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37th PARLIAMENT, 1st SESSION

Special Committee on Non-Medical Use of Drugs

EVIDENCE

CONTENTS

Thursday, May 23, 2002

1405

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

1410

Mr. Blair Buchholz (Manager of Youth Services, Calder Centre)

1415

1420

The Chair

Mr. Blair Buchholz

The Chair

Mr. Bill Logue (Executive Director, Larson House)

1425

The Chair

Mr. Ernie How (Coordinator, Addictions Services - Outpatient)

1430

1435

1440

The Chair

Ms. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance)

Mr. Bill Logue

The Chair

Mr. Ernie How

The Chair

1445

Mr. Blair Buchholz

The Chair

Ms. Carol Skelton

Mr. Bill Logue

Ms. Carol Skelton

Mr. Bill Logue

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Ernie How

Ms. Carol Skelton

Mr. Bill Logue

1450

Ms. Carol Skelton

Mr. Bill Logue

Ms. Carol Skelton

Mr. Ernie How

Ms. Carol Skelton

Mr. Bill Logue

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Ernie How

Mr. Bill Logue

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

1455

The Chair

Mr. Blair Buchholz

Mr. Réal Ménard

Mr. Bill Logue

1500

Mr. Réal Ménard

Mr. Bill Logue

Mr. Réal Ménard

The Chair

Mr. Ernie How

The Chair

Mr. Réal Ménard

1505

Mr. Blair Buchholz

The Chair

Mr. Ernie How

Mr. Bill Logue

The Chair

1510

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

1515

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Mr. Dominic LeBlanc (Beauséjour—Petitcodiac, Lib.)

Mr. Bill Logue

1520

Mr. Dominic LeBlanc

Mr. Bill Logue

Mr. Dominic LeBlanc

Mr. Bill Logue

Mr. Ernie How

The Chair

Mr. Ernie How

The Chair

Mr. Blair Buchholz

1525

The Chair

Ms. Carol Skelton

Mr. Ernie How

Ms. Carol Skelton

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Ms. Carol Skelton

Mr. Bill Logue

Ms. Carol Skelton

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Bill Logue

Mrs. Skelton

1530

Mr. Bill Logue

Ms. Carol Skelton

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Ernie How

The Chair

Mr. Bill Logue

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Bill Logue

Mrs. Skelton

1535

Mr. Ernie How

Ms. Carol Skelton

Mr. Ernie How

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Blair Buchholz

Ms. Carol Skelton

Mr. Bill Logue

Ms. Carol Skelton

Mr. Bill Logue

Mrs. Skelton

1540

Mr. Bill Logue

The Chair

Mr. Ernie How

The Chair

Mr. Ernie How

The Chair

Mr. Blair Buchholz

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

1545

Mr. Réal Ménard

The Chair

Mr. Blair Buchholz

The Chair

Mr. Ernie How

1550

The Chair

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Mr. Réal Ménard

The Chair

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Mr. Ernie How

The Chair

1555

Mr. Blair Buchholz

Mr. Réal Ménard

The Chair

Mr. Bill Logue

The Chair

Mr. Ernie How

The Chair

Mr. Blair Buchholz

The Chair

Mr. Blair Buchholz

The Chair

1600

Mr. Dominic LeBlanc

The Chair

Mr. Dominic LeBlanc

The Chair

Mr. Ernie How

Mr. Dominic LeBlanc

Mr. Ernie How

Mr. Dominic LeBlanc

Mr. Ernie How

The Chair

Mr. Blair Buchholz

1605

The Chair

Mr. Bill Logue

Mr. Dominic LeBlanc

Mr. Bill Logue

Mr. Dominic LeBlanc

Mr. Bill Logue

Mr. Dominic LeBlanc

The Chair

Mr. Blair Buchholz

The Chair

Mr. Blair Buchholz

1610

The Chair

Mr. Blair Buchholz

The Chair

Mr. Ernie How

1615

The Chair

Mr. Bill Logue

Mr. Blair Buchholz

The Chair

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Mr. Blair Buchholz

1620

The Chair

Mr. Blair Buchholz

Mr. Bill Logue

The Chair

Mr. Bill Logue

The Chair

Mr. Blair Buchholz

The Chair

Mr. Bill Logue

The Chair

Mr. Ernie How

The Chair

Mr. Ernie How

1625

Mr. Blair Buchholz

The Chair

Mr. Blair Buchholz

The Chair

Mr. Bill Logue

The Chair

Mr. Bill Logue

1630

The Chair

Mr. Ernie How

The Chair

Ms. Carol Skelton

Mr. Ernie How

Ms. Carol Skelton

Mr. Blair Buchholz

Ms. Carol Skelton

The Chair

Mr. Blair Buchholz

The Chair

Mr. Blair Buchholz

The Chair

CANADA

Special Committee on Non-Medical Use of Drugs

NUMBER 047

1st SESSION

37th PARLIAMENT

EVIDENCE

Thursday, May 23, 2002

[Recorded by Electronic Apparatus]

¸ (1405)

[English]

The Chair (Ms. Paddy Torsney (Burlington, Lib.)): I'll call this meeting to order. We are the Special Committee on Non-Medical Use of Drugs. We're here in Saskatoon to hear from people this afternoon on drug treatment.

I'll give you the spiel. We were struck in May last year to consider the factors underlying or relating to the non-medical use of drugs. In April this year we also received a mandate to refer the subject matter of Bill C-344, an act to amend the Contraventions Act and the Controlled Drugs and Substances Act relating to marijuana.

This committee has had hearings in different parts of the country, and has been looking at harm reduction, treatment, prevention, and law enforcement. We're very pleased to be in Saskatoon today.

We have representatives from all political parties on the committee, but today we have just three. I'll introduce them to you. Carol Skelton is a member right here in Saskatoon. Réal Ménard is a member of the Bloc Québécois, from Montreal, and Dominic Leblanc is from New Brunswick. I am Paddy Torsney, the member of Parliament for Burlington, Ontario.

Chantal Collin and Marilyn Pilon are our researchers, and Eugene is our substitute clerk for this week. We're very happy to have him with us, especially since he knows a whole bunch of stuff about military issues.

Our witnesses today are, from the Calder Centre, Blair Buchholz, manager of youth services; from Larson House we have Bill Logue, the director; and from Addictions Services--Outpatient, we have the coordinator, Ernie How.

Gentlemen, what I propose is that you each have about ten minutes to make an opening statement, tell us what's going on, what your wish list is. Then we will turn to the members of Parliament for questions. I'll give you a signal at about nine minutes, and you can do your conclusion, and then we'll do a wrap-up comment at the end, or you can tell me you're just about finished. At ten minutes, I'll try to give you the time to finish.

Blair, you're first.

¸ (1410)

Mr. Blair Buchholz (Manager of Youth Services, Calder Centre): I was prepared to come and talk about what we offer at Calder Centre.

Calder Centre is an in-patient treatment facility. It serves individuals and families affected by chemical dependencies. We are part of Saskatoon District Health. We're part of the family health services care group here. We are a provincial resource. We provide services to adults, youth, and families from across the province. We take referrals right across the province.

Last year we provided services to 355 adults, 155 youth, and 182 family members.

Our service delivery is guided by the Saskatchewan model of recovery services, and we also try to be consistent with the federal best practices. Those are the things we mark and measure ourselves against.

We offer developmental, holistic service delivery. It's based on the biocycle-social-spiritual model of recovery. We take a multidisciplinary team approach at Calder. Some of the characteristics of the therapeutic interventions include that they are client-centred and “brief solution”-focused, involving motivational interviewing, a trans-theoretical model of change, providing cognitive behavioural life skills training and reality therapy.

Our main thrust is with the trans-theoretical model of change and motivational interviewing, although different people from different backgrounds use different therapeutic approaches.

Our staff is multidisciplinary, as I mentioned. It includes addiction counsellors, a nurse, recreation therapists, a family counsellor, a spiritual counsellor. We have an aboriginal support worker, a clinical psychologist, research and quality outcome assistance, and a primary prevention specialist. We also have a provincial support unit that provides services to the province in terms of clinical direction, and some group work with the addictions community to assist with consistency within the province. We also have a project where we have a dual-diagnosis case worker.

Our contracted services include a physician, a psychiatrist, elders, public health educators, and nutritionists. Those are people who work alongside us, but they are on contract. Service partners are quite extensive. To mention some of them, there's SaskHealth's mental health services and medical services, the Department of Social Services, the Department of Education, Saskatoon Tribal Council, NNADAP, and the University of Saskatchewan.

In the adult program, we have 32 in-patient beds. There's a core four-week program; however, that's flexible to meet individual needs. There's a female chemical dependency program, which runs as gender-specific, and a male chemical dependency program that runs as male-specific. Then we have what we refer to as a “substance affected” group, which provides services to people who have been severely impacted or debilitated by somebody else's substance abuse. We do in-patient work with that group as well.

We have a separate youth program at Calder Centre. We have 12 beds in a different wing, and there are separate programs but in the same institution, servicing 12- to 18-year-olds. It is also run on a core four-week program; however, it's flexible, once again, to meet individual needs. We have some youth who don't stay as long, and we have youth who stay six to eight weeks, as a sort of maximum. Typically, the youth will stick around for four weeks and complete that portion.

We have co-gender and gender-specific programming in the youth program. There is also a classroom program that is part of a Nutana integrated schooling service project. Basically, we operate through primary case management, providing individual and group counselling. We do psycho-educational groups, life skills training, and recreational programs. Streaming and assessment is done comprehensively. It includes psychological screening, educational screening, medical and psychiatric.

We have family programming based on individual family needs. That varies from several hours to several days, and on the extreme end would be the substance-affected in-patient group. We try to provide that service based on individual need, and we try not to replicate what's going on in the community. If they are getting a family service in the community, we would try to work with the comunity case manager and the family to make sure their needs are met there.

We have aboriginal-specific programming. It's fairly comprehensive. We are not an aboriginal-based program, but we have a high population of first nations people receiving services at Calder Centre. We have regular elder involvement, including sweats, healing circles, pipe ceremonies, dances, pow-wows, crafts, and those kinds of things. Our aboriginal support worker is a full-time person who coordinates those services and is trained in medicine wheel.

¸ (1415)

So we do try to ensure that people's cultural and spiritual needs are met, no matter what background they have. We have another spiritual counsellor who provides services more generally to the rest of the population.

People have to volunteer and want to be involved in our programming, but typically in the youth program we see the non-aboriginal and aboriginal kids participating side by side. It's been very successful. We've had very little racial tension at all or any of those kinds of situations, so they seem to enjoy learning from each other in a cross-cultural environment.

In addition to that, we do recreation therapy. We have a heavy emphasis on alternatives and bridging to the community.

That's an overview of what we provide at Calder Centre. I haven't kept an eye on my clock, but I imagine I'm fairly close.

¸ (1420)

The Chair: Is there anything on your wish list for this committee to consider?

Mr. Blair Buchholz: I'd hope that generally through the course of your proceedings you would have a good hard look at the services being provided across the nation. It's obviously an area that impacts society a great deal, and I think my thoughts are that in this area in particular the use of IV drugs by the younger population is at a critical point. So resources are always an issue when those things come up.

The biggest things that come up that I hear about are in the youth end, where we don't have as much of a continuum of care as the adult service providers have. That would be in the area of withdrawal management and detox, and there's not a facility there.

On the opposite end, in more long-term treatment that is aboriginal-based programming, longer programming, in the provincial resources there are two first nations facilities for youth, but they're solvent and inhalants specific. They don't deal with poly substance. I think that if you surveyed the community addictions people out there, they would endorse that there's maybe a need in aboriginal-based programming specifically for that target group.

On both ends of the continuum of care, it's light, so we designed programs to hit the bulk of the population and provide the best service we can with the resources we have.

The Chair: Thank you very much.

Mr. Logue.

Mr. Bill Logue (Executive Director, Larson House): Thank you very much.

I'm William David Logue, and I have the privilege of being the executive director of Larson House here in the city of Saskatoon.

Larson House is a non-profit charitable organization that is funded provincially by provincial health through the Saskatoon District Health Board. We are a detoxification stabilization transition unit, and our primary job is to be on the front lines of addiction. So we are normally the first contact any individual will have whose life is running into trouble where they are losing control of their life.

If you know about the twelve-step program, step one says that we admit we're powerless over alcohol and drugs and our life becomes unmanageable. What happens in our case is most people are experiencing the last end of that: their life has become unmanageable and they're brought to Larson House for many different reasons.

