SNUD Committee Meeting

Notices of Meeting include information about the subject matter to be examined by the committee and date, time and place of the meeting, as well as a list of any witnesses scheduled to appear. The Evidence is the edited and revised transcript of what is said before a committee. The Minutes of Proceedings are the official record of the business conducted by the committee at a sitting.

For an advanced search, use Publication Search tool.

If you have any questions or comments regarding the accessibility of this publication, please contact us at accessible@parl.gc.ca.

Previous day publication Next day publication

37th PARLIAMENT, 1st SESSION

Special Committee on Non-Medical Use of Drugs

EVIDENCE

CONTENTS

Tuesday, April 16, 2002

0840

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

0845

Dr. Robert Adamec (Faculty of Psychology, Memorial University of Newfoundland)

0850

0855

0900

The Chair

Dr. William McKim (Faculty of Psychology, Memorial University of Newfoundland)

0905

0910

0915

The Chair

Mr. Mike Patriquen (Member, Marijuana Party of Canada)

0920

0925

The Chair

Mr. Randy White

Mr. Mike Patriquen

Mr. White (Langley--Abbotsford)

0930

Dr. William McKim

The Chair

Mr. Randy White

Dr. William McKim

Mr. White (Langley--Abbotsford)

Dr. Robert Adamec

The Chair

Mr. Mike Patriquen

0935

0940

Mr. Randy White

Mr. Mike Patriquen

Dr. Robert Adamec

Dr. William McKim

The Chair

Mr. Réal Ménard (Hochelaga--Maisonneuve, BQ)

Dr. Robert Adamec

0945

Mr. Ménard

Dr. Robert Adamec

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

Dr. William McKim

0950

Mr. Ménard

Dr. William McKim

Mr. Réal Ménard

Dr. William McKim

Mr. Réal Ménard

The Chair

Dr. Robert Adamec

0955

Mr. Ménard

Mr. Mike Patriquen

Mr. Réal Ménard

The Chair

Ms. Libby Davies (Vancouver East, NDP)

1000

Dr. William McKim

The Chair

Dr. Robert Adamec

1005

Mr. Mike Patriquen

Ms. Libby Davies

Dr. William McKim

1010

The Chair

Ms. Hedy Fry (Vancouver Centre, Lib.)

The Chair

Dr. Robert Adamec

1015

Dr. William McKim

1020

Ms. Libby Davies

Dr. William McKim

Ms. Hedy Fry

The Chair

Ms. Hedy Fry

The Chair

Dr. William McKim

Ms. Libby Davies

Dr. William McKim

The Chair

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

1025

Dr. William McKim

1030

Mr. Derek Lee

Dr. William McKim

Mr. Derek Lee

Dr. William McKim

Mr. Derek Lee

Dr. William McKim

Mr. Derek Lee

Dr. William McKim

Ms. Libby Davies

Dr. William McKim

1035

1040

Mr. Derek Lee

The Chair

1045

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

Dr. William McKim

The Chair

Ms. Carole-Marie Allard (Laval East, Lib.)

Dr. William McKim

The Chair

Dr. Robert Adamec

Ms. Carole-Marie Allard

Mr. Mike Patriquen

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Mr. Randy White

Mr. Réal Ménard

Mr. Randy White

The Chair

Dr. Robert Adamec

Mr. White (Langley--Abbotsford)

Dr. Robert Adamec

Dr. William McKim

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Mr. Mike Patriquen

The Chair

Mr. Mike Patriquen

The Chair

Mr. Réal Ménard

The Chair

Dr. Robert Adamec

Mr. Réal Ménard

The Chair

Mr. Mike Patriquen

Mr. Réal Ménard

Mr. Mike Patriquen

Mr. Réal Ménard

The Chair

Mr. Mike Patriquen

The Chair

Dr. Robert Adamec

The Chair

Dr. William McKim

The Chair

Ms. Libby Davies

The Chair

Dr. William McKim

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. William McKim

The Chair

Dr. William McKim

The Chair

Dr. William McKim

The Chair

Dr. William McKim

The Chair

Dr. William McKim

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Mr. Derek Lee

Mr. Mike Patriquen

The Chair

Mr. Derek Lee

The Chair

Mr. Mike Patriquen

The Chair

Dr. Robert Adamec

The Chair

Dr. Robert Adamec

The Chair

Dr. William McKim

The Chair

CANADA

Special Committee on Non-Medical Use of Drugs

NUMBER 035

1st SESSION

37th PARLIAMENT

EVIDENCE

Tuesday, April 16, 2002

[Recorded by Electronic Apparatus]

¾ (0840)

[English]

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

Good morning. We are the Special Committee on the Non-Medical Use of Drugs, and we're very happy to be here in Halifax this morning.

We have with us, on our panel on research and drug policy, from Memorial University, Dr. Robert Adamec, a professor of psychology; Dr. William McKim, also a professor of psychology; and from the Marijuana Party of Canada, Mike Patriquen.

So that you have an idea of who we all are, I'm Paddy Torsney. I'm the member of Parliament for Burlington, Ontario, which is not too far from Toronto. We have representatives from four out of the five political parties around the table, and there are other members of the committee who are not with us today but who will get a copy of the transcript.

We have the vice-chair of the committee, Randy White, who's from Langley—Abottsford and a member of the Canadian Alliance. We have Kevin Sorenson, who's from Crowfoot in Alberta, not too far from Edmonton. We have Réal Ménard from the Bloc Québécois, who's from the south part of Montreal, Hochelaga--Maisonneuve. We have Libby Davies, from Vancouver East, who's a member of the New Democratic Party. Also from Vancouver we have Dr. Hedy Fry, and from Scarborough—Rouge River, Derek Lee. And we have our researcher, Chantal Collin, and our clerk, Carol Chafe.

I understand that you each have presentations of something under 10 minutes.

Mr. Patriquen, I'm not sure how long your presentation will be. About 10 minutes, okay.

I'll give you a signal when you're at about one minute, and then we will go to questions from the members of Parliament to the witnesses.

Dr. Adamec.

¾ (0845)

Dr. Robert Adamec (Faculty of Psychology, Memorial University of Newfoundland): I'm going to present a brief power-point presentation.

I'd like to describe to you why I'm here. I'm actually a psychologist but I'm also a behavioural neuroscientist. I got into working in the field of addictions a bit by accident. I'd like to describe the circumstance, because I think it suggests a model for something that might be continued.

As I said, I'm a basic researcher. I'm funded by CIHR. I went to an MRC-sponsored meeting in 1996 that was trying to bring together university researchers with health care professionals to try to see if there could be a cross-fertilization of basic or research expertise to address health care issues. At that meeting I met Minnie Wasmeir, who was then the director of the western health region in Newfoundland. It's divided into six regions. I asked her why she was there and she said that there was this growing evidence of increased use of certain substances among Newfoundland youth. I should mention that there has been this ongoing epidemiological study in Atlantic Canada, spearheaded by Christine Poulin, that has monitored the use of various substances among Newfoundland youth over a two-year cycle.

Minnie Wasmeir said these numbers were certainly of interest because they pointed out the problem, but she also said they didn't tell her why. She asked me whether there was anything I could do to help her out in that regard, and I suggested to her that there might be a technique that could at least point the finger at some important influences. I'd like to speak briefly about some of our findings using that methodology. That technique is something called “path analysis”.

Now, as this indicates, path analysis is a mathematical method that makes possible--in this application, anyway--identification of possible influences on substance use. More importantly, it can be used to identify the magnitude of those influences from different sources. As I hope to point out in this brief presentation, this can have implications for designing interventions.

Now, the discovery of those influences is valuable for directing attention to the sources of the problem--and you'll see why that's important in a moment--and also for targeting interventions towards the most influential sources.

Another thing we had hoped to do but did not receive funding for was to use this methodology on reapplication after an intervention to provide a quantitative assessment of the effectiveness of the intervention. I'll try to give you some brief examples of what I mean by all this.

We completed a study of Newfoundland use, and this is based on a sample of 3,293, a random sample of grade 8 and grade 11 students. I'm not going to go into the enormous--

Mr. Randy White (Langley--Abbotsford, Canadian Alliance): That's a study and a half.

Dr. Robert Adamec: I don't wish to go over it in great detail. I want to just highlight some points of this.

This is a path model. What is a path model? Well, these are quantitative measures. This is based on a questionnaire administered to these youths, so this is what's inside their heads. These are what they believe to be the case.

In a path model you identify variables that are measured--these are quantitative--and in this kind of model an influence, that is, that which may be influencing another variable, is the source of an arrow. The target of that influence is at the end of the arrow. The numbers within the arrow are called “standardized path coefficients”. These vary between minus one and plus one, and this indicates the direction of effect, either negative--reducing--or positive--increasing. The larger the path coefficient, the stronger the effect or influence.

Now, we based this initially on a model using these variables as our starting point, and this is a model that had been developed by some researchers in the United States, including Webster, which in fact had been replicated in several populations internationally, so it was a good starting point. We had added variables such as availability and a variety of activities because there had been some suggestion that increased use was due to an inability to engage in activities, so basically the kids were bored.

In this model a green arrow indicates that ultimately it influences drinking, which is a composite measure of frequency and quantity. Red arrows are negative or inhibitory influences. I don't want to go into all the details of this. I just want to point some things out. Fatter arrows indicate stronger influences, so one of the things that path analysis can do is indicate both the complexity of factors that may be controlling the use of a substance, but it can also direct your attention to putative powerful sources of the problem. If you look at this, it's quite clear that a very important influence is perceived peer use of the substance.

Now, you can go further and ask the question, how good is the prediction or how powerful is the influence? As this model indicates, the whole model could account for 90% of drinking, that is, there is 90% accuracy for predicting drinking. However, perceived peer drinking accounts for 88.4% of that. So it's a very, very powerful influence. All these others are contributing just a smidgen more.

Now, effect decomposition is a way of determining the degree of influence of predictors on predicted variables, and this 88.4% prediction or accuracy is mediated by both the direct influence and influences on their own norms about drinking and their own preferences.

You can break this down further into direct effect, which gives you a 65.6% accuracy of prediction and indirect effects, which are through these other interleading paths, which give you an accuracy of prediction of about 24.4%--or degree of influence if you want to look at it that way.

Well, this kind of information...and I should tell you that we've done path analyses on alcohol use, marijuana use, hashish use, non-prescription use of prescription pills or drugs, use of solvents, and also cigarette smoking and caffeine use. At any rate, by looking at these kinds of paths and looking at this kind of effect decomposition one can have a research-based, mathematically derived suggestion for an intervention.

¾ (0850)

We suggested several possible interventions to the health regions. In the case of alcohol, one is to attack the peer drinking influence directly. Now, we can't tell them how to do this--this is part of the problem--but we're directing attention to the issue. If you could break that connection, the model would predict that a successful, complete breaking of the influence would result in a 66% decrease in the use of alcohol. This is derived from the percentage of the variance predicted by that variable.

Another possibility is to intervene with the predictors of peer drinking. This is actually a less effective strategy and very difficult to do because the predictors of peer drinking probably derive primarily from perceived parental drinking behaviour and parental norms. You literally would have to modify the behaviour of parents. This also might not be a good strategy depending on the age of the adolescent, because in our own models, parental influence diminishes in older adolescents, which is not surprising, whereas in younger adolescents it has a stronger effect.

In any event, the model would predict that this kind of intervention would result in only a 30% drop in drinking. So again, you can start making choices on the basis of expected effect or influence of different variables, which you might then attack in your interventions.

We had hoped that if we could apply these interventions--we were unable to obtain funding for them--we could expect to see some drop in the use of the target substance. We could then also determine whether or not our intervention had actually acted on the variables we had targeted. The expectation would be that these path coefficients should drop statistically to zero, had we actually been effective in breaking the links we had targeted.

There is one unique thing about this idea. As far as I know, there are no quantitative measures of program evaluation or assessment of the effectiveness of interventions in drug abuse. This presents a possible method for assessing the effectiveness of different interventions.

I'm almost finished. I just want to give you a flavour of some of the other things we've looked at.

We did look at pill use. The only thing I want to point out with this is that the use of prescription drugs is actually somewhat problematic. In our other substances we found an age split; the frequency grew as kids grew older. But in the case of solvents and pill use, it was being used equally by younger and older teenagers.

The other problem pointed out by this path model is that use of other substances, such as alcohol and solvents, is part of the equation in the use of pills, suggesting that there is a combined use here. This speaks to the issue of trying to assess harmfulness in the use of substances and may suggest that there is a mixed use of substances, at least among Newfoundland teenagers, which certainly might increase the risk to their health. We see a similar issue, although not quite as acute, with regard to the use of solvents. Again, pills are predictive of the use of solvents.

I want to back up. We did also do this on the use of marijuana and hashish, and in this case the picture shifts. Peer use is a very important predictor of own use, but interestingly enough, availability of substance, which was not really a powerful predictor in our other substances, is in fact becoming more prominent. What is interesting here is that a very strong predictor or influence on availability is parental use, which then influences their own use through influences on peer norms and peer use. There are a number of ways you might interpret this, but in some sense it suggests that there's something about the parent's behaviour that is in fact making marijuana and hashish more available for use by these teenagers.

I guess the only point I want to make with all of this is that if you think what I've said has some value.... I have the reports here, if you'd care to read them in detail. I think the idea of trying to bring together a cross-fertilization of various expertise can lead perhaps to a novel means of beginning to deal with these problems.

¾ (0855)

I think there should be more fostering of this. This had been begun by the MRC. Actually, the meeting I described at the beginning of my talk took place in 1996. There have not been too many attempts since then to try to provide this cross-fertilization. But I think unique approaches to these problems might be derived from a continuation of these programs.

There was a question raised about a position on whether or not a CIHR institute ought to be established. I certainly think it ought to be. But by doing it, you raise the priority; you should also, then, increase funding. However, I would add the caveat, being a basic researcher, that if you were to do this you'd want to put in new money and not do it at the expense of the already strapped budgets of the CIHR institutes.

Finally, you also asked the question about the advisability of having a national strategy for information-gathering. I would most strongly support that, with the following caveats.

My support comes from the attempt in the Atlantic provinces by Christine Poulin to do this drug use survey, which has been ongoing, in three cycles now, every two years. She is an epidemiologist who tries to apply good epidemiological methodology to assess use of substances. It's as a result of this, actually, that Dr. Wasmeir raised the concern with me, because they are able to track changes in substance use that were creating some concerns for the health care officials. I think Christine Poulin would like to bring this to a national level, and I think any help she could have in that regard would be valuable.

The other point I want to make, though, is if you're going to have a national strategy for gathering information, you should be very clear about what you hope to gain from it. The kind of information that's gathered by an epidemiological study gives you assessments of population usages in percentage terms. That kind of information cannot be applied in a quantitative analysis, for example, like this one, where you need to really ask different kinds of questions. I think if such a strategy were adopted, you'd want to get lots of expert input as to what the desired outcome was and a clear specification of the kinds of information you would want to gather. Then you'd need to fund it properly to allow a repeated cycling, with a proper national sampling, using a standardized set of measurement instruments.

I guess I'll stop there.

¿ (0900)

The Chair: Thank you, Dr. Adamec.

Dr. McKim.

