

I think we have to look very carefully at that rationale in Canada, and if we're going to implement them find a better rationale, since most of our drug offenders don't get sentenced to very long terms of imprisonment. I think we need a lot more carrots if we want people to go to drug court and benefit from that experience.

The Chair: Dr. Riley and then Dr. Millson.

Dr. Diane Riley: I'd certainly concur with what's been said so far. I've studied drug courts, both here and in the United States, and I think it is quite true that this is very much a United States solution, where, like some of the recent cases I've been involved with, say, you have sentences of 337 years, or where you're having people put away for murder because they've given birth to a stillborn child and they found traces of cocaine in the mother--a black mother, of course. One can see how they've been accepted there.

Even so, I would argue that their being accepted in the United States is a slippery slope. This is still an extension of our existing criminal justice system and we know that that is not working. I think it's dangerous to start introducing a treatment model in this way, because before you know it we'll have a treatment industry as large as the criminal justice industry.

What we're doing to address Libby Davies' concern is racial and social class profiling of the worst kind, and the end product of this that I could see in a place like the United States, and where we might follow, is to end up with a treatment industry that would do the kind of mental and social cleansing that we saw under the Soviet federation. I think it has truly frightening prospects. Again, it would be directed only at those who seem to be deviant, and we know that if you're rich enough you can get away with being called eccentric.

So I have serious concerns about it. I think we should be directing that money elsewhere, to prevention, to treatment if needed. I think it's appalling that in order to get treatment you have to go through a drug court. We should be making this available to those who need it, and especially to women who need it, because they're really outside the system, especially pregnant women and women with children. I think what drug courts do is they give us a sense of doing something. It's like doing a little bit of harm reduction. It's a dangerous thing. It's not the solution. It's just a band-aid.

À (1045)

The Chair: Thank you.

Dr. Millson.

Dr. Peggy Millson: On the point mentioned about other treatment within the community in Toronto and its availability, we have had a dramatic increase in the number of people who are able to receive methadone in Ontario since the shift. It's one of the few good things that has happened. It was a mixed blessing when the Ontario College of Physicians and Surgeons took over licensing people for methadone administration.

However, those programs are very bare-bones. You go in daily or weekly to a family doctor, who does a very cursory check-up, and you get your prescription. Those aren't comprehensive programs. It makes so much more sense to put resources into comprehensive programs. There is definitely a class bias in that.

If you're an employable, well-educated, middle-class heroin addict, you can probably just manage your visit to the methadone physician. Your biggest concern is getting out of there in time so you can get back to your job and nobody knows you're going for your methadone dose. But if you're a street user with a grade eleven education, who hasn't had a job in ten years, just getting yourself sorted out from your addiction is not your only issue. There are just so many resources in providing really good comprehensive treatment that will prevent recidivism. You need the person onside. I think the person has to be committed, to some degree, to those changes.

I'm not ruling out the possibility that some people will make the first step under force, but we know that a lot of people will make the first step toward treatment by going to a needle exchange and finally talking to somebody who's welcoming and non-judgmental, and will talk to them about their drug use. That is a much better way to go and a much better use of resources, if we really want to prevent some of this drug-related crime.

The Chair: Dr. Remis, do you want to comment?

Dr. Robert Remis: No.

The Chair: Okay.

Ms. Libby Davies: Do I have more time?

The Chair: There will be another round.

Before I turn to Mr. Lee, can I introduce Dr. Hedy Fry, who is the Liberal member from Vancouver Centre, and flew through the night? We're very happy to have you here, with your luggage as well.

Mr. Lee.

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

I'll start with Alan Young.

Are drug courts not simply a modified form of diversion, recognition that the mainstream judicial system--the Queen versus Jones--doesn't work? Family court, where you have an applicant versus a respondent in a mud-slinging match, doesn't work for a lot of family law disputes either. Isn't that all drug court is?

Mr. Alan Young: There's no question it's a form of formalized diversion, which you can also get without going to drug court. Of course, if the premise or predicate of creating the drug court is the inadequacy of the criminal justice response or traditional adversarial justice, I wonder why that didn't lead us to consider something a bit more novel than something that's just an adjunct.

From the point of view of the administration of justice, which is something we don't talk about that much, drug court and even diversion costs the system a lot. For example, I represented an AIDS patient--I want people to understand how trivial criminal justice can be--who was caught with one joint in his car. He smoked for medicinal purposes--I do a lot of work in that area. They wouldn't divert him because their policy says that if you're in a car, diversion doesn't apply. But I kept harping on the fact that this was a very sick man and it was a very minor offence. I bring it up because it took ten appearances to get diversion, until they changed their minds. If you start doing a bit of a cost-benefit assessment on what that's costing taxpayers, you have to wonder why we do it.

So why do we have just an adjunct to criminal justice? If we know criminal justice is ineffective, why don't we create something innovative that may effectively work?

Mr. Derek Lee: Thank you.

Let's shift to sociology here. I think my colleagues on the committee are hoping to maybe move the goal posts a little bit in this area. We don't regard it as just a question of law.

In sociology, do you think it would be useful if we could crystallize in our report---I may be wrong in saying this--that there is always going to be a base rate of addiction or intoxication in a society, just like we have a kind of base or structural rate of unemployment?

The economists say we'll never really get to zero unemployment. You have to accept that there are people between jobs and some people who don't want to work all the time, so you're always going to have 2%, 3%, 4%, even 5% unemployment. So I'm suggesting that we're always going to have a base rate of addiction to something, that there are those among us, fellow travellers in life, who will wish a diversion, even if many of them are the more vulnerable in society. I'm not discounting their presence in life among us, but is it fair for me to say to everybody, let's recognize that it's always going to be there, so it's a question of socially managing it, assisting those people to manage themselves, and we've got to put resources into that?

We have a number of specialists here. Dr. Erickson.

À (1050)

Dr. Patricia Erickson: That's a very good question, a very challenging one, but I think we don't really know what a base rate of addiction is for each substance, because the legal controls and access, social approval, perceived health risks all vary a lot. If a drug is legally available, as nicotine and alcohol have been, you could probably estimate something around 10% of people are going to have, say, alcohol problems. That could be subject to dispute, but that's the rough figure I've a heard a number of my colleagues quote. For smoking, for nicotine, it seems to be quite a bit higher. It did affect 60% to 70% of Canadians.