At Larson House we take referrals from absolutely any source. We'll take referrals from people themselves on the street, from the police, from doctors, from our colleagues here, from outpatients, even from in-patients. Anybody who actively needs a safe environment in which to withdraw from alcohol and drugs comes to Larson House.

When we get these clients, we will bring them in and secure them and make sure they're seen medically so that we oversee their withdrawal so they'll withdraw safely. Obviously, if they're in rougher shape and they're starting to get into difficulties, we would transfer them to the hospital, where they would be overseen by the doctors there and their medical care would be overseen to keep them safe so they could come back to Larson House and continue their treatment.

At Larson House at this point in time we're running at a maximum of 18 beds, and we run on average about 102% to 103% occupancy every month. Last year we ran at a total of 106% and we delivered services to roughly 980 clients, delivering a total of 9,680 client stay days.

Our facility is running at full capacity. We are staffed only by nine full-time and nine part-time staff at this time. This includes one medical officer. And we do have an attending doctor who comes in Mondays, Wednesdays, and Thursdays to help oversee the care of our clients.

Now, in a social setting, non-medical detox, our prime goal is to get that individual stable, to get them through withdrawal, no matter what that may be--whether they're withdrawing off heroin, cocaine, alcohol, whatever it is. Our prime directive is to get them physically and psychologically stable, so they're going to start to be able to think and to make some decisions as to what direction they want their life to go in from that point in time.

When we get these individuals in, we do work at getting them stable. We introduce them to the disease concept of addiction and we also introduce them to the self-help groups of Alcoholics Anonymous, Narcotics Anonymous, so these individuals will realize there is help and places they can go to continue with their help.

At this point in time, also, in accordance with the Saskatchewan model of recovery we'll introduce them to their clinical case managers. As ADS outpatients, we will get these people involved there, so that they can get further assessment should they need in-patient treatment or continued treatment on an outpatient basis, say, for relapse therapy or continued assessments through the outpatient people to go on to Calder Centre for further in-patient treatment.

Now, having said that, sometimes at Larson House we also have the ability to refer clients to other units within the province. We utilize Hopeview, Indian Head, and also Slim Thorpe centres within the province to make additional referrals to get the clients into treatment.

To put it in a nutshell, that's basically what we do. But what you have to understand is in a detoxification unit we are the ground floor. We're the beginning.

I've been asked what I would like to see change, or what kind of wish list I have. Here in Saskatoon we are trying desperately to have what we call a brief detoxification unit to be built and installed onto Larson House. This is in ongoing negotiations at this point in time. Rather than have people who are picked up by the police simply incarcerated in a cell, they would come to the brief detox, where they would be treated by trained individuals who would look after their needs, get them stabilized for the first 24 hours, and start an initial indoctrination, or get them to understand that there is a place they can go. After they're stable they can either decide to leave or they can go on for further help through the formal detoxification unit, rather than a person just being held in a cell and kicked out in the morning. This would give them some hope and some idea that there is something they can do, and also let the individual feel as if they're being treated a little more humanely than just being put into a cell. So we're hoping for that.

We're also hoping that along with this unit will be a 12- to 14-bed halfway unit, which would be part of the brief detox but on the top floor. This would be a long-term living environment for clients, where they could stay anywhere from three to six to nine months, so they can make that transition back to normality, to recovery, working or doing what they need to do. But they would have a safe, stable, alcohol-free and drug-free environment in which to live and to get some long-term foundation toward recovery and stability.

That's basically what I have to share with you at this point in time. If there are any questions you have....

¸ (1425)

The Chair: Thank you.

Mr. How.

Mr. Ernie How (Coordinator, Addictions Services - Outpatient): Thank you.

On behalf of our staff and Battlefords Health District, I'd like to thank you for the opportunity to present this.

The issues I'll be raising are solely from the perspective of what we see. We don't make any pretense that we can back this up by research. It's what we see on a daily basis.

In the handout I started off with a bit of an overview. Battlefords Health District Mental Health Services is the overseeing body of addiction services. It is one of the few places that has that close association. We're in the same geographical location, with common management, and with central intake services for mental health and addiction. Both the services are included in Battlefords Union Hospital. It's coming together very well. We are functioning very efficiently as co-partners and partners at this time, but still we need to go further.

Part of addiction services in the Battlefords is Hopeview Rehabilitation Centre. It's a nine-bed co-ed facility, and it has a 90-day program. It's the only 90-day program in the province, with the exception of the Salvation Army outreach program here in Saskatoon. It has a strong 12-step component, with emphasis on developing routine life skills. Residents tend to be poly-drug users, possibly with a concurrent mental health disorder. Individuals who come to this facility tend to be those who have gone once or twice to the shorter stay programs, so Hopeview is sometimes viewed as a last resort.

There is collaboration with Mental Health Services to meet residents' needs. It has one full-time counsellor plus five support staff. It's staffed 24 hours a day. They're presently working on adding a social detox component to the program. This is to provide a continuum of care. If we have to refer someone to Bill's facility, there's sometimes a break between when we can get the person out of there into treatment. So this is to address a small percentage of that.

The emphasis of the program is on developing daily routines. In short, they're responsible for cooking and cleaning and caring for the grounds. So it helps in developing these basic life skills.

The outpatient department, in which I work, has five counsellors plus one support staff. We're open five days a week from eight to five. We're physically located in the Battlefords Mental Health Centre, but we have a separate entrance. That seems to be very important to our clientele, as there still is a stigma so that some people don't want to be associated with mental health problems. We see approximately 600 clients a year. After-hours emergencies are handled through the hospital emergency unit and the mental health staff who are on nights. They hold these people on the unit overnight until we're able to see them in the morning, or if they're safe to go home we'll do a referral and make contact the next day.

Our office offers a safe driving program. That's for people who have been picked up for impaired driving or other medical reasons. We see about 120 clients a year in that program. As part of that, we provide some education about safe driving to the community.

The adult program sees 300 clients per year, again for all drug types. It provides assessment and referrals. We conduct ongoing day recovery groups. We provide services to both individuals and families and to Battlefords' correctional facilities. There's a community-based one and a closed facility. There is an ongoing program for individuals and groups at the regional college. This is for people who wish to complete grade 12 through the GED program. This involves high-risk clientele, and we're getting them when they're stable. We're having some really positive feedback from that. Community education and prevention is a very big part of that.

I'd like to say a little bit about our demographics. Our clientele are 40% non-aboriginal and 60% aboriginal or aboriginal ancestry. Ten percent are engaging in injection drug use of some type, 56% in alcohol use, and 36% in alcohol and drugs.

We offer problem gambling services out of our outpatient unit, and we see about 50 clients per year. We provide assessment, referrals, and treatment. Fifty percent of these clients have a concurrent mental health disorder. This is higher than any other service in the province. We think the reason for that is our close association with the mental health services and receiving cross-referrals. We offer community education and prevention. We cover four health districts.

Under the youth services program, we have individual and group services. We see about 160 clients per year. We provide assessment, referrals, and treatment for those 18 years and younger. We see a wide range of drugs used, both medical and non-medical. One of the things that youth workers often identify, which kids present, is relationship and family problems, and they see that as their primary problem, not the youth. Often these workers are spending a lot of time helping the kids work through these issues, which in turn helps them deal with the actual abuse of the substance. We provide services in both closed and open custody youth correctional facilities. We have offices in both high schools. There are only two high schools, and they actually see clients in the schools.

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As for prevention awareness in the community, 80% of our clientele are referred by legal services, and 63% of the females by legal services. Alcohol and drug use is reported by 88%, and when you compare this to the adults who are coming in at 36%, we see a very dramatic increase in drug use in the youth. Only 10% of the youth report alcohol use only.

One of the issues we've been able to identify is that profiles of the people who are coming to our services change substantially. In the past, our clientele were mainly alcohol abusers; presently our clientele are using multiple substances, plus have possible concurrent mental health disorders.

The training and resources needed to deal with this have not kept up, and many of the treatment models that have been used in the past may not fit well. An example of that is our requirement for total abstinence from any mood-altering substance, while often the clientele with concurrent disorders have to be on some type of mood-altering substance, which creates a conflict.

Between addictions and mental health services, we are also still losing some clients who don't fit in to either category really as well. Although we're doing better, it's still an area that needs to be addressed.

There's a lack of understanding of how the modern drugs are affecting the physical and mental health of the addicts, and those could be Ecstasy, speed, and some of those other ones we classify as modern.

In terms of the impact marijuana is having on our clientele--and there again, what we see sometimes is difficult--it's against what the norm is and what the research is saying. Is there a link between depression and pot? Some research says there is. We often question it with our clientele. Is pot or marijuana causing mental health disorders, or is it a factor in their onset? Again, with the concurrent disorders it's an area that really needs some research.

The lack of motivation, the amotivational syndrome, is very prevalent. Lots of the information on the medical use of marijuana is leading to the normalization of its use without awareness of its negative effects. There's a lot of promotion about the benefits of it, without looking at the counter-effects.

Our youth worker identifies the number of times the youth are engaged in very high-risk activities, such as going into the parents' medicine cabinet, crushing a mixture of pills, and snorting them or even at times injecting them, without knowing what they're taking or what their effects may be. One that I always try to address is the sniffing, solvent abuse. It's very difficult to access this information. A lot of shame is attached. Sniffers are at the bottom of the hierarchy that moves up until you get into the opiate or heroin users.

Our provincial databases only track what's happened in the past year, so they are missing a lot of that information. The damage is very similar to what we may see in people with FAS and FAE effects. For the clientele we work with as adults who are sniffers, the deterioration in the five or six years that we work with them is just phenomenal.

Many youth use for two to three years, usually in the age range from eight to twelve. When they come to an age where they're able to access crime for money or get a part-time job, they will quit the sniffing and move on to other drugs, whatever they may be. This is very contrary to what the standard of acceptance is.

As the sniffers are considered to be at the bottom of the heap, we have to be very cautious we don't pass them by. When we think of non-medical drug use, there's money for needle exchanges and methadone programs. It's very easy to miss this group, and yet it's very significant. When I worked in the correctional centres I spent some time talking with inmates, and more than 50% of them had been sniffers at a young age and have moved on.

Another issue we run into as we work closely with the hospitals and mental health services is a knowledge of basic addiction information in the medical staff. The opposite would be the addiction workers' lack of understanding that these people are coming from a different perspective.

An example of the fragmentation of services and agencies overlapping with minimal resources would be the Kids First program. It started up in North Alfred a year ago. This has been a year when it has been all management and bureaucracy until the program is created. There have been a number of agencies in the city that, if they were to have had those resources, would have had workers on the street actually accomplishing something a year ago.

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The Kids First program is a good program. I'm using it as an example of an overlap where another level of bureaucracy has been created.

Due to waiting times, it's difficult to provide immediate service for addicts. Often when you ask addicts what you could do to make a difference so they'd come in sooner, they say they want someone there to help when asked. I'm sure Bill will back this up. Often by the time we can find beds, and resources to deal with their needs, it's too long and they're back using. We need some type of process in place where they can walk in and get service immediately.

Those are the issues we raised. Thank you.

¸ (1440)

The Chair: Thank you. We'll have some good time for questions.

Ms. Skelton.

Ms. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance): Thank you very much for appearing before us this afternoon.

Our lead critic, Randy White, wasn't able to be here today because his mother is very ill. It's my privilege to sit on the committee.

Although it is not really in my riding, Bill is in my riding. I understand. I was at the official opening of Calder House. I understand.

I want to ask a basic question. Basically, it's assumed there is a provincial and territorial responsibility for health departments to look after addiction services. What do you think the federal government's role should be in addiction services?

Mr. Bill Logue: I think the federal government could take an active role in starting to set national standards of care, especially around addictions. I would also like to see the federal government take a leading role in determining the direction of care in which we would go.

Right now we have a pile of issues around harm reduction. There are a lot of things about harm reduction that are good. There are a lot of things about harm reduction that are not. There should be a process put in place, where highly trained professionals sit down and work out a viable strategy, in order to give all the provinces in this country a direction to deal with the problem.

We have twelve or nine provinces. I forget how many we have. Everyone's doing their own thing. The problem is you can't get the same kind of treatment in Quebec that you can in British Columbia, or vice-versa. There should be standardization across this country.