Dr. William McKim (Faculty of Psychology, Memorial University of Newfoundland): Good morning, everybody. I want to thank the committee for asking me to come and talk to them.

I want to start off by giving some indication of where I'm coming from here. I started off, when I went to graduate school over 30 years ago, with an interest in drugs, and did a doctoral dissertation using laboratory rats and obscure substances like scopolamine. But I have maintained an interest in drugs throughout my entire career and have done research in laboratory animals, rats, monkeys and pigeons, and I've also done research on human beings. So I have sort of a diverse background in different species.

One of the things that has had perhaps the biggest influence on my thinking is the fact that, back in 1972, which is now 30 years ago, I started teaching a course at Memorial University on drugs, “Drugs and Behaviour”. I've been teaching that course for about 30 years. What that has done is draw my attention to the broader field--scientists tend to get specialized in very specific areas--of drug use and public policy and the legal status of drugs, because this is what my students want to know about. It deals with all kinds of drugs.

So I've had the for the last 30 years to pay particularly close attention to the entire field of addiction and addiction research and drug effects, including the legal status of drugs and various other aspects of public policy with regard to drugs.

One of the interesting things about teaching about drugs.... Well, it's a general principle, I guess, about teaching in general, that one sure way to find out whether you really understand something is to try to teach it to somebody else. And undergraduate students are particularly good at finding out and detecting if you don't really know what you're talking about. So I put it forward to you that my experience in teaching about drugs has, in fact, given me a rather unique overview of the entire field.

About the middle of the 1980s I became increasingly frustrated that there was no textbook in the field that I found useful. I had tried all kinds of books. For a couple of years we used the text of the Le Dain commission report as a textbook for the course. In fact what I ended up doing was to write a textbook. It was published by Prentice-Hall, and I've just finished writing a fifth edition, which is in fact what also has drawn my attention to the whole field. I've left with the committee two copies of the fourth edition. The fifth edition is in press at the moment. So a lot of what I'm going to say or going to refer to you can in fact find in that textbook.

One of the things that I have found of interest is that in the last 30 years there has been an unbelievable increase in the knowledge about or understanding about what drugs are, what they do, and why people take them. In fact when I first started teaching the course in 1972, I can remember telling my students that we were pretty sure that opiate drugs--this would be heroin and morphine--acted at receptors inside the brain, but we had no idea what these receptors were or why they existed. We didn't know anything about them. In fact I can remember telling my students that perhaps the reason we had opiate receptors in our brains was because God wanted us to enjoy morphine and heroin, which of course didn't impress too many people. I got their attention, anyway.

Of course a couple of years after I said that, we discovered opiate receptors and we know why they exist and what they do. We also discovered endogenous opiates, which we call endorphins and enkephalins. Our knowledge of the brain and how it handles drugs and how it responds to drugs has just ballooned in what we know about it.

One of the other things, of course, that I noticed is that in the last 30 years there has been virtually no change whatsoever in public policy with regard to drugs. We have a tremendous knowledge of what drugs can do now, a tremendous change in our understanding, yet there's been virtually no change in public policy or the legal status of any of these drugs. The legal status of drugs in fact is determined not at all by what we know about drugs in terms of pharmacology, but in fact by historical precedent. History and politics determine our public policy with regard to drugs, and certainly not the investigations of research scientists.

I can give you an example of this. Returning to the opiate drugs, for example, there are basically three drugs that are of interest: codeine and morphine, which of course are the active ingredients in opium, and can be separated and in fact are used separately; and there's heroin, which is a semi-synthetic. To produce heroin, basically you take a molecule of morphine and you add acetyl groups to it, and it becomes di-acetyl morphine. That's done in various illicit clandestine labs around the world.

What's interesting is that all three of these substances--codeine, morphine, and heroin--do the same thing inside the brain. They all work at the same receptor site. As a matter of fact, the first thing the body does when you stick heroin into it is to remove those two acetyls and turn them back into morphine again. Codeine is also metabolized into mono-acetyl morphine, or mono-morphine, and it works virtually the same receptor site. So we have three drugs: codeine, morphine, and heroin.

Just look at the legal status. You can walk into a drugstore and you can buy codeine over the counter. If you want to use morphine, you can certainly do that: the doctor will give you a prescription for morphine if you're in pain. But you can't even use heroin if you're dying in great pain due to cancer. It's just considered such a terrible drug, it's not even used for medical purposes.

I tell my students this is an example of the lack of rationale in our public policy with regard to drugs. If you go into it, the reason we treat these substances differently is largely historical and largely political. If you go back and look at the history, I think you'll find that the reason heroin is considered with such fear and is treated so harshly has a lot to do with American politics.

¿ (0905)

Many years ago, when the Harrison narcotic laws were adopted in the States, the reason heroin was treated with such harshness was that at the time the United States was trying to negotiate a trade pact with China. China was very upset that opium products were being imported into China, and they didn't want their citizens using them. So in order to impress China, the United States said, “We're going to have to institute some very strict international rules on trading these substances”, and in order to look sincere they thought they had to put in place very restrictive laws domestically. So the Harrison Narcotic Act was passed.

That's why, for example, in the United States heroin is completely illegal and considered not to have any medical use. That didn't happen in England. In England heroin is not treated the same way it is in the United States. We in Canada tend to have a drug policy that follows very closely that of the United States. So, indirectly, we now treat heroin in the way the United States did first. We simply followed their policy, as near as I can tell.

The point I am making is that our public policy, particularly the legal status of drugs, is determined by history and politics, basically, not by any kind of basic or even applied research that's available, and that's a shame. Maybe 30 years ago there was an excuse for it, but there isn't an excuse now. We know a lot about drugs and why they do what they do and how they do it. There's still a lot of research to be done, but I think it should be guiding public policy to a greater extent than it already is.

One of the things I have seen change in terms of public policy, which I approve of, is the field of harm reduction, introduced within the last 30 years. I think it works. I think it's a very enlightening way of dealing with substances. It does cause a lot of people some apprehension, because it seems to be making it easier to use drugs by reducing the harm that drugs do. I can see why that disturbs a number of people, because it could be perceived as encouraging drug use by making it easier to do so.

One of the areas where there has been some interesting research done is the field of behavioural economics. This is a fairly new field that combines what we know about psychology and economics. If you think about it, the two fields are really quite similar. They both deal with consumption behaviour. Buying cornflakes and buying heroin are governed by very much the same sorts of rules. Economists have studied to a great extent what kinds of consequences there are for consumption when you change the price of cornflakes and when you make it harder or easier to get.

A lot of this information can be applied to why people use drugs. If you make drugs easier to get and harder to get, what does that do to the consumption of the drugs? To a large extent our public policy with regard to the legal status of drugs and the enforcement of drug laws have to do with making drugs harder to get, drying up the supply, and increasing the price. If you take something like tobacco, it is an established government policy to make it more expensive so people will use it less.

There are very powerful mathematical methods of predicting what's going to happen when you increase or decrease the cost of a drug. Harm reduction is just a method of decreasing the cost of a drug not just in financial terms but to an individual. Using these economics techniques, you can predict with some certainty what's going to happen when you make drugs cheaper and easier to get. It gives you some understanding of how to play off these two techniques, reducing the supply and increasing the cost, but yet trying to provide a more humane approach to drugs.

¿ (0910)

I've been getting the finger signal from the chair, so I'm going to stop at this point. The basic point I want to make is there's a lot of really useful information out there that could be used to make a very enlightened and powerful public policy to achieve the goals that we want to achieve. I urge the committee to pay particular attention to those new sources of information and all those interesting facts that have been uncovered in the last 30 years.

¿ (0915)

The Chair: Thank you, Dr. McKim. I'm sure my colleagues are going to have lots of questions for you.

Mr. Patriquen.

Mr. Mike Patriquen (Member, Marijuana Party of Canada): Good morning. My name is Mike Patriquen. I'm with the federal Marijuana Party. This morning I'll be giving a presentation on harm reduction based on the European and North American drug policy models.

In the late sixties and early seventies, governments in Holland, England, the United States, and Canada all appointed special commissions to investigate the growing incidence of illicit drug use. These commissions had essentially the same task as your committee. If you have not yet examined their findings, I would suggest you do so.

All of the commissions came back to their respective governments and advised to a greater or lesser degree that a prohibition-based drug policy on cannabis was ineffective, innately flawed, and likely counterproductive. All concluded that cannabis was not harmful enough to citizens who used it to merit criminal sanctions on its use.

Thirty years later, the reactions of all four governments to those reports have proven the initial findings correct.

Holland was the only country that took the advice of their experts. In 1976 the Dutch allowed what are now called “cannabis cafés” to open to the public. By doing this, they destroyed the vast majority of the country's drug black market and most of the problems associated with it. The most important consideration of the Dutch government was that this move would eliminate easy access by teens to heroin and other hard drugs. This was a natural extension of their easy access to the cannabis black market.

The Dutch cannabis cafés put cannabis sales to adults in public places where police could keep an eye on teen access and attempts by the black marketeers to gain access to cannabis users. To the Dutch, harm reduction meant eliminating the cannabis component of the drug black market. By volume of transactions, cannabis sales accounted for over 99% of all illicit drug sales that existed at that time in all four countries.

The three countries that ignored their own experts found that their countries' illicit drug black markets were suddenly 100 to 1,000 times the size of that in the Netherlands overnight. Now, 30 years later, Dutch drug policy is serving as a model for most of Europe.

On May 7, 2001, the Spanish newspaper El Pais reported that only four European Union countries still prohibit cannabis consumption.

Europe continues along a trend towards decriminalization of illegal drugs. Of the 15 countries in the European Union, seven do not punish personal consumption of any drug or only impose administrative fines. With regard to cannabis, tolerance is almost universal. Only Sweden, France, Finland, and Greece still maintain penalties.

Switzerland has come the furthest by taking the Dutch model to its logical conclusion. The Swiss government is enacting legislation to end cannabis prohibition altogether. All parties agreed to this. The Swiss government specifically stated that legalizing cannabis is an essential part of harm reduction. In their debates, Swiss legislators repeatedly cited the Dutch drug policy success, especially their success in keeping their citizens away from hard drugs.

The argument may be advanced that the Swiss were not signatories to the UN Single Convention on Drugs, so they were able to make this bold move. We as signatories are able as well to end prohibition on cannabis. A clause in the treaty allows us out if the treaty offends our Constitution. We can emphatically state that the prohibition on cannabis offends the charter in our right to life, liberty, and security of the person.

For Britain it should be noted that the introduction of the caution system for cannabis possession, which is basically a fine-based option, came in the nineties and put them onto this El Pais newspaper list as a country that had decriminalized cannabis use. Such half measures do nothing to address the corrosive influence of a vast cannabis black market. Britain is therefore enacting legislation now to downgrade cannabis to a class C drug. This will mean the police cannot arrest or even fine anyone for simple possession. As well, two Dutch-style cannabis cafés have opened in the U.K. in the last month with no police interference. There are a dozen more planned.

As the sale of cannabis in this way becomes open to the general public, youth access to hard drugs will fall. These recent British moves seem radical for an English-speaking country that has been bombarded by Reefer Madness-type yellow journalism from the U.S. for over three-quarters of a century. However, a comparison of their 1999 drug use and crime stats with those of Holland is all we need to understand why they are taking this action, much to the chagrin of the hard-right U.S. administration.

Please bear in mind that a number of U.S. drug policy experts have concluded that in the U.S. and likely in Canada and the U.K. there is widespread underreporting of drug use because of the criminal penalties and harsh official sanctions imposed on those who consume illicit drugs. The realistic Dutch attitude towards drug use likely means more accurate stats.

The teenagers in the following table are 15- and 16-year-olds from the U.K. and Holland. I have added one stat from the 2000 U.S. study, Monitoring the Future, to include U.S. grade 10 students who are approximately the same age. This table can be found on page 6 of the hard copy I've passed around if you'd just like to glance at that.

From the table, note that twice as many British and American teens in this age group have tried cannabis as have their Dutch peers. This is in part because licensed cannabis sellers in Holland can and do lose their licences if they sell to teens. Realistic drug education in Holland as opposed to North American drug education is also a factor. There they just say “know”.

Note as well that over 200 times as many British 15- and 16-year-olds have tried heroin as have their counterparts in Holland and that Britain has 2.5 times as many problem, hard-core heroin addicts per capita than do the Dutch.

According to a report released recently by a blue-ribbon think-tank appointed by the British prime minister, there are now 500 times as many hard drug addicts in Britain as there were in the 1960s. The report also states that Britain is in the top five countries worldwide in terms of heroin consumption, with the U.S. being number one. Since the 1980s the number of addicts has doubled every four years. In 1998 there were nearly 3,500 drug-related deaths in Britain, none of which were attributable to cannabis consumption.

The Office of National Statistics recorded a 110% rise in heroin- or morphine-related deaths between 1995 and the year 2000, to 754 per year. The number of deaths linked to cocaine quadrupled to 87 a year. By comparison, heroin use in the Netherlands is just not an issue. The number of addicts has been stable at around 25,000 for 20 years, and the addicts are getting older, with few young people joining them.

The U.S. has proven that no matter how much money is spent on a prohibitory approach to drug policy, teen and adult drug usage rates do not decline. In the last 30 years the Dutch have proven that their teens can't gain access to the illegal market for hard drugs. Fewer than one in a thousand Dutch 15- to 16-year-olds have even tried heroin. Currently, teen heroin use numbers in North America are in the same ballpark as those in the U.K., and they are also rising at an alarming rate.

The U.S. versus Dutch drug and crime rate comparison in appendix 2, parts A and B, though dated, proves that even with an annual expenditure of anywhere from 40 billion to 120-plus billion tax dollars on drug prohibition annually, the Americans use all forms of illicit drugs at rates far higher than the Dutch do and have rates of hard drug use that are astronomical when compared with Holland's.

¿ (0920)

The Canadian Centre on Substance Abuse tells us that our drug use rates are roughly twice those of Holland for cannabis use. Our hard drugs usage is also through the roof compared with Holland's. Canada's drug use rates are roughly equivalent to those in the U.S., the U.K., and Australia, whose prohibitory drug policies mandate a huge cannabis black market as well.

There is no denying that the worldwide illicit drug trade is a massive problem, recently estimated to have global annual retail sales of approximately $150 billion U.S. This is about half the amount spent globally on legitimate pharmaceuticals. Global consumer spending on tobacco is $204 billion, alcohol $240 billion.

The Dutch response to the illicit drug-related problems that your committee is examining was to simply destroy the black market by legalizing, in a sense, cannabis, and therefore doing exactly what the commissions called for three decades ago.

The British had learned that unless there is a legal or quasi-legal supply of cannabis to adults, there is no effective harm reduction. Harm reduction starts with eliminating the cannabis black market by legitimizing cannabis. That is exactly the reason the British and Swiss are changing their laws. Most of Europe appears to be moving in the same direction. It is just a fact that the hard drug problem is a direct result of having a cannabis black market.

As long as the drug black market is 100 to 1,000 times the size it would be without cannabis, then the black market will be in every high school in every neighbourhood. This is the current situation in Canada, the U.S., and the U.K.; 100 to 1,000 times more of our people are being introduced to hard drugs than would be the case if cannabis could be purchased in a legal, controlled environment. The situation will not change until we radically change our country's approach to drug policy by ending the cannabis prohibition. We will then enjoy true harm reduction.