What could change without it being prohibited? The rates of nicotine addiction went way down as people stopped, as people took the patch and gum. I think they can be manipulated. It's very much more difficult to say what would be the lowest rate you could have for opiates if they were legally available. My own view is different from Alan Young's. Those drugs are probably far too risky to have them at the corner store. I think there are always going to be drugs that we have to be very careful with. Perhaps a medical gatekeeper approach for opiates is the best we could realistically do.

I think your basic point, that those problems are there and they need to be managed, is a very important one. We don't really know why it is that with the tremendous appeal drugs can have for people, most people control their use. Whatever drug you're looking at, the norm is controlled use in otherwise functioning individuals. They can take it or leave it. We don't know why a small number get so involved that it seems to be the centre of their lives, and it may not be too soon that researchers sort this out. As Dr. Millson said, we're working on it. We would like to help answer those questions, but the practical issue is what you said. In the meantime we have to keep it down and try to minimize the harm.

The Chair: Dr. Riley.

Dr. Diane Riley: It's a fascinating question. I don't think the need for intoxication has ever been zero in correspondence to unemployment. I think the reason we'll always see intoxication and some level of dependency is that it's a very basic human need to alter consciousness, for whatever reasons. I think we are starting to understand that. We see that in all societies and throughout recorded history.

I'm not comfortable with the term “addiction”. I prefer to use the term “dependency”, although I'm not sure that really gets us much further. I think one of the things we see is that there is a tendency for human beings to become dependent upon things.

Now, some of us are lucky enough or well off enough to be dependent, if we are using substances, on licit or legal substances. Some people don't become dependent on substances but become dependent on other habits, such as running and so on. I mean, just a natural part of being human is to have habits. Some of them we call good, some of them we call bad.

Because I do international work and because I am also trained as an anthropologist working in places like New Guinea and so on over the years, I've never ceased to be amazed at how what one country calls good can be the lowest form of behaviour imaginable in another. But in each of these places I've studied and the drugs that I've studied, I've noticed there is certainly something that shifts when you move from the intoxication and dependency we see in some of the “developing cultures” to our developed culture.

One of the things you often see in countries such as Papua New Guinea or parts of Brazil in the Amazon is that they are very much still locked into ritual and religious use. So what we see is a package of social controls and a support system around that. This means that the habits, or whatever you want to call them, are not getting out of control or are not interfering with aspects of life.

The other thing you see, and I think this is vitally important, is there's quite a difference in the level of dependency and the kinds of harms that are attendant upon the use of the more natural plant forms, such as, say, use of marijuana and coca leaf versus use of cocaine. It is quite different, and I think we have to examine that. As something becomes more refined, then we are opening up human beings to a different level of harm.

One of the really bad things that prohibition has meant is that we have produced more and more refined drugs because they're easier to smuggle. I think we have to go back to an examination of the effects of the less refined products.

I also think that one of the things that breaks social control and ritual apart is dislocation. People are living in societies and in communities that lack a sense of community, that are very disordered, and I think once you impose that you start to see much more disorderly kinds of behaviour.

À (1055)

The Chair: Thank you.

Dr. Remis, there was one figure that was used and I think you were a bit surprised by it.

Dr. Robert Remis: It was when you were talking about the proportion of people who smoke. It may have been as high as Dr. Erickson mentioned at some point, but the current rate, I think, is around 25% of people who are regular smokers.

Perhaps I could make a couple of quick points to kind of wrap up a couple of things.

An allusion was made to the issue of access to treatment. Although I don't have a lot of front-line experience of this, my sense is that across Canada there is not really equal and adequate access to detox treatment services or to methadone maintenance in general. It seems to me that should not be an obstacle. When a person is ready to avail themself of treatment, there should be a minimum of delay.

Actually, that's something that could be tracked properly with surveillance. If we did have a national drug strategy, that's something we'd really look at, the waiting times, just as we look at waiting times for a transplant or a hip prosthesis, or whatever. This is something we should really be tracking and it shouldn't be more than a few weeks, realizing of course that this may not necessarily be curative for everyone. We also know that with cigarette smoking it may take several attempts at withdrawal and cessation before one finally succeeds in withdrawing.

The fact that there is recidivism is not necessarily in itself an absolute failure. But I think the obstacles to access to treatment should be totally removed so that people would have days or, at most, weeks rather than months and even years, I understand, in some communities, to get into these services. It seems absolutely unacceptable to me that these services aren't readily available.

I'm not a pharmacologist, but another point I'd like to make is that there is a difference between a habit and an addiction or dependence. We all know that with some of these serious drugs there is pharmacologic dependence, not just psychological habituation.

Á (1100)

With drugs such as heroin it is well known pharmacologically that there is tolerance. For example, one requires a higher and higher dose to get the same effect. There is also withdrawal, not just psychological anxiety or concern. There are actual life-threatening physiological consequences to withdrawal from heroin. People die from sudden withdrawal after injecting for a long period of time. There is a difference in terms of drugs that are pharmacologically addictive.

Finally, there is a bit of miscellaneous information. I can come back to it later. I have a few comments on safe injection sites.

The Chair: Do you want to give us your comments now?

Dr. Robert Remis: I think the idea of safe injection sites is very interesting and appealing. It certainly deserves a trial. I think it's something we need to look at in spheres of policy. We need to try some new things with proper evaluation.

I think safe injection sites are potentially a good harm-reduction intervention. I have done some corner-of-the-envelope calculations. I wonder whether the actual number of injection sites we could provide would ever be anywhere near the real need. Some very quick calculations with the numbers I've seen suggested we might need 100 to 150 of them in Vancouver. I would be concerned about its capacity eventually to meet the need, but I think it's a very interesting possible intervention.

The Chair: Thank you.

Dr. Erickson, I think you wanted to get back in.

Dr. Patricia Erickson: On the tobacco issue, I think the point is the prevalence of tobacco use has declined dramatically from the 60% or 70% levels we saw in the 1960s, at which almost everyone was dependent upon for the amount they were smoking.... Rates have gone down dramatically without criminally prohibiting it and going through all the drug war stuff. It shows the power of social stigma and environmental controls in health messages. I think we often underestimate the possibilities of looking at tobacco from the other side of the mirror and seeing how we might have a harm reduction approach that would do some of these things and stop short of criminalization.

The Chair: Thank you.

Dr. Young.

