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37th PARLIAMENT, 1st SESSION

Special Committee on Non-Medical Use of Drugs

EVIDENCE

CONTENTS

Thursday, August 29, 2002

0945

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

Mr. Michel Perron (President, Canadian Executive Council on Addictions; Chief Executive Officer, Canadian Centre on Substance Abuse)

Mr. John Borody (Chief Executive Officer, Addictions Foundation of Manitoba, Canadian Executive Council on Addictions)

The Chair

Mr. John Borody

0950

0955

Mr. Murray Finnerty (Chief Executive Officer, Alberta Alcohol and Drug Abuse Commission, Canadian Executive Council on Addictions)

1000

1005

1010

The Chair

1015

Mr. John Borody

Dr. Patrick Smith (Vice-President, Clinical Programs, Centre for Addiction and Mental Health, Canadian Excecutive Council on Addiction)

1020

Mr. Murray Finnerty

1025

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

Mr. Michel Perron

Mr. Réal Ménard

1030

Mr. Michel Perron

Mr. Murray Finnerty

Dr. Patrick Smith

1035

The Chair

Carole-Marie Allard (Laval East)

Mr. Michel Perron

Ms. Carole-Marie Allard

Mr. Michel Perron

Ms. Carole-Marie Allard

Mr. Michel Perron

Ms. Carole-Marie Allard

Mr. Michel Perron

Mr. Murray Finnerty

1040

Mr. John Borody

Dr. Patrick Smith

1045

The Chair

Mr. Michel Perron

Ms. Carole-Marie Allard

The Chair

Dr. Patrick Smith

1050

The Chair

Dr. Patrick Smith

Mr. Kevin Sorenson

Dr. Patrick Smith

1055

The Chair

Mr. Michel Perron

Mr. Murray Finnerty

Mr. Randy White

Mr. Murray Finnerty

Mr. Kevin Sorenson

The Chair

Dr. Patrick Smith

1100

Mr. Kevin Sorenson

Mr. John Borody

Mr. Michel Perron

1105

The Chair

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

Mr. Murray Finnerty

1110

Mr. Derek Lee

Dr. Patrick Smith

Mr. John Borody

1115

The Chair

Mr. Derek Lee

Mr. John Borody

Mr. Derek Lee

1120

The Chair

Mr. John Borody

Mr. Michel Perron

The Chair

Mr. Réal Ménard

1125

Mr. Réal Ménard

1130

Mr. Réal Ménard

Mr. Michel Perron

The Chair

Ms. Hedy Fry (Vancouver Centre, Lib.)

The Chair

Mr. John Borody

1135

The Chair

Mr. Murray Finnerty

The Chair

Mr. Michel Perron

The Chair

Mr. Michel Perron

The Chair

1140

Mr. Murray Finnerty

Mr. Michel Perron

The Chair

1145

The Chair

Mr. Randy White

Dr. Patrick Smith

Mr. Randy White

Mr. John Borody

Dr. Patrick Smith

Mr. Murray Finnerty

Mr. Randy White

1150

Mr. Murray Finnerty

The Chair

Mr. John Borody

Mr. Randy White

1155

The Chair

Mr. Michel Perron

The Chair

Ms. Carole-Marie Allard

The Chair

Mr. Michel Perron

Mr. Murray Finnerty

1200

Ms. Carole-Marie Allard

The Chair

Mr. Kevin Sorenson

Mr. Murray Finnerty

1205

Mr. Kevin Sorenson

Mr. Murray Finnerty

The Chair

Mr. Murray Finnerty

The Chair

Ms. Hedy Fry

Mr. Murray Finnerty

1210

Ms. Hedy Fry

The Chair

Mr. Michel Perron

The Chair

Mr. Derek Lee

The Chair

Mr. John Borody

1215

The Chair

1220

The Chair

Mr. Michel Perron

The Chair

CANADA

Special Committee on Non-Medical Use of Drugs

NUMBER 056

1st SESSION

37th PARLIAMENT

EVIDENCE

Thursday, August 29, 2002

[Recorded by Electronic Apparatus]

¿ (0945)

[English]

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

Good morning, everybody. This is the Special Committee on Non-Medical Use of Drugs, as I've said many times. We were struck in May 2001 to consider the factors underlying or relating to the non-medical use of drugs in Canada. As of April of this year we were also given the subject matter of a private member's bill related to marijuana.

We are pleased to have as our witness this morning the Canadian Executive Council on Addictions. Their representatives are Michel Perron, president of the council and chief executive officer of the Canadian Centre on Substance Abuse; John Borody, chief executive officer of the Addictions Foundation of Manitoba; Murray Finnerty, chief executive officer of the Alberta Alcohol and Drug Abuse Commission, which everybody knows as AADAC; and Patrick Smith, vice president of clinical programs at the Centre for Addiction and Mental Health.

Gentlemen, welcome. I think you have prepared a presentation for us, and then we'll have some time for questions and answers.

Michel.

Mr. Michel Perron (President, Canadian Executive Council on Addictions; Chief Executive Officer, Canadian Centre on Substance Abuse): Good morning. Thank you, Madam Chair and honourable members of Parliament. Thank you for the introduction.

I should mention that one of our other board directors, Mr. Dan Reist of the Kaiser Foundation in British Columbia, asked me to extend his sincere regrets that he was not able to join us here today.

I would also like at this point, Madam Chair, to thank the clerk of the committee, Ms. Carol Chafe, for her work in facilitating our participation here today and in having the documents we submitted translated. Her work is very much appreciated by us. Of course, it stands to reason, Madam Chair, that your efforts are also very much appreciated.

Members of the committee, it is indeed an honour for us to be here today. Very shortly I will turn the floor over to Mr. Borody and Mr. Finnerty, who will deliver our presentation.

We understand that this committee is in its final stretch. As you have travelled across Canada, the United States, and Europe, I'm certain that your thoughts and priorities are becoming all the clearer on what is required for Canada in the area of drug policy. We know you have heard from academics, government officials, police officers, NGOs, and a wide cross-section of concerned citizens. We are also fairly certain that among the numerous presentations you have received many were diametrically opposed to each other in their recommendations, yet each group was convinced they had it right. Of course, herein lies the challenge for your committee.

I believe, however, that our group represented here today can bring a unique perspective to this dialogue. We are here as members of the Canadian Executive Council on Addictions. My colleagues will introduce that organization in a moment. We are chief executive officers responsible for the remaining addiction organizations in Canada. Our views are focused on the macro drug policy issues required to effectively carry out our work, and we believe these issues are most relevant to your mandate. We hope our presentation and exchange afterwards will be helpful to you at this late stage in your deliberations.