That's my presentation. I've made a number of recommendations to the committee. They're in the hard copy for your consideration.

Thank you very much.

¿ (0925)

The Chair: Thank you.

Colleagues, in the hard copy the recommendations are on page 11, if you're looking for them.

Thank you to all of our witnesses.

I'll now turn to questions from members of Parliament. I'll give each questioner about 10 minutes. They'll ask a question. If the question is directed exactly to you, you're welcome to respond. If you also want to respond to the question, just give me a signal and I'll keep track of who else is interested in answering.

The first questioner will be Mr. White.

Mr. Randy White: Thank you, Madam Chairman.

Good morning, and thank you for your presentations.

I have three questions. The first one is a relatively quick one.

Mike, are you saying that legalization of marijuana includes the reduction of heroin and cocaine use?

Mr. Mike Patriquen: Yes, that's exactly what I'm saying, Mr. White. I'm saying that at least 99% of the illicit drug market in the country right now is for cannabis. Young people purchasing their cannabis, which most people and a number of our Supreme Court justices see as a benign natural substance, have access to the hard drug market.

Unfortunately, the days of cannabis dealers being pure cannabis dealers are long gone. It looks like the criminal element has pretty well taken over that market. It also appears that these people don't care if they're selling cannabis, or stolen CDs, or heroin, or cocaine. So when young people go out to purchase their cannabis they're introduced to these hard drugs.

So if the cannabis market were legitimized and put in a proper marketplace, when the young people went to purchase their cannabis they would get it there and they would have absolutely no contact with a source supply for hard drugs. This is exactly what has been proven true in Holland over the years.

Mr. Randy White: Thank you.

I'd like to ask each one of you two questions. First, would you define, in your own words, in one or two sentences, harm reduction.

Second, given that this committee is the first committee since the Le Dain commission to look at drugs in Canada from Parliament's point of view--we do have to make recommendations to the House of Commons around the end of November--I'd like to get, if you would, your top two priorities that this committee should make recommendations for. They could ultimately be legislative change or recommendations for debates in the House of Commons. What are the two biggest priorities in your own mind that this committee should make a recommendation for?

I'd like to go back to the first question and ask Dr. McKim to start. Define for me harm reduction, if you would.

¿ (0930)

Dr. William McKim: The notion of harm reduction has been around actually for quite a long period of time. We used to call it tertiary treatment. This was the notion that if you had a problem there are three ways to deal with it. You can try to prevent it from happening in the first place. If somebody's using drugs, you can try to prevent them from starting, try to make them stop, and if you can't make them stop, try to reduce the harm that it is going to do to them and indirectly to society in general, because treating an addict is a pretty expensive proposition. It is still probably cheaper than not treating the addict at all.

Harm reduction is the philosophy, I suppose, that it benefits not only the user but also society if you make an attempt to try to reduce the harm of the addiction or the disease or the disorder or whatever it is. It's a concept that doesn't necessarily apply only to drug use. The idea is that you try to reduce the harm that it's doing to the user, and as a consequence you reduce the harm it's doing to the rest of society. Eventually it becomes quite obvious that the harm that's happening to these people is in fact harming all of us. It's not just a matter of trying to make it easier for people to use drugs. It's a matter of reducing the harm to all of us. There was a thing in the news quite recently about safe injection sites being set up.

Mr. Randy White: Is that harm reduction?

Dr. William McKim: That is harm reduction, yes. The idea is that, if you can reduce the amount of hepatitis and AIDS and bring people who are heavy-duty drug users in contact with the medical profession and with health care, then you can reduce the harm that's happening to them and you can also reduce the spread of AIDS. That is something that benefits all of us.

The Chair: Are you going to ask him to answer the second question as well?

Mr. Randy White: Yes, on the two priorities the witnesses think this committee should deal with.

Dr. William McKim: Given the fact that you have to make your report by November, and given the complexity of the issues that are involved, what I really would like to see is some attempt to rationalize and review public policy with regard to drug use from a global perspective. We need to stand back a long way and look at everything we are doing with regard to drugs--the drug strategies, enforcement options, treatment availability, and funding of more research, as Dr. Adamec has suggested.

I don't think this committee will be able to do that itself. What I would like to see is to have it recommend some kind of standing committee or some organ of Parliament that can keep track of everything that's going on and rationalize all the research that's happening with regard to drug use--a well-funded operation that can in fact try to rationalize public policy in a general sense, try to break the connection between history and politics with public policy, and try to make it rational.

Of course, going along with that would be increased funding for research, because I think that is absolutely, vitally important. We have to know what the implications are of what we are doing--the kind of thing perhaps that Dr. Adamec has suggested, where, by using these techniques, he's able to make some kind of rational guess at what will happen if we do this and what will happen over here in an extremely complex system.

Mr. Randy White: So just capsulize this rationalized drug use from a global perspective, maybe in a standing committee sort of way and watch over it, and the second one is increase funding for research.

Dr. William McKim: Yes.

Mr. Randy White: Thank you.

Dr. Robert Adamec: Dr. McKim has said many things I would reiterate.

On the definition of harm reduction, I think the important points are harm to self--and this is also a health care issue--and harm to society, both indirectly, but also directly, because substance use and abuse can have direct impacts in societal harm. An example is irresponsible use of alcohol--death due to driving under the influence and so on. So I think harm reduction is finding means of reducing both harm to the user and the spinoff harm to society, not just in cost but also in derangement of behaviour that may lead to direct harm to other members of the society.

Allowing for use of drugs or legalization of drugs I think meets with some disapproval on the part of people, as if it's giving up. On the other hand, I think an interesting example that people should take is the experiment in prohibition in the United States in the 1920s and 1930s. The Mafia grew to enormous prominence as a result of creating a black market for alcohol. So I think you have to weigh decisions about whether or not you legalize a substance that has potential harm against the possible societal cost of criminalizing it.

We, as a society, allow ourselves to use a very dangerous substance called alcohol. It kills, it destroys families, and so on. But we accept a certain societal responsibility and charge each of us to behave responsibly toward it. So I think you should keep that in mind when you think about harm reduction strategies and use of substances.

With regard to the top priorities, again this is coming from my own perspective, which is as a researcher. I would reiterate what Dr. McKim said. Certainly I know, as a problem solver, that you can't solve a problem unless you can define it. So I think you need to make it a priority to define the problem well, which requires a coordinated national effort at gathering information across the country on the problem. So you need a national strategy and a coordinated effort. As well, as I will reiterate, you should be very clear as to what your goals are for that in terms of the kind and quality of information you will gather.

I think that establishing perhaps a CHR institute specifically directed toward the issues of substance use and abuse and possibly providing information for national policy is a good idea. It gives it a national priority. It can also help to focus. These kinds of institutes put out calls for research, which are basically guided by the needs and purposes of the formation of the institute in the first place. And certainly government, in funding this institute, has every right in helping to specify what those priorities are for that institute. So I think that would be a good mechanism for enacting this.

However, again the caveat: please provide new funding, and don't starve the already starving other institutes, if you choose to go that route.

Mr. Randy White: Thank you.

The Chair: Mr. Patriquen.

Mr. Mike Patriquen: First, on harm reduction, I look at that on three levels, basically. The first level would be the hard drug addicts we have at the moment. How can we reduce harm to them? They already have a pretty rough lot in life. I think the best way to do that would be from what we're seeing now with the safe injection sites, which should proliferate across the country and hopefully cut down on the harm of disease or the spreading throughout that particular community.

Another way, which is quite important, would be to look at expanding the methadone programs that we now have to some extent, and perhaps take a look at prescription heroin, as they are in Europe. This would provide a safe, consistent, standardized, and cheap source of drugs for the addicted community that we do have, which would again help their health problems through overdoses and this type of thing and cut down on the petty crime that we see, mostly out west and in the greater-sized urban centres.

On the second level, I look at those who might potentially join this community of addicts. This is probably the greatest area where we could do some harm reduction, to keep them out of that community.

¿ (0935)

The substance of my presentation is that by ending Canada's prohibition, we can effectively end access to young people joining that community. So I would urge the committee to take a hard look at that.

The third level of harm reduction is on cannabis. The greatest harm caused by cannabis is in the laws surrounding it. There are many in our society who actually think it's legal. There really are. As a member of the Marijuana Party, I meet people every day who think marijuana is legal and you can't even be fined for it, let alone go to jail for it. Yet 66,000 of our citizens were charged with cannabis crimes last year, and they're all suffering for it. We have many thousands of people in our prisons for it and many thousands of families suffering for nothing. That's a large part of harm to our society. I would suggest that to reduce that harm, we end the prohibition.

As for the two main recommendations I would make to the committee, obviously the first one is to end the cannabis prohibition, for any number of reasons. It will cut down on access to the hard drug market and any number of levels of harm reduction. The second recommendation I would make is to have Parliament take a really hard look at the $500 million that's in that drug awareness or drug war program budget, whatever it's called these days. Of that money, 95% is going to enforcement. The Auditor General says it's just being thrown down a black hole. There's no accounting for it, no statistics on whether it's being allocated wisely.

So 95% of it is going to the RCMP and 90% of that is going to the war on pot. I consider it money wasted. I would say we should take a really hard look at reallocating the bulk of that money to expand and improve voluntary hard drug treatment programs, and to introduce effective drug education programs based on some European models.

Those would be my two recommendations.

¿ (0940)

Mr. Randy White: Just for clarification, did I hear two of you say that legalizing drugs is a form of harm reduction? I thought Robert and Mike used--

Mr. Mike Patriquen: I said legalizing cannabis, ending the prohibition, yes. That's a great form of harm reduction.

Dr. Robert Adamec: I suggested that in some instances, yes, that's one of the implications.

Dr. William McKim: I would suggest that it could be. I don't think we really know at this point, in many cases, what the effect of legalizing a drug will be. We have examples that we can look at internationally. I think it's something we could direct a little bit more attention to. Up until now I don't think it's been given serious consideration, even as a possibility. Changing the legal status of some drugs, perhaps not even legalizing them but changing the legal status, may in fact be quite beneficial.

The Chair: Thank you, Dr. McKim, and thank you to all the witnesses.

Now we'll have questions in French.

[Translation]

Mr. Ménard.

Mr. Réal Ménard (Hochelaga--Maisonneuve, BQ): Thank you, Madam Chair. I have a question for each of the witnesses and I will start with Mr. Adamec.

In the study you did on youth in Newfoundland, there seems to be a correlation between the fact that young people are bored, left to their own devices, and drug consumption. Does that apply to society in general, or is that correlation more evident in poorer areas where there is less recreation or sports equipment available? The reason I am asking you that question is that when this committee travels, we go to different areas, both rich and poor. It would appear that drug consumption is the same for both groups.

So in your study on youths, did social class have any bearing on a particular trend? That is my first question.

[English]

Dr. Robert Adamec: I can't answer as to whether or not it would be applicable across the country. We had hoped actually to see if these path models might be generalizable and we sought funding to do that but could not do it.

The other thing, though, and I'd like to make a clarification, is that focus groups in Newfoundland had suggested the issue you raised--that is, that they, adolescents, were bored, and as a result of not having sufficient activities turn to the use of alcohol and other substances to entertain themselves. Our path models don't really support that. There is some influence, but the actual major source of influence is really more within the network probably of peer homogenization of behaviour. They are probably doing it to blend in with their peer groups.

There are some things missing from our models. There is in fact a cultural characteristic--for instance, as folklore has actually pointed out to me, the use of trips to cabins in Newfoundland. This is a very major source of recreation where in fact they entertain each other in groups going off to cabins. The other thing I should say is that alcohol is in fact very much a part of the culture. So there are all of these factors influencing it.

If I understood you correctly, and you were saying that boredom is not a factor elsewhere, I would say I wouldn't be surprised by that given the results we got from our models. As I say, we were surprised by that because focus groups in Newfoundland before we did this study had suggested that was the reason: there were teenagers saying, “We don't have anything to do.” My guess is that if our models are correct, it would probably be a mistake to try to build lots of recreation centres if the purpose were to reduce drug use. On the other hand, it still might not be a bad idea for other reasons.

¿ (0945)

[Translation]

Mr. Réal Ménard: What I am trying to understand is not whether your model can be applied across the country. I realize there may be circumstances that are peculiar to Newfoundland, but have you noticed any differences between richer neighbourhoods and poorer ones in terms of that boredom, the idleness that some youths experience?

For example, do you feel that if Newfoundland had a sports and leisure policy, with considerable resources, more sports and leisure equipment, that young people would be less likely to take drugs, or do you think they would use the same means to feel accepted in a group?

We went to Burlington and Hochelaga—Maisonneuve, and in both places, there were people dealing with drug problems.

[English]

Dr. Robert Adamec: I wouldn't disagree with you. I think probably...perhaps for a different reason. I'm not sure it would be so much relieving boredom as providing youth with youth examples that would not reify the use of alcohol. For example, a commitment to sports and fitness definitely precludes use of drugs that diminish your capability. So in fact going down that trail might be a valuable way to break the link between peer use of substances and the actual use by changing the peers to whom they relate. So I think that certainly might have a benefit.

In terms of your question about different socio-economic levels, we didn't really split our analysis that way. We analysed by different sectors, health care regions in Newfoundland, and there are some that are poorer than others. Our models, with some slight variation, did apply in all of them, but we didn't specifically try to make a distinction between richer and poorer, although, as you know, Newfoundland is a relatively poor province, so the population who you'd consider rich are actually in a minority anyway. We're dealing with a relatively poor population to start with.

[Translation]

Mr. Réal Ménard: I am going to ask your colleague a question, if I may, Madam Chair.

The Chair: Dr. McKim wants to answer as well.

Mr. Réal Ménard: So you cannot stop him.

[English]

Dr. William McKim: When this study was designed I was involved in it, and it was at my suggestion that the activities were put in the analysis. As Dr. Adamec has pointed out, the notion of providing alternative activities didn't seem to influence in a statistical sense the consumption of drugs.

I was surprised and perhaps a little disappointed by that, because I had every reason to believe in fact that this would be the case.

I suspect that one of the reasons that didn't show up was because this was a questionnaire survey and we were dealing with the perceptions of the students themselves. They may not have understood the relationship between alternative activities and drug use, so it didn't show up on the questionnaire.

I believe what you're suggesting to be absolutely true on the basis of some of these breakthroughs I've talked about in understanding drug use. We very often tell our students, “Just say no to drugs”, but it's a bit more involved than that. We know it's a lot easier to say no to drugs if you can say yes to something else.

We also know from the basis of economic analyses that one of the best ways you can get people to stop consuming one thing is to provide an alternative, and I use the term “consumption” in a very broad sense. We know, for example, that if you look at where drugs are a real problem, it's in places like inner cities, prisons, and isolated communities of native people like Davis Inlet, where there is in fact nothing else to do.

One other interesting thing that came out of the survey, just by way of a footnote, is that in St. John's and the urban areas there was virtually no solvent abuse: almost no glue sniffing or gasoline sniffing. That was largely a rural activity. As a matter of fact, I was involved in the development of some of the questions, and we had focus groups of teenagers looking over our questions. This was in St. John's, and we actually had to explain to some of them, yes, people actually do sniff gasoline, and they said, wow, I've never heard of that before.