For “reciprocity” to pay for addiction, it's in Saskatchewan, Alberta, and Manitoba. It's not a nationwide thing. There are provincial boundaries that give guidelines for the care of addictions in this country. It's wrong. Anyone coming from any part of the country should get the same level of treatment no matter where they are. We should have a benchmark that tells us what's acceptable in this country, not what's not acceptable. I think we should all be working off the same page.

We need a national body to sit down and help set up the rules of engagement, or whatever you want to call it, so we all work on the same page. Detox will work in this manner. Outpatient will work in this manner. Inpatient will work in this manner. The needs for youth detox will be the same across the country for every province. The needs for adult detox should be the same. We'll all work under the same set of rules trying to achieve the same goals. Then I think, nationally, we'll start to really put something together and improve. We should not have a strong addiction program in Alberta, for example, because they happen to be a little richer than some of the other provinces.

Everybody in this country should get the same level and quality of addiction care, no matter where they are. To me, it is extremely important.

The Chair: Do either of the other gentlemen want to answer?

Mr. Ernie How: The area I would identify where the federal government should be involved is in the research component of it, not only researching drugs the addicts are using, but also researching best practices. You get my point.

The Chair: Blair.

¸ (1445)

Mr. Blair Buchholz: I had the honour of going down to Ottawa for the workshop on best practices on youth and substance abuse, and I found that to be a really helpful experience. I think we need more efforts in that area to support the rest of the country in terms of what Ernie mentioned, just the research and getting people together to work together.

There's no real governing kind of agency over practices, as Bill has indicated. So there is no real standard set across the country in terms of those kinds of things.

Probably the most confusing part for me, at times, is working with our people of aboriginal ancestry, and jurisdictional issues in terms of who's providing what service would probably be the most poignant issue to me in terms of providing services in the province.

As I say, there are probably four first nations adult treatment programs in the province--I'm not sure of the exact number, but quite a few--yet there are none for youth. Sometimes whether a youth has status or is non-status, there is such a variance in what's available to them. There are a lot of youth who have relocated to the urban settings and aren't on reserves, so they might not have the same privileges or they don't have the connection with medical services branch and the ability to access services in a timely way. They kind of fall between the lines in some ways.

I think if the provinces and the federal government were able to sit down and look at who is actually going to be responsible.... I know that's there, but it sometimes gets lost, and I think there is a group of people who aren't getting what they need because there is crossfire on jurisdiction.

The Chair: Ms. Skelton.

Ms. Carol Skelton: Just listening to you, somebody mentioned that we have Slim Thorpe and Calder Centre. How many centres do we have in Saskatchewan?

Mr. Bill Logue: In-patient treatment centres?

Ms. Carol Skelton: Can you name the different ones and how many in each level, how many detox?

Mr. Bill Logue: For detox, there is Larson House; there is Angus Campbell in Moose Jaw; Slim Thorpe has the four-bed unit--

Ms. Carol Skelton: How many beds are there, for each?

Mr. Bill Logue: Beds for each?

Ms. Carol Skelton: So how many detox beds do we have?

Mr. Bill Logue: Okay, this is roughly. I know Slim Thorpe has four. Larson House has 18. I believe Angus Campbell has 20, and I think Regina has 24. Then there is a two-bed unit in Kipling, and possibly a two-bed unit now in Battleford.

Mr. Blair Buchholz: It's not running.

Mr. Bill Logue: It's not running yet.

Mr. Blair Buchholz: There are also MACSI facilities within the province--

Mr. Bill Logue: Oh, right.

Mr. Blair Buchholz: --and NAC in Regina, who provide services as well.

In terms of adult treatment, I believe Slim Thorpe does some of that, bed-wise, as well. There is Pine Lodge, an adult program there, and then there's the Calder Centre as well.

I'm not sure of the exact number of beds that first nations organizations have. The provincial government has that information.

Ms. Carol Skelton: And you have 12 youth beds for the whole province of Saskatchewan?

Mr. Blair Buchholz: Yes. The different detox centres will take youth under the age of 18, some under the age of 16--the odd person, the odd time--but it's not a very good fit. They're quite vulnerable kids, and there's not a heavy amount of structure in those facilities.

So for age 16 and over, Angus Campbell in Moose Jaw will take youth, some at a time, but there's definitely difficulty getting detoxification or immediate access to service for a youth needing stabilization. We take kids who have detox issues, but we're a treatment program and we don't just respond to kind of a drop-off situation.

Ms. Carol Skelton: Mr. How, I understand you're using the Battleford mental health facility, the old hospital grounds.

Mr. Ernie How: We're located with the short-term mental health facility. It's in the Union Hospital.

Ms. Carol Skelton: Oh, it's in the Union Hospital.

Mr. Ernie How: Yes.

Ms. Carol Skelton: So you're using extra beds or extra area that was in the Union Hospital.

Mr. Ernie How: Yes.

Ms. Carol Skelton: With the reduction of the health districts and everything, is this going to cause another problem with Saskatchewan, with the redistribution again with the health districts, and is it going to cause you problems working your whole areas through? I know when the health districts changed from SADAC--

Mr. Bill Logue For Larson House, this won't make an impact, because since our inception we've always been a provincial service.

¸ (1450)

Ms. Carol Skelton: Okay. So it's not going to cause problems. The whole area of treatment will stay the same across the province. Is that right?

Mr. Bill Logue: Yes. Our mandate has always been the Saskatoon area, and the rest of the province as room is available.

Ms. Carol Skelton: It's not going to cause a problem, then.

Mr. Ernie How: We're not anticipating a whole lot of change in how we deliver services.

Ms. Carol Skelton: Basically, the province is all on the same wavelength all the way across, all your treatment programs and everything. Your standards are the same in each centre and you all work together. Is that so?

Mr. Bill Logue: I know each detox will have its own policies and procedures. I mean, we'll operate roughly the same way--

Ms. Carol Skelton: But your standard would be the same all across the province.

Mr. Bill Logue: Pretty much the same, yes.

Mr. Blair Buchholz: At one point in time, and then through the decommissioning people do follow different kinds of policies in different areas. But I think meeting the challenges of the Saskatchewan model recovery services is something that I think is fairly widely accepted across the province. People try to follow those 12 clinical principles in general.

Ms. Carol Skelton: So if the federal government set standards, as Bill was talking about, you have the same standards right across the province. So if we said all of Canada has to be the same, then Saskatchewan would say “Well, we're all the same”. I mean, each health district isn't different.

Mr. Blair Buchholz: Well, you might get a different approach in one health district from another--hopefully not significantly--but they do operate autonomously in the different health districts. There's no central place that governs anything like that, or sets the standards. It's more an agreement that people have made as addictions workers. We have tried to keep together the provincial entity, the provincial working group. Right now the inner agency is meeting at the Park Town. There's a gathering of provincial addictions counsellors that are participating in a conference, so there is an informal set of structures that people try to abide by.

Ms. Carol Skelton: Our chair mentioned this morning that it's mandated in Ontario that each area has a needle exchange program.

The Chair: It's the delivery that's different.

Ms. Carol Skelton: Does North Battleford have a needle exchange program?

Mr. Ernie How: No, it doesn't. They're currently working toward it. I guess if all goes well it will be operating by the end of the year.

Mr. Bill Logue: Perhaps I may interject a little here.

At one time we did have SADAC provincially. With the devolution of the commission, what we lost was the central body. At one time in Saskatchewan, if a new program was coming online--let's say the methadone program--it would have been approved and set down by SADAC and the rules of how you get in and what they were going to do would have been set as a provincial standard.

Now, with the devolution of the commission of SADAC, what happens is each health district, if they're going to do it, does it on their own. This is where we have some confusion and this is where we've been running into difficulties, because with new programs, everybody will be off doing their own thing in their own way. We've lost that provincial cohesion.

But when you look at the way we generally operate, like the old CBOs such as Ryerson House, Calder Centre, North Battleford, that had been set up.... Yes, we try to follow the SMRSs that have been set down, but a lot of the new programs and that sort of thing have been started up and every health district kind of does their own thing. So we are running into a bit of confusion there, and it would be a lot simpler if we had a central body again that would set the provincial standard.

The Chair: Thank you, Ms. Skelton.

Mr. Ménard.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Madam Chair,

[English]

I'm going to speak in French.

[Translation]

I want to come back to the federal government's role, and ensure that I understand what you consider ideal. At this time, treatment is a provincial responsibility, and people in different provinces do not have access to the same range of insurable treatment. Obviously, there is a resource issue here. It would be much easier if the federal government were to restore transfer payments to the provinces, to ensure that provinces can deal with the demand for detox and related services.

If there were a national standard... First of all, the way that people see treatment is associated with a number of values. Some people believe in quitting cold turkey, while others believe in the 12-step model. Some people don't believe in methadone treatment. We have seen a wide variety of views. So far, we have visited seven or eight cities. The situation in Halifax seems significantly different from the situation in Hochelaga--Maisonneuve, my riding, or the situation in Saskatoon. Isn't the effort to come up with a centralized model something of an ideological trap? Should the federal government not simply be providing resources?

Those are my initial questions. After you have answered those, I would like to discuss some of the treatments you provide.

¸ (1455)

[English]

The Chair: Mr. Buchholz.

Mr. Blair Buchholz: I would agree with you myself. My personal opinion would be that the vehicle is federal transfer payments and that regional or provincial determination as to what's best.... There are very different types of issues in the north, in the east, and in the west. I do believe that should happen.

On the other hand, I do believe there should be accountability within the context of transfer payments to make sure that the basic services are provided and that those transfer payments are designated. If they're specifically for detox, then that's where they should go. I'm not sure what parameters you place on transfer payments, but I do believe that the Government of Saskatchewan should determine what's the best for people with that.

Also, within that, once again I'm going to go back to jurisdictional issues. With first nations I'm not really clear on all those issues, but I do believe there's separate funding available for those particular individuals. I agree with you in terms of the transfer payments.

You had wanted to know more details about the programs we offer. Was that the last part of the question you had?

Mr. Réal Ménard: No. I don't know if your colleague wants to add something.

[Translation]

I have a very specific question. You have already answered my question on funding.

Since this morning, there is one thing I have been trying to understand. People seem to be saying that in Saskatoon, the largest city in Saskatchewan—which has a fairly small percentage of Canada's population... Let us compare the current situation with the situation 10 years ago. I don't know whether you were already practicing 10 years ago. Can you give us some explanation as to why the number of people mainlining drugs in 2002 in Saskatoon is higher than it used to be?

I will give you an explanation for that. When a professor of Newfoundland's Memorial University appeared before committee members, he said that there was often a relationship between drug use and the lack of available recreational and sports equipment in a given community. Do you believe that this is applicable here? Does the city provide accessible sports equipment, arenas and basketball courts? What is the explanation for the figures we are seeing, in your opinion? How is the current situation different from the situation 10 years ago, let's say?

[English]

Mr. Bill Logue: Well, maybe I can answer your question.

I've been running a detox for the last 14 years--detoxification--and let's just get it that we're talking about national standards. For me and detoxification, my issues are a lot different from what these individuals have, because what happens is that when people are sick, they're sick, sir. They are suffering from the physical and psychological effects of alcohol and drugs, and they must be stabilized before any other thing occurs in dealing with these people. They must be brought back to a healthy standard so they can function.

Fourteen years ago I used to deal mainly with alcoholics and a person who would occasionally smoke pot. We would see a little Talwin and Ritalin. When we had the occasional morphine or heroine addict, a real one from Vancouver, we as addiction workers would all get together to have a look at this guy--and I kid you not, because that was really something--and we'd say “Wow! Look at that. Real, actual track marks.” We were all amazed.

This was the big-city issue of Vancouver. We were like the backwater. We were small-town Canada here in Saskatoon 14 years ago, but today we have big-city issues and the progression of more severe drug abuse has come to Saskatchewan. It's an issue that seems to be getting worse and worse.

This is what has happened in Saskatchewan. Why? I don't know if there's more money or if children don't have the resources they should have in order to play hockey and to do things. I get a great many young men, anywhere from 17 to 19 years old, who have no direction in their lives, who have nothing to do. They can't get employment. They can't get into the armed forces. So what do they do? Out of sheer boredom they seem to turn to other things. As you say, perhaps we must do more to try to provide the youth of this country with viable alternatives, rather than alcohol or drugs.