I would now like to turn it over to Mr. John Borody.

Mr. John Borody (Chief Executive Officer, Addictions Foundation of Manitoba, Canadian Executive Council on Addictions): Good morning, and thanks to the committee for allowing us to speak to you this morning.

We are here today to speak on behalf of the Canadian Executive Council on Addictions about what we think is needed in Canada to achieve a greater level of coordination and collaboration in programming intended to prevent illicit drug abuse. When we talk about drugs, I want to ensure that we include alcohol as part of the presentation. Specifically, I will begin by providing you with an overview of the Canadian Executive Council on Addictions on current pressures facing the field of addictions in Canada and on our efforts to identify priorities required in a national drug strategy. Afterwards my colleague Murray Finnerty will highlight for you how provincial addiction agencies work and our view on how best we fit within a national drug strategy where the federal government leadership and investment is present and is needed.

The Canadian Executive Council on Addictions, CECA, was established earlier this year to provide a forum to influence national public policy related to addictions. Its membership is made up of senior executives of addiction agencies operating in Canada under a legislated federal or provincial mandate or recognized provincial authority as approved by the board of directors. Current membership is from B.C., Alberta, Manitoba, Ontario, and a nationally represented organization, CCSA. My colleagues and I are excited at the prospects of our new organization and how we can work together in this complex, emotionally and ideologically charged environment. Our appearance today marks our first formal joint presentation, and I can think of no better start than this one.

I will give some of the background. Like other health-related jurisdictions, addictions programs have experienced a great deal of change in the past five to ten years, and we now find ourselves at a crossroads. Although some of us have been in existence as distinct programs in provinces for some 50 years--and there I'd highlight AADAC and the AFM--changes over the past decade have left other organizations either unrecognizable to their founders or incorporated within the purview of other community-based programs. Some examples would be ARF in Ontario, which is now part of CAMH, and SADAC, which was a similar agency to the AFM and AADAC in Saskatchewan and is now buried into the regional health authorities.

The Chair: I wonder if when you use an acronym like ARF you could give us the full name.

Mr. John Borody: Yes. It's the Addictions Research Foundation.

The factors acting on the addictions field have been the same as those affecting other health and community service sectors. Rapid social and economic change, restructuring within government, provincial health care reform, budget reductions, and rising expectations for accountability have fragmented the addictions field, which has deeply affected both research and programming.

The addictions field is losing its profile within the context of health issues and on the political agenda. In the year 2000 the Liberal government committed itself in its red book three to a renewed national drug strategy. Unfortunately, we have not seen any further action on this front. In a brief to the provincial government of British Columbia the Kaiser Youth Foundation stated that addiction services “suffer from having avery low priority and profile, no clear provincial”--and in some cases, federal--“strategy, a lack of focus and leadership,inadequate consultation and coordination, inconsistent and unreliable funding, minusculeprevention efforts, and little or no research.” Our hope is that this committee will redress this most serious gap.

The impact of addiction problems in Canada has been well documented. More than one in five deaths and hundreds of thousands of hospitalizations a year result from use and abuse of substances. It was interesting to note this morning, when I listened to Canada A.M., that two of the stories in the news had drugs and/or alcohol as part of the story. You don't even have to go to some of the literature. All you have to do is watch recent newscasts. The cost to the economy is more than $18 billion a year, including more than $4 billion in direct health care costs. Not only do addictions affect the substance abuser, they have an effect on the abuser's immediate family and on the community. There is a general recognition in the addictions field that the landscape of addictions has changed since the creation of Canada's drug strategy in 1987, which, as you know, was not renewed in 1997.

The current climate incorporates debates on drug legalization and harm reduction approaches. Our clients have also become more complex. Increasingly, we are dealing with a community that is facing complications with mental health issues. Many of our younger clients are showing signs of fetal alcohol syndrome and fetal alcohol effect. We have had to incorporate new services to address public health concerns as a result of an increase in the number of our clients exhibiting HIV, and most of our injection-drug users have hepatitis C. As an example, in the case of the AFM, we recently did a survey of our clients. About 95% of our injection-drug users have hepatitis C.

Unlike the traditional model of viewing addictions as just a disease, we now see this affliction as being more of a bio-psycho-social phenomenon. Addiction issues are now being seen as tied to the country's economic prosperity, population health, and social cohesion.

How would we go about initiating a national dialogue? In the fall of 2000 CECA came into being when the heads of the Addictions Foundation of Manitoba, the Alberta Alcohol and Drug Abuse Commission, the Canadian Centre on Substance Abuse, and the Centre for Addictions and Mental Health commissioned a discussion paper to reflect the current literature and thinking on the status of addictions within the Canadian context. We recognized that it was incumbent upon us, as leaders in the field of addictions, to take on this role. The paper formed the basis for a meeting held in Winnipeg in December 2000. In February 2001 a report entitled “Towards a New National Focus and Drug Strategy: Synthesis of the December 5, 2000, Symposium” was prepared by the hosting agencies and circulated to the federal, provincial, and territorial governments. The document provided a synthesis of the day-long event in December 2000, which was attended by approximately 44 participants representing a wide range of stakeholders across Canada.

¿ (0950)

The objective of the symposium was to provide representatives of different departments within federal, provincial, and territorial governments and multi-sectoral agencies with a forum to assess the addictions environment, identify priority issues, and prescribe a course of proposed action. By all accounts, the event achieved its goal. There was a great deal of consensus on what the next steps were and how we should get there. I would like to underscore this point. The event in Winnipeg confirmed that there exists a very high level of consensus among professionals in this field on most of our major issues. We believe this is an area the committee can capitalize on. Specifically, there was agreement that what is missing is a national drug strategy, which is needed to assist provincial governments in the development of their goals within a constitutionally mandated responsibility.

Another key outcome of the symposium was the identification of guiding principles that should be incorporated into the development of such a national strategy. It was recommended that the guiding principles be based on a social perspective of “first, do no harm”, and then be further refined into macro and micro principles. In the macro arena, the strategy should be integrated, balanced, and sustainable. It needs to be meaningful and relevant. It needs to be multi-sectoral and comprehensive. It needs to support evidence-based practice and encourage and support innovation. It needs to reflect tolerance and respect, including the rights of individuals with drug-related problems. In more of a micro perspective on a national drug strategy, it needs to be inclusive of stakeholders. It needs to consider the full ramifications of interventions and strategies. It needs to include support for community capacity building approaches, it needs to focus on appropriate outcome measures, it needs to focus on and support maximizing innovative interventions, and it needs to focus on the harm caused by drugs rather than drug use.