¿ (0950)

[Translation]

Mr. Réal Ménard: If I may, I would like to follow up with a second question to keep within my time and to give everyone a chance to speak. I want to hear your opinion.

You suggested, in fact stated, that when a person injects substances such as codeine, morphine and heroin, which belong to the opiates family, the body has approximately the same reaction and that—I am not sure whether I understood correctly—it is as if those substances were converted into heroin in our body. So could you tell me again exactly what you said about those three substances. Codeine is available over the counter, morphine is a prescription drug, heroin is illegal, but our body metabolizes the three of them in about the same way. I would like you to expand on that.

[English]

Dr. William McKim: Yes, that is in fact what I said. Technically, it's not exactly true. We know that they all work at the same receptor site in the brain, something called a “mu receptor”, which seems to be largely responsible for the euphoric effects, the reinforcing effects, the effects that cause a person to want to repeat taking the drug.

The difference between, say, morphine and heroin, as I explained, is that the heroin is basically the morphine molecule with two acetyl complexes added to it. The reason there is a difference, why people prefer heroin to morphine, is because that chemical change increases the speed with which it can get into the brain and increases the intensity of the effect. But the effect it has is in fact precisely the same as that of any other drug that works at those particular receptors. It just becomes much more potent, and it happens a lot faster. The speed with which a drug effect occurs is very important in determining the power it can gain over an individual in terms of controlling their behaviour.

[Translation]

Mr. Réal Ménard: So your reasoning is that if we consider only the chemical aspect of drugs and disregard all the moral issues, on a social level, heroin should be treated the same as morphine and codeine. Apart from any moral considerations, as far as the chemical components of the drugs are concerned and the way the receptors deal with them, you do not see any difference between them.

[English]

Dr. William McKim: I would say that if you made the appropriate adjustments for potency and if I were to inject you with each of those drugs, you couldn't tell the difference. They do have a different history, and there are differences in availability. I'm not saying they are the same thing, but I'm saying that the differences that do exist can't justify the tremendously different way we treat them.

[Translation]

Mr. Réal Ménard: May I ask one last question?

[English]

The Chair: Dr. Adamec wants to respond, and then you can quickly ask a last question, Monsieur Ménard.

Dr. Robert Adamec: I just wanted to respond just to a comment made by Dr. McKim. Actually, I think he must have misremembered the issue regarding solvents. I'm looking at the data, and there was no difference between regions in Newfoundland as to the use of solvents. We had in fact about a 40% use rate of solvents; it was equal across all regions, and it was not peculiar to the Labrador northern region at all. This is actually quite alarming: 40% use. The only differences we found were in St. John's; for example, females used it less than males in terms of the proportion using solvents.

My suspicion is that if you look at solvents and pills, there is no split between age. I think it's because they're more readily available. Solvents are things like glue and gasoline, while pills they can rob from the medicine cabinet.

¿ (0955)

[Translation]

Mr. Réal Ménard: I have one last question for your colleague from the Marijuana Party of Canada. In the French version of your brief, you say that 11 of the 15 members of the European Union decriminalized the use of marijuana or other illegal drugs.

Could you tell us in which countries it is still illegal and give us the reasons you think those four countries...? I know you can't go into detail, but I would like us to fully understand the difference. What are the four remaining countries and why do you think they did not decriminalize drug consumption?

[English]

Mr. Mike Patriquen: The four remaining countries are, I believe, Sweden, Finland, Greece, and Hungary. Sweden and Finland are the only countries I have any data on whatsoever. There's just no information coming out of the other countries, or none in our databases. Sweden in particular has a very strong prohibitory approach to all drugs, so strong in fact that the police are empowered to stop any citizen on any street at any time, anyone they even suspect of using drugs, and force them to provide a urine or blood sample immediately.

Now, this approach worked pretty well in the 1980s, and their drug use rates went down considerably. The U.S. and other prohibition groups have been using the numbers from the studies, but in the 1990s these numbers went up. The most recent numbers we have are from the mid-1990s, although this report was released on 30 November, 2000, by a fellow by the name of Lief Lenke, who teaches criminology at the University of Stockholm and who's advised the Council of Europe on drug policy. He explains:

In the 1990s, you can see that this very good [previous] situation in this [drug] area deteriorated. And I think the situation is back to about what was going on in the 1970s, before the very restrictive Swedish policy was introduced and enforced. So now you see in the 1990s there has been a rather strong increase in young people experimenting with drugs. We have studies with conscripts. Every year, the conscripts are interviewed about their drug habits and so on, and we can see that there has been an increase from 7% use in the 1980s to 16 to 17% now.

So we can see that Sweden is now up higher for drug use rates than we're seeing in Canada.

Mr. Réal Ménard: Thank you.

The Chair: Madam Davies.

Ms. Libby Davies (Vancouver East, NDP): Thank you very much.

It's been very interesting to hear each of you today. I've been wondering as we've been going through the questions whether it would be possible to do a study today that would show us the economic and social impacts today if alcohol were prohibited and--sort of flipping the coin on the other side--try to figure out what kinds of situations we'd see. I could see people calling for safe drinking sites because the black market had just gone crazy...or regulations about who could drink...rules around that, anyway. It just raises an interesting possibility, and I certainly agree with each of you where you have stated that the current policies just seem to be so incredibly irrational and based on, well, racism for one thing. Canada's original opium laws in Vancouver were based on racism.

One of the questions we're grappling with is, how do we present the beginnings of rational arguments or recommendations for a policy? It's important to consider what the barriers to this are. I wonder if you would like to talk about this.

It seems to me that there's a huge body of evidence now about the enormous social and economic cost of our current policies and how they have failed. This view is supported by all kinds of expert opinion from scientists, public health officials, community groups, and drug users. In Vancouver this week we have safe injection demonstration sites being set up. I hope at some point they will be approved. So we have this whole body of opinion and still we come up against these barriers.

Certainly law enforcement is one, with the sheer weight it has. But in terms of putting forward the beginnings of a rational policy, do you see the vested interests there more as political or judicial? Do you see public attitudes as a barrier? How would you characterize these barriers?

À (1000)

Dr. William McKim: There are a great many barriers. You've identified many of them. You are the politicians and probably know better than I do what the political barriers are. A lot of those barriers are related in fact to public opinion, and I'm sure most elected representatives would be reluctant to take the position that many would call being “soft on drugs” by expressing a more radical view. It's doubtful whether this can be changed by public education.

There are very real barriers. You've identified as well the people who have a tremendous stake in the status quo, the law enforcement agencies. There are also international restrictions. It's very difficult for one country to unilaterally change its current policy. It can be done, as we've seen; but Canada and the United States are in lock-step in so many ways--and after September 11 it seems our policies are becoming more closely allied in all sorts of areas, particularly those having to do with the border.

Perhaps you need to consult with political scientists to get a more appropriate answer to your question. But there are a great many barriers. I can't imagine the ideal world, which I have suggested we should have, where we go back and establish a completely rational drug policy. I don't imagine this could ever happen, but it's something we need to keep in mind and work toward, identifying what these barriers are so that we can better deal with them.

The Chair: Dr. Adamec.

Dr. Robert Adamec: I'm no expert; I'll give an opinion as a private citizen.

Certainly public opinion is one of the greatest barriers, as you've identified. You can see an example of this from the debates surrounding capital punishment in the United States. People can come out with all kinds of statistics pointing out why this may or may not be a rational thing to do; but it often boils down to a personal statement of what one believes to be right. Arguments presented are often disputed in terms of their factual validity. You can get into an endless round of debates, when in fact the issue, at its base, is an emotional one.

From a public perspective, the idea of legalizing the use of various drugs is frightening, because people are afraid it is going to open a door to promoting the use of drugs among youth. For example, you can imagine people recklessly driving around under the influence of various compounds.

Some of the examples Mike has given are good ones in that they point out that where societies have taken the bold step of making these experiments, the actual outcomes have been shown to be far more positive than people realize. If the government committed itself to trying to go down that road, it would need to bring people in from these societies who have actually had these experiences and who would then testify to the real benefits of having done this.

As for academic arguments based on data and so on, all you have to do is look at counterSpin any night to get an idea of the kinds of debates you can get into, with basically everyone having to agree to disagree at the end of the day, even though you have a lot of smart and informed people there.

Certainly I am a proponent of a rational policy. I consider myself a rational human being, and I look at outcomes as really the justifications. But in terms of public viewpoints, issues of morality and fear have to be addressed when this issue is being debated. You need to find some way to convince people--assuming you are--that...[Technical difficulty--Editor].

À (1005)

Mr. Mike Patriquen: The problem of ending the cannabis prohibition rests squarely on the shoulders of the politicians. As we've shown quite well, this would go a long way to reducing the harm caused by all illicit drugs.

I have spoken to any number of police officers, asking them why they waste their time and our money chasing people who are growing pot. They say because the law is on the books and it's their job to enforce it. I've asked judges how they can send a person away to a federal penitentiary to live with criminals for cannabis offences--“It's on the books. I could have given him life. He's lucky he only got five years. When the law changes, we won't sentence people like him any more”.

I've read every pivotal case on the constitutional validity of cannabis laws that has come before provincial supreme courts so far. Judges at that level are loath to strike down any laws we have because they say it is a matter for Parliament.

Three studies were conducted nationwide last year on what citizens thought of cannabis prohibition. These studies were all statistically valid. Between 48% and 49% of Canadians want the prohibition ended altogether--not decriminalized, not legalized, not quasi-legalized, just end the prohibition; anything Canadians want to do with cannabis within our borders should be legal. So 16 million Canadians think that.

Only 300 people in the country can do anything about what those 16 million people want, and they are you and your colleagues. The international treaties are not that much of a barrier; those other countries will get over it, but I know there are a lot of problems with the U.S. The U.S. and its border present all the problems. But these are political problems and it's up to you folks to do something about them.

Ms. Libby Davies: I want to come back to the issue of what drives public opinion. You identified fear. Many people think that if we change our drug laws we'll be turning everyone into drug users and addicts. Stripped down, what does this amount to? Is it the fear of growing addictions? If it is, that's one of the issues.

Do we have enough evidence to show that we may even be able to manage addiction issues better through a rational policy? Your example about codeine is useful here. If our fear is that our kids will all become drug users, do you feel we have enough evidence to show that by moving away from prohibition to harm reduction or even legalization, we may actually be better able to manage the issue of abuse and addiction? Perhaps alcohol would be an example here as well.

Dr. William McKim: Dr. Adamec's graphs give you just a hint or a suggestion of how complex social issues are. Everything in fact is related to everything else; cause is almost impossible to determine. The techniques Dr. Adamec showed you are in some ways the best means we have of trying to figure this out without doing specific long-term studies.

Knowing what is going to happen down the road when you change one social variable, predicting what's going to happen to something else, is a real problem. No matter how good a social scientist you are, it's a very risky business. The only way we can get some idea of whether this sort of thing is going to work is to look at places where it has been done already--and even then, it is a different society. There are so many imponderables and unknowns.

I don't think you can absolutely reassure people that when we do this to this law, it is going to make everything better here in that particular place, because there are wheels within wheels. You almost have to do this as a matter of faith.

Now, how does that help you, when dealing with trying to convince the public, that we know what we're talking about? It's not easy to do. And I don't want to leave you with the impression that the scientific community is going to provide you with all those answers, but I think there are a lot of answers out there that need to be found. Scientific research, including social, neurophysiological, and behavioural, can provide a great deal of direction, but ultimately there's no test, apart from just doing it.

Ms. Libby Davies: Thank you.

À (1010)

The Chair: Thank you, Ms. Davies.

Dr. Fry.

Ms. Hedy Fry (Vancouver Centre, Lib.): Thank you very much for your presentations. I think many of the questions have been asked across the way, so I have many answers.

I just want to ask a couple of questions, specifically one to Dr. Adamec. You suggested that for marijuana, the predictor of use was availability and parental influence. Can you elaborate on what you mean by “parental influence”, and can you elaborate on what you mean by “availability”? It's interesting to note that in countries like Australia and in other areas in which availability.... I mean, even in Holland, where there was easy access in terms of availability, in fact use did not go up. So I didn't know quite what you meant by availability.

On parental influence, is it whether parents use or don't use, or whether parents ask you? I didn't really get the answer to that.

The next question is to Dr. McKim. You made some very interesting observations. I think the concept that history and politics determine public policy is absolutely right. As a physician, I can tell you that for me, it's not what defines what I do. What research tells me and the outcomes I see occurring define what I do.

I know that is harder to do...and Libby asked a question with regard to public policy. It's not as easy, as a politician, to define things based on outcome, good evidence, etc. One has to consider a whole lot of the other things.

Given that, do you believe one can influence the public's perception with good outcomes, and not necessarily the path of physiology and the pharmacology of research, etc.? In other words, if we see that outcomes have improved or worsened, based on certain behaviours or strategies, can we then use that to influence public policy?

As well, you've talked about buying behaviour in terms of drugs. Could you elaborate on that a little bit?

Thank you.

The Chair: Dr. Adamec.

Dr. Robert Adamec: I didn't have time to tell you the actual metrics we used in trying to define it. This is a questionnaire, as I said before, so we were trying to track the pathway of influences in the minds of the teenagers. We did not independently assess any of these influences.

For example, the issue of availability was measured. This was a standard set of questions, so let me modify it for each substance. There were three questions. The first was, “If the money were not a problem, how difficult would it be for you to buy hash or marijuana?” They had five choices ranging from not at all difficult to somewhat difficult to impossible.

We applied an ordinal numerical scale to this, so “not at all difficult” was a maximal number, and “impossible” was a minimal number. So it would range from zero to five. For example, a score of five would be “very easy to get”.

The question was, “With the money you usually have, how difficult is it for you to get hash or marijuana?” We used the same scale. Then, “How difficult is it for you to get hash or marijuana for free?” We combined those. Now, this is a problem, because we're combining both the ability to buy as well as the ability to obtain free.

With regard to parental use, we had questions regarding their perception of...and this was a combination of mother and father. We asked separate questions, but we combined mother and father, partly because we had some adolescents who didn't have a mother or a father. We did a weighted average.

So we asked, “Does your mother use hash or marijuana?”, ranging from never to nearly every day. Again, we used a numerical scale from zero to seven. We asked the same for the father. So “parental use” reflects their perception of how frequently their parents use the substance.

Regarding parental norms, a norm is an issue of the parent perceiving whether or not it is a good thing to use this substance, again on a numerical scale.

I'm going to give these reports to the committee as well, so if you wanted to, you could read the report in detail. Norms reflect the attitude of your parents about your using hash or marijuana: They strongly think I should; mildly think I should; don't care either way; mildly think I should not; or strongly think I should not. So this is like a moral imperative regarding whether not you should be doing this. Peer norm is the same reflection--for example, I believe my peers believe it's a good idea to use this stuff.

So these path models suggest, if you follow the path, that the actual influence ranges from parental norms that are guiding their youth, and their youth is a very strong predictor of the availability of marijuana to teenagers, or as perceived by them to be available.