¹ (1500)

[Translation]

Mr. Réal Ménard: In Halifax, for example, there is a port and that entails particular circumstances. I know that Saskatchewan is first and foremost a Prairie province, and it doesn't have the features associated with ports. Do you have the impression that organized crime is making easier inroads into Saskatchewan that it was 10 years ago, or is it simply because you are in the Vancouver axis? That could be a reasonable hypothesis, since Vancouver is a hub of organized crime. In Canada, the largest quantities of cannabis are produced in Vancouver and Montreal, because both those cities have ports. Using the information available, are you at all tempted to draw a link between the current situation, and the presence of the Hells Angels and similar groups among the 35 criminal biker gangs in Canada?

[English]

Mr. Bill Logue: It's at the street level here in Saskatoon, and that has also increased. We know that there's more organized crime and there are more individuals who are using illegal means in order to get money to buy drugs.

In Saskatoon, right where Larson House is, we've continuously fought with the issue of prostitution. We do know prostitution is the major vehicle for any small-time drug dealer. If I want to get money, if I have to come up with $8,000 or $9,000 to buy myself a pound of heroin, I have two fast ways to do that. I can take a gun and rob a bank, but that's dangerous, or I can get hold of two or three girls, get them addicted and make them work the street for me. That's a really fast way to get the money, and that's what's going on.

[Translation]

Mr. Réal Ménard: Do I have any time left, Madam Chair?

The Chair: We have to give the witnesses a chance to answer.

Mr. Réal Ménard: Fine, we can do that.

[English]

Mr. Ernie How: I will go back to talking about the lack of resources.

In our service area there are 70,000 people and it's a two-and-a-half-hour drive to cross it. We're really spread out. We often have issues with Saskatoon, with some of the treatments they develop here. The government expects us just to move it over, and it doesn't work in our small communities.

The lack of things for kids and people to do in a community of 500 or 600 is a very big issue.

In terms of organized crime, we don't see a lot of it in the small communities, but what is happening is the dealers will travel to Saskatoon or Edmonton and bring it in from there. We don't have organized prostitution, as Saskatoon or some of the major centres do.

That makes a real mesh of chemicals that these people are using because it's almost a case of whoever can bring in the drug of choice this week. These are the problems that face us.

[Translation]

The Chair: A short question.

Mr. Réal Ménard: We know that people who take drugs do so for all kinds of personal reasons, and we cannot apply a single context or framework to them all. If, as legislators, we took the prohibition on drugs out of the Criminal Code, and made drug use less legal, with that in your view change the drug user profile or would it change nothing? Is there some relation between people's distress and the legislative framework? In your community, do you see some relation between the drug use profile and the current legislative system?

¹ (1505)

[English]

Mr. Blair Buchholz: I'll try to respond to that. I'm going to step back a little bit, because I didn't comment on the difference from ten years ago. When I worked in youth treatment ten years ago, the typical client was a middle- or upper-class Caucasian. We had very few first nations youth involved in treatment. That has totally flip-flopped. Right now we're at 65% first nations, and a very different economic level.

The whole issue around why this is different in Saskatoon from the way it was is that the whole demographic has changed. There's an urbanization, youth flocking to the city. I agree with Bill that one of the problems we have here is the manipulation of drug dealers and other predators working on vulnerable youth to get them involved in sexual exploitation and prostitution, however you want to frame that.

With that urbanization, there are major issues of change of culture--a lot of people are coming from small towns or from reserves--and also issues of poverty. Displaced people have a lot of issues. We have a lot of people in Saskatoon now who weren't there in those numbers ten years ago. It's at a critical point where the health care system, judicial system, social services, everybody is trying to adapt and trying to meet the needs of a very difficult group of people who have chosen to live in the city.

I just don't know if I can answer your question about the availability of the chemicals. I believe most of the individuals who are addicted and are using the IV drugs are people who are going to gravitate toward substance abuse in one way or another. In other words, they're multi-problem. It's not just an issue of one thing or another; there's a whole bunch of issues going on in their lives. There is symptomatic relief use, relief of symptoms to make their lives better. Like you say, there are different athletic programs available. A lot of them are underutilized.

We have difficulties with family norms and values in terms of what's okay for kids. There are a lot of kids in the streets just running around. So it's complex. There are economic issues, family issues, displacement, marginalization. It's very different from what it was 15 years ago here.

The Chair: Thank you.

Mr. Logue or Mr. How.

Mr. Ernie How: I don't believe changing the prohibition is going to make the problem go away by any means. An addict is always going to be an addict. For whatever reason, he's destined to travel that journey. Is taking the prohibition away going to just make it a more acceptable norm? Are we going to have more people just trying? A legal deterrent for young people is still a deterrent, because a lot of them have futures and look forward the future and they don't want to bugger their journey up. They are very conscious of their behaviour.

Mr. Bill Logue: On that, I guess I take a stronger point of view. I would like to see the laws tightened up. I would like to see individuals--not the poor little drug addict who's buying an eighth on the street corner or some poor soul who's horribly addicted to morphine and shoving a needle in his arm.... I don't want to see that guy doing 10 or 15 years in the pen. I want him to get help. I want to try to return him back to normality.

I would sure like to see the federal government put a lot more money and resources in the hands of the police so they can actively go after the major suppliers and the people who are bringing large amounts of drugs into this country. I would like to see those people pay such a high penalty that it will make them think twice before they would ever want to do that. I mean life sentences, because these people are destroying human lives. They're destroying our youth. They're starting a moral decay in the fabric of this country. If you look at history, most major nations did not fall because of invasion from without; it was moral decay from within.

I really think this is an issue. If we want to have a Canada 50, 75, or 200 years from now, this is something we have to take really strong action on, not turn our back on it and not try to be an ostrich and hide our head in a hole hoping it will go away. I think we have to take an active stance and really go after this and the people who are causing the problems. That's the way I feel. I don't know how much stronger I can point that out.

The Chair: Thank you very much.

Thank you very much, Mr. Ménard.

I'd like to pursue this one issue a little bit with you, Mr. Logue. In Atlantic Canada we heard that the drug of choice was not heroin but Dilaudid, which is a prescription drug. We've also heard a lot here about Ritalin and Talwin. They are drugs dispensed for medical purposes, which find their way into the black market.

In Atlantic Canada they suggested that one of the drawbacks of cracking down on the illegal use of prescription drugs would be that it would open up a market for heroin. If people have this need, for whatever reason, to intoxicate themselves or alter their state, they're going to find whatever is available. In that case, you're not really cracking down on a heroin dealer or a biker gang, you're cracking down on a doctor.

So let's say there's a bad doctor giving these drugs away. The challenge, of course, is that people who actually need the drugs sometimes can't get them, and that creates its own set of problems.

¹ (1510)

Mr. Bill Logue: Okay, but I believe that is simply an excuse. If I'm a medical doctor, somebody needs to be on Dilaudid, I write that prescription, and that person gets it, I have no problem with that. But sometimes family members steal those prescriptions. There's a multitude of ways these drugs get on the street, and there's no way you're going to be able to ensure that does not happen.

But if somebody has somebody else's prescription and they're selling it, they're obviously breaking the law. And if a doctor is writing copious numbers of prescriptions for Dilaudid or morphine, there should be a system in place to govern that doctor.

I can't see that being very stringent with prescription drugs is going to give the Hell's Angels a higher market for their morphine. They're selling all the morphine they can right now to whoever they can.

The Chair: Yes, but some of the people on the street working with that population have told us they believe cracking down on prescription drug use would create a demand. Somebody's always willing to meet that demand. At whatever price, no matter what the jail sentence, they will find someone to meet that demand because it's a risk opportunity. First of all, you never think you're going to get caught, and if you can make enough money you might even be willing to pay the consequences of getting caught.

Mr. Bill Logue: That may be so, but I still think if you have deterrents in place you're going to stop it. Simply putting your hands up, taking a laissez-faire attitude toward it, and saying “Well if it's prescription, that's okay” can't benefit society.

The Chair: I'm not suggesting to take a laissez-faire attitude. In fact, the Auditor General determined that at a federal level we spend 95% of all our money on reducing supply, but only 5% of our money on reducing demand--and that demand is insatiable. So if we never reduce that demand, we'll never get anywhere with interdiction and supply reduction. There will always be somebody, for whatever price, or there will be a new substance that people will steal, or do whatever, to get hold of.

They would argue not to worry so much about that other side, and really work on intense demand reduction strategies. Most of those are in the hands of the provinces right now, constitutionally, given they deliver health care and education, which are the two main vehicles for turning off demand.

Mr. Bill Logue: Right, but I look at the models in Europe--Denmark and Holland. They've taken a looser stand on the supply of drugs and narcotics in their countries, but look what's happened to them over the past twenty years.

The Chair: What?

Mr. Bill Logue: They've had a horrible problem. Drug use almost tripled in those countries. Now they're taking a harder stance on that.

The Chair: Most of them have just opened up access to drugs. Maybe you could get me whatever study you're citing.

Lastly, you mentioned that you wanted national standards, yet I found it interesting that you were talking about a specific kind of detox you were going to set up because it was relevant to your neighbourhood and the area you're working in.

¹ (1515)

Mr. Bill Logue: It is relevant to any neighbourhood that has a police department that is picking up alcoholics and drug addicts and putting them in a drunk tank.

The Chair: You're the first one to mention that kind of an innovative program, so obviously it might be that they've been moving ahead on something that's needed in other places. Some people would argue that local flexibility allows for more creative solutions.

Mr. Bill Logue: When I was talking, I didn't mean that there'd be stringent national controls that would dictate to every small town just exactly how they were going to do this or approach that problem. What I meant was that there'd be a national control thing: in this area we should have a detox, and the detox should be able to provide this type of service to the client. If you wanted that service delivery to be a certain way and if you wanted it to be specific to the needs of that individual community, that's fine, but whether towns of a certain size should have a detox or have these kinds of supports should be mandated nationally.

As to the individual delivery of that service, maybe I wasn't clear, but I didn't mean that it would be written in stone by the federal government for how you operate it, just that these types of services should be in place nationally.

The Chair: That's good.

Mr. LeBlanc.

Mr. Dominic LeBlanc (Beauséjour—Petitcodiac, Lib.): Thank you, Madam Chair.

Thank you all for your presentations and your answers to my colleagues' questions.

Mr. Ménard asked the question I wanted to ask about decriminalizing marijuana. He beat me to it, which is the advantage of being in the opposition.

Bill, you answered the question in terms of a much more aggressive approach and much more severe sentences for large-scale traffickers and organized crime networks, but I'm not sure if you answered the specific question about decriminalizing simple possession. You said that you don't think we should lock up an addict who's been picked up with marijuana so he does ten years in prison or something. I think there's a fairly broad consensus on that.

Do you think there's any value to decriminalizing? That doesn't mean legalizing; it would mean that a person who ends up in your facility doesn't also end up with a criminal record at the end of some judicial process for the possession or marijuana. I'd be interested, Bill, to hear your view on that specific question.

From the others on the panel who have experience in treatment programs--I wasn't on the trip where some of my colleagues went to Toronto and looked at the idea of a drug court, which has been set up in some other jurisdictions--do you think there's some value in mandated or coercive treatment? I think it was Ernie who said that some of the people he sees are there by some judicial order. From your experience in treatment, is there some value when an addict who is engaged in a pattern of criminal behaviour is told by a judge that he or she is going to go to prison for whatever criminal activity they were caught for? Or rather, is there value in a mandated three-month treatment or in an extended treatment period?

I think it was Bill who said the first step of the 12 is accepting that you need some help, and perhaps having the judge tell you that may not be as simple as realizing it yourself. How do you see that coercive treatment as part of the outcome of a judicial process? There were two questions in there.

Mr. Bill Logue: To answer the one on the simple possession of marijuana, I believe marijuana is a gateway drug. Almost every heroin addict I've ever met started by using marijuana. I think marijuana is an extremely dangerous drug, yet I don't want to see people go to jail for ten years for simple possession. No, I wouldn't want to see that.

I think there should be some vehicle in place that would hold the person responsible for their actions. Marijuana is an illegal substance in this country. It's started a lot of habits. Why would we be afraid to enforce the law?

If I have three drinks and I get in my car, are you going to charge me for impaired driving? Yes, you are, because that's the law in this country. So I do believe anybody who's possessing marijuana, as long as we want to say it's an illegal substance in this country, should at least have to pay a fine. I don't care if it's a slap on the hand or whatever, but it should not be condoned, that it's okay to have it. No, it's not okay to have; it's an illegal substance.