Mr. Alan Young: Since the spectre of addiction was raised, I do want to make this comment. We can't take addiction and use it as the basis for our existing criminal prohibition. Some drugs, unlike marijuana, are addictive and lead to behaviour that's very injurious to society. You have to be very careful.

I see almost everyone around the room has a coffee mug. If you had two or three coffees this morning, I guarantee if you decide to stop drinking coffee, starting tomorrow, you'll have a headache. It's withdrawal and is not such a big deal. Clearly the worst drug to withdraw from is alcohol.

I did a lot of work with heroin junkies. I was very surprised when I read Bruce Alexander's book, Peaceful Measures. He had a chapter about heroin addiction. For most people withdrawal is like a bad flu. Yet I grew up watching movies of people literally convulsing and dying. Right now I have three people I once represented who do work for me because I don't charge them.They do gardening work, walk my dog, and things like that. They all kicked heroin within a weekend and have all stuck to it.

We have to take the horror stories about addiction with a grain of salt, although it does make for good cinema. In terms of the headache you're going to have tomorrow from abstaining from coffee, just take that with some other drugs and magnify it a bit. It's not necessarily the evil for which we have to have a criminal sanction.

The Chair: Thank you.

Dr. Riley, and that will be the last person this round.

Dr. Diane Riley: When I said I would rather use the term “dependency”, and talked about habits, I was not trying to say there isn't pharmacological dependency. Of course there is with some substances. But it's also interesting, when we look at certain behaviours that we might call habits, that we also can detect physiological changes and withdrawal in people. I think we have to be careful about getting too caught up in the notion of what a drug is and so on.

That said, I think we certainly do see drugs of dependency, both pharmacological and psychological in nature. We must take care of that. We must provide services for people who want to withdraw from those. And as Alan Young has said, one of the worst is alcohol. I think it's appalling that we have so few services that are humane. The kinds of detox services we have are just disgusting in most parts of this country.

Á (1105)

The other one that I'd like to raise, just so it's on the agenda, is solvents and inhalants. I think those are dreadful ones for people to withdraw from, and we really must improve there, especially for native communities. I just want to put that on your list of things.

The Chair: Thank you.

With the witnesses' and the committee members' indulgence, I wonder if we might just suspend for five minutes. Thank you.

Á (1106)

Á (1112)

The Chair: If I can just get everyone back to the table, we'll resume our hearing with questioning from Dr. Hedy Fry.

Á (1115)

Ms. Hedy Fry (Vancouver Centre, Lib.): If I do not have a cup of coffee in the morning, I get a headache by about five o'clock in the afternoon. It will not go away with anything but a cup of coffee, so I think that leads me into my question.

Dr. Remis, you have mentioned the pharmacological and physiological components of addiction. I think we need to look at addiction from a totally different perspective. We continue to look at addiction as something that is a criminal thing, and we have therefore criminalized it. Really, one of the things I've heard you saying this morning...all of you, in fact, have come together to talk about this almost as something that needs to be dealt with in public health models in which you look at setting measurable goals for achieving certain results that you can measure at a particular end in time, and in which you set up a coordinated and comprehensive strategy to deal with it.

The big question that someone has asked this morning—and I think that someone was Randy—was whether or not it was possible for us to have a coordinated strategy. Well, I think it is very possible for us to have a coordinated strategy. In fact, if we do not have a coordinated and comprehensive strategy, we will be dealing with this 25 years from now and we'll be asking the same questions and listening to the same witnesses saying the same things over and over.

The challenge to having a coordinated comprehensive strategy—and I would like to have Dr. Remis respond to this, or maybe Dr. Millson—is that within government and as legislators, we have always tended to look at issues from a very vertical, silo-like perspective, as opposed to a horizontal perspective. But in medicine and in public health, one looks at a problem and sees the sociological or socio-economic components to it, the health components to it, the preventative components, reduction components, rehabilitation components, etc., and you come up with this strategy in which everyone, regardless of their discipline, works as a team to deal with the issue. I think that is where we have to twist it. We have to look at this within government from that particular perspective of horizontality, in terms of how we work together across that horizontal spectrum to deal with this issue. So I wanted to ask how you see us doing that, how you see us developing that comprehensive model based on a kind of horizontal public health model.

The second question I want to ask is for Alan Young. I know you asked about legalization. It's my understanding, and I'd like it clarified, please, that to legalize at this point in time would be very difficult because of international agreements and international law, but one can decriminalize. The two are separate things. It is possible to look at a decriminalization model, which in fact is a model the European Council just adopted about six months ago and is now beginning to be implemented, where those who use are in a component where it should be decriminalized, whereas the international trafficking--the massive crime syndicates--is the one you criminalize and you deal with that from that perspective.

I'd like to hear your comments, please, about legalization versus decriminalization and that kind of model, and I'd like to hear from Dr. Remis about the issue of horizontality in a public health model.

Á (1120)

Dr. Robert Remis: I think there's little doubt that a coordinated, reflected, comprehensive, and multidisciplinary approach would go a long way to improving our effectiveness in terms of dealing with this enormous social problem. Obviously, in a few minutes one can't really develop the details of how such a body would look--a council or a coordinating committee. I'm not sure what the best vehicle would be.

Clearly, there needs to be, as I mentioned, a multidisciplinary--you need people with different kinds of experience, in terms of front-line experience, programmatic research, research at many different levels, surveillance. Clearly you'd need different people who will have broad experience and good skills to develop some of these policies.

I think the policies would be developed very much in collaboration with the provinces. We could reflect on various guidelines for good practice. We could use, for example, some of our skills and evaluative ability, such as we do for clinical practice. Actually, Canada is a leader in terms of good clinical practice and actually classifying, using scientific knowledge, different kinds of medical interventions. A group at McMaster, McGill, and others have developed an approach that I think is very exciting in the sense that rather than just move on gut feelings and crusades, we could actually take an evidence-based approach to this whole problem.

I think we obviously need some good prevention research. It's an area that is sadly lacking in the whole area of public health, and in particular communicable diseases--HIV. We do so many things that are not properly evaluated in Canada, such as even needle exchanges--in the field we all believe strongly in the availability of a clean needle for each injection. There's never been a proper evaluation of any needle exchange program in Canada, to the best of my knowledge, a really proper one, which is more than just a simple process in terms of, well, we delivered x number of needles last year.