Now, we can't say for certain what that actually means, although it does suggest that the parental behaviour suggests they have a stash at home, and in fact they may be making it available to their kids, or the kids may be obtaining it from their parental sources. So that would be the interpretation of either quantitative scale.

This, you have to understand, is in a prohibited environment, where you can't obtain this very easily, unless you do it through the black market or from friends, peers, or a parental source. So it doesn't surprise me that if you're interested in trying it, availability might be a predictor. If you made it readily available, it would no longer become so, because it would not be an issue in obtaining the drug, and you wouldn't expect a relationship.

À (1015)

Dr. William McKim: As I understand your question, it was about influencing public opinion and whether we could convince people by giving them positive outcomes.

Changing public opinion is something that is, I suspect, both difficult and easy in a sense. If you're trying to sell people soap powder or something like that, you are an expert in trying to change public opinion. The advertising industry does it all the time. There have been a lot of campaigns based upon that model, trying to convince people not to use drugs, with some claiming tremendous success or moderate success, and some perhaps very little success. I'm not entirely convinced that public education campaigns really do an awful lot apart from declaring what the government's position is on a certain thing. Whether or not people's actual behaviour is influenced terribly by that....

It's instructive to look at trends in alcohol and tobacco use over time. We know that alcohol and tobacco consumption has been declining in North America and through western democracies for quite some time. The reasons for this decline are numerous, and to some extent we're not entirely sure, although some people claim that increased public education has in fact been responsible for this.

What I suspect has happened is that it has to do with a tremendous awareness or consciousness of health issues. People are generally not smoking or drinking as much as they used to. It's largely for health reasons. People are also jogging more than they used to, and doing all kinds of other health-related activities. Whether these trends are going to continue is difficult to say

If you look over the last 100 to 150 years of alcohol consumption, you'll see there's about a 60- or 70-year cycle where it goes up and then it goes down. It sort of peaks every 60 or 70 years. The actual graph appears in the textbook that I've provided copies of.

This predicts that alcohol consumption will continue to decline, but then it will go back up again. Every time it's declined it's been associated with something. Previous declines have been associated with the temperance movement, or a religious--

À (1020)

Ms. Libby Davies: Every time it's declined...?

Dr. William McKim: Every time it's declined it seems to be related to revivalist, temperance types of.... We're talking 70 to 80 years ago and so on, and even before that.

So whether we can deliberately change public perceptions and policies by campaigns and rational argument is, I think, a question that we can't...and probably in some cases we can, but in many cases these things are accidental and have to do with totally different issues that we have no particular control over.

The answer to your question: I don't know.

Ms. Hedy Fry: Okay, thank you.

Can I have one more?

The Chair: One question.

Ms. Hedy Fry: All right.

I think this is key. At the end of the day, I think what this committee is going to have to do is come up with a series of recommendations based on what we've heard from everyone we've listened to. While history and politics determine public policy, I think leadership and information can also determine what this committee will do, and whether or not we have the leadership and the courage to do some of the things we've heard over the past while that people have presented to us.

The question, however, about influence is that in countries where they have made marijuana or cannabis available, it has been shown that decline is occurring--and this is out of the Canadian Public Health Association's statistics. It has been shown that what has caused a decrease in the use of cannabis amongst young people is knowledge of the negative health effects of the substance. In fact, there has been a lot of information coming out with regard to negative health effects, either from the smoking--the amount of tar and other harmful substances in the smoke, which I think is supposed to be more than from tobacco--and in terms of cognitive impairment over a long period of time--the loss of memory and the inability to handle machinery and drive, etc., if you're using substances. People have begun to realize this can be bad for them in the long run.

So I do think that with good research, good information on the predictors of what would create use, and our knowledge about health information, we can change this.

I would be very interested, however, in asking one important question: how do we get hold of your book? I would really like to look at the information on buying behaviour and what that has to do with this issue. We know the largest use of substances by adolescents in Canada is on two available substances--one of them is alcohol and the other is tobacco. It's much larger than the use of cannabis among young people. I would like to be able to balance that kind of information, in terms of buying behaviour, etc., even when something is regulated and is available.

Thank you.

The Chair: We'll look at the logistics of the book once I determine how much it costs. We will have at least one copy with our researcher, and it will be available for lending.

Dr. William McKim: I brought two copies with me. That's all I had room for in my carry-on. Because a fifth edition is coming out, I have a number of extra ones. Perhaps that's not enough for the entire committee, but I can arrange to send three or four more to you.

Ms. Libby Davies: When is the other copy coming out?

Dr. William McKim: It'll be out in the fall.

The Chair: Not until the fall. All right, we'll talk about that later.

Derek, did you have any questions?

Mr. Derek Lee (Scarborough--Rouge River, Lib.): Yes, I have lots of questions. There's one I would like to put here to Professor McKim.

You've talked about the benefits of understanding what all of the non-medically used drugs do technically, medically, and you've described the codeine, morphine, heroin connection. Is there a source, such as your book, where we can synthesize and reduce what all of these different drugs do, so we can talk straight about what we're dealing with? In foods we talk about proteins and fats and carbohydrates, so we know what we're dealing with and how the body uses these things. Is there a source where we can kind of reduce and synthesize all of the talk and the words and everything to a fairly low common denominator, as you have done with codeine, morphine, and heroin, so we can try to crystallize a better awareness of what we're dealing with?

Everybody is approaching this public policy issue from their own little cubbyholes, where they use the existing paradigms, the moral template, the historical template and the political template, and we can't move because we're so stuck on the structures people seem to live within.

À (1025)

Dr. William McKim: I can recommend that you have a look at chapter five in the textbook. In fact, there is a common denominator that we are now beginning to understand. Virtually all drugs of abuse have a sort of final common neurological pathway. It's a long way from neuroscience to public policy, but I agree with you that's a good place to start.

On the final common pathway, it turns out that the mechanisms in our brains that control our behaviour and motivation--and I guess we get to use the term pleasure, but otherwise it could be known as positive reinforcement--are basically mediated by a brain mechanism that is fairly complicated, but we can call it the mesolimbic dopamine system.

It turns out that virtually every drug that is subject to abuse and is self-administered stimulates the mesolimbic dopamine system. Drugs like amphetamine, cocaine, and the opiates do it directly through the mu receptor I talked about. Some, like tobacco and alcohol, do it indirectly. But it is a final common path, and that particular brain mechanism evolved so we would repeat doing things that were beneficial for the species.

When we evolved, drugs weren't generally available, so we didn't evolve a protection mechanism to protect us from them. When you take a drug, the brain is basically tricked into thinking it did something good and it should do it again. Eating also does that. We like to eat and we remember what we did in order to get ourselves food. It also works for sex and various other basic motivations. The same brain mechanisms seem to be responsible for taking drugs.

So there is a common denominator and a common neurological mechanism that all these drugs share, and they all control drugs in more or less the same fashion. The differences we see in drugs are differences in consequences.

Apart from that particular mechanism, which all these drugs have in common, there are lots of other things drugs do to the brain. Alcohol, for example, will ruin your coordination, judgment and so on, which are essentially mechanisms that are independent of why we take the drug.

With drugs like tobacco, nicotine is not a terribly dangerous drug; the tobacco smoke is really the problem. So the harmful aspects that drugs have in many cases aren't related to the sort of reinforcing mesolimbic dopamine system brain mechanisms.

Where are we going from here? I think if we understand that all drugs have this common mechanism, and that it is similar to the mechanism that controls other forms of consumptive behaviour such as eating, then I think we have available to us a vast array of knowledge derived from studying these other kinds of behaviours. Now we can apply it to drug use.

Dr. Fry suggested she wanted to understand buying behaviour better and the economics of consuming substances. One of the things we know, for example--cut me off if I'm rambling here, because I tend to do that, but I'll try to be short--is that the mesolimbic dopamine system appears to need so much activity in the course of a day. We accomplish it by eating and having sex and hanging out with people, being social. These are all things that stimulate the mesolimbic dopamine system, and we are evolved so that these would make us want to repeat those activities. They all compete with each other. When you're doing one thing you're not doing something else, and the way behaviour is generally organized is that we tend to spread our behaviour out among all these sources of activities that can do this for us. Doing drugs is just one of them.

If you have a lot of alternatives to drugs, then you may do drugs but you also do lots of other things. If you don't have any alternative, then you tend to spend most of your time consuming drugs. There are mathematical rules that determine what proportion of your time you spend doing various things in relation to the degree of harm and/or reinforcement or pleasure you derive from these activities.

À (1030)

Mr. Derek Lee: Is food one of those things that uses the same biological function?

Dr. William McKim: Yes, it is.

Mr. Derek Lee: There's one other scale--I'll call it the “harm” scale--that the non-medically used drugs allegedly are implicated in, and that is the propensity to induce biological dependence, addiction.

So in your book or in the literature, is there a good indication of this propensity to induce dependence, biological or psychological? The reason I'm asking this is I was surprised to see that heroin, as one of the great array of drugs out there, had a propensity to addict--and I may be wrong in this--of around 18% or 20%. So 18% or 20% of the people who take heroin will become physically dependent; the other 80% or so will not. This statistic was contained in, I think, the Economist magazine review of illegal drugs, about a year ago.

Does what I've said, from your point of view, sound reasonable? Am I thinking straight here, that this terrible drug called heroin is only going to physically addict about 20% of the people who use it, whereas nicotine addicts about 70% or 80% of the people who use it?

Dr. William McKim: First of all, let me say that one of the advances I have noticed in the last 30 years is the discovery, perhaps counterintuitive, that physical dependence is defined by having withdrawal symptoms when you stop taking a drug. Physical dependence is not a terribly important factor in determining whether people use drugs or not. In fact, it varies with different drugs. It's not terribly important in alcohol. It's a bit more important in heroin and opiate addiction, but it is in fact not the defining characteristic of what we might call addiction.

I say that with the caveat that I'm not sure how to define addiction. But physical dependence is, in fact, not that important in determining whether a person takes a drug or whether a person doesn't.

That may sound a little surprising, but--

Mr. Derek Lee: You mean the first time--

Dr. William McKim: Any time.

Mr. Derek Lee: --or the hundredth time?

Dr. William McKim: It could be the hundredth time. Whether somebody is or isn't physically dependent is not a terribly important issue in the decision to take a drug.

We use the term dependence--meaning physical dependence--almost interchangeably with addiction, and it's not the same thing. In fact it's really quite different. Physical dependence has not a great deal to do with whether we take a drug or don't. What does have to do with whether we take a drug is whether the drug actually stimulates the mesolimbic dopamine system.

We know from doing all kinds of studies that it's a fairly big deal. In fact, in the States there are lots of laboratories that do nothing but determine the abuse liability of various substances. They have very specific procedures that involve laboratory animals--rats and monkeys--and the degree to which an organism will work to deliver a substance to themselves, to give themselves an infusion of that substance. That has a lot to do with the speed of effect and the intensity of the effect on the mesolimbic dopamine system and basically almost nothing to do with the formation of physical dependence.

It is possible to define or rank drugs in terms of their abuse liability, but basically it has not much to do with whether the drug produces physical dependence or not.

Mr. Derek Lee: But isn't dependency a factor in our perception of whether or not there's an abuse of a drug?

Dr. William McKim: It certainly is, and that, I believe, is a mistake.

Mr. Derek Lee: Oh, it's a mistake.

Dr. William McKim: Yes.

Mr. Derek Lee: Because if a drug like heroin didn't induce dependency, didn't cause addiction, and didn't bring about other harms--you know, it's not like toxic smoke, it doesn't otherwise harm the body--then wouldn't heroin just be like sugar?

Dr. William McKim: No, in fact, it wouldn't.

Mr. Derek Lee: I mean, you would just take it because it affects a system in the brain. If it didn't induce dependency and you didn't get addicted to it, you would just take it because you liked to take it: you weren't addicted to it, you weren't dependent on it, and it didn't cause any other harms; it just kept your brain active. Is that a fair way to look at it?

Dr. William McKim: There are a couple of interesting historical examples. A guy called William Stewart Halstead was one of the founders of Johns Hopkins Medical School and a pioneer in aseptic surgery. After he died, they looked at his diaries and discovered he had been injecting himself with morphine throughout most of his career. He was in fact addicted, physically dependent on morphine. He said the only time it ever interfered with his surgery, with his physical ability, was when he was trying to stop and going through withdrawal.

Being physically dependent wasn't the problem. There was no problem, as long as he had a supply.

Mr. Derek Lee: But we as legislators ought to include propensity to addict, if I may use that term--

Dr. William McKim: Well, certainly--

Mr. Derek Lee: --as an indication of some harm to society.

Dr. William McKim: --but you're going to have to separate the notion of physical dependence from addiction.

Ms. Libby Davies: What is the difference? I need to hear that again.

I'm sorry for interrupting.

Mr. Derek Lee: Ms. Davies has a good question.

Please, go ahead.

Ms. Libby Davies: Could you explain the difference--again, I'm sorry to interrupt--between physical dependence and addiction?

Dr. William McKim: Taking a substance has the capacity to gain control over your behaviour. If you take a substance, it activates the part of your brain that wants or directs you to take it again.

You remember how you did it, how you achieved it, and you have a tendency to repeat that behaviour. This is a mechanism that's evolved inside our brains. It's perfectly adaptive and it works very well. It's preserved our species and many other species for a very long period of time.

The problem is the drugs short-circuit that, so that whenever you take a drug it tricks your brain into thinking you have just done something good and adaptive and makes you want to do it again. It's that capacity that's the problem, not physical dependence.

Physical dependence happens with some drugs and doesn't happen with others. We tend to think of hard drugs and soft drugs, and for a long time people believed that was the defining characteristic of addiction. I don't believe it really is. When you do these careful studies, the tendency to consume a drug often has nothing to do with whether the organism is physically dependent or not--and that includes humans.

À (1035)

As a matter of fact, there are some interesting studies done with methadone maintenance clinics. In order to receive methadone maintenance you generally have to.... There's no point in giving it to somebody who's not physically dependent, because presumably methadone postpones withdrawal symptoms. But one of the ways they test to see if people are physically dependent is to give them an injection of Naloxone. Naloxone immediately blocks the new receptors so that if there's any morphine or heroin or anything like that in their body, it stops acting right away, and the person will show physical withdrawal symptoms. And a surprising number of people who come for methadone maintenance, who legitimately believe they are physically dependent, in fact aren't physically dependent. They think they are. They think they're strung out. But in fact they're not physically dependent.

À (1040)

Mr. Derek Lee: That's fascinating stuff. I don't know where to take it.

I'll pause here, Madam Chair.

The Chair: Can I just ask that we in fact pause for five minutes? Some people have some physical things they need to do.

À (1045)

The Chair: Mr. Lee, are you finished with this round? We're going to have a second round of questions.

Dr. Adamec, you wanted to make a comment.

Dr. Robert Adamec: I want to make a comment on the previous discussion, just so the committee is not totally sent off in the wrong direction as a result of that discussion. I was discussing this with my colleague, Dr. McKim, as well.