At the conclusion of the symposium participants confirmed what was needed to move the drug strategy agenda forward. A political champion in the federal arena is needed. The strategy has to be built with national dialogue and stakeholder input. The commitment at the federal government level has to be clearly demonstrated in the budgetary process. A clear vision and strategic framework is required at the national level.

Finally, participants also said that a successful implementation of a national drug strategy will require community capacity building and a national buy-in by all Canadians, with ongoing federal support and commitment. This process needs to ensure broad collaboration and coordination at the federal, provincial, territorial, and municipal levels during the strategy's development and implementation.

Madam Chair, I can assure you that CECA is committed to supporting you and our governments in this regard.

I would now like Mr. Murray Finnerty to provide you with an overview of how provincial addiction agencies work.

Thank you.

¿ (0955)

Mr. Murray Finnerty (Chief Executive Officer, Alberta Alcohol and Drug Abuse Commission, Canadian Executive Council on Addictions): Thank you, John.

Good morning, Madam Chair and committee members.

I'll spend very little time on how provincial agencies work, and then give you our thoughts on particular measures we feel you might consider in your deliberations.

As John has noted, there are now few separate agencies coordinating addictions left in the provinces. The two prominent ones are the Alberta Alcohol and Drug Abuse Commission and the Addictions Foundation of Manitoba, which are still constituted as separate crown agencies to deliver services and to provide a focus on and coordinate the issue of addictions in our jurisdictions. However, every other province does have a similar central coordinating mechanism. A major one in Ontario, of course, is the Centre for Addictions and Mental Health. A number of other provinces, such as British Columbia, Yukon, and Quebec, have central agencies of a different form, but every province has a central mechanism of some kind, perhaps a secretariat in their health ministry, that attempts to give some focus to addiction in their provinces. I, of course, will speak somewhat more from the perspective of AADAC, the Alberta Alcohol and Drug Abuse Commission.

Most agencies in provinces report to their ministers of health, health and wellness, or whatever the specific title is. All of us are mandated to operate and fund services addressing alcohol and other drug problems and to conduct related research. Some of us have a collateral responsibility for gambling, but most of the focus is on alcohol and drugs.

How do we define our core businesses? Most of us, using similar terminology, focus on providing residents with current and accurate information about alcohol and drugs and informing them about our programs. All of us have prevention programs to varying degrees. We provide programs and services that are designed to prevent problems with alcohol, other drugs and in some cases, gambling, and to reduce the harm associated with substance abuse. Prevention strategies are intended to increase protective factors and reduce risk factors for the population as a whole and within specific target groups. All of us operate treatment facilities, either directly or by contracting out. It's a broad continuum of treatment services to assist adults, youth, and families to improve or to recover from the harmful effects of alcohol and other drugs.

How do we conduct our business? In most cases we pursue, at the provincial level, integration, collaboration, and innovation in providing leadership to ensure a coordinated system of programs with a single point of entry and service delivery at locations across the jurisdiction. Among the benefits of this coordinated approach is that it provides a greater degree of consistency in service delivery and economies of scale. As you know, addiction, by its nature, involves a wide range of interlinked issues, substances, and behaviours, such as poverty, crime, unemployment, mental health, and others. Stakeholders are equally diverse and include health, corrections, schools, social services, courts, police services, and so on.

What are the risks? With a wide range of autonomous stakeholders, addictions initiatives can easily be subjected to a stovepipe phenomenon, where various organizations deal independently with some aspects of addictions. This is one of our problems in Canada. When this happens, redundancies, missed opportunities, a lack of synergy, and gaps occur, perpetuating the current fragmentation of efforts. It's our view that we can achieve much through partnership and collaboration in the addictions field. Today we feel there's a new openness to change and advancement. In the globalized marketplace of this century, new alliances are being struck among organizations that have traditionally worked in isolation.

There are successful examples of initiatives that would never have happened if it were not for collaboration. One is our experience in Alberta with the recent major initiative in tobacco prevention and cessation, whereby government and non-government stakeholders worked to build a consensus, and then proceeded with planning and implementation. I'll return to tobacco in a moment, about how it could perhaps inspire a similar focus and investment for alcohol and illicit drugs in Canada.

À (1000)

How do we collaborate? A number of us are involved in various interprovincial initiatives: the Canadian Centre for Substance Abuse national working group on addiction policy, the Canadian Community Epidemiology Network on Drug Use, the Canadian Tobacco Control Research Institute, the organization you see in front of you today, and the Advisory Committee on Population Health working group on tobacco control.

As you are well aware, the 2001 Report of the Auditor General of Canada estimates that the economic cost of illicit drugs alone to Canadians exceeds $5 billion per year. As the report does not include losses due to the use of alcohol and tobacco, this is a very conservative projection. As mentioned earlier, in 1992 the Canadian Centre on Substance Abuse estimated the annual cost at $18 billion, with $4 billion in direct costs.

The Auditor General's Report summarized the need as follows. If Canada is to reduce the impact of illicit drugs, we will have to address weaknesses in leadership, coordination, information, and public reporting. It should be noted that these recommendations echo those John outlined at our December 2000 symposium of Canadian executives involved with addictions. It's clear from this history that change is needed on the part of the federal government in how they view addictions and their role in a national drug strategy.

Is this easier said than done? We have a good example we would like to propose. It's emerging that we have learned from our experience in our partnerships with tobacco, which involved collaborative relationships with provincial partners--western provincial partners in our case--and national partners. At the national level this is co-chaired by Health Canada. I think it's a good example we could look to for a successful model to collaborate nationally.

How does this national partnership in tobacco control work and how could it be a template for partnerships focusing on other substances? The forum, as I noted, is the Advisory Committee on Population Health working group on tobacco control. This group is based on an understanding that no one organization can take it upon itself to solve this complex societal issue. The working group provides a forum for collaboration between federal, provincial, and territorial governments on elements of the new direction for tobacco control in Canada. It develops and monitors progress on a work plan for joint action, it brings forward issues of importance and provides advice, which eventually get to the conference of deputy ministers of health, it integrates tobacco control within the broader population and public health agenda, and it facilitates continued collaboration with non-governmental organizations active in tobacco control.

It's based on the understanding that provincial and national partners need each other to make a positive difference. It's also based on the importance of speaking a similar language and ensuring that each partner is on side, or at least aware of the other partners' positions, and on each province having a part in rolling out a strategy. The group is co-chaired by representatives of the federal government and the provinces, with funding from Health Canada. The working group reports to the Advisory Committee on Population Health.