So developing a program for preventive research I think would really be exciting, with enabling grants such as innovation-type grants. Safe injection sites would be another one. Rather than having to scramble around for research moneys from CIHR, or even going to NIDA--I think it's really kind of lamentable that this is something that's obviously important and potentially very productive from a public health point of view--why don't we take a comprehensive, organized approach to this where we allow people to test their ideas over a period of two or three years? God knows, we couldn't do worse than we're doing now.

So we need to really look at some of these new kinds of innovations and properly evaluate them.

Those are just some ideas.

The Chair: Thank you.

Just before I turn to Dr. Millson, I want to remind everybody that the mikes are very sensitive.

Dr. Remis.

Dr. Robert Remis: The National Institute on Drug Abuse has funded, for example, the Montreal and Vancouver studies, which I think is actually a very sad commentary on our research capacity. They actually had to go to NIDA to get funding for these two cohorts.

The Chair: Alternatively, we had great researchers who were--

Dr. Robert Remis: They were turned down in Canada first.

The Chair: Dr. Millson.

Dr. Peggy Millson: I just want to add one point, which is that in public health now we've gone very much towards looking more at community development and health promotion as a component of what we do. We don't just do things to people any more; we do things with them. We bring in their points of view. We wouldn't do a lot of programs without involving the people who are recipients, so that we know we're doing it right and we have that built in from the beginning.

I think that's really important with injection drug use as well. I think that's another area that should be examined, the capacity-building within the drug-using community, to actually enable them to have a stronger voice.

In Vancouver there has been some of this. It has its difficulties; it has its issues. There's always “who speaks for whom and are some voices still excluded”, but I think it's a good start.

There's a small group in Toronto as well. In most other places this is very underdeveloped, and I think this is another area that needs to be brought in if we're really going to go into a public health team model. These are the people who really know the situation better than anybody.

Obviously I believe in the need for outside researchers as well, because I think you have to take both perspectives. I do think that direct involvement and the whole health promotion, looking beyond just...do the local, but look at the global as well. That's really important. Certainly amongst the really severely addicted people, which my research would be focused on, there are horrendous rates of sexual abuse to children, things that we should be preventing. These people have been made vulnerable by life circumstances that we should have been doing something about before they got to that point.

I think that's really important with injection drug use as well. I think this is another area that should be examined, the capacity building within the drug-using community to actually enable them to have a stronger voice.

In Vancouver there has been some of this, and it has its difficulties, it has its issues. There's always who speaks for whom and are some voices still excluded, but I think it's a good start. And there's a small group in Toronto as well. In most other places, this is very underdeveloped, and I think this is another area that needs to be brought in if we're going to really go into a public health team model. These are the people who really know the situation better than anybody.

Obviously, I believe in the need for outside researchers as well, because I think you have to take both perspectives, but I do think that direct involvement and the whole health promotion, looking at the local but at the global as well, is really important, because certainly among the really severely addicted people who my research would be focused on there are horrendous rates of sexual abuse of children, things that we should be preventing. These people have been made vulnerable by life circumstances that we should have been doing something about before before they got to this stage.

Á (1125)

The Chair: Professor Young.

Mr. Alan Young: On the legalization, decriminalization point, there are a number of things that have to be said.

First, with respect to legalization, legalization is not an option on the table right now, because you're probably right, the international treaties prevent that, which is very sad really, because starting with the Shanghai conference in 1908, going up to the 1961 Single convention, these were treaties that were created on the basis of such an absence of information. It's sad that they govern today's situation, because they really don't reflect our understanding today. Putting that aside, there would have to be an international community response to move to legalization.

The other thing about legalization is it requires an integration into the market economy. If you're going to say a drug is legalized, then you have to figure out the distribution network--for intance, whether it would be in the private sector, or whether we'd do what we did in the 1920s, just monopolize the sale of alcohol. That's really not in the cards and it's probably more a pipe dream than something real to talk about.

In terms of decriminalization, there's absolutely nothing in international law that prevents Canada from doing this. Every time I've gone to court challenging government policy, government lawyers always raise the spectre of the 1961 convention. It's very upsetting to me, because if they simply would open their eyes--I'm not being facetious--and look across the ocean, it hasn't prevented all of Europe from decriminalizing, and most of Australia.

Here's where we stand in fact, and I should be very clear on this. Italy, Spain, and Portugal have done it through legislation, not de facto. They've actually changed their law and moved to administrative sanction for all drugs--there's no difference between cannabis and heroin. Holland, Germany, Belgium, Switzerland, and Luxembourg all have what is called de facto decriminalization. They just turn a blind eye, and that's what happens there. So most of the western world has changed.

In 1997, in a case that I brought relating to cannabis, on which Drs. Riley and Erickson were experts, the judge concluded that Canada and the United States are out of step with the rest of the western world. I think it's really important to note that looking at our drug policy and making progressive reform is not a heretical task in the year 2002. We're not front-runners; we're not even close--we're lagging way behind.

So I think decriminalization is something that not only international law permits, but in fact when you read the 1988 convention on psychotropic drugs--and maybe someone could correct me, I don't know the exact title--you'll see that it actually encourages novelty in dealing with what they call “minor instances of criminality”, and no one really in North America has taken them up on that call for creativity.

Ms. Libby Davies: What countries have instituted decriminalization?

Mr. Alan Young: Holland was the beginning.

Ms. Libby Davies: Holland, Belgium, Germany--

Mr. Alan Young: Germany was very against them and they used to prosecute Dutch people very sternly. Then they realized they can't do it any more, so they've gone, all of northern Germany. And there's Belgium...Switzerland is about to change their law on the books, but right now it's just de facto. And there's also Luxembourg, if that's still a country.

Ms. Libby Davies: I see. What about Spain and Portugal?

Mr. Alan Young: Spain, Portugal, and Italy actually have changed their legislation to create an administrative regime. Italy and Spain did it four years ago, Portugal did it last year.

The Chair: Dr. Riley.

Dr. Diane Riley: I think when we talk about this, it's good to have definitions of some of the other terms that can be used, because legalization is a very broad category. We're talking about different forms of regulation and the kinds of systems we'd like to see, so I think we should start to use the term “regulation”, rather than speaking of legalization versus decriminalization. Within that, I'd like to say that one form of legalization, a narrow form, is medicalization, and more and more countries, of course, are moving to the medicalization of certain drugs, including heroin, as we're seeing in heroin trials and we will be seeing in Canada and the United States shortly.