One thing you should realize is that research in animals is suggesting that there may be another way to define “addiction”. I don't dispute what Bill said about activating the mesolimbic dopamine system, but it's clear that drugs of abuse may well be sensitizing it, and that sensitization may use mechanisms that the brain uses for storing memories, learning, and memory, particularly the glutamate system. So the sensitization can be a long-term one. That is, the system becomes hyper-responsive to these substances, so the message that's sent is very powerful and perhaps abnormally exaggerated.

It gets very complicated, because when you have a very powerful activation you can also have the development of a tolerance. The system actually develops a tolerance for its own chemical messages, which then leads to the seeking of increased dosages of these substances. That gets into the cycle of the need for more and more of the substance to achieve the same physical effect.

That has a cost. Certainly a good example is cocaine, a very expensive illicit drug. The initial effects are wonderful. I've never personally tried it, but I know people who have. I never inhaled.

Voices: Oh, oh!

Dr. Robert Adamec: From what they tell me, the effects are wonderful. You feel totally effective. After awhile you have to take more or you can't achieve the same effect, and after awhile you get after-effects that are terrible--crashing depressions and so on.

So it's not a simple activation of a motivational system. It's complex, partly because of its excessive activation, which leads to very abnormal oscillations. There are changes in your brain as a result of this, which are producing patterns of use that are not as benign as motivational states, or eating, or engaging in pleasurable activities.

The Chair: But is part of that dependent on the substance?

Dr. Robert Adamec: Yes, it would be.

The Chair: I would think, for instance, that somebody who drinks more alcohol on a regular basis doesn't exhibit the signs of being drunk, but for those people who don't drink very often, one drink and they're loopy.

Dr. Robert Adamec: Now, there's an example of the development of tolerance to the effects.

The Chair: Okay, but there isn't always a need to have more. Some people might be addicted, and some people might not be.

Dr. Robert Adamec: No, I agree with that, but I think certainly if you get into this cycle of desire of trying to achieve an effect that you got from the initial sensitization to the drug, with tolerance you won't be seeking more of it.

The Chair: But Dr. McKim had also talked about other things that would induce the same responses--for instance, physical exercise, sex, or some of those things. For many people it could be just running five kilometres every day.

Dr. Robert Adamec: Yes, physical exercise can do that. I'm a runner and I'm addicted to it, I feel terrible if I don't get in my five miles. But it's an addiction that I guess has a more positive outcome and is more benign.

The Chair: But you wouldn't necessarily need more all the time, as in the cocaine example. You wouldn't have to run five miles today and--

Dr. Robert Adamec: Well, there's a limit. I'll admit from my own experience that I got into a cycle and ended up running ten miles a day. My body couldn't take it. I had to cut back because my joints were suffering.

The Chair: But your brain didn't suffer when you went back to just five.

Dr. Robert Adamec: No, it didn't. In any event, I think there are examples like that, but they are more benign. Is it really terrible to be addicted to running? Not really, but it might be to be addicted to cocaine.

The Chair: It might be if you're supposed to be working.

Dr. Robert Adamec: That's why I get up at 5:30 in the morning, so I can run.

The Chair: You see? Then you're losing sleep.

Dr. McKim.

Dr. William McKim: Yes, I want to thank Bob here for pointing that out. In fact, I didn't want to leave you with the impression that taking a drug was just like eating, or just like sex, or just like physical activity. There are important differences. One, as Bob has pointed out, is something called “sensitization”. The more you use a drug the more sensitive the system becomes to it and the more it has this ability to control your behaviour.

So repeated use of a drug does make a difference. The difference is not physical dependence; the difference is in fact the sensitization to the activating effect of the drug.

There are other changes as well that are in fact perhaps even more insidious. This is obvious, for example, with a drug like alcohol. I mentioned that behaviour is a balance between a whole bunch of kinds of activities, one of which could be the use of drugs, and if you have a lot of competition, then drugs tend not to gain that big a control over your behaviour.

One of the things that alcohol does, for example, is undermine the pleasure you could get, or the positive effect, or the ability to obtain positive effects, from other things in your life, like your marriage, your family, your job and other kinds of activities. When you're drunk you can't get the kind of social pleasure you get from having a family and a good family life. You probably will lose your job so you don't have that to occupy your attention.

There are all kinds of other ways being intoxicated can undermine competing sources of reinforcement, and you get into kind of a spiral where the only source of pleasure or positive reinforcement you get in your life is from the alcohol. It is undermining all the competition, so to speak.

So, no, in fact, it's not just like any other source of reinforcement. Another one is that you tend not to satiate to the positive effects of drugs. For example, there's only so much you can eat and there's only so much, at least if you're a male, sex you can engage in. There are mechanisms that shut you down after a little while, so that you physically just can't continue to use it, but that's not true with drugs. There's no reason why you physically can't continue to pump heroin into your arm as long as you want to, as long as heroin is there.

So it uses the same basic brain mechanisms, but it is much more dangerous and much more insidious.

The Chair: It's funny how the word “sex” can just get everybody going.

I have another round of questions and then I have some follow-up ones as well.

Mr. White or Madam Allard.

[Translation]

Ms. Carole-Marie Allard (Laval East, Lib.): I think it has been proven that the more you make love, the more you want to make love. Dopamine must have something to do with it.

Dr. McKim, what struck me this morning was the extent of pharmacological knowledge of drugs and, conversely, the extent of my ignorance.

You are broadening our discussion. Our mandate is, of course, to study the non-medical use of drugs, but I find it interesting that you say, and I quote:

[English]

Because different people have the same opportunities for intake of a drug and only some end up under its control, the mechanisms responsible for the addiction seem to be in the person rather than in the drug.

[Translation]

It is interesting, because let's say one day there were a test for children to determine their propensity towards drug addiction; might we then be able to identify future drug addicts when they are still children? I'm sure parents would be very happy to have their children tested. It would be like a thyroid test.

Nowadays, genetic testing is done for potential illnesses. So should such a drug test be contemplated?

I had an interesting experience last summer. A very prominig young person told me that he had been depressed his entire childhood. At one point, he even attempted suicide. That lasted until he consulted a psychiatrist who did a test to measure the substances in his brain and he discovered that he was indeed lacking a substance; I think it was serotonin. He took medication and that helped increased his zest for life considerably.

So might there be something to help us identify potential addicts among young people? That is my question.

[English]

Dr. William McKim: That's an interesting question. I did say that in fact there are a lot of individual differences in who will become controlled by taking a drug and who won't. Obviously the differences may lie in individual neurophysiology; there may be many other possible sources of this difference. But the environment of the individual is surely important to consider. Each individual has a different environment.

Identifying those important aspects of the environment is probably going to be of more benefit than trying to identify what's actually going on in terms of the neural chemistry of a particular individual. Dr. Adamec has just shown us a lot of environmental variables and how they can influence whether drugs are used or not. That's a fruitful line of research.

Many studies have been done with regard to the genetics of alcoholism in particular. While some encouraging things have been found, there is quite clearly no alcoholism gene. You can't look at the genes and say, “Whoops, that's missing, so this is going to happen.” There is no alcoholism gene.

There is a genetic influence, although some people would argue that there isn't. If you read the literature, there appears to be a genetic influence, which possibly involves the interaction of particular brain chemicals like dopamine or serotonin. And environment is a factor as well. Take identical twins, for example. If one becomes an alcoholic--I can't remember the exact statistics--there's about 60% to 70% chance the other one will be. But this means there's a 30% chance the other one won't be.

Genetics clearly makes a difference, but it's more a matter of a subtle interaction between brain chemistry and environment that determines the outcome. And my speculation is that environment probably has a bigger influence than brain chemistry.

The Chair: Dr. Adamec, would you care to respond?

Dr. Robert Adamec: We represent different sides of the spectrum, but I do agree with Bill, in a sense, where he's espousing something called an epigenetic approach, in which genes are the machinery of producing phenotypes, the actual expression of the gene. That phenotype expression, however, is very much linked to genetic influences.

The point you raise is a very valid one, though, and that's about vulnerability. This is an issue throughout medicine, particularly in psychiatry, of individuals who may or may not be vulnerable for particular kinds of disorders. That issue certainly applies to the addictions.

There is an active area of research in trying to find gene markers for these. And Bill is right; as far as I know, they haven't really found a gene for it, but there are intriguing leads. I think the best you could hope for would be to find a test for someone who might be at risk, and ideally, although I'm not sure you could even do that, maybe state the degree of risk. But risk means you have perhaps the propensity, and then if you were to be exposed to certain precipitating environmental events, you then might go on, with some degree of certainty, to develop a problem.

So I think the answer to your question is certainly that there is a hope. It may well be possible. It hasn't been achieved yet, but a lot of researchers are working on the problem. But I think Bill is right that the expression of phenotype from genotype is very much environmentally influenced as well. Which one is more important is an open question. I think it's an empirical one.

Ms. Carole-Marie Allard: Thank you.

I have another question for Mr. Patriquen.

[Translation]

Do you think decriminalizing marijuana for medical purposes sent a mixed message to young people about the legality of marijuana?

[English]

Mr. Mike Patriquen: I think there's a great deal of confusion out there surrounding the cannabis laws. Up until mid-1998, pretty much all cannabis was considered evil and illegal. In mid-1998, the laws were quietly changed surrounding the hemp crop, hemp being low-THC cannabis.

So we have cannabis out there, and it used to be poison, people are thinking, and they've been told this for three quarters of a century. It lessened and lessened, and now it's not just poison, but the hemp crop is being processed into therapeutic supplements. Something that, up until mid-1998, was poison to our systems is now being sold quite well as a health supplement. We're told hemp is now good for us--that's low-THC cannabis. Once you get over a certain quantitative amount of THC in there, you're back to evil again. But now, since 1999, you're only evil if it's used for non-medical purposes. So then it's good.

So, yes, the laws are all over the place, and we need things standardized. If it's good, it's good; make it legal. If it's bad, throw it all out. But I don't think that will come about.

The Chair: Do the doctors want to comment? Certainly that would affect inclination to use, would it not?

Dr. Adamec.

Dr. Robert Adamec: I don't think there's any evidence that the use of marijuana is addictive.

The Chair: Yes, but if it were decriminalized, would it increase the availability, for instance?

Dr. Robert Adamec: We actually had a discussion about this, and I guess it depends on what group you're looking at.

For example, if an adult prohibits something to an adolescent, that's a strong motive to go and try it. So I think making it available and allowing responsible experimentation may not be a bad idea.

The example I gave my colleague here was that I was raised in an Italian family and I drank wine from the time I was eight years of age. It's part of the culture. But it was done in a very responsible context. I have never used alcohol irresponsibly in my life, and I have never felt a strong motive. When I went to university, I was not like those colleagues of mine who were falling down drunk in the dorm, because I had no desire to use excessively a substance that I had been prohibited use of while I was a much younger person.

So it depends on the age group, but I think for young people, as someone commented--I think it was Dr. Fry--we need information as well.

So if people are informed, particularly young people, about the substances they're experimenting with and they can learn the boundaries of it, then you can promote responsible use in them.

By making it available, you demystify it. They may try it, and they may find they don't like it. But there wouldn't be this whole overlay of trying to access a tabooed substance, which is really a motive if you're a teenager. You're an iconoclast, and you want to do what parents tell you not to do. Plus there's the issue of introducing this whole other element when you criminalize it, which is the black market and all that comes with that.

So I don't think it would promote the use. I think it might promote responsible use, and in some people it wouldn't promote use at all, because they'll have tried it and found it's not all that interesting.

The Chair: Mr. White.

Mr. Randy White: I find this discussion interesting, disturbing, and somewhat concerning. I guess I go back to my simple upbringing in Nova Scotia, where many of these things--certainly drugs--were never talked about, because they weren't an issue back when I was a young fellow. But prohibition was in my family. Alcohol and cigarettes were prohibited.

It amazes me today how people interrelate something called an “addiction to running” with the discussion we're having. I just don't follow those kinds of lines.

I come from a--

Mr. Réal Ménard: And sex.

Mr. Randy White: And sex.

I don't know, somewhere along the line I missed something. I have a quantum leap to make here, and the quantum leaps is this. I represent a relatively conservative constituency in British Columbia today. I come from a relatively conservative background in Atlantic Canada. I have a quantum leap to make in order to make any attempt at all to go into this world of harm reduction.

You've convinced me today that the end goal of harm reduction is basically legalization of drugs. I asked you that question, and you affirmed that.

I've heard about harm reduction thus far from people across this country as meaning legalization of drugs, safe shoot-up sites, needle exchanges, methadone maintenance, and heroin maintenance. Even in regard to needle exchanges, I heard one person, when asked the question, “How many needles do you give out?”, answer, “I give a hundred to a person”.

Why would you give a hundred to a person? Because they then can give them to other people.

There is no standard in this harm reduction ideology. It just seems that to some extent it's an easy way out of a difficult problem. I can assure you that, when the report comes out, harm reduction will not get an easy ride with this person, because I don't think the people I represent buy into it.

I'm being forthright with you, and I can assure you, I'm not the only one in the House of Commons who thinks like this. I'm certain I'm not the only one within my party or in any other party who thinks like this.

In view of that, and from what you've said, how do you expect politicians to change the way things are?

The Chair: I see that Dr. Adamec would like to respond, and Dr. McKim as well.

I'll start with you, Dr. Adamec.

Dr. Robert Adamec: I have a couple of things to say.

I want to respond to your thing about the link to running as an addiction. In fact, there is a neuromechanism that might apply, because one of the things that happens when you run is that the actual physical stress causes the release of endogenous opiate compounds called endorphins, and they bind with the same receptors that heroin binds to.

So there might be a physical link between the two, although the kind of activation might be qualitatively different. It's not such a stretch.

Mr. Randy White: Well, speak for yourself. I work out every day, I drank a fair bit in my day, and I no longer drink. So I discount anybody saying there is a correlation between that kind of activity and addiction to drugs. I just discount it.

Dr. Robert Adamec: Fine. I mean, I wouldn't call it an addiction. It was used in quotes because it's certainly not the same kind of compulsion. I just wanted to say there is a neurochemical link between the two activities.

In any event, with regard to your other question, I don't know how to answer it. I think you have to decide what your goals are. We've heard from Mike here, who has given us a lot of information from other countries showing that harm reduction methodologies actually lead to reduced usage, and criminalization does not work as effectively. If you want to be totally pragmatic about it, that's the kind of information you need to attend to.

As politicians, you make decisions that are presumably in the interests of society. If you take the pragmatic approach, there is a route and a suggested course of action. If you come from a cultural background where prohibition actually worked, then I understand how that gives you a gut sense of the efficacy of that.

The problem is that if you look at that applied on a societal level, it doesn't seem to be working, and I can think of two examples. Mike's submission suggested criminalization created more problems, at least with respect with to marijuana, than it solved.

On the other issue of prohibition in the family, I'll point to my path models here. Kids model what their parents do. They have a very strong hypocrisy detector. So it's not enough for a parent to say their kids shouldn't use substances X and Y if they actually use them themselves.

If as politicians you want to take the family prohibition route, you have to convince parents to change their behaviour, and that's a tough one to do. So you're faced with a very difficult problem. You have to decide where you want to go, the outcome you want, and then figure out how to get there.

In the submissions I have heard there are suggested models, but as you have pointed out, they are fraught with difficulties from the point of view of people's personal perspectives.