Madam Chair, I would urge your committee's consideration of this successful partnership and its potential application to the field of addictions.

As John indicated at the outset, CECA is a new organization. Nonetheless, our limited membership encompasses leaders in the field of addictions in Canada today. We came together because we recognized the importance of working in a true partnership where we learn from each other and support our collective needs.

À (1005)

This parliamentary committee on the non-medical use of drugs has a very important mandate. Indeed, the field of addictions in Canada is looking to you to serve as a catalyst for action and leadership from the federal government. As I am sure others have stated, Canada does not have a national drug strategy. We are the only G-8 country that does not have one. Since 1997 the federal government, in our opinion, has not capitalized on many opportunities to address this important social issue. It affects virtually all other government priorities, including children, youth, first nations, and employment. As John noted, it is on the news every day.

As CEOs, we know the value of constructive criticism. However, we appreciate all the more the value of proposed solutions. We seriously recognize that your committee has a very significant challenge as it develops its recommendations. We hope the following is useful to your deliberations.

We would recommend, as the Canadian Executive Council on Addictions, first, that the federal government demonstrate strong leadership by appointing a champion to lead the development of a new national drug strategy that will ensure a greater level of coordination, integration and synchronization of efforts. Second, the development of a comprehensive and integrated national drug strategy would enable the development and implementation of a national drug policy, where provincial governments would work with the federal government champion to ensure a strong and complementary implementation of the strategy. Third, we recommend that the federal government invest in the availability of good information on the prevalence of drug abuse, its impact on society, and best practices to support the development and implementation of a national drug strategy at the federal and provincial levels.

As part of a new national drug strategy, our council would like to further recommend that Health Canada's leadership role be reaffirmed, but it has to be in a revitalized manner, so that it is a revitalized national drug strategy. They need to be provided with the benefit of an explicit mandate and resources to carry this out.

We also recommend that all orders of government commit themselves to sustained investment and to facilitating the social change required to ensure a successful outcome; that Canada maintain a balance between supply and demand reduction strategies and move towards stronger integration of these efforts; that the federal government strengthen and capitalize on the valued and unique role of the Canadian Centre on Substance Abuse in the areas of research, dissemination of data and information through a national clearinghouse, and advising on development and implementation of a national drug strategy. The point we are making here is that you already have a centre with elements of the mandate that should be strengthened.

Madam Chair, Canada's drug problems are a critical and urgent matter. The collective knowledge and commitment of the organizations you see represented here today are definitely at your disposal. We sincerely hope we can move together quickly to address this most important health and security issue facing Canadians today.

À (1010)

The Chair: Thank you, Mr. Finnerty and Mr. Borody.

Mr. White.

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

Thanks to all four of you for coming here today. You are likely the last group of witnesses this committee will hear from. There may be others, but I think you're very close to the last. But you're not least, I can assure you. Some of the recommendations you put before this committee were actually very much in line with the way I am thinking, except for one, and I'll deal with that.

From time to time I remove young people from very serious situations, crack houses and so on. I move them from my province to other provinces to get them out of their area. I want to compliment AADAC and its affiliates for helping in that way. When there's an immediate need to remove somebody and place them somewhere, they don't say, they should be clean for three weeks before we take them and we want a resumé and some references. It's, yes, we understand that you need help, we'll make way. That's the way this kind of life has to work. So my compliments to you on that.

We had Health Canada here yesterday, and I stated my opinion very clearly. I'm not impressed in the least with the way they are coordinating things. There may be some good in what they're doing, but I just feel that far too much federal money is being blown away on various projects that don't necessarily reap satisfactory benefits. I could cite some but I don't think it's necessary. I could cite a lot of them. I'm sure you could, too.

One of the difficulties with a government department coordinating issues like this, as even Health Canada said yesterday, is that there are 11 other departments involved. One of my colleagues corrected them and said there were 14. It is difficult, if not impossible, I think, to get one department coordinating the others and saying, we're going to give you x number of dollars. Each department gets its money from a separate avenue, so to speak, in a budget. I would maintain that in order for an organization to do an effective cooperation, coordinating job in this country, it would have to get the federal dollars and look at how they are dispensed by way of achievements, goals, and successes more than by giving the departments more money and trying to figure out where it has gone. Even the departments can't tell us where the money is going.

I want to ask you two questions. I want to find out about this national coordinating agency and how you could see Health Canada coordinating it, as opposed to a separate agency within a department perhaps, a more autonomous agency, which would also be accommodated by a champion, I suppose. I'd like to know how you actually see that working in view of the fact that, quite frankly, these government departments aren't coordinated at all. One doesn't make the other one do things, it just says please. If they don't want to do it, they don't do it. That's my first question.

My second one is as follows. Most of us know that there are some serious problems. This committee is acutely aware of it, and you've profiled it. But it doesn't matter a darn what we write as a strategy. You can look at the 1988 and the 1994 strategies. I did that when I initially wrote the motion for the House of Commons. What prompted me to write the motion to initiate this was that I took out the Conservative national drug strategy document and the Liberal one, and lo and behold, they're both darn near the same, yet the problem is worse. So my point is that it doesn't matter what you write in a rhetorical document, it matters what happens at the street level. I want to know how the deliberations here will actually get down to helping that kid in a crack house to get out of there and into detox and short-term, intermediate, and long-term care.

So those are my two questions: how do we get this to the street, and are you absolutely certain that the coordinating agency should be Health Canada?

À (1015)

I want to know how the deliberations here actually will get down to helping that kid in a crack house to get out of there, get into detox, and get into short-term, intermediate, or long-term care.

There are two questions. How do we get this to the street? Are you absolutely certain that the coordinating agency should be Health Canada?

Mr. John Borody: I'll make an attempt at the first one. I want to give you just a preamble. I've worked for the federal government as a bureaucrat, I've worked for the Alberta government, the Saskatchewan government, and the Manitoba government, and I've also worked on the other side. I think I have a good understanding of how government works--or I can't hold down a job, one of the two. What I have found is that government and the ministers responsible for those departments have an accountability to the public to ensure that things are done. I think, when we're looking at a national coordinating role for Health Canada, that's what we mean. It doesn't necessarily mean the department within government has to do all the activities in the implementation or development.