Now, if we want to decriminalize it, then make it a legal substance. Just say fine, you can go out in your back yard.... We can make beer and wine in our basements. If this is what the federal government wants, then just say fine, okay.

¹ (1520)

Mr. Dominic LeBlanc: But, Bill, be careful. First of all, I'm not sure that's what the federal government wants.

Something can be an illegal substance, the possession of which is not a criminal offence. You can have open beer on the back seat of your car and get charged, and not get a criminal record. That's an administrative offence.

I think you're right regarding legalizing it and saying the possession of it is not an offence. My own personal view is that wouldn't be helpful. But some people advocate--and my own mind isn't made up--that you can decriminalize. The fact is, in my province, New Brunswick, if you're caught hunting a moose illegally, the sentence or the punishment is much more severe than if you're caught with marijuana. Yet you get a criminal record for the marijuana and not for jacking a moose in New Brunswick.

Are you suggesting we maintain it as an illegal substance, without the criminal sanction--you said a slap on the wrist, a fine? Would that meet the same test, in your mind, as an actual criminal record?

Mr. Bill Logue: To be quite honest with you, I've never really pondered that. I do believe that marijuana is a dangerous substance. I know if I had a child on the street and somebody possessed marijuana and introduced my child to pot by giving him a roach or a joint, I'd be pretty choked up, because that person shouldn't have the right to do that.

Mr. Dominic LeBlanc: What about mandated treatment?

Mr. Bill Logue: I don't believe in it. The simple fact is if a person does not want to change, they can go into a treatment centre and they can walk the walk, but they won't talk the talk. That doesn't mean they have to accept anything. I've seen a lot of people put into treatment by probations and everything else, and sure, they go through it, but if they have no personal intention or they don't want to change, there's not going to be a change happening. There's no counsellor in the world I know of who can force anybody to do anything they really don't want to do or aren't motivated to do.

Mr. Ernie How: I'd like to take a run at that.

On this term “gateway drug”, I was talking to a student just a few days ago, and they had this classification that alcohol, cigarettes, and pot were gateway drugs. So it's okay to do a gateway drug, as long as you don't change. It had a totally different meaning to it.

That comes back to my earlier point, that the dissemination of the research that's going on, especially with marijuana now, isn't current and isn't keeping up with the changes.

Fifty percent of our clientele is legal services. In the last five or six years, I don't ever remember any one of those with a possession charge. So I'm wondering if that's even relevant in our day. The charges are just not being handed out.

We have some success with these mandated clients. At times they're frustrating, but there are successes. Also, in terms of mandated programs, the SGI program or the safe driving program is a mandated program. If you lose your licence, you have to do this. We've seen some very, very powerful and effective results coming out of that program. Drunks we see in the hospital, at times expecting to die, enter this program wanting their licence back, and it's changed their lives. It's been just phenomenal.

So when you talk about mandated treatment, there's one I think we're very pleased with, and provincially it's met its objectives. Also, on a counsellor level in a service area, it's been a very rewarding program to work in.

The Chair: What's SGI?

Mr. Ernie How: Saskatchewan government insurance.

The Chair: Mr. Buchholtz, would you like to comment?

Mr. Blair Buchholz: Sure.

I guess I would just echo Ernie's comments. I don't know that simple possession, in effect decriminalization, would have any impact, because from what I understand and see, there are not a lot of people charged with simple possession.

I could be wrong. It might be happening in other areas quite a bit. I know even in Vancouver recently, they'll go in and find a grow operation and just take it out, and not even charge the people for that. I suppose there are different approaches to it. If you are going to have it, use it; if you're not, then don't have it. That's what I would say, although I wouldn't want to endorse cannabis use.

In terms of the whole coercive thing, I work primarily in the youth area right now, and almost all of them are externally motivated, either through the court system or family or whatever the case. We rarely get kids who say “I want this, I really need it, and I've bottomed out”. I think in the youth end it does happen, and there are youths who recognize they have a problem, but most of them are contemplating and not really sure to what extent their problem is. Often it's in their probation order, or it's the legal thrust there.

I would say we've seen a lot of successes with people who are mandated to get a service. They get a chance to take a time out, do some thinking, maybe make some changes. With youth it doesn't mean they are going to be abstinent necessarily, but they will try a different plan and try some different strategies to improve their life. I think it can be of benefit.

I've also seen the other side of the overuse of the legal system. We have the highest incarceration rates in North America here in Saskatchewan for young offenders, and it has done nothing to help us. I think there is a balance there in terms of I see the opportunities to assist and help people to make changes through those interventions rather than just incarceration. If you don't have a program that helps to rehabilitate the individual, then you are just throwing money out the window. There will be bigger YO facilities. With the new YO Act there are some good changes happening, but once again, it comes back to funding.

A concrete example of that here in Saskatchewan would be the shift towards moving from the incarceration model to more of a community therapeutic model, and involving kids in more treatment-related activities, either outpatient or inpatient, whatever the case may be. Yet there is no money attached to that. Basically they are drawing on the therapeutic community, which is already stretched and wait-listed, to do still more of these activities through the new act, yet there is no money following. There was some short transition funding, but there are no programming dollars, and the people running the young offenders facilities aren't going to be closing beds because the demographics show them that they are going to need those beds.

Once again, people need to have a look at the whole system, and where the dollars are going to go, whether they're going to go to incarceration, or whether they're going to go to more of a therapeutic model.

Maybe I didn't answer your question, but....

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The Chair: Thank you very much.

Ms. Skelton.

Ms. Carol Skelton: I would like to know if we can get those numbers from the SGI program. Do you have them, or will you be able to forward them to us?

Mr. Ernie How: Like program results, the number of people?

Ms. Carol Skelton: Yes. The whole overview of that whole program.

I believe, Bill, that you were speaking about a mattress detox? Is that the correct name for it, that is what you were looking for in Saskatoon?

Mr. Bill Logue: Yes, that was a brief detox, or some people refer to it as a mattress detox.

The Chair: So those people would actually have a choice, go to jail, or come to you?

Mr. Bill Logue: Basically.

The Chair: So it's like a mandated program, then? That was the one you didn't support earlier? Not that I was detecting an inconsistency there, Mr. Logue. But maybe you meant treatment.

Ms. Carol Skelton: I want to go back to the crime thing, the gang issue and everything like that.

We were talking earlier this morning about the large cities. We have as much of a problem in our cities as the large cities do, do we not? Am I correct when I say that?

Mr. Bill Logue: That's correct.

Ms. Carol Skelton: What would you say, Blair?

Mr. Blair Buchholz: I would agree with that.

Ms. Carol Skelton: So we're basically seeing every aspect of drug usage in Saskatoon and Regina?

Mr. Bill Logue: Yes.

Ms. Carol Skelton: Are they coming in from the Hell's Angels? Are the gangs bringing them in? Where are they coming from--the coast? Do you have any ideas?

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Mr. Bill Logue: They're probably coming in from every avenue that's available. You'll have drugs coming in from the coast. Probably the west coast is one of the major areas where it comes through. It comes up through the States. A person who wants to make an illegal dollar, if they're in that business, they're going to do it any way. Whether it's the Hell's Angels or whether it's somebody who's in business for themselves, people are going to do what they have to do in order to bring it in. I think Saskatoon is vulnerable in the same way that any big city is.

Ms. Carol Skelton: Were you going to say something, Blair?

Mr. Blair Buchholz: No. I just have something that I can maybe bring up when Mr. LeBlanc comes back. I didn't answer his question. I had another point and it just struck me.

Ms. Carol Skelton: In your opinion, what is the most important thing the federal government could do to help you in your field? What would be the most important thing we could do to help you?

Mr. Ernie How: I would go back to research. Research the effects the drugs are having on people and also what's happening in our communities. Do some research, so that we can poll what's happening in Saskatoon, in Winnipeg, in North Battleford. Have that national database so it's consistent and ongoing. Then we can track trends. Maybe that information is there, but it's very fragmented and very hard to access. To me that would be probably the most important thing: to get that standardized, very consistent research, and research using the actual drugs that our youth are using, rather than some marijuana grown in a greenhouse that may not be representative of what's on the street.

The Chair: Mr. Logue.

Mr. Bill Logue: Probably the most important thing would be just being a major resource to the provinces, seeing that the money is there to continue developing programs and seeing that we can deliver them honestly to the people who need them the worst.

Mr. Blair Buchholz: Looking at the big picture and looking at the funding dollars where they are and whether resources need to be reallocated towards more prevention and therapeutic activities would be important.

I'm sure you folks are well aware of the social cost and the financial cost of addiction. It's a treatable illness, and I believe there's a lot we can do about it. Some of it can happen by trying to work harder and doing a better job, but I would suggest that investing resources in this area would save in the long term in terms of cost to the justice system, health--in all those areas.

I would encourage you to deliberate on the impact this issue has on the country and try to determine what the appropriate level of resources would be to assist people.

Ms. Carol Skelton: A question for each of you because you each are from a different facility. How long of a delay do you have getting people into let's say detox, each section? How often do you turn people away?

One thing that disturbed me this morning is I found out we only have 12 youth beds in Saskatchewan. That to me is a problem for our province. How often do you turn people away?

Mr. Bill Logue: Daily. As I say, we run at roughly 100% occupancy all the time. It's not uncommon some days that we'll turn away 25 or 26 requests for detox. As soon as we discharge clients, there are clients lined up for them. How we run over 100% occupancy is we hot-rack the beds. What happens is if I get six clients discharging in the morning, the staff will go up and do a discharge. They'll clean the bed and change the linen and do the room. What we call hot rack means the matress is still hot by the time the other client sits on the bed. That bed is actually counting two clients until midnight. That's what we mean by hot rack.

Ms. Carol Skelton That's how you got the 150%.

Mr. Bill Logue: Yes. It's every day.

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Mr. Ernie How: For our service, it's just an individual phoning in and wanting an appointment to see a counsellor. You're probably looking at three or four weeks for one at best.

For somebody who's in crisis we make an accommodation to see them, hopefully the same day and within one day at the most. We'll do that in no-show times, or if it means somebody has to work through lunch, it happens.

Ms. Carol Skelton: How many times do you have people in crisis? For example, do you have them every day?

Mr. Ernie How: I would say that daily you'd have somebody who needed something. Sometimes it just takes a telephone intervention, and sometimes you actually have to see somebody.

Ms. Carol Skelton: Blair?

Mr. Blair Buchholz: We have a wait list, but it's a seasonal thing. Typically, in summer there's a little less demand, but when the school season hits, usually right from October through till May or June, we have a wait list. That's anywhere from two weeks to four weeks, seven to ten clients. It's a treatment facility, and there is a wait list, certainly. We don't turn anybody away, but with kids there are windows of opportunity.

Ms. Carol Skelton: That is in the youth part?

Mr. Blair Buchholz: Right.

In the adult area there hasn't historically been a whole bunch of wait lists, but this year we've seen an increase in the adult end as well, where wey've had a wait list of a week or two, maybe three.

With kids it becomes problematic because of the window of opportunity. If it's not there and available to them at the time, they change their minds pretty quickly. Some people consider the wait lists to be problematic, but if you're looking at a treatment program with a two- to four-week wait list, a lot of people don't see that as a major problem.

Ms. Carol Skelton: Do you feel that having 12 youth beds in a province of the size of Saskatchewan is adequate?

Mr. Blair Buchholz: There are a few ways to look at this. A lot of good work happens in the community. We're looking at what is the right service at the right time? Overall, yes, we're under-resourced, and I mentioned the detox area. At the same time, we often get referrals where there's not really an appropriate fit for a client either. A lot can happen in the community, and assessment is the key issue.

There are lots of good, creative programs out in the community. People need to explore a lot of different options rather than just say beds, beds, beds. You have to take a lot of time and do a lot of research to establish what types of beds are necessary and where they're needed.

Ms. Carol Skelton: This question goes back to my roots in rural Saskatchewan. Are you finding a lot more clients from the rural areas, that is, farmers?

Mr. Bill Logue: Yes, we're getting a lot more individuals off the farm coming in for detox now than we ever used to before.

One thing is, we have to clarify the difference between beds--for example, in-patient beds. Detox beds are a lot different because we are dealing with people in crisis all the time. People who come to detox are in crisis. They're sick. They've lost manageability of their life, and they're frightened. They need help, and they need help now.