The other thing I'd like to say is that from my experience with the international law--and because I do international work, I've been dealing with this now for the past ten years--there is a lot of leeway within the treaties, much more than most people seem to think. Of course, the treaties also state quite clearly that none of the treaties themselves should override the sovereignty of the nation. I think that's something that in Canada we should bear in mind, because this is not meant to go against what the country would choose to do for itself. The treaties cannot do that.

The other thing that is happening is that in the international organizations, including one I work with, the United Nations drug control program, we are now in discussions about re-examination of the international treaties, really brought on by the dire situation with respect to the spread of HIV-AIDS, but also, more and more international organizations are really concerned about the spread of organized crime, which is directly driven by prohibition. So I think we're going to see some very major changes over the next while.

Á (1130)

The Chair: Thank you.

Before I turn to Mr. White, I have a couple of questions myself.

Dr. Millson and I were talking earlier. On the one hand, we have all these young people who are becoming veggies and are into organic foods and all kinds of trends towards being natural, and yet on the other hand, there's Ecstasy, there's heroin. There seems to be some experimentation, Dr. Erickson, that might not be so healthy. In Abbotsford we heard from a friend of Randy White's who lost five years and put herself at great physical risk through experimenting with heroin, and I'm not sure that in the end she was very happy with the choices she made or really had the information to make the choices she made. It seemed everybody was doing it and it wasn't a big deal, and yet she feels pretty darned lucky to have survived the whole thing.

How do we manage that experimentation? What is the message that should be going to our young people, who, by and large, when we talk to them, say things like “I need to escape”?

Dr. Riley, I think it was you who mentioned sports. We were at a rehab centre for young people. The top athlete at her school was there, and kids told us the whole football team was doing heroin by mid-season. They were just not the profile of kids who I thought.... One of them should be on one of our national teams, and here she was with a pretty messed-up drug habit at 17. Socio-economically, this kid was like the beauty queen. It was shocking to us--at least, it was shocking to me. So that's one question I had.

Dr. Millson, I wonder if you would be able to describe to us the trauma scene, because certainly, Dr. Remis, you talk about much higher IV drug use in the city of Toronto and within the province of Ontario than exists in Vancouver, yet in Vancouver it's so obvious. So the numbers surprised me a little bit.

Dr. Young, you talk about the criminal justice system not being appropriate for psycho-substances, but surely there are parts of it--kids, pushing, control of the chemicals. I wonder if you want to be a bit more specific on that.

Dr. Erickson.

Dr. Patricia Erickson: In the passage from childhood to adulthood adolescents are exposed to a lot of really dangerous things--drugs, cars, jet skis, all sorts of things--and drugs are out there. One of the aspects of a free society is that people have the right to make bad decisions.

Á (1135)

We would like to protect our younger members from making bad decisions prematurely. It's a very important part of public health. That's the dilemma. But criminal law is not a health statute; it's a criminal statute that tells you if you do this you're a bad person, and if we catch you we'll punish you.

I think we could get better messages and better education out if we didn't try to scare young people out of using drugs, didn't try to glamorize them and make them attractive to the risk-takers. Risk-taking is part of adolescence, but let's hope the risk-taking doesn't involve shooting up heroin. Let's hope it's a couple of attempts at marijuana, or maybe one Ecstasy trip.

The Chair: Dr. Remis.

Dr. Robert Remis: I have just a couple of quick points.

First of all, in terms of injection drug use in Toronto and Vancouver, Toronto is bigger than Vancouver, so the rates are somewhat higher in Vancouver.

If you're talking about use in the overall population, our estimate in Vancouver was 0.70% and in Toronto it was 0.56%, so it's about 25% higher in Vancouver than in Toronto. Obviously these numbers are subject to a certain amount of interpretation.

It could be that the drug scene is much more concentrated and visible in Vancouver. As Dr. Millson mentioned, it is more diffuse and sort of multi-centric in Toronto, so we maybe don't realize it as much.

There's one little quick point I want to make, which was made earlier by Alan Young, on the issue of the deleterious effects. Obviously no drug, whether it's medical or non-medical, is totally without side effects, but some might actually be seriously dangerous, such as Ecstasy. Some research I have seen pass a committee I participate in shows that perhaps even a single use of Ecstasy may have an effect on centres in the brain, whereas the odd joint may be smoked with impunity. I'm not sure that's true about the odd tablet of Ecstasy, or certain kinds of methamphetamine or other drugs. So we have to be careful, because there may be some drugs that are really bad--not all of them, but there may be some.

The Chair: Right.

Peggy.

Dr. Peggy Millson: Do you want me to speak a little bit more about Toronto?

There are a variety of areas in Toronto, and that has affected, for example, service provision. There are concerns that it's difficult to find users in some parts of the city, even though they're strongly suspected to be there. We have a very diffuse scene, compared to the very concentrated downtown east side of Vancouver.

That's not to say there aren't particular areas. For example, the Parkdale area is well known for heroin use. It tends to have a concentration of people with mental health problems because it's in the area of the former mental hospital, where people lived before they were told to go elsewhere.

There is also an area, as Dr. Erickson mentioned, where there is crack use, and so on. So it is more diffuse, which has pluses and minuses. It may mean there's less opportunity for networking of people who don't know each other, hence less opportunity to spread viruses, compared to the situation in the downtown east side. If they share equipment at all, people tend to share in confined groups with people they know. These are all tendencies, and there are undoubtedly exceptions to everything.

Toronto has always had--initially anyway--a very good prevention program. The needle exchange started in 1989 and we've had cocaine here since the early days, so there was always awareness of the need to provide the number of needles people requested--not to have limits on the number of needles people could exchange, and those sorts of policies, which I think has been helpful.

There was also a process in Toronto of trying to decentralize needle exchange and to provide it in a variety of service settings. It was funded and managed by the health department but it took place in community health centres, for example, or other kinds of service agencies, where their own clients, who already knew and trusted them, could also access needle exchange.

I'd also like to indicate that Toronto has not had the infusion of prevention resources in recent years that Vancouver has had--quite the contrary--so I say this with some caution. I think a lot of effort has gone into preventing HIV in Toronto, and I think there has been a reasonable degree of success. It's not perfect, but there has been some success. At the same time, I think that's always in danger and that the social policies in place now are endangering that more and more.