The reason I say this is that I think one of the things we would probably tell you as agencies outside of government is that we can actually get things done because we are not tied to government. However, we do respect where our funding comes from. There is a very tight line and a very tight balance that we run every day. The other thing is that we are not dealing with agencies in the same way bureaucrats do. Bureaucrats have to make sure, as you know, every document that goes out has the i's dotted and the t's crossed. We don't need to do that. We are more action-oriented and more outcome-oriented. I think you will find that in an agency environment, when we make a determination that we need to get something done, we can usually act within days or weeks, not months.

We talked about a national coordination. I think we need a champion at the federal level. When we're talking about a champion, we're talking about an elected champion, somebody who'll actually stand up and say this is really important and who will sit on it and make sure things are happening. That would be the person who would work with Health Canada to devise the process we may want to follow. However, you may want to contract out that process to groups or a group that can actually make it happen.

So when we were talking about national coordination, I think we were recognizing that the accountability needs to be with the government, because they're the ones who have the responsibility to the public, they're the ones who are elected. However, let's recognize that they may not necessarily be the ones who need to do the dirty deed, that there are others who can work, and that therefore, government can be more of a controlling agency to make sure things are happening. Other groups can be out there, such as ourselves, the AFM, working with Health Canada. We see this as being more of a partnership arrangement, and maybe one individual or one group outside that actually would be doing a lot more of the work.

Dr. Patrick Smith (Vice-President, Clinical Programs, Centre for Addiction and Mental Health, Canadian Excecutive Council on Addiction): I will follow up on that, if I may.

I'll speak from the perspective of Ontario. We had an example of where the needs in addictions were not on a par with other health issues in Ontario, so the Ontario Substance Abuse Bureau was developed. At first, that meant a revitalization for the field of addictions. It meant investment carved out specifically for this population. It was a great thing when the Ontario Substance Abuse Bureau was separated out from the rest of health care, but also had a very distinct mandate. Twelve years later we found out that every time we went to the Ministry of Health about anything that had to with addictions, they'd already ticked their box of addictions: they'd developed the Ontario Substance Abuse Bureau. They didn't give it any renewed funding in 11 years, and what it ended up doing was marginalizing the addictions field, separating it out further from a broader health context.

When people have addictions, they don't just present to addiction agencies. We know they present to emergency rooms, to the police, and to all kinds of places. The only challenge with separating it out from that political accountability is that it can be marginalized, which gives the excuse for the health ministry to say, we've dealt with that, that's the Ontario Substance Abuse Bureau's problem. Again, there were 11 years of no increased funding, when the rest of health was getting increases. That is just one example. We would say, if that were to happen nationally to addictions, we would be in trouble.

Another example of what we're talking about in coordination is that we're calling for a champion, but also for the national drug strategy to very clearly articulate the role of the interdepartmental and inter-ministerial contributions to these issues, because it's not just health. We know that.

As for people in the field, Canada has an amazing group of experts who have the best practices, who are creating best practices around the world, and who are developing innovative ideas and programs. The Toronto drug treatment court is one example. Everyone we went to said that it was a great idea, but someone else should fund it. Is it crime prevention or is it treatment? It's not “or”, it's “and”. It is crime prevention and it is treatment. Finally, someone had to catch the ping-pong ball that was going back and forth by saying, okay, we'll try to fund this pilot. That's one good example of what very clearly calls for inter-ministerial support. It needs to be supported from where the money is going to be saved, from the criminal side, but it also is health and it is treatment. Health needs to be able to play a part.

We are still in our pilot, but it's one example of where even getting that off the ground was a challenge. If Canada's experts had to face barriers every time to implement on the ground the kinds of programs that are going to make a difference, just to find out because people are ping-ponging back and forth who is going to fund it.... I think that's one of our challenges, a national drug strategy that clearly articulates both interdepartmental and inter-ministerial support, but also the federal, provincial, and municipal commitments. Anything that can speed that up would be helpful.

À (1020)

Mr. Murray Finnerty: The two questions are very much related. Perhaps on the second question, as my colleagues have said, keeping within a political context, i.e., an elected champion, the ministry of health, etc., it's extremely important that we don't isolate the field. You need a vigorous, credible, senior leader for this at the working level who can get out across the country and look at what the provinces are doing to see what makes a difference at the street level.

There are some innovative things. Patrick has mentioned drug courts. There are a number of other things. There are special initiatives, particularly in provinces that don't have the extra resources, that the federal government could identify.

There is a lot of coordination that needs to be done. In Alberta, in particular, we are concerned about the lack of coordination with our services and on-reserve services and whether treaty people are indeed going to the facilities that are funded on reserve. Our experience is that they are not, they are coming off reserve. We would like to work with the federal agencies to maybe integrate some of their treatment centres. The fact is that if your cousin runs the treatment centre, you're not going to go there. You go off reserve to Edmonton or Calgary and come into our system. We need to coordinate those kinds of things.

You could go province by province--and I am sure each individually has certain issues to deal with--and focus on prevention. I think we do a fairly decent job in Alberta, but I know other provinces are greatly lacking in preventive resources. Maybe that's an initiative the federal government could look at, the point being, how do you make a difference at the street level? You need to have, in my opinion, a senior person at the national level who can get out, get around, and identify what's needed in individual cases.

It should stay within the mandate of health, but I don't know whether an ADM in health or something is going to do it, because it gets caught up in all the interdepartmental stuff. I know exactly what you're talking about. Maybe you could contract this out to someone who could actually vigorously pursue the strategy and who could speak somewhat independently of the department. As John said, this is a fine line here if you want to maintain your funding and credibility within a department, but you need somebody who is a little bit removed and can get out there and say, okay, guys, let's cut the BS and get this done.

À (1025)

The Chair: Merci beaucoup.

Monsieur Ménard.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): The more I took part in the this committee's work—and I think I have attended most of the meetings—the more I more I came to realize that there is a tremendous paradox that the committee will find difficult to resolve.

First, you are calling on leadership from the federal government. How can the federal government's leadership be legitimate when the budgets show—you know that we are in the process of drafting a report—that in the fight against drug use, the federal government has invested $104 million? Of this, $70 million—according to the figures we have been given—goes to aboriginal communities, which are, technically, the responsibility of the federal government.

I am trying to understand how the government that is the furthest from its citizens, the government that has nothing to do with social services except in the case of aboriginals, the government that has nothing to do with schools or education, in other words, the direct ties that would allow for an integrated strategy, how this government is supposed play a leadership role? This is a paradox that will not be easy to resolve.

So, where does this conviction come from, that it is up to the federal government to play a leadership role? I understand that the provinces have different approaches. We travelled across the country, and obviously the government of Quebec's strategy was not the same as that of Manitoba, which in turn differed from that of Nova Scotia.