I can't give you an answer. I'm a pragmatist. I say get there any way you can, for the greater societal good.

The Chair: Dr. McKim.

Dr. William McKim: I agree with what Bob has said. It's basically a problem-solving issue. You figure out where you want to go and try to figure out the best way to get there. If the best way to get there seems to conflict with your values or the values of the people who elected you, that's a problem you have to solve. You're the politicians, and I can't help you with that.

I should say one thing, though. I did not say that harm reduction was the same as legalization. I said we might have to consider changing the legal status of a number of drugs and we should do that, keeping in mind the ultimate effect this is going to achieve. We cannot assume that making drugs easier to get will produce more people with drug problems. It doesn't necessarily always work that way.

One other quick comment has to do with the problem you're having with running and drug use. You have to acknowledge, I suppose, that the brain basically controls behaviour. We still have a long way to go, but the leaps being made in neuroscience nowadays are just breathtaking, especially in the link between brain mechanisms and behaviour.

We now have a reasonably good understanding of what controls behaviour--what parts of the brain control it and the link between neurochemistry and behaviour. Admittedly we have a very long way to go, but I'm absolutely amazed at how much we can achieve at the moment.

The trouble is, however, this leaves no room for good old-fashioned notions of voluntary control.

We have to admit that to a large extent our behaviour is not under our voluntary control; it's under the control of our mesolimbic dopamine systems, if you will. What we perceive is going on in our behaviour may just be a rationalization. We may think we're doing something because we're a religious person, or we're doing it because we believe it to be right, but in fact that may be a post hoc explanation of what our brain is telling us to do. I know that's kind of a disturbing philosophical position. It arises from an attempt to apply science to study something like behaviour and what we consider voluntary control.

In any case, I should also point out, just by way of another footnote, that when I was young my father was a United Church minister. I was raised in a home where there was no alcohol at all. I know precisely what you're talking about, about changing people's behaviours, and the strength of the belief systems that are associated with them, and how difficult it is to convince people that maybe it's better for individuals and even society to liberalize or decriminalize or make drugs more available. It's not an easy sell.

The Chair: Thank you.

Dr. Robert Adamec: I want to assure Mr. White I wasn't saying legalization of all drugs either. Certainly I have some in mind, but I agree with Bill that the status of them would have to be changed on a rational basis--although I would probably agree that legalizing marijuana would be not an unreasonable thing to do.

On the other hand, legalizing heroin use probably is not a good idea. But some harm avoidance strategy would probably be very useful, because where it's been applied in other countries it has proven efficacious.

So I think it's too simple an answer to say, “Legalize all drugs; harm avoidance means that.” I think it really has to be applied on a case-by-case basis.

Mr. Randy White: That's your answer, not mine.

Dr. Robert Adamec: Well, I was thinking of marijuana at the time, and I just wanted to clarify that I wasn't saying all drugs. Certainly I would be opposed to legalizing use of heroin, for example, for recreational purposes.

The Chair: Let me just put a question on that.

Alternatively, Dr. McKim has pointed out that the basic substance of codeine, heroin, and morphine are the same, and yet they're treated very differently. Therefore, you get different outcomes, different abuse patterns, and what have you. Isn't there a possibility some people could argue that controlling the substances, much as morphine and codeine are controlled--making all the products available in some capacity, but controlling vis-à-vis their danger factor or some other set of components--may be a better way to regulate the system than the current illegal and legal systems?

Dr. Robert Adamec: No, no, I agree. As I said, legalizing for recreational use. For example, you can get access to morphine, but you can't do it without a doctor's prescription, and there has to be a sound medical reason for the prescription. So, yes, there is a regulation there, and it's a targeted use.

The Chair: Mr. Patriquen, in your presentation I think you indicated that for children you wouldn't recommend that marijuana be available, but for adults it would be. The example was Holland, where children can't get access.

Mr. Mike Patriquen: Yes, that's correct.

The Chair: So there'd be some form of regulation even within that legalization framework.

Mr. Mike Patriquen: Yes, much the same as there are no criminal sanctions on beer, but it is regulated at a provincial and somewhat at a federal level to allow access to it without any criminal sanctions or penalties by law.

The Chair: And it's evolved, of course. In our province, anyway, you had to have a card to buy alcohol in the sixties, and spouses could get each other's cards pulled. There was a reporting mechanism. And you couldn't even touch the bottles when you purchased them; you had to write it down on a piece of paper and hand it in. I guess it would be too enticing to actually see them was the thinking at the time.

So things have evolved in perhaps a better or worse way, depending on your perspective.

Monsieur Ménard.

[Translation]

Mr. Réal Ménard: Thank you, Madam Chair.

Of course, it is not easy to absorb all this information, but it is certainly one of the more interesting panels we have had.

I have two or three short questions to ask you. If I am not mistaken, two or three years ago, a bill was passed to create 13 health research institutes, and of those, there was one for toxicology. It is not an institute specializing in drugs, but I would like to know how much contact you have with the groups of researchers studying those issues. Of course, it is too late to re-design the various research institutes, but I would be curious to know how much those researchers talk to each other.

I know that the real message you want to give us today is that there must be a better balance between the knowledge we have of drugs and their legal status. But none of you said that no distinction should be made between marijuana and heroin. We realize a qualitative distinction must always be made. Do we have the best legislative framework for that? Probably not, but as legislators, we must make that distinction. If one day we do start to decriminalize, you would not accept marijuana, heroin and cocaine being treated the same way.

Is that an accurate interpretation of your statements?

[English]

The Chair: Dr. Adamec.

Dr. Robert Adamec: First, as I tried to clarify before, I wouldn't treat heroin, marijuana, and some of these other drugs equally. I think you have to treat them individually in terms of the potential harm they may be doing.

On the other hand, there are certain contexts in which they can be used. This is a whole other issue. The use of heroin in reducing pain in terminal cancer patients, for example; this is where societal attitudes about a drug, which is considered to be highly addictive and very dangerous, have restricted its use in, say, a therapeutic setting.

I think the cases have to be treated individually. So public policy, legislation, has to be done on an individual basis. I wouldn't make a blanket statement about all of them.

[Translation]

Mr. Réal Ménard: I will reformulate my question to make it very, very clear. If tomorrow morning, at the end of our work... Would I be correct in saying that given the current level of knowledge, legalizing marijuana would not have any negative effect on health and physical well-being? For example, besides all the scientific knowledge, given all the studies that have been done, given all the information we have, could we, as legislators, table a bill in the House of Commons tomorrow morning to decriminalize marijuana without needing to worry about negative physiological consequences for our fellow citizens? I am taking moral values out of the equation completely, because it depends on your environment, it depends on all sorts of data that are subjective. But given the scientific knowledge we have, could a minister of the Crown table a bill to legalize marijuana, without any fear of physical, physiological and negative consequences for our fellow citizens? Let's take it step by step. Let's talk about marijuana.

[English]

The Chair: Mr. Patriquen and Dr. Adamec.

Mr. Mike Patriquen: First, you keep using the terminology “decriminalization” and “legalization” interchangeably. They are not even in the same ballpark.

Mr. Réal Ménard: I know that.

Mr. Mike Patriquen: So you're speaking of “legalization”, ending the prohibition. Yes, I think you very well could make that statement that outside of the harm effect from inhaling smoked cannabis...there is a definite negative health impact from doing too much of that. People could look at another method of ingestion over some harm reduction there. But yes, I think you could recommend to the Prime Minister, and the members of your party, and the rest of the House that Canadians are ready to have the cannabis prohibition lifted. I'm 100% behind that.

[Translation]

Mr. Réal Ménard: One of your colleagues, Dr. Evans, known for his expertise in the psychology of pain and dependency, came to meet us in Toronto, if I'm not mistaken. He said he would not like to live in a society where the pilot of the plane he was about to get on had consumed marijuana before takeoff.

You are telling us—and it might be interesting to also hear your colleagues' views—that in terms of a person's faculties, his physical integrity, his ability to make decisions in various spheres of society, if tomorrow morning we lived in a society where there was no longer any obstacle to consuming drugs, there would be no consequences in terms of consumption and good decisions being made for society.

[English]

Mr. Mike Patriquen: I don't think I'd want to get on an airplane tomorrow morning if the pilot just drank a couple of quarts of whiskey, but airline pilots are not predisposed to doing things like that.

A voice: [Editor's Note: Inaudible]

Mr. Mike Patriquen: Everyone knows that cannabis is a product that can do that, and I don't think we're going to have responsible people--or any people, for that matter--out experimenting with a substance like that in dangerous situations. There would need to be some education to go with it for those who have been asleep for the last 20 years.

[Translation]

Mr. Réal Ménard: Yes, but if you claim there are no negative consequences, no effect... If a member of Parliament has a glass of wine before going to vote in the House of Commons, no one thinks his ability to make good decisions is impairerd. Is that not correct, Madam Chair? Perhaps you do it on occasion. Perhaps I do.

The Chair: Sometimes, members of Parliament drink a lot.

Mr. Réal Ménard: Can you make the same comparison between smoking marijuana and having a glass of wine, before getting involved in a decision-making process? As legislators, we are trying to see how far we can go. For the past little while, each of you has been inviting us to give drugs a new status, depending on their effects. You are saying that the legislative framework is inappropriate. A distinction is made between marijuana and heroin based on their effect on individuals. What I am trying to understand is the following: is there enough conclusive evidence and advanced knowledge about marijuana for us to say that its consumption should not be controlled?

You say that a reasonable individual, in performing of his duties, should not... So marijuana does have an effect.

[English]

The Chair: The order is Mr. Patriquen, Dr. Adamec, and Dr. McKim.

Mr. Mike Patriquen: Yes, as I've said, some regulatory aspects and education will have to be looked at. People will have to be informed about what could happen if they use this product, just as they are now when they use any health food product, which often state that there may be side effects that have happened to other people, and you should be aware that they could happen to you.

But none of those things that may happen are dangerous in themselves. That's the main issue to look at. Is this such a dangerous substance that its use and sale should be criminalized? Should people be kept away from it? I'd say no, but there are certain aspects of it that people should be educated on, though I would say that's a minor point.

The Chair: Dr. Adamec.

Dr. Robert Adamec: If you state the case as extremely as that, I'd have to say no, it shouldn't be. But it's just like alcohol, and if I follow you, your logic dictates that we should criminalize the use of alcohol, which our society has not done. We know the effects of alcohol in many different contexts; in the case of the airline pilot example, there are laws governing the judicious use of the substance prior to getting into a position of public responsibility.

We know enough about marijuana to know that in high doses it can impair judgment and it can modify senses of time and distance. I wouldn't want a pilot stoned on marijuana to fly a plane I was travelling on from here to St. John's. Certainly, I wouldn't. But at the same time I wouldn't want him to have had several drinks, or even one, before he took off in that aircraft.

The point is, we still allow the responsible use of certain substances, particularly euphoriants, even though we know they can have impairing effects. We have to have rules governing their use within the boundaries of what we know about those effects. Frankly, the evidence suggests that marijuana is probably less harmful than alcohol, except for the smoking effects if you inhale it.

The Chair: Dr. McKim.

Dr. William McKim: To respond to that very interesting hypothetical question, I think it would be quite possible, if we were to do what you suggest and tomorrow morning it would be perfectly legal to take marijuana, that there would in fact be negative effects on some individuals in some cases. The best I think we can hope for is to look at statistics. And that is in fact all we have been listening to here, statistics.

For some individuals it might in fact be an absolute disaster. But from a statistical point of view, from the point of view of society, would society be better off? Basically it's a trade-off, I think. We' wouldn't wake up and be in the best of all possible worlds if we were to do this. There are down effects and there are positive effects. And it's a trade-off.

And I think that you at least, in this committee, have to listen to the arguments on both sides and make up your minds as to whether the positive effects are better than the negative effects. And there will be negative effects, I grant you that.

The Chair: Merci beaucoup, Monsieur Ménard.

Madam Davies.

Ms. Libby Davies: Thank you very much, Paddy.

It's been a really very fascinating discussion this morning and very helpful.

I wanted to come back to your information about the factors that cause someone to become addicted, and the information you provided about some of the other environmental or even social factors that contribute to that. And I want to distinguish for a minute between recreational use of drugs and people who are driven to use drugs for other reasons, like dealing with trauma or pain. The community that I represent is very different from Randy's. Most of the drug users in that community are people who have been deinstitutionalized, who are poor, who are often dealing with a lot of trauma.

So to get back to your issue about how we're all striving to have this sense of well-being, maybe if you have a balance in your life and you can get it through sex, food, work challenge, or whatever, you can have that balance. If you don't, if those things are missing, it seems to me that the imperative to seek that relief becomes stronger and stronger.

And I wonder about kind of the hypocrisy of the law as well, in terms of its enforcement. I don't know if I'm right or wrong in this, but my perception is that the visibility of the problem is what we attack, so it's basically an attack on poor people, where it's very visible.

In terms of recreational use, if you're a stockbroker and you're managing your use quite well and you have a safe supply, your chances of getting caught are not that high, probably, relative to someone at Main and Hastings who's on the street, and every few weeks the police go through their big scoops and they throw everybody wherever they throw them and it continues on. So it seems to me that another factor that comes into this is the factor of class or even socio-economics, and that we fool ourselves that it's a “moral” problem, or that we have these laws because it's a moral issue. It's also an issue around law enforcement that really targets particular segments of our community.

I wonder whether you have any opinions on that. Because it seems to me that at least that's one place we could begin with harm reduction. We have thousands of people dying from overdoses. We could stop that if we had safe injection sites tomorrow, yet we don't do it.

The Chair: Dr. McKim.

Dr. William McKim: Just to illustrate what you've just said, and I won't make much more of a comment, if you look at the history of the legal status of opiate drugs, opium itself was quite widely used in England. Sherlock Holmes was a fictional character, but he was typical of the sort of upper-class people of his day. He was shooting up cocaine and he was taking morphine. Upper-class people were using opiate drugs. Laudanum was very common among authors and writers in the 19th century.

If you read some of the definitive histories, you'll find out the only reason the British government imposed legal sanctions, or tried to get control over the use of opium and morphine, was because of a widespread perception that poor people were starting to use it. It was okay for the upper class to shoot up and drink their laudanum, but the perception was that working-class women were doping up their babies so they could go off to work in the factories. That was what motivated the very first laws against opium and morphine.

You're right, it is a class thing. Often the drug laws are motivated by what we perceive other aspects of society are doing. I think that just illustrates the point you were trying to make.

The Chair: Thank you.

Dr. Adamec.

Dr. Robert Adamec: I can't provide you with any answers, but I think you've raised an important issue here. There are, certainly, other reasons people use substances. Socio-economics is certainly one. If you marginalize a group of people, and then their reward for being marginalized is to be thrown in prison, you just add to the despair. That's certainly a problem.

Then you raised the issue about trauma. One of my areas of interest is post-traumatic stress disorder, and certainly low socio-economic status is considered to be a predisposing factor in individuals who are more likely to encounter traumatic kinds of events.

This is a long-standing, serious psychiatric disorder. It's coming to be believed that it has the highest prevalence of any disorder in the population of North America. One of the consequences of that is a co-morbid addiction, where they believe people are turning to drugs in the form of self-medication. We don't really have effective modalities of treatment.