I realize that you are at the federal level and are not necessarily directly involved in all of those things, but the situation is never static, and I think you can never feel there isn't a problem just because you haven't seen it yet.

Á (1140)

The Chair: Thank you.

Dr. Young and then Dr. Riley.

Mr. Alan Young: I'll touch briefly on legalization, but before I do that, I have to make a very brief comment on something the doctor said about insidious drugs and using Ecstasy as an example and saying there's a study out and that a single dose of Ecstasy causes harm. My comment is that one of the tragic aspects of our war on drugs is that people like myself, and many others, will read that and not believe it. And I won't believe it. I will check it out. I will see who did the study, whether it's NIDA research, because I know what that means, and whether it was a good control group.

I say this because there has been so much misinformation to support prohibition that when something comes out that we should be listening to, no one's going to listen to it. That has always been a problem when you try to create social policy based on misinformation. I'm a teacher. You would want me to believe that, and you would want me to espouse that to students, but I can't, because I've seen so many faulty studies being paraded around as science. Sorry, but I just had to say that.

About legalization, you asked me what should be criminal, because you want to see whether I simply say let everyone do what they want and go to hell in a hand basket. That's not exactly my position, but there are some limits.

I must tell you that distribution to children is not an issue for me. That is media mythology. I can tell you from dealing with drug traffickers for 18 years that nobody sells to children. Children sell to children. The easiest way to get caught is by selling to kids. Do you think you'll sell to a ten-year-old whose mother still does their laundry and checks their pocket and finds the cannabis? You avoid children. It's the way to get caught. You will find somebody youthful who might be a distributor for you. That's the way it was always done in junior high and high school. If you think of someone coming to a school to sell drugs, do you think they're not going to be detected as being an older person coming there? it's just not an issue.

With regard to what should still be illegal, that includes selling adulterated drugs and administering a noxious substance, which is still in the Criminal Code. That's something like Cathy Evelyn Smith injecting John Belushi with an eight-ball and he died. So there are still secondary crimes that will be addressed.

But the main crime--and I know that's the wrong word and that I shouldn't be using it--the main regulatory offence that would be in existence, and a pretty strong one, would be selling anything adulterated that is not in accordance with FDA regulations, if we're still going to use the Food and Drugs Act in the future.

The Chair: Thank you.

Dr. Riley.

Dr. Diane Riley: I think you were asking me about the use of drugs by people in the high socio-economic bracket and in relationship to sports.

The Chair: It's about what should be our messaging to people, especially when we're seeing an atypical group. I always thought it should be things such as get involved in sports and get high on life, and it turns out that's not necessarily working.

Dr. Diane Riley: I think the first thing, just by way of a backgrounder, is that all levels of society use drugs. We know that people who are rich and bored very often will use more than other sectors. The way our system works is that it's the lower end that gets caught.

I think, relating back to what Dr. Erickson said, that the message has to be about risk-taking. We have to, as a society, acknowledge that all youths want to take risks.

When you look at it from an anthropological perspective, there is a stage in life that in some societies is called “rites of passage“, but we have lost our official rites of passage. Although we do it in different ways, I'd like to see them brought back in. I don't know what they'd look like, but I think it would be an interesting discussion.

This is what kids are doing, and I think the best thing we can do is to educate children and their parents. Parents come to me--I'm sure they come to all of us--saying, “Oh, please, my kids know more about drugs than I do. What am I going to do?“ We need honest education about drugs and their effects, for everyone.

I, like some others here, teach in the medical school at the University of Toronto, and the amount of education about illicit drugs is minimal. I think we need to improve education right across the board. But it has to be honest; it has to be about harm reduction; it has to tell kids and youth and parents how to recognize the signs of overdose and how to take care of it. Most of all it has to tell kids what drugs are going to do to you, because at the moment there is so much misinformation that kids tend not to believe anything they've heard.

One of the things they did very successfully as part of the national program in the Netherlands when they de facto decriminalized marijuana, and one of the reasons they have such low levels of marijuana users compared to North America, is that they took on a massive education campaign about the real effects of drugs. A lot of that effect was to de-glamorize the drugs, but it also taught kids to be much more careful around harder drugs, taught them what would happen with soft drugs, and so on.

I think we need that, but we also need education about risk-taking in general and need to allow for that risk-taking but to have better safety nets. Education is part of the safety net, but social policy writ large is also part of it.

Á (1145)

The Chair: Thank you, Dr. Riley.

Mr. White, I think we're going to have to go into about five-minute rounds, if everyone can do that.

Mr. Randy White: Thank you. I have three issues that I guess everybody is wrestling with.

First, Dr. Remis, you said, “Those of us in the field feel strongly about this harm reduction model.” I believe you said something like that. I'd like to correct you. I don't believe that's so at all. I think there are those in the field who believe in a harm reduction model, but most communities in this country, I think, would very much question it.

My own community of 130,000 people is wrestling with needle exchanges--not safe injection sites, but needle exchanges. Many people are saying it's not harm reduction, it's harm extension when you have a safe shoot-up site.

Given that, it's difficult, I'm sure, for a committee that's looking at this thing across Canada to suggest that a model of harm reduction that includes safe shoot-up sites, perhaps, and needle exchange and so on, be a standard for a country like ours when in fact I don't believe the majority of people believe it. I'd like you to comment on that, but I'll get my other two questions out here quickly.

The second question I had for Dr. Erickson. The experience I've had thus far with rehabilitation facilities in this country is that they are few and far between. One in particular I've been working with for some time. It's a great program; they could house 34 people in it. It's a rehabilitation program for drug-addicted teenage girls. They have five people in it because the government won't refer people: the cost is higher than putting them in a foster home, and so forth. Once they've finished there after 13 weeks, they go out on the street, because there's nothing else. This gets down to money and will by local governments. I'd just like you to comment on that.

Á (1150)

Finally, to Dr. Riley, you made a comment about directing our money toward prevention. I could agree with that, but the fact is that we're dealing with a pyramid scheme here. The guys at the top are making all the dollars by selling drugs, and they're pushing further and further down the line to get more and more people, in order to get richer and richer. The people selling down the line are doing the same thing. It's a basic pyramid scheme.

So I wrestle with how much money we could possibly put into prevention, into rehabilitation, into treatment, and into enforcement when, all along, we have these guys at the top and all the way down the scheme, saying it's money for them. Regardless of how much training and education you give to young people, those guys will find a way to push drugs to them. I wonder if you can elaborate on that.