However, would the best way for the federal government to contribute, other than with the institutes and with aboriginal communities, where it has a fiduciary responsibility, not be through financial contributions, by way of the transfer payments? I would need to hear many more arguments than those you presented here today to convince me that this leadership has to come from the federal government. That was my first question.

Mr. Michel Perron: Thank you for your question, it is, in fact, a very good one.

One point that we should probably point out, as you know well, is that the federal government is not all alone in the context of this national strategy. This strategy would include not only the federal government, but all of the other levels of government as well, in addition to NGOs and the private sector. Everyone has a responsibility. So, when we say that it is up to the federal group to play a leadership role in coordinating this, we do not mean that they should do so alone, or independently of the others.

However, I do believe that federal departments have a responsibility, an important commitment in the context of a national drug strategy. Whether we are talking about the solicitor general and prisons and policing; the Department of Justice and legislation; Health Canada and programs involving prevention, rehabilitation and cost sharing with the provinces.

As far as I am concerned, your question touches on the appropriate roles and responsibilities for each level of government. I think that is a very good question because that is exactly what Mr. Smith was talking about when he said that if we knew who was responsible for what, then we could concentrate on these elements and work together, in partnership.

Obviously Health Canada places a great deal of emphasis, not only in the context of drugs, prevention and treatment—I am not familiar with the exact figures that you quoted—but also on seniors, aboriginal peoples, and youth with AIDS and hepatitis C. So, it is important that there be coordination not only between departments, but also within departments. So, efforts being made for AIDS and hepatitis C should complement the drug strategy.

That said, in Canada, we have always viewed the drug problem as a health problem rather than a police or justice problem. It is not independent of these problems, but for us, it is clearly a health problem first and foremost. I believe that this is the reason that the council recommends that the starting point, in terms of leadership, should be the Department of Health, but not alone. I will give the floor to my colleagues.

Mr. Réal Ménard: Just one moment, if you will allow me. Honestly, there has been dozens, if not hundreds of pages written that clearly define the jurisdictions of the different governments.

At the same time, you must be aware that $104 million amounts to a sprinkling, and that you represent the flagship of this strategy, with $1.5 million. All of this seems quite artificial, because the main actors involved cannot have the same impulse as the federal government. I am not saying that there is no role for the federal government to play, but I think that if we are talking about leadership.... The word “leadership” means something, it means that you initiate, you coordinate and ensure that people are working together.

The federal government, as far as the provinces are concerned, does not have much credibility when it comes to transfer payments, for example, and I say this without my usual partisan attitude.

Which leads to my second question, if you will allow it, so that we can have a productive exchange. I have two important questions for you. I was looking at your resumé Mr. Perron, and you are an expert who has travelled extensively, so I would like to ask you if there was a foreign model that coul be held up as an example, which one would be the best to follow?

Second, ideally, what kind of legislation would you like to see in order to bring together the public objectives that you would like to pursue and the criminal code, or other legislation? What specifically would you like to see—and please try to be very precise—in terms of legislative amendments? Those are my two questions.

À (1030)

Mr. Michel Perron: I will answer your first question, since it was addressed to me, and I will let me colleagues answer the second.

The model I prefer. Indeed, I have had the opportunity to travel around the world and would answer by saying that I think we should create a model that borrows from others, from the British, the Australians and maybe the Germans, but that is tailored to our needs, here in Canada.

I know that this is not the answer you would like to hear. I could say, "yes, we should have a person appointed who would report to the Privy Council, someone who would be 'independent', or to our centre, according to our role as mandated by federal legislation". Obviously, there is a need for a coordinator. We should be able to identify someone who is responsible for this issue at the federal level. Who should this be? Should it be the Minister of Justice, the Minister of Health? Who? And if we make them accountable, what will they do?

I think that we could base our model on the Australian model, but I fear that we would be creating a new strategy based on Australia's model from four years ago. What we must do is come up with a strategy based on our own needs, which you have been examining over the past few months.

So, we should borrow, but we must build something that is good and that reflects, as you said, the challenge between the Ottawa and the provinces, as well as each of their respective responsibilities.

Mr. Réal Ménard: Thank you.

[English]

Mr. Murray Finnerty: If I may comment, Madam Chair, I don't think we should dismiss lightly the need for and the leadership that is demonstrated by good research and data collection, the crying need across Canada. We frankly don't know what's going on, we really don't. You'll notice that even in some of the statistics we're using it's 1992 economic impact data. For God's sake, that's 10 years old. If only we had--I don't know what the number is--a sufficiently funded sustainable budget from Health Canada or Michel's centre, I don't know where, even to give us relevant current data.

One of the things I've found in the tobacco initiative in Alberta is that the federal government is up to speed on tobacco. It does regular surveys. We get relevant data every six months or every year. We know where we're at. We know what the trends are. That shows leadership. If we'd just get up to speed on what's happening.... Most of us know there has been a lot of change in drug prevalence in Canada. The last study done nationally was in 1994. We can't afford to do that province by province. Even if we could, that's not the way to go. We need comparable data jurisdictionally across Canada. Just for that role and proper leadership in the data collection and trends, if all of us were working together in designing these surveys, etc., the natural outcome when we got that stuff would be to say, if that's the trend we pick up on, look what's happening here. Marijuana is up to 44% in high schools now, so what are we doing across the country, guys?

Don't dismiss lightly the acute role for $10 million or $20 million in consistent funding and proper data collection in this country, because frankly, we haven't done anything for 10 years. We don't know the exact extent of cocaine use in Edmonton. The last data are from 10 years ago. We can't afford to do it. That's a key role. That's my pet peeve.

Dr. Patrick Smith: Madam Chair, I also think it's important to think about this. If we look at addictions and funding and coordination vis-à-vis any other health issue, what would Canada be doing if our approach to infectious diseases were as disintegrated and as limited? I think Health Canada would be stepping up to the plate to influence what's happening in provinces. Right now it's willy-nilly, whatever the provinces want to do. If a particular province wants to hold the line on addictions funding for 11 years, it can do that. We must ask ourselves if we would allow Health Canada to do that for infectious diseases or if it would play a much more prominent leadership role.

Leadership--I agree with my colleague--is not in being the transfer payment agency, but in outlining what the requirements and the deliverables need to be for the provinces. I think that's what we agree on. We must be clear, through the national drug strategy, about what we need from provinces. The data are here to show that addiction issues have every bit as much of an impact as infectious disease issues on the health of this country. We have limited research to show that. There's no one who disagrees with that. It's a challenge for us. How do we get addictions on a par with other health issues? It is actually much too costly to overlook.