Our dynamics are a little different from in-patient or outpatient dynamics. If they have somebody in crisis at an outpatient clinic, evidently they try to get them in detox because that's where they need to be initially to start things going.

When we refuse people, what we do is tell them to keep calling back. We intake and discharge around the clock, and hopefully within a day or so we'll be able to discharge somebody after a three- or four-day stay. Hopefully, it will be sooner. We'll try to get them in as soon as we have a bed open up.

Ms. Carol Skelton: Thank you very much.

I want to go back to the rural question. Because of the agricultural problems we've had in Saskatchewan over the last two years or three years, I've noticed a de-population in the rural areas. Are you finding that's--

Mr. Bill Logue: Yes. We're getting a lot of farmers who do come to us requesting detox. We're getting a lot of interventions from rural addiction workers with farm families who are running into a great deal of trouble because of depression and because of vulnerability. We're getting a lot of middle-aged farmers coming in--they used to be higher-income--totally depressed and suicidal. Those numbers have gone up. We haven't kept specific numbers, but yes, we're seeing much more than we ever used to.

Ms. Carol Skelton: You don't have specific numbers on that?

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Mr. Bill Logue: No, we've never kept track of that.

The Chair: Mr. How.

Mr. Ernie How: The other thing that happens with detox in small rural communities is that there's detox going on in the local hospitals and it's not being labelled as such. I know in North Battleford there are probably two to three in there at any one time going through some form of detox, although the numbers are never tracked.

Ms. Carol Skelton: It's always been accepted, sort of.

Mr. Ernie How: Yes.

The Chair: Can you answer the rural question?

Mr. Ernie How: With our service, I can't say we've seen any different trends.

The Chair: Mr. Buchholz.

Mr. Blair Buchholz: I would say we're fairly evenly represented when I look at our referral sources across the province. If you look at the population, it's fairly equally distributed by population. That means we get them from all over.

The Chair: Mr. Ménard.

[Translation]

Mr. Réal Ménard: Thank you.

I also thought that 12 beds for young people is not very much, but just think—you're in the province, there was a Bolshevik government with social concerns, Madam Chair. Isn't the current Saskatchewan government in a coalition with the NDP? Am I mistaken about this?

The Chair: [Editor's Note: Inaudible]...is twice as large than in British Columbia.

Mr. Réal Ménard: In a more serious vein, I will ask two questions. First of all, you know that a Senate committee chaired by Pierre Claude Nolin has drafted a report of its consultations in which it is maintained that cannabis is not a gateway drug, a drug that leads to escalating use. Two scientific studies cited in the report indicate that cannabis may be a gateway to drug use, but there is no scientific theory proving that cannabis leads to escalating drug use. Using cannabis today does not mean you will be using heroin or other hard drugs tomorrow. As stakeholders in the field, you may receive a copy of the report.

In 1998, Parliament passed a bill establishing the Canadian Institutes of Health Research. Some 15 institutes were established under the bill. One of them, which is located in Montreal, focuses on addiction specifically. I think it would be a good idea to obtain some information on this. As the chair of course remembers, the Canadian Institutes of Health Research are not physical structures, or buildings, but rather networks of researchers across Canada. A great deal of research is underway on the types of addiction and dependence that become manifest, and the way in which dependency models are created. Seven or eight experts across Canada are working on these issues.

What's interesting to see is that the CIHR budget is increasing, and next year should reach $500 million. According to researchers, who always want more money, this may not be enough. However, significantly more money is being invested in research than we saw five years ago. I'm not here to defend or promote the government. As you know, Madam Chair, here on this side of the table, we must not lose sight of our role as critics, and we will continue to fulfil our role. I simply wanted to provide you with this information.

So there is an institute specializing in addiction. In fact, it specializes in addiction and mental health. I am more familiar with researchers in Toronto and Montreal, but I would not be surprised to hear that there are researchers on the west coast, in Saskatchewan, in Manitoba and in British Columbia working on these issues as well.

Those are the two comments I wished to make. I also have two questions. As a committee one important issue we will have to consider is decriminalization, along with the treatments that should be provided to communities. Obviously, treatments cannot be provided by the federal government. To ensure that I understand everything correctly, there is one point I would like you to clarify. You said that the profiles of people using your services have changed. One of the factors to which you attribute this is urbanization, where people leave the countryside and migrate to large cities like Saskatoon. You also stated—and I would like more details on this—that you did not consider the link with organized crime to be significant. You do not feel that organized crime has a more significant presence here than it did 10 years ago. Did I understand that correctly?

The Chair: Everyone in the group can contribute an answer, but this should perhaps be a question for the enforcement panel.

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Mr. Réal Ménard: We have to be multidisciplinary to some extent, Madam Chair. We should not classify people into rigid categories. If we were any more flexible than our chairperson, we would easily find employment with the Cirque du Soleil.

[English]

The Chair: If I could also add, for your benefit, in Alberta they were suggesting it was the Outlaws motorcycle gang, not the Hell's Angels. I'm not sure what the local colours are here, but it could be similar.

Would anyone like to respond?

Mr. Blair Buchholz: I have a few different questions, so I'll start at the beginning.

The Chair: Sure.

Mr. Blair Buchholz: With regard to marijuana and gateway drugs, I think it has more to do with the availability of drugs and the different norms where people hang around in groups. What other people are using often creates the availability.

I don't know what the actual research says. I think people seek different kinds of highs, as well. We see a lot of people who don't really care for pot. They're more into speed, Ritalin, and that kind of a buzz or high, rather than marijuana, opiates, depressives, and that kind of thing.

I would concur with you, although marijuana is a drug that's used and then people seek a bigger high, I don't necessarily think there's that much of a correlation, that I've read about, around the gateway thing.

I want to go to the MAST study. It was done in the States, but I think it's really important for people to understand why it was such a good study.

When you talk about the people who are researching, and spending a lot of time on research in terms of clinical modalities, the MAST study in the States looked at cognitive behavioural 12-step programs. It looked at all the different treatment modalities and how effective they were. At the end of the day, they found out they were all equally effective for the most part.

What mattered was identifying the state of change, the readiness for involvement, and the treatment they were matched to. It was the key factor. People became well through 12-step programs in cognitive behaviour no matter what different kinds of therapy there were. I think there were four or five different ones.

What really mattered goes back to your coercion thing. How ready are people? Are they better in an outpatient environment or in-patient environment? What's the best match for them in terms of service?

I think the money spent on research is great. There are a lot of breakthroughs in the neuro-psychology of addiction with different interventions and treatments. They're finding different kinds of medicines to help people with withdrawal management and to help them reduce cravings.

I think it needs to be continued. The technology in medical advancements is a place we need to look at in terms of helping and giving a multidisciplinary approach to treating the individual.

Here, the Apollos, in Regina, and the Rebels are the bike gangs. I think they're associated with the Hell's Angels, who are now here formally. I think there's definitely a link. The Indian Posse, as we understand it, and the Warriors are two factions or groups that we see within the first nations group, primarily with the young. There are smaller gangs, like the West Side gang and others.

Certainly gangs and organized crime are factors in terms of feeding drugs for addiction and encouraging property crime, prostitution, and other larger crimes to keep everyone's addictions alive. There's definitely, I think, a relationship there.

The Chair: Thank you.

Mr. How.

Mr. Ernie How: I have a comment on gateway drugs and marijuana. If it's marijuana, sniffing, or whatever they're starting to do, the process or activity is normalizing the use of a mood-altering substance to make you feel better. Rather than dealing with the issues facing you as a youth, or at any age, any time we engage in that kind of use, we're not learning to deal with life in a positive way, whether it's marijuana, speed, or whatever. Marijuana is as much a culprit as any of the others and has become very socially acceptable.

In North Battleford, on the link with organized crime, although it's Hell's Angels territory we don't see them there that often. But our major drug dealers have been around for a while. The main one in town has been dealing since I was 18 years old, and he's still dealing and running some prostitutes. In talking to his clientele or his people, they're going to Edmonton or Saskatoon and buying from the Hell's Angels, or sometimes the Asian gangs. So although our small community may not be directly affected, it is very much impacted by the Hell's Angels and organized crime.

In the smaller native-based communities, it's the native organizations, such as Indian Posse and Manitoba Warriors. The Warriors are very well organized in the communities in which they work.

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The Chair: Thank you.

Mr. Logue.

Mr. Bill Logue: Just on my experience with marijuana, I deal with people on a daily basis who come into Larson House and have used marijuana and continue to use marijuana. They have stated to me on many occasions that it was one of the things they initially started with. After using that drug, they wanted to move up to using another drug, or experimenting.

I can't bring down a big $3 million paper and say this proves that, but I know the clients I work with, and a large number of them have run into a great deal of trouble in their lives through the use of marijuana, and then graduating to other drugs. I still find it to be a very dangerous drug, and the more accessible it is, the greater our problems will be.

The Chair: Just as a corollary to that, they report marijuana as opposed to alcohol.

Mr. Bill Logue: Most people today who come in use both alcohol and marijuana. That's the norm.

The Chair: Mr. Ménard.

[Translation]

Mr. Réal Ménard: Thank you. I find that we make a good team, Madam Chair. And we therefore benefit from working together.

What is the success rate of the treatment models you described earlier? If someone comes to you and shows a genuine willingness to get off drugs, and goes through all the different stages that you described, if the will is really there, would you say that the success rate was eight out of ten, seven out of ten, or six out of ten? What sort of figures do you have available?

[English]

The Chair: Mr. Logue.

Mr. Bill Logue: In detox, if they walk out the door alive after seven days, that's basically a success rate in detoxification, believe it or not. I've had a client in as many as 63 times, and on the 64th time he made it. So when you run a detox, it's not how many times the person comes in; it's being there for them when they need you, so you can provide them with the human self-esteem, self-worth, and support they need.

Somebody might come in one time, get an introduction in a day, and never look back. That's a success. Somebody might come in eight times and then make it. Somebody might come in nine times and make it. But we don't keep a record that says this guy came in this one time and he's sober today. We don't have anything like that, where we can give you a perfect mark as our success rate. I don't think anybody really truly can in addictions. The one thing I tell my staff in detox is if people leave here alive, it's a victory.

The Chair: How many people don't make it out?

Mr. Bill Logue: We haven't lost anybody there yet.

The Chair: Okay, just checking.

Mr. Ernie How: In our service, we've been looking at that. We haven't done any outcomes yet, because what is success? If somebody comes out and doesn't drink, is that success? If somebody comes out and drinks five beers a day instead of ten, is that success? We don't know.

So we've initiated a performance indicator. Every time a client is seen in our service, they fill out a little questionnaire. We ask about their social life and their personal relationships. We measure those things to try to determine at what point we have the biggest impact on that client's life. Then we try to gear our services that way. That's measurable and achievable, while monitoring outcomes is very difficult.

The Chair: Mr. Buchholz.

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Mr. Blair Buchholz: I think the old benchmark used to be abstinence, so if they stayed chemically free, then.... People used to try to determine what success rates were for different programs based on abstinence, but I don't think that's commonly acceptable now. It's more around global assessment of functioning or quality of life indicators. Certainly you look at reduced use and abstinence as being positive indicators, but if a person has decreased their criminal activity, decreased anti-social types of behaviour, decreased their use, increased family relationships, personal relationships, their ability to function in society, those are certainly good indicators.

We're doing a research project right now in our program that's measuring use as well, because it's important to see if we're actually helping to curb use, for sure, but also looking at the quality of life indicators to see if people are healthier, feeling better and doing well. We also have program completion rates that basically only tell us that the person's been there for a period of time and has made it through the program. But those are also important for us to see trends in terms of whether we're meeting the needs of the client and how we're doing that.

[Translation]

Mr. Réal Ménard: Do I have any time left?

The Chair: Yes.

Mr. Réal Ménard: I do so much enjoy working with you, Madam Chair. You are extremely generous. If only you could chair other committees in addition to this one.

You have probably heard about the three phases of the Canadian Strategy on HIV/Aids, which were implemented between 1989 and 1993, 1993 and 1993 and 1997, and 1997 to the present. The strategy, initially established by the Conservatives, had its funding renewed, with $49 million invested every four years. Is there any link between the various federal stakeholders involved in implementing the strategy? The strategy focuses on five areas: research, documentation, treatment, aboriginal people and cooperation among communities. Given the fact that the link between injectable drug use and AIDS is frequently somewhat tenuous, what are your views on the strategy?

[English]

The Chair: Mr. Logue.

Mr. Bill Logue: I have no information on that whatsoever.