There you go, I get five minutes.

The Chair: We have to hear from Dr. Remis, Dr. Erickson, and Dr. Riley in a minute and a half.

Dr. Robert Remis: Well, I hope I wasn't giving the presumption that I was speaking for all Canadians in saying we all believe in harm reduction. Canada is a diverse nation, a community of communities, and of course there is controversy and some division. What I meant was that it's clearly a consensus within the public health community across Canada, especially in the large urban centres. That's based on a very simple premise that, despite all of the ideology and discussion, a policy of abstinence and eradication just hasn't worked and will not work. There will always be a small subset of people who will do all kinds of things in this world and who cannot be stopped. That has to be recognized.

It would be a good thing if you had a recipe for eliminating the problem of injection. That would be a wonderful intervention. But we don't have one, for many reasons. Some might argue that the next best thing might be bad and that there are many deleterious effects from injection—we've heard all about them—but, at the very least, we can minimize the harm by giving people the opportunity, to the extent possible, to stop these harmful patterns, but also to limit the impact, for example, of acquiring a serious and often fatal blood-borne infection like HIV, hepatitis B, or hepatitis C.

Sure, there are some strong opponents of, say, needle exchanges in the U.S., for example, but with all due respect, that argument is no longer relied on in our communities. It may be in your community and there may be people who are still very much against it, but I think the reality is that people will inject, so we have to do all that's possible to minimize the deleterious impacts of what they're inevitably going to do.

The Chair: Dr. Erickson.

Dr. Patricia Erickson: I would reiterate that treating a drug problem in isolation may be of immediate benefit to the young person, but if you don't have integration into housing, occupational training, community support, and fostering, the person goes back out in the street. I interviewed a number of crack-using prostitutes a few years ago, and it's very difficult to find an easy answer without providing a much better social welfare system, a basic safety net, and counselling and support to the ones who really need it.

The Chair: Dr. Riley.

Dr. Diane Riley: On the issue of prevention in the face of such free availability of drugs, first of all, to reiterate what my colleagues have said, it would have to be a comprehensive approach involving prevention, harm reduction, treatment, and law enforcement. I think, too, that we have to recognize that the free availability of drugs is a product of prohibition and the black market system that we have. Different forms of regulation will take care of that.

Having said that and having identified the problem at the heart of the current market system that we have, I'd like to address Dr. Remis's comment about whether or not we have a recipe for stopping injection. Although we don't per se, in the work I've done on the patterns of drug use in regions of the world, we certainly do see a pattern of shift to and from injection that is dictated largely by the drug market, by the potency of the drug, and by the nature of the drug available.

Yes, I think we could look at shifting populations away from injection, and I think we need to do that. It is something we are doing at the international level now. But we keep coming back to this issue of the market. It's the market that's driving the problem. So let's get at the heart of the market and the system we have. It's not a system of regulation. What we have at the moment is total chaos and total availability. Let's start with that, and I think we'll start to see vast improvements. The money then can be redirected where it needs to go.

The Chair: Thank you.

Ms. Davies.

Ms. Libby Davies: Thank you, Paddy.

I want to pick up on an earlier comment Diane made: if we ever did have clinical trials for a heroin maintenance program, medicalization is, in some regards, a form of legalization. There are all kinds of drugs that are not available to the general public unless you get a prescription, so they're illegal, except when they're prescribed. So that is something that is very much a real possibility.

We've heard some really excellent ideas today, and the questions have been really good, but I think the question we're grappling with is, how are we actually going to bring about this change? I've been talking to people in the downtown east side for five years and saying, we're on the verge of something really big, and this is going to change, and yet there's also a very high level of frustration. People can see that there's a consensus, at least, I think, in some local communities, certainly in the city of Vancouver, but to translate that into a national plan that's going to fundamentally change the approach we've had is a huge challenge. To me, it really does come down to political leadership as well, with all these reports that say the same thing.

So I wonder whether you have any advice in that regard, because I hate to see another committee with another report.... What do you see as something that is going to be a catalyst to change that response politically at the highest level? I'm not necessarily talking about this committee, as we've had very good discussions here. What do we need to do? I think arguments on moral grounds don't work, so do we need to emphasize more economic grounds? I don't know. It's a question I'm always confronted with, and I just don't want to see us become more and more frustrated with it this year.

The Chair: Dr. Remis.

Dr. Robert Remis: With any sort of question of social and political change, there are many stages in a health promotion model. Clearly, there has to be development of political will. The establishment of this committee, obviously, is a very encouraging step. It may have impact, it may not; it may just be determined. But I think part of it is mobilizing public opinion. I'm not sure what people out there really think, but there need to be more and more leaders of public opinion, not only in our communities, but in others, who speak publicly and start to fuel a serious national debate about this, a serious reflection on the realities of what we're facing now and the implications of our current policies. I think we have to engage the country in this debate, because that's how we'll mobilize, for example, decision-makers to make the legislative changes that are obviously necessary.

The Chair: Thank you.

Dr. Young.

Mr. Alan Young: It has nothing to do, necessarily, with law reform, but as an initial step, I think the government has a moral obligation to start setting the record straight with the information average Canadians possess about drugs. That's what I think the problem is. We grew up in an era, most of us, and it still continues today, when the information that came out was so inaccurate and so hysterical. When we talk about not all Canadians embracing harm reduction, it's probably true. I did some cases up in northern Ontario, and it's a whole different world there; they're still thinking of reports and shows they saw in the 1950s.

So government has to learn how to work better with media on this issue. I mean no disrespect here, but if we look behind us, there are two rows for the press, and there's nobody there. I can guarantee you that if you call Julian Fantino, the chief of police of Toronto, to come and give a presentation on this, it would be packed.

Á (1155)

You will see the distinction. As a government, you have to realize you're only going to change and mobilize public opinion when you start getting information out there. It's not very sexy information. The type of information the public likes is front page news about heroin killing brain cells. They don't really like news stories about heroin not killing brain cells because it's not much to read. It's not very exciting. The control of information has to happen to move forward.

Â (1200)

The Chair: We will encourage you this afternoon to read your testimony from this morning.

Dr. Riley.

Dr. Diane Riley: Yes. I think the answer is political will. Unfortunately, we can't bottle or sell it. Although I think one encouraging sign is this committee, and of course the Senate committee. Perhaps at some point we'll see a joint committee.