Finally, I think what we would want to do is congratulate the government--I'm not always in a position to be able to do this--on the development of the CIHR. The funding and the revitalization in the Canadian Institutes of Health Research will be a vehicle to do exactly what Murray is saying, but if addiction has to fight its way with every other health initiative, like cancer and infectious diseases, just to get viewed at the same level, then this country will be sorry for that down the road.

À (1035)

[Translation]

The Chair: Thank you.

Ms. Allard.

Carole-Marie Allard (Laval East): Mr. Perron, you mentioned the striking of an executive committee where Quebec was not present. You did not mention Quebec's presence on your Canadian Executive Council. Is there some reason for this? Can you explain Quebec's absence to us?

Mr. Michel Perron: Yes. Discussions are currently underway with Mr. Michel Germain, the executive director of the Standing Committee on the Campaign Against Drugs .

First, when we came together, the CAMH and the other organizations you see here, we wondered who else should join us: British Columbia came, and the Yukon is preparing to join us too, with the approval of their minister of health. The same applies to Mr. German, who received approval from his board, but is still waiting for approval from Quebec's ministry of health. Once he receives it, he will join us and we can move on to the next step.

Ms. Carole-Marie Allard: Have your discussions been underway for long now?

Mr. Michel Perron: A few months.

Ms. Carole-Marie Allard: A few months. That is fairly slow.

Mr. Michel Perron: We expect Mr. Germain will be at the table with us at the next meeting of the council, which will take place at the same time as the World Forum in Montreal.

Ms. Carole-Marie Allard: Since becoming a member of this committee, I have gotten the feeling that there are a lot of bureaucrats who talk a lot, hold a lot of meetings, sit on the same committees and things never change in the streets.

Mr. Finnerty, you mentioned that what was needed was a supervisor at the national level who could get out and identify the problems in the street.

How could more provincial structures—and Mr. Perron, you may be able to speak to this—be of any use? Why not go directly to the communities and meet with people to see what the real problems are, and how we can react in a timely manner?

By accepting your role, we are creating yet another layer, which may prevent funds getting directly to the streets, as Mr. White said. I need some convincing as to how this would work. Why must the provinces be involved in this structure that you are proposing?

Mr. Michel Perron: I will let my provincial colleagues answer.

[English]

Mr. Murray Finnerty: In all honesty, we are very fortunate in Alberta. For 3 million people we have a $58 million budget at AADAC, which is huge compared with others across the country. Thankfully, our government continues to recognize this. As a service provider on the ground in Alberta, I think we are in pretty decent shape. There are a lot of jurisdictions in Canada that don't have those kinds of resources.

I was speaking not on behalf of Alberta when I was making those comments, but more on behalf of a national, coordinated strategy. We need a champion and a leader at the federal level, as in a lot of areas where the actual services are delivered by the provinces. There's no question about that jurisdictionally. We need someone we can get together with and coordinate across the country.

I appreciated the remarks from British Columbia about AADAC responding to needs in British Columbia, but that doesn't happen across the country with interchange of services and coordination of those levels of agreements. There just is a role at the federal level for a credible body to bring everybody together. I can sit in Alberta and say, we're pretty good, guys, thanks, get lost, but what's happening in the Maritimes, what's happening in other jurisdictions? That's the role. There's the other thing that is sadly lacking. For instance, the three of us you see here would perhaps would echo the comments that we're fairly well-funded and coordinated, but even keeping us on the same page with our strategies, because people move in this country.... We all should be aiming towards the same kinds of goals and similar kinds of programming.

Everybody keeps bringing up the example of the drug court strategy. Well, criminal prosecutions rest at the federal level. That initiative, in some manner, is being tried in Calgary, but frankly, there is no funding for it to carry on. It's working, but we are scrambling interdepartmentally. Are we going to pick up this provincially? Is it at the federal level? For all those kinds of things we need a place to go to and say, hey, this is working. Now how do we get the right people to make this happen? We need the federal government to be part of that.

À (1040)

Mr. John Borody: I would just like to echo some comments Murray made. I think this goes back to the report we did in December in Winnipeg. We heard from a lot of jurisdictions. I think Murray is right that provincially we're doing a fairly good job--although I'm not as well funded as Murray is in Alberta--and I do think, given our mandate, that we are doing a good job. Where we seem to fall down quite a bit is when you look at the balance between supply and demand. The supply side, the coming in, is mostly federal. It's through Canada Customs, through the RCMP, and in some provinces it will be through their provincial police. We don't have that integrated approach or that ability to find out where there are trends.

As an example, last week there was a big drug bust in Winnipeg on some new kind of leafy material that was found. We had a phone call asking about the material. First, we'd never heard of it before, and we weren't even aware that this had taken place. It makes it really awkward for us to be involved in the dialogue when we get surprises like that in the community. That's just one example.

I think what we were looking at is that as Murray mentioned, there are federal departments that have responsibilities and there are provincial departments that have responsibilities. If it's coordinated strategy at a national level, hopefully, there'll be all those linkages made, so that when it gets down to our level we'll be involved as well.

One of the other reasons we got together was to share research. I come from an acute care side, from a hospital background. One of the things I was really impressed with in addiction services was that it is one of the only areas of health that really uses research to design programs. On the acute care side we use emotions. When the community says it wants more heart transplants, we get them more heart transplants, and whether or not there's any value in it doesn't matter. On the addiction side we actually do look at best practices and research to see where there's value, and then argue for the money up front.

I think we can do much more at a national level in looking at trends, doing research, and sharing examples than we can at a provincial level. I think there's a whole bunch of things we can gain in doing this.

Dr. Patrick Smith: I think we've been differentially effective in our provinces for adequate funding and adequate coordination, but I think there's a primary reason why we came together. You've experienced a vast number of different opinions from the addictions field on what the right solutions are. What we recognized was that there was a time for us to come together to bring some consensus on the issues there is consensus on, because many times what we hear about, even at a provincial level, is the difficulty they have in just deciding, saying, okay, you're all saying do A, so we're going to fund it. They have so many differences of opinion that inertia sets in and they don't do anything.

We have not been effective at getting addictions recognized as a health issue on the same level as others, so one of the things we thought is that if we could come together to do this, it would be of benefit.

À (1045)

[Translation]

The Chair: Mr. Perron.

[English]

Mr. Michel Perron: As a brief follow-up, Madame Allard, to your question with respect to the roles, we've heard a lot about the provinces, but you're quite right.