The Chair: Mr. How.

Mr. Ernie How: There was a strategy in our community. There are a couple of workers who work with the AIDS issue in terms of prevention and awareness. In the Battlefords we are in the initial stages of the needle exchange. The methadone program is on the table for discussion, so we are just starting to address that aspect.

The Battlefords Tribal Council, which operates out of the Battlefords, has a worker who does a lot of prevention work, awareness work around the AIDS program. But I couldn't specifically set out the federal program, no.

The Chair: Mr. Buchholz.

Mr. Blair Buchholz: Not formally in terms of the federal program. I sat on a provincial committee of people from across the province who looked at blood-borne pathogens, HIV. We made a report to the chief medical officer in Saskatchewan, so I'm aware of some different programs that are going on through first nations' organizations and locally that way, methadone maintenance programs. I'm aware of some serendipity studies, those kinds of things that have happened. I just know it's a major problem. Certainly hepatitis C is one we see. AIDS is definitely one, but hepatitis C is very rampant in this area as well.

The Chair: Thank you, Mr. Ménard.

In terms of your residential care, especially of the youth outreach, do you work on hepatitis C or AIDS or any of those in terms of education about protecting yourself?

Mr. Blair Buchholz: Yes, we actually have public health come in to make some presentations to youth, so we do try to educate youth. We don't teach them how to use needles properly and those kinds of things. We don't go to that extreme, but we do--

The Chair: Condoms.

Mr. Blair Buchholz: Yes, they get all that information. We provide that, too.

We do service clients on methadone as well, so that's certainly something. There are methadone programs here in Saskatoon. We don't keep methadone on site. They go out to the pharmacies and get it, but if they're stabilized on methadone, we will provide a service to them as well.

The Chair: Thank you, Mr. LeBlanc.

You didn't want to do that survey for Mr. How, did you?

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Mr. Dominic LeBlanc: No, I'll leave that to you and Réal; there seems to be a good camaraderie here.

The Chair: It's a relationship survey all the MPs were nervous about.

Mr. Dominic LeBlanc: That's right. I resent the idea that you have to fill out some form about your personal relationships as somehow a measure of your integration into society. It's quite alarming.

I want to also add to what Réal said about the outstanding work you're doing here. Every time Réal begins by complimenting you.

I have one question. One of our colleagues who represents the downtown east side of Vancouver who has travelled with this committee to many of the hearings is advocating.... I don't want to speak for her. On a number of occasions she talks about her community's search for problems with injection drug use including safe injection sites and heroin maintenance programs.

All of you are involved at various levels in the treatment of addiction. We had some people this morning who felt that some of these harm reduction strategies in fact may be counterproductive.

I recognize that every community has different needs. In rural New Brunswick a safe injection site may not be as appropriate as in the downtown east side of Vancouver or other large urban centres. I wonder if you have any views on what message that might send if the federal government participated in a research project that involved a safe injection site and a heroin maintenance program.

The Chair: Mr. How.

Mr. Ernie How: I think it comes back again to it's normalizing the use, it's acceptable. Hey, it's okay to go and do this. I believe that's the message the general population gets, especially the youth and the susceptible people.

In terms of what needs to happen in Vancouver, that's so different from here. I've read some of the research and some of the literature on that, and it comes from both ways. Personally, I'm not sure where I would take a stand on it. I know in the city of North Battleford, no, it wouldn't go.

Mr. Dominic LeBlanc: It wouldn't go for what reason, because of public acceptance, or because it would have no research value or it may not be needed?

Mr. Ernie How: Yes, it most likely isn't needed, but also on what type of evidence-based research or decision-making are you putting that in? And the public's acceptance would be very up against it too, very much so.

Mr. Dominic LeBlanc: How would your community react to people in Vancouver saying that in their communitythey need a safe injection site and a heroin maintenance program?

Mr. Ernie How: Other than it is.... Hey, it's okay for them to have it. We're talking about the people who are susceptible to travel that journey, not the general population. The general population would say why are we doing this, giving them more drugs, making it easier for them? It sends the wrong message to people who are susceptible to doing that.

The Chair: Mr. Buchholz.

Mr. Blair Buchholz: I find the prospect a little frightening, but the realities are very different in downtown Saskatoon, where a lot of this is going on in Vancouver, and in these areas. So I think one needs to separate addictions treatment or chemical dependency treatment from certain elements of harm reduction on the opposite end. That's where a lot of problems come into play in terms of territories and people's ideas and issues.

Personally, if it's well researched and it's shown to reduce disease and save people's lives.... I know there are other places, in Britain and across Europe, that are doing similar things. I'm not sure what their results are. I'm not sure if it's been a helpful thing or if it's something that's being utilized. For my part, if it's done through public health or done in other areas, in outreach and those kinds of things, that's fine, but when you associate it with addictions treatment, it becomes a different kind of entity. Addictions treatment tries to help people curb and reduce their use rather than maintain a level of use in a safe way.

The harm reduction debate is alive and well in Saskatchewan. I'm not saying there's no place for it; I'm just not sure exactly where it needs to be located and with which service. Certainly there are a lot of people out there spreading disease and dying, and something needs to be happening about that as well.

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The Chair: Thank you.

Mr. Logue.

Mr. Bill Logue: Before being able to comment on that I would have a need to know what the criteria are for the safe shooting site. Does it mean anybody who wants to come in can come in and say “I want a shot of morphine” and they will simply give it to him, or is it for people who are chronic, habitual morphine addicts, who have a long history, who are individuals at risk, or who may be carrying the HIV or AIDS virus, and can come in and get their morphine and the needle disposed of properly? What would be the criteria of that program?

I would hate to see, or I could not support, any program where an 18-year-old could simply walk in wanting to try morphine and say “Give me a shot. Let me know what it's like.” I'd have a really big problem with that.

I guess if it were a program that was dealing with chronically, habitually addicted individuals--people who have tried absolutely every recourse to control their lives and have no other options open to them--and it is the last resort in trying to control infectious disease, and they meet specific, very tight, very controlled criteria to get in to get that service, I guess in that situation I could maybe support it. But if it were simply for an individual to come in off the street for no reason, to get shot up, to have a nurse show him how to use a rig, I would really have a problem with it. It would depend what it would be about.

Mr. Dominic LeBlanc: I think your point is well taken. I don't think it was meant to be like a drug buffet or some smorgasbord where you show up and can simply be introduced to different drugs. As I understand the advocates for it, they are saying it is for the hard-core addicts who have perhaps been using for many years. It's unclear. While some people suggest a safe shooting site would not involve heroin maintenance and you would have to bring your own drugs to the site, others go a step further and say that a heroin maintenance program, for example, would allow these people to be given--I suppose by some prescription form--drugs at the safe injection site.

Mr. Bill Logue: Again, I would have to see the criteria for the program. If it were stringently controlled, and again, if it were to improve the quality of life of an individual, depending on the criteria, again, it would be something I would have to--

Mr. Dominic LeBlanc: From your experience, you wouldn't be ideologically opposed to some experiment under those certain conditions?

Mr. Bill Logue: Under certain conditions, as long as it wasn't free entry for anybody off the street, or an opportunity for somebody to experiment, I would look at it.

Mr. Dominic LeBlanc: Thank you.

The Chair: Thank you.

I have a couple of questions for you. Before I ask my question, did you want to answer another question earlier?

Mr. Blair Buchholz: That was for Mr. LeBlanc. You were gone out of the room, and--

The Chair: We have a policy of not reporting when somebody is here or not here.

Mr. Blair Buchholz: Okay, but you had mentioned a question. If I could just respond, something came to mind shortly after you left. You had talked about the drug courts and that initiative, and I just wanted to draw attention to a couple of things that are going on in the city along those lines. One of the things is circle courts. There's a new initiative in the justice circles. It involves therapeutic service providers, mental health, addictions, outreach workers; it's more of a circle court, where the youth would come to court, and there are elders and helpers or providers there to move towards a therapeutic plan, as opposed to incarceration. That's one of the innovations that's going on and meeting with some success.

There is another one called Operation Help, and it's geared to a slightly higher age group, perhaps 16 to 18 and into the 20s, for people involved in prostitution. It works in conjunction with the vice squad, helping providers, outreach workers, elders. When the vice go out, individuals who would normally be arrested and incarcerated have an opportunity to go to a circle and receive help from the therapeutic community or elders. They do that voluntarily, and if they choose not to, they will have due process. It's an alternative to just throwing people into the status quo justice system.

I did want to let you know that there are some variations on the drug court that are more focused on voluntary therapeutic involvement.

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The Chair: Thank you. That actually does fit nicely into what I was going to ask you.

Certainly we've heard about the distress of people in different parts of this country who are working on treatment. People end their treatment and they're going back to the very same life they had. They leave detox and they don't get into any kind of treatment program.

It's stressful to watch people not have the integrated services afterwards and the support they need. Is Saskatchewan doing a better job? Are you doing a better job in some of the smaller communities, perhaps? Is there a linkage between the health services and the social services so that people are getting that safety net to make some changes in their lives? Are there any programs? The circle court or Operation Help might be helping to coordinate some of those services, but does more need to be done? Is that something we should set up as a best practice?

Mr. Blair Buchholz: I think more needs to be done. There are certainly a lot of initiatives going on there. Especially in the youth area, there's more fragmentation in terms of service providers. There are a number of different innovations I could draw on, some really good partnership projects that are going on. There are some successes there, but I think overall there's still a lot further to go in terms of people working together and providing continuity of care when a person leaves service.

In addiction services, we know recovery occurs in the community and in-patient treatment is just a little sliver of time in a person's life, so the whole model is set up around community referral and having an addictions counsellor in the community and coordinating the care afterwards.

I'll talk about the youth a little bit. The youth we deal with are multi-problem. We have a lot of kids who have severe FAS or FAE. They have behavioural disorders and some of them have psychiatric disorders. They're multi-problem youth. We're working towards it, but we don't have the really good integrated case planning and the resources to deal with those really difficult kids as we would like. It's stretching every different service. So there are a lot of challenges out there for us.

It's frustrating at times being an in-patient treatment service provider, making recommendations and not seeing them happen. We'll get a read on a kid and maybe do some psychological assessment, and we'll have a fairly good sense of what the youth might need in the community, but we have no way of reinforcing that it continues or it happens because we're not part of the rest of the therapeutic community out in the community. We work closely with them, but it's a big province and there are all kinds of different things going on.

People would say they're taxed or stressed that they don't have the resources to incorporate long-term therapeutic care in terms of therapy for sexual traumatization or many of these things. Those services just aren't available in rural Saskatchewan in the way they need to be.

The Chair: Mr. How.

Mr. Ernie How: In our community, our linkage with mental health has gone a long way to that. In the last couple of years we've worked out a system where we have access to mental health files and they have come to us, and that's gone a long way.

We have an excellent working relationship with the tribal council, and that's very beneficial in the continuum of care after somebody has been with us or has come from a treatment centre. It very much falls back upon the individual community and service providers to reach out and develop this network for those people. But absolutely it should be part of the best practice standards; I think we're getting better at it, but we still have a long way to go.

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The Chair: Okay, thank you.

Mr. Logue.

Mr. Bill Logue: What's happening with us is that an awful lot more needs to be done. It's not uncommon that I'm discharging people after the end of their detoxification, say, to ADS and to no fixed address. They have no place to go. By the time they get into Larson House, I try to get hold of social services; and then they'll an appointment that is two weeks from the time I've talked to them, so that individual has no place to go. We've lost the Salvation Army men's group here in the city, which was a mainstay. I could at least get these fellows in there, and now it's gone. So a lot of times we're just discharging these people back to the streets.

The Chair: Where did the Salvation Army house go?

Mr. Bill Logue: The program's closed down.

The Chair: Was this because there wasn't a need, or because they couldn't deliver?

Mr. Bill Logue: I'm not sure. They never said. I'm sure there was a need. I don't know if the reason was financial, a change in their finances.

Mr. Blair Buchholz: I think the home itself needed drastic renovations to meet the fire code.

Mr. Bill Logue: I don't know about that. They spent two and a half million on it a few years ago.

The Chair: So, Mr. Logue, people come into your program, some in crisis, and they show up at your door and you hot-wire them or something.

Mr. Bill Logue: We get them into beds.

The Chair: You get them into beds and then they clear all the drugs out of their systems. How long are they there for?

Mr. Bill Logue: The mandated stay is anywhere from three to seven days.