It's certainly an active area of investigation. This is a whole other can of worms here, but it is certainly an issue that impacts on the interface between the health care system's ability to deal with these kinds of problems and one of the spinoff difficulties, which is substance use and abuse.

You've put your finger on, I think, a serious issue, but not an easy one to solve. I certainly think individuals who are suffering from these kinds of disorders and use these substances for that reason do not belong in jail. They belong under the care of a competent psychiatrist.

The Chair: Thank you.

I have a couple of questions before we wrap up.

I'd like to clarify, Dr. Adamec, in reference to CIHR, I think in fact it's the institute of mental health that's been working on this, not toxicology.

Dr. Robert Adamec: I guess to answer the question, I don't have much conversation with toxicologists, partly because the discipline is quite different from the kinds of issues we're dealing with here.

The Chair: Are you involved at all in the mental health institute?

Dr. Robert Adamec: Yes. I am funded by that institute, actually.

The Chair: But you would prefer there would be an entire new institute, with new money, just for--

Dr. Robert Adamec: Yes, emphasize the “new money”. But, yes, I would think a new institute would give it a priority, and I'll tell you why. We had an experience with this path study I described to you. We put in an application to the Canadian alliance for health research, where we had the entire province on side, all health--

The Chair: You don't mean the Canadian Alliance....

Dr. Robert Adamec: No, not the party.

The Chair: Thank you.

Dr. Robert Adamec: This is a new CIHR initiative, the CAHR, actually the Community Alliance for Health Research. It's to bring basic health research and health researchers together to deal with common problems.

It didn't have a lot of money. It was a one-shot deal. We had the entire province of Newfoundland, including the RCMP, on side to try to initiate interventions and also to try to export it to other provinces. We were unable to get it funded. The letter of intent had a good review, but they felt it didn't have enough research.

What I'm thinking is that one way to make it a priority is to have an institute devoted to this, with clear guidelines as to what kinds of research they would actually want to have funded, so it would give it some sense of direction.

I would suggest that if you were to pick up from what's been said here, if the idea were to really make it both an instrument of policy and for information to feed back to policy, then that could be one of the guiding principles.

But you could also use it as a mechanism for trying to develop rational, research-based means of developing interventions to deal with problems of substance use and abuse. Unfortunately, in the institute it's in now, it gets buried with a large number of other priorities. It's with neuro sciences and mental health. That is huge in terms of the demands, huge. That's why I suggested a separate institute with more money, to reflect the priority, if in fact that is the will of the House of Commons. If it's considered to be a priority, then make it one.

The Chair: Okay. The second thing is that, in your study, you clearly did some past research on marijuana, hashish, alcohol, and solvents.

Dr. Robert Adamec: And also the use of prescription drugs without a prescription. We looked at cigarette smoking and caffeine use as well.

The Chair: Caffeine use, talked about in the House of Commons!

But no heroin?

Dr. Robert Adamec: Right.

The Chair: Is that because it's not very common?

Dr. Robert Adamec: No, actually, I had some students ask why we didn't look into that. We didn't. There is supposedly some use, but we don't know about its prevalence.

The Chair: These studies you've done are determinants about the likelihood of use, or what are the influences on use.

Dr. Robert Adamec: Yes.

The Chair: They're not actually about who's using what. In other words, I can't extrapolate exactly how many teens in Newfoundland are using hash or marijuana.

Dr. Robert Adamec: Our phase one report, where we actually did a statistical analysis--not just a path analysis, but actual numbers--does have that information explicit by region, by sex, and by age.

The Chair: Okay. That would be of interest to us.

Dr. Robert Adamec: I have the report here.

The Chair: One of the challenges that we understand exists is there aren't really good numbers about who's doing what. There are some who say...for instance, in B.C. I think I heard at least one person say, “Look, please don't fund more counting analysis but fund rehab, because that's a bigger priority for us.” If everything is competing, that was a greater need. So if you have some of that research, it would be helpful.

Dr. McKim, did you want to comment?

Dr. William McKim: Yes. As a footnote, when we did this study, we did it in conjunction with the study that was being conducted by Dr. Christiane Poulin here in Halifax.

The Chair: She's coming tomorrow, Wednesday.

Dr. William McKim: That's good, because we looked at grades 8 and 11 when we did our survey, and she looked at grades 7, 9, 10, and 12. This was all done at the same time, in conjunction with her study. Hers was much more clearly a counting study, as you call it. The same format has been used repeatedly so that trends can be detected and so on. If you want to find out the extent of the problem in terms of numbers, her study is probably a better one to look at than ours. We were interested in why this happened, and she was actually looking at how much of it is happening.

The Chair: Here's the other question for you. Let's say we were to have a new regime in Canada and things were controlled differently--because that's really what it is about. From your evidence, prices would certainly change, and from what we've heard about the number of drug busts, the restriction of access to heroin or cocaine would drive the price up--and all that demand/supply information. But if we were to actually have a new system, and really educate people about the risks and challenges, and ensure that people had a better system of understanding what their own personal risk was....

The example you gave, Dr. McKim, was of the alcoholic who, on the one hand, has to balance out the desire to drink, and, on the other hand, the risks and damage to the family. At certain points in this person's life it may change. A young person may say, “Well, this isn't appropriate for me now”, but in these other circumstances it might change.

We heard from a guy at the dopamine centre in Montreal who said he couldn't tell himself he would never do heroin; he had to say to himself, “If seven conditions are met, then I will allow myself to do it again”. They were quite stringent, so he didn't feel it was going to happen in the next short while. But wouldn't we benefit, as a society, from having a population more educated about risks and rewards and appropriate behaviours for certain levels, or ages, or occupations, or whatever? Wouldn't there be a better system of evaluating choices? Could we ever get there, or would the receptors take over?

Dr. William McKim: My response to that, first of all, is that use of drugs is not a rational phenomenon. I think you probably could understand that. Why would an alcoholic continue to drink when he or she knows what it's doing to him and his family life and his health? Why do people continue to smoke? There's an even better one. We all know people who smoke, and if you ask them whether they're afraid of lung cancer, they acknowledge that they're increasing their risk, but they say they're still going to smoke. You have to keep in mind that we're not dealing here with a particularly rational sort of behaviour.

The Chair: Drug behaviours can be rational, though.

Dr. William McKim: Yes, but even then, if you look at the study, what your peers do is absolutely essential in determining whether you're going to take a drug too. If all your peers are doing it, you may be as rational as you want to be, but it's going to be a big influence on you if all your buddies are doing it and you're not. We all know how important peers are to teenagers in decision-making like that.

Some interesting studies have been done on this particular problem, and they have to do with how individuals determine the net worth of a particular activity. It's sort of an economic type of study again. When it comes right down to deciding whether they're going to do something or not, most individuals have a very short-term bookkeeping scheme. They look at the benefits it's going to give them and they look at the harm, and they weigh the two of them off. Often we'll tend to look at a very short period of time. The idea is that if you're deciding whether you're going to go out and drink tonight, the pleasure you get from drinking will have a much bigger influence on your decision than the hangover you're going to have the next morning, because your bookkeeping encloses only a very short period of time.

What you have to try to do is to get people to expand their bookkeeping scheme. When you decide to light up a cigarette, you weigh the momentary pleasure you're going to get from that cigarette against the possibility that 20 years in the future you're going to get cancer. You have to be able to allow people or convince people or approach people in such a way that you can expand their bookkeeping scheme to see all this. It may be perfectly rational, but people don't take all those rational facts into account.

The Chair: Is it possible to expand that?

Dr. William McKim: Well, people made a great deal of, and even made fun of, the whole business of putting pictures of rotting teeth, cancerous lungs, and whatever on cigarette packages. That's one way you can do it, in fact. That technically is a way. There was one story told about a guy who wanted to quit smoking. What he did to help himself control smoking was to put a picture of his granddaughter inside the cellophane of the cigarette pack so that every time he pulled it out he was reminded of the long-term consequences of smoking. It worked for him.

That's the kind of thing you can do, and it's not easy. I think that's something else we need to pay attention to in terms of research. How do you get people to apply a long-term bookkeeping scheme so they can make a rational decision? A lot of decision-making, especially with regard to drugs, is not rational.

The Chair: Right.

Dr. Adamec.

Dr. Robert Adamec: I don't disagree with what Bill says. I even had a personal experience in that regard, because I smoked for 20 years and then I quit. I was at a karate camp and I decided I wanted to be a black belt. I knew I couldn't do it if I continued to smoke, so I quit. I had a good reason to, and I'm glad I did, of course.

The point I want to make is that if you're going to use.... He mentioned putting lungs, decaying teeth, etc., on cigarette packages. There is an old study in industrial psychology that shows you have to be careful. If you go down that route, you'll want to market test every attempt, because too-alarming presentations of consequences of bad behaviour often lead to people going into denial. In fact it doesn't influence their behaviour, and it may actually promote it. So you have to be very careful.

I saw a very interesting ad and I'm wondering what happened to it. I'm not sure if it was government-promoted. It was an anti-smoking ad aimed at teenagers, where they had this young girl go into a bathroom with a friend. They were all excited, and were lighting up, and then the sign says simply: “Smoking. It will suck the life out of you.” They had her age right before your eyes.

I remember it well, and thought it was very effective, but I'd be curious to know what kind of impact it actually had on teenagers.

The last point I'd like to make is if you want to modify behaviour, you have two broad populations to think about. One very important one is young people. That's the time to try to get them, because they're the ones who are going to experiment, and they'll go down the road or not. The harm done to them is very significant if they start when they're very young. There should be a concentration.

You still also have to deal with adults, particularly parents. As I said before, our model certainly indicates--and so does a host of psychological literature--that until they are about 16 or 17, kids model very much what their parents do. If you adopt the attitude, as a parent, of do as I say and not as I do, the old hypocrisy meter will go off and you won't get a lot of compliance on the part of your kids. So parental education is also very important.

If these factors are identified as being important.... You see campaigns on talking to your kids about drugs. I think the message should be out there also about modelling, because your kids model what you do. Our path model suggests not only do they model their parents, but they may choose their friends based on what their parents do.

The Chair: Speaking of ads, one of the churches out of the U.S. has an ad showing the children being yelled at by their parents, and then the children yelling at their dolls. You know, take a break, look at what you're doing; your children are modelling your behaviour.

Dr. Robert Adamec: Exactly. There's clear evidence of that in spousal abuse. Spousal abusers come from homes where they have either witnessed abuse or been subjected to abuse themselves.

The Chair: Several of my colleagues have said that this has been one of our very interesting panels. It's entirely possible that we will have more questions of you.

Mr. Lee.

Mr. Derek Lee: I want to take this opportunity, if I may, to ask a very brief question. It has to do with the Canadian Medical Association report that was offered to the Senate committee looking at the same area.

In their executive summary, they say they want to make it clear that cannabis is an addictive substance and that addiction is a disease.

On the first part, can I ask Mr. Patriquen...? I'm looking for very brief answers, because we're running out of time.

Mr. Mike Patriquen: I don't believe...maybe 150 years ago, but when was it dated?

The Chair: In the last year.

Mr. Derek Lee: March 11, 2002.

Now, I realize the Canadian Medical Association has politics behind the scenes, too. They have small-town doctors and big-town doctors and everything in the middle.

Could I have very quick reactions on either of those two statements--one, that cannabis is an addictive substance, and two, that addiction is a disease--particularly from the two doctors?

The Chair: Mr. Patriquen, I think you disagree.

Mr. Mike Patriquen: Yes. Cannabis is not an addictive substance. The other question I'll leave to the doctors.

The Chair: Okay.

Dr. Adamec and then Dr. McKim.

Dr. Robert Adamec: As far as I know there's no clear evidence that cannabis is addictive. As for addiction being a disease, I guess it depends on what you define as a disease. Its use is probably due to an abnormal functioning of the brain, and in that regard you might call it a disease.

I might defer to Dr. Fry. You are the physician. What does the doctor define as...?

The Chair: We'll get her opinion later. Your opinion is what we're looking for.

Dr. Robert Adamec: If you think of disease as physiological functioning that is either deranged or outside of normal functioning, then I would say it is.

The Chair: Dr. McKim.

Dr. William McKim: Very quickly, addiction is what it is, and whether it's a disease or not depends on your definition of disease. I think that's what Dr. Adamec was saying. So if you think of addiction as being a highly sensitized mesolimbic dopamine system that compels people to perform or behave in a certain way, that's what it is. If you define disease as an abnormality in the mesolimbic dopamine system, then it's a disease; if you don't, then it's not a disease.

It's interesting to note that a guy named Leshner, who used to be the head of NIDA in the States, made a really big deal of addiction being a brain disease. Every time he got a chance to talk about it, he said that.

He did this, I believe, for political reasons. In fact, he could make a good argument for the sensitized mesolimbic dopamine system being an abnormally functioning brain mechanism, which constitutes a disease by a number of medical definitions. It may be politically feasible for him to do that, and in fact maybe this committee might adopt a similar position. If you think you want to convince the people who vote for you that in fact the best way to handle people with this disease of addiction is to change our laws, then that might be a technique you could use. It wouldn't be wrong. I wouldn't particularly object to it. Personally, I don't think it's a disease, but that has, as I say, more to do with my definition of disease than my understanding of what addiction is.

The Chair: Thank you.

Again, I think my colleagues will agree that this was one of the more interesting panels we've had, and certainly it's been great to bounce a lot of the ideas back and forth. You've caused us to think a lot, and that's really helpful.

This committee will continue to hear witnesses and receive testimony or information, probably through to the end of June and even after that if there's something earth-shattering. We have to report in November. If you have information, if you have colleagues whom you think we should hear from, or if you have ideas or studies that come up, please direct the information to our clerk. She'll make sure the material is distributed to everybody.

We really appreciate both your time in preparing your presentations and coming to see us today. We also really appreciate the work you're doing in each of your areas and your dedication to it. It's really quite wonderful, and we wish you lots of good luck.

Some hon. members: Hear, hear!

The Chair: They don't usually applaud.

You guys are free to go, although I know a couple of people want to catch you on the way out.

Colleagues, I need you to do one thing for the House of Commons before we leave. It turns out that on Wednesday, when we passed a couple of motions, we did not have full quorum to pass motions, so I just need to read the motions and I need you to agree or disagree.

One, that up to four members and one researcher travel to Vancouver to participate in the IDEAS conference from May 1 to 3 inclusive.

Some hon. members: Agreed.

The Chair: Two, that the Special Committee on the Non-Medical Use of Drugs seek the authorization of the House to travel to Switzerland, Germany, and the Netherlands from June 14 to 22, 2002, inclusive in relation to its mandate, and that the necessary staff accompany the committee.

Some hon. members: Agreed.

The Chair: Three, that the Special Committee on the Non-Medical Use of Drugs seek the authorization of the House to travel to New York and Washington from June 2 to June 6, 2002, and that the necessary staff accompany the committee.

Some hon. members: Agreed.

The Chair: And four, that the clerk, in consultation with the chair, be instructed to make the necessary travel arrangements to Europe using the most cost-effective routing.

Some hon. members: Agreed.

The Chair: Thank you.

I'll continue to work that process out. We're trying to get our House orders through.

The meeting is adjourned.