In a number of countries there has been a major effort toward national strategy and national reform. Sadly, one of the catalysts has been the drug problem hit home to the leader of the country or someone very high up. It's the kind of personal thing I know you have to see in many parts. I think in the absence of that we have to rely on people like yourselves who are on this committee to be champions for it. Also, as some of us do, we need more op-eds to the newspaper to really keep it on the burner, because it keeps dropping off.

I gave my first talk in 1988 at the national conference in Vancouver on how to prevent the spread of HIV among drug users. Then we were saying it was great. We had a window of opportunity. Every year since then I've given a talk in Vancouver. Always there have been terrific plans. Now in Vancouver there is a fabulous four-tiered plan. It just needs the political will to go forward. I think we have to help in those situations, help Vancouver to push it forward, and take some joint ownership.

We need a national drug strategy as of now. I think it would really help, because some politicians would champion this. I know the Liberals are very much behind it. I used to work for the national organization on policy and research that was sunsetted as part of the last closure of the last strategy. We had a terrific amount of support. I think it would be one of the key things to start doing. We'd move forward.

I think it would be absolutely immoral and negligent to leave it and just keep having this. We owe it, if not just to ourselves, certainly to our children. We can see the situation coming. There's a steamroller coming with HIV, hepatitis C, and overdoses. In the countries I work in where this is a problem there is a lost generation. It's a lost generation of kids wandering the streets with no parents. There are incredible problems that become too expensive to solve.

We're headed that way. We have reached the level where HIV is over 10% among our drug users. We know from our international studies it is the point of no return unless major interventions are put in place. We've been saying it at the national, local, and international level for years, but Canada will not hear it. Why won't it listen? I think there are people here today who are listening and they have to carry it forward. We need a mechanism as well.

Thank you.

The Chair: Thank you, Dr. Riley.

For the information of witnesses, could we go until 12:15? No? Doctor Young might have to leave. We'll try to do our best.

I'll do a quick round to Mr. Lee and to Dr. Fry.

Mr. Derek Lee: The committee is hopeful of moving the goal posts a little bit in terms of strategy.

Can I ask a question? You can just say yes or no. Does everyone understand what the national drug strategy is, or do we get blanks? I don't know what it is. I read it in the last few weeks. I know I did. Each of you, from a studied, disciplined point of view, comes from a different perspective. Everyone had good suggestions about where we go from here. I am at a loss.

Could one of you tell us how all of this feeds into a national strategy? What are the objectives? Are we trying to make people happy, spend less money, or change the law? I don't know. Does anybody have a 30-second comeback on that?

The Chair: Dr. Riley, then Dr. Young.

Â (1205)

Dr. Diane Riley: I think it may help you to know where our current national strategy came from. We didn't have one at all, and then there was to be an international meeting around drug control policies. It was embarrassing that Canada didn't have one, so they put together something that went on the website, and this is really something that is a strategy for the internal Ministry of Health. It is not a strategy that combined all of the different players, as was in our old drug strategy. I think you need to know that. That's all it is. It's not a comprehensive thing. It was just put together in the heat of the moment. Little wonder people don't know what it is, because it's just a filler.

The Chair: Dr. Young.

Mr. Alan Young: The only time I've heard of a national drug strategy it was actually one of Mulroney's last hurrahs. It was a very thin document. It didn't say very much, but it was about allocation of moneys, big moneys, in the whole area of studying, chasing, prosecuting, researching illicit drugs--a big pie to divide up. National drug policy is how you divide up that money, which currently, and under the Mulroney strategy, is mostly still in law enforcement.

I think the question you asked, which to me is a vital question, is what would be the objective? If you don't have the objective, the strategy is meaningless; it's just a buzzword. For me and my discipline and where I come from, the strategy is to teach responsible drug use--not to try to create Canada as a drug-free zone, because that's an impossibility, and we'd be throwing away money, but to set up the infrastructure so that people can learn about drugs, make informed choices, and hopefully in a free and democratic society choose perhaps abstention, because even though I seem to be advocating drug use, I recognize fully that the healthiest lifestyle, both physically and spiritually, is one where you're drug-free. But it's a free society, and people make those choices.

I'm sorry that I have to leave. I thank you for inviting me.

The Chair: Can I just ask, would you extend that to licit and illicit drugs?

Mr. Alan Young: Everything. When you say national drug strategy, if you divide things based on their legal status, you're making a horrible mistake, because probably some of the greatest danger to Canadian society from drug use comes from prescription drugs. I think that's well recognized. So we have to look at it as a global package and look at the reasons why people take drugs and then try to give them the tools to make informed choices that will protect themselves and their families.

Thank you.

The Chair: Thank you.

Dr. Fry, you had a quick question.

Ms. Hedy Fry: Yes, I just wanted to comment.

You've talked a lot about prevention. I heard questions that asked what is the use of prevention, because at the end of the day it's not going to make any difference when you have a lot of people who are selling this and it becomes a matter of their economic well-being or their economic good. Therefore, all kinds of criminal activities surround us. How do you beat criminal activity, because it's always out there for young people?

I think the whole concept that I've heard both Dr. Riley and Dr. Remis saying is that if you educate people with the truth, if you give them the objective and not the moral and ideological kind of education, which is that drugs are bad, and if you use them you are a bad person and therefore you become riff-raff, and why do we need to spend money on all of these people who are sort of the flotsam and jetsam of the world, let's just let them go to pot.... We will never have the ability to put money into something if we believe in that kind of moral and ideological piece, that some people are throw-away people.

For me, the issue you're talking about here is education, so I wanted to talk about an education strategy, and have you expand on it just a little bit. What I'm hearing you saying is if we remove the morality and the criminality out of the use--and I'm not talking about taking criminality out of the trafficking, but out of the use of substances--then what we need to talk about are the objective reasons why the use of certain substances can be something you would want young people to stay away from. So you have to get objective solutions.

My question therefore is why is it that people in the public health sector aren't doing this, and making concerted efforts to do this kind of education so that we can remove the media hype, the political hype, and the moral hype? I know what the answer is going to be--that you have been doing it. But my question is how do you do it so that it's sexy and it reaches young people in a manner in which they will hear it? Is there a way to do that?

Dr. Diane Riley: I know you think we're going to say that we have been doing it, and in fact in some ways we have. But I'd like to say....

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