The Chair: So at the end of seven days...?

Mr. Bill Logue: That all depends on physical condition. Let's say the person was using narcotics and his or her detox kicked in five days after the last use, which is not uncommon, then I'm going to keep that person longer.

The Chair: Then you can keep people until after--

Mr. Bill Logue: Yes. I'll keep some people longer than the mandated stay to make sure they are physically stable. But irrespective of that, it's normally three to seven days. After that time I'm going to try to make a referral.

If the person is from the Saskatoon Health District, I'm going to make sure he or she gets to ADS, Alcohol and Drug Services, in a sturdy stone building so he or she can get a clinical case manager. The clinical case manager will hopefully do an assessment to determine whether that person should go to inpatient or outpatient.

Unfortunately, a lot of the people I get are in such sheer distress--and they've lost everything, because I'm dealing with the sickest of the sick--by the time they come to us, they've probably lost most of their family supports and they have no place to go, so it's pretty tough. We have very minimal resources to get these people a place to stay, but we try to do our best.

You can't just go to see an emergency worker any more. You have to get an appointment, and that could be two or three weeks down the road. So some of these people are left to their own wits after they're done with us.

The Chair: In the summer, that might not be as much of a problem if I'm twenty years old and I'm going to be walking out the door.

Mr. Bill Logue: Okay, well, what happens at Larson House when it's cold and it's forty below, yes, we do drag our feet trying to make sure we have a warm and safe environment for that person to go to.

A lot of people don't realize this, but in the middle of the night we'll be full, with 18 people in the room, and it'll be three in the morning and somebody will knock at the door, inebriated. It's forty below and these people are scared and cold and have no place to go. So my staff start laying them down on the floor in the lobby. We don't admit them per se, but we keep them in a warm, safe environment so they won't freeze. Then when the morning comes we let them go.

The Chair: Now, are you participating in any of the homelessness initiatives? For instance, in my area people who are--

Mr. Bill Logue: We work closely with the crisis intervention programs, especially with homeless women. They will work toward trying to get these ladies into a safe environment. But with the homeless programs per se, officially it's no. We haven't been working with them. We've never even been approached by them.

The Chair: And do any of you have to get the judicial system involved in order to mandate or draw people together in terms of getting the services together? For instance, if you knew someone's only option was to go work in one of the hourly hotels, if they were the only places where the person could find warmth, is there a way for you to get such a person charged or into a circle court? Do you ever have to work with judicial partners to try to make sure that people are getting services?

Mr. Blair Buchholz: We have a partnership with the Department of Social Services. They actually access three of our beds for the street youth who are involved in IV drug use, so they have a quicker access point. They're pretty good at finding a resource. There are times when you'd want it to be better. But I don't think we've ever had anybody leave feeling as if they weren't going to get their needs met or be forced onto the street. So far they've been pretty good about finding them a decent place--with the youth anyhow.

With adults, there are always situations where people are feeling uncomfortable when the best option is maybe the YM-YWCA and they don't have much money in their pocket and it's going to be a while before they get any. Obviously the options become pretty slim for them, and they invariably choose to go back to what they know.

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The Chair: And sometimes they don't have that option any more because frankly their family, friends, or whoever, are sick of them--

Mr. Bill Buchholz: Yes.

Mr. Blair Buchholz: A lot of advocating happens with community case managers and workers, so I don't think anybody has come to the point where they've needed to call in any heavier authorities.

We find the department--at least with our group--has been pretty good at meeting their needs. But then it's a treatment situation where people's living situations are typically more stabilized than what Bill comes up against.

Mr. Bill Logue: When there's a welfare cheque at the beginning of the month, a lot of my clients will have it spent in two days. They've been drinking and then they'll be at my place. Then I can hold them for seven. They go to social services, but they have their allotment for the month. Then they have no resources. It's really hard to get these people in a safe environment for a period of time.

The Chair: Are there ways for social services to deliver the money on a quarterly basis or anything--a quarter of the month?

Mr. Bill Logue: I do believe some people can get on a program where they can get half.

The Chair: We also heard in Vancouver, actually, that some of the places took those welfare cheques right at the beginning of the month. Some of them actually supplied drugs during part of it, too, and that was part of the challenge for them. Is that an issue at all here? They were basically scum landlords we were hearing about.

No, not so much. That's where you have serious IV drug use and a whole lot of social problems, I guess.

You mentioned you'll treat people on methadone.

Mr. Blair Buchholz: If they're stabilized. Usually if they come in too quickly on methadone, newly introduced to it, there is a period of time when there is some incoherence and they're not really with it. So treatment programming is not that effective. Typically, people who are say stabilized medically on it can come in for treatment programming.

The Chair: Do you ever have to detoxify somebody who's also on methadone?

Mr. Bill Logue: We're in talks right now with our funder in that regard about possibly developing a program where we'd take somebody on methadone and then detoxify them off other drugs if they're abusing in conjunction with the methadone. At this point in time, we haven't come to a resolution on staff and resources or what we would need extra in order to take on this additional work. But we will take somebody who is on methadone, if they're down to 30 milligrams, and then take them off the rest.

The Chair: Mr. How, if people are on methadone programs and they've come home to North Battleford or something, can they continue to get services?

Mr. Ernie How: There is a pharmacist who will dispense. We don't have a doctor in North Battleford who will do the prescribing, so it has to come in. We are running into some real difficulties, in that corrections once in a while will refer someone into the community on methadone without the follow-up prescriptions. Also, we've had people coming into the interval house on methadone from other communities without the proper prescriptions. Until we can get a doctor on board, it's a real hole these people are falling through.

The Chair: The other thing we heard about in a couple of places, especially in Toronto and especially at the drug court, was some of the people--your client group--have a lot of problems. Sometimes they have physical problems--pain--that may have been part of the way they got started into the process of substance abuse. It really takes some creative ways to solve and manage their pain problems, without allowing them to continue into these incredible substance abuses.

Are there enough doctors in the province that you can work with who can figure out which drugs will work better or help people through that process? I know it's a bit of a problem in my province, and we heard about doctors who are supposed to have known that people are addicts and are still drawing up scrips for Percocet and Dilaudid and all these things, and you're thinking, whoa, did you notice they're an addict and that you might want to choose something else or work on other treatment types for pain management? Is that something that's advanced here in Saskatchewan?

Mr. Ernie How: I would say it is not advanced, not at all, and it's a real area that needs to be addressed. Addicts often complain about being put on substances they shouldn't be by their doctor. It goes back to the lack of awareness of physicians and nurses about addicts and implications that these medications have for them.

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Mr. Blair Buchholz: At Calder we host a provincial medicine advisory group and they've done some initiatives like establishing provincial protocol for withdrawal management and methadone and these kinds of things.

I know the issue has come up and is an issue they're looking at. We've taken some training in complementary care and there are a few things we do offer at Calder to try to educate people about it. But we've also treated people who have severe pain management issues and have other addiction-related issues where they've actually kept on with certain medications.

We had a gal with us not too long ago whose fingertips were dying due to IV drug use and she was in an extreme amount of pain. There was no other option but to have that treated with a narcotic, because she was going to lose her fingers. But she was still open to being treated. So you need to make some determinations.

With the physician who works with us, we feel quite comfortable in terms of being able to make that kind of a call. There is a lot of interest in it, but I think we concur with the rest of the folks that there's a long way to go.

We're doing some education of a doctor who has had some issues with over-prescription of narcotics, so he's coming to spend some time with us at Calder Centre for a few weeks, doing a bit of learning.

The Chair: So you're going to make him more aware of the--

Mr. Blair Buchholz: He's supposed to come and spend a couple of weeks to a month doing some education on addiction. Hopefully that will curb the practice of the prescribing. We'll see.

The Chair: Is that an informal process, or is the doctor actually charged?

Mr. Blair Buchholz:Yes, it is. I don't even know if I should talk about it. It's through a relationship with the College of Physicians and Surgeons and our association with different practitioners.

The Chair: That's great.

Mr. Logue.

Mr. Bill Logue: One thing in defence of the doctors, with a lot of people coming through addiction treatments and so on, when they go to their doctor and he says “I'll prescribe this drug, it will set you up again”, they don't bother telling their doctor that they're addicted or that they just came out of treatment. That's a major problem. I'm saying that just in defence of some doctors, because there are an awful lot of good ones.

I mean, we do know certain physicians in the city who are very interested in working with people with addictions and who are interested in working with people with addictions who are suffering chronic pain. They are willing to prescribe alternatives and that sort of thing. But they're few and far between and they're probably so overbooked that they're really tough to get to see.

We always suggest to our clients that when they're dealing with their doctor they should be perfectly up front and honest with them, telling them that they have been dealing with a substance abuse problem and make them aware.

I find most physicians, if they are aware, will certainly go out of their way to try to not prescribe anything addictive or look for a non-addictive alternative. Not all of them but most we've ever dealt with have been very supportive in that way.

If we could get some sort of a process established where we had a specialty clinic set up to deal with those specific issues, it would probably go a long way to helping a lot of people.

The Chair: In Toronto, it really did strike us as fascinating the number of ways in which these people had problems. One poor person was actually struck by a car on their way to treatment, broke their leg in so many places and it set them back so badly with all kinds of horrible family issues that any one thing would have been enough to knock all of us over. Yet this person had to deal with all of them, and in addition was trying to deal with a substance abuse problem. It was remarkable that they got up in the morning and kept going.

Mr. Bill Logue: It's not uncommon. We've had people who have been hurt in a worker's compensation accident a year and a half earlier, who have come to us chronically addicted to codeine and have to be taken off, and they're still on worker's compensation. It's quite an issue.

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The Chair: We need more education.

Mr. How, you mentioned that you're a coordinator with mental health services and that's helping.

Mr. Ernie How: Yes, it has really been beneficial to the clients. A large number of our referrals now come for people actually on the psychiatric ward, and we will see them the best we can and deliver the best service for them at that time.

It takes a lot of flexibility and also joint training, joint workshops and that. The mental health side participates with us, or we'll participate with them.

The central intake is beneficial, in that when somebody phones they're assessed to which area they need to be at initially, and if there's a multiple area, it occurs. Being under the one umbrella, we don't need releases of information to move information around between them, too. So it's working really well, and it seems to be really well accepted by the clients.

The Chair: Okay. Did anybody else have any other questions?

Ms. Carol Skelton: I just have one question. Do you have access to the CPIC system?

Mr. Ernie How: No. It depends how much money you have.

Ms. Carol Skelton: But you don't have access--don't say no too fast--in Saskatchewan.

I just wondered, do they list drug usage on the CPIC system, or would you know that?

Mr. Blair Buchholz: We do have the ability, not through CPIC but through health, to get a person's drug history if they voluntarily sign. So we can find out what prescription medication they've actually been on and any trends or issues with it, but in terms of criminal stuff, we are legislated to be able to see what they call the predisposition reports from young offenders and those kinds of things, but we don't have computer access to CPIC.

Ms. Carol Skelton: Okay. It was just a question.

The Chair: So you have a centralized data bank for all prescriptions in the province of Saskatchewan?

Mr. Blair Buchholz: Well, there's a triplicate program for narcotics.

The Chair: But those are for narcotics.

Mr. Blair Buchholz: Right, but you can go to health, and I think they can bring up records on what people have been using, in correspondence with their hospitalization number.

The Chair: Do you have a free drug program here?

Mr. Blair Buchholz: A what?

The Chair: Does everyone get their prescription drugs...?

Mr. Blair Buchholz: No, not free.

The Chair: Okay. So you have a triplicate program. They don't in some provinces, and that's part of the reason they have huge narcotic problems, perhaps--prescription narcotics.

So you have some information, if they give consent.

Mr. Blair Buchholz: Right.

The Chair: All right.

This committee is going to continue to do its work, and we're supposed to report in November 2002. It always makes Chantal and Marilyn nervous when I report that to everybody, but technically that's still our deadline. So if there are other studies, ideas, programs, or something that you think we should be looking at, we'd be happy to have you make that reference to us by contacting Carol Chafe, who is normally our clerk and who would make sure that it gets distributed to all of us in both official languages.

We really appreciate both the effort that you put into your presentation today and your spending the time with us, because I know you could be doing lots of other valuable things. We also really appreciate the work you're doing in the communities, and with the people you're working with. It makes a huge difference. We're very impressed by what you do and we wish you all the best of luck with your efforts.

I will adjourn this meeting.