[Translation]

Municipalities have a very important role to play. What I think is very important is that we identify who is responsible for what. If we could just do that.

What exactly is Health Canada responsible for? What are the provincial ministries responsible for? The delivery of treatment services? Great. Are they doing research? Yes. Can they share this? Can they help research institutions?

What are municipalities doing? What are all the small NGOs doing, on a volunteer basis?How can we integrate, coordinate and bring these efforts together? The ADER is very well funded, which is great. But what is the ADER doing to help the maritimes, for example?

I just want to come back to the fact that municipalities have a very big role to play. In fact, they themselves have taken the lead recently by creating their own municipal strategies. It is great to see them leading and making the effort, but we have 10 different municipal strategies, which are all a bit scattered. What are their links to the provinces, because they do seek funding from the provinces? What are their links to the federal government? Are they linked together at all?

This just demonstrates, again, the need for a larger vision, a vision for coordinated and integrated services, if we really want our national drug strategy to work. It is not enough to say: reduce the demand, reduce the supply. That is the old approach. We need to know how to integrate our efforts to really reduce the harmful effects of drug abuse.

Ms. Carole-Marie Allard: The problem is that the streets belong to municipalities. So, it is municipalities that have to deal with the homelessness problem. So if I wanted an drug treatment court in Laval, I would have to speak with the judges in Laval. This just goes to show that it all starts at the municipal level.

I was a member of the task force on urban issues, which was able to closely examine, from an urban perspective, all of the policies that were being proposed. A rural policy already exists, so the cities are being left to fend for themselves.

So I guess that is my question. Sometimes, any help that comes from the federal or provincial levels is imposed upon communities, but at the ground level, the disaster surrounding the drug problem remains unchanged.

So, that is why I wonder if we might have a better solution if we could start from the ground level and work our way up. What are your thoughts on this?

[English]

The Chair: Mr. Smith.

Dr. Patrick Smith: I would actually say the people who are working on the ground are hands on and do have the strategies. Strategies have been put into documents. Documents have gone for funding. It's always a bit disturbing when I hear that we just don't have the answer.

As you can probably tell from my accent, I come from the U.S. I have been in Canada for five years. I had a parent of a teenager in my office--and this wasn't the first time--the other day complaining that in the fifth largest city in North America, Toronto, there is no residential treatment for youth. You have to go to Thunder Bay as your closest place. For a family to be involved in their teenager's treatment is paramount, so sending your kid off to Thunder Bay is just not a good option. But many people go south of the border. They go to Hazelton. They go to places in the States. I have spent my career in the States. The expertise is here. The proposals for youth treatment programs are in the government. The strategies have been proposed, and if it were that kind of need in any other health area, it wouldn't be left unmet.

It's not just that we don't have the answers. There are a lot of strategies and good ideas for good programs that we know work, that we know there is a need for, and there is no way to get them implemented here. Canada is paying far more to send teenagers to Hazelton at $30,000 U.S. a pop. It's happening every day.

I lived in Little Rock, Arkansas, a very small city. I had four different alternatives where I could send a teenager who needed residential treatment. There has got to be some in-between. This is something that is pretty amazing, that we have let it go this far in respect of addressing the needs. But it isn't because of people around scratching their heads figuring out what we need. We know what we need. The people close to the ground, as you are saying, know what we need. There is absolutely nothing at a leadership level that puts the pressure on the right people to address the issues.

À (1050)

The Chair: Mr. Sorenson.

Mr. Kevin Sorenson (Crowfoot, Canadian Alliance): Thank you again for coming.

Mr. Smith, in Little Rock, Arkansas, where you had all those choices to send the individuals who were addicted, were they private centres or were they publicly funded centres?

Dr. Patrick Smith: It was a mix of both. Where I worked was the fifth largest children's hospital in the United States. It was a publicly funded institution, but there were also private ones. You had a Charter Hospital--if you don't get help at Charter, please get help somewhere. So there were a number of alternatives.

Let me just say to you that the reverse brain drain from health care providers in the United States is because of some of the challenges with an unintegrated.... I don't think we would necessarily want to have the same thing from the U.S. just brought up here. The challenges with that are that you spend a lot more of your time in the bureaucracy of HMOs and all that. Less of your health care dollar gets to actual health care, so that there is no coordination of the services. It's not necessarily the best thing. It's just being able to have choices that are integrated. The benefit of something like AADAC is that at least with a standardized assessment you can appropriately match clients to where they need to be. It's the same with our centre to the degree that we have the services.

I should just reiterate, if we had in Ontario the funding per capita they have in Alberta, we would be able to implement a lot of the programs we have, even if the federal national drug strategy would say, addictions is a health issue, and if you provinces don't address it, everyone in Canada suffers, and this is the funding per capita you should be putting of your health dollars towards this issue.

Mr. Kevin Sorenson: Of course, we are talking about dollars and cents. Unfortunately, it is a terrible thing when that part comes into the equation. We're dealing with people's health. I see Mr. Finnerty is from Hanna, and I'm from that area of the country as well. I've changed since I started on this committee and since I've started looking at people who have been dealing with addictions. I think I've probably become a lot more compassionate and a lot more understanding of what's going on in all parts of the country, but it still bothers me to a degree when I hear you ask how we get addiction on a par with other diseases. When we are dealing with an equation where dollars and cents do play a major part in factoring out health care dollars, it's awfully hard to sell to the public that the guy who is self-induced, many times, but not always, should be able to receive the same kind of dollars up front in health care as the guy who has cancer and all that. I don't think the argument sells, but I do believe we need to look at ways to put money into addictions and into centres.

The question has been asked by every individual, provincial or federal. We always look at federal dollars that can come down and be provincially implemented, but they always come with the standards that have to be in place as well. I have a lot of confidence in what's going on in Alberta, because I see a government that is committed to doing it. Maybe that is all we need, a directive to the provinces to meet a certain standard and dollars will follow, but to have a universal plan for everyone as a one thing fits all....

Dr. Patrick Smith: I would agree with you. You don't want a universal plan, because the issues are different across the provinces, across the municipalities, in urban and rural areas, as you mentioned. I would also say that we've all learned more about addictions as we've got into this field. Addictions also means teenagers who drink too much in college, so a lot of us are far less removed from the big picture of addictions than we would like to think.

It is most important to recognize that you don't need to be compassionate to put dollars into substance abuse and addictions. You just have to think about the prosperity of your country. The social costs of untreated addictions are much greater than the social costs of most other health issues that mainly affect the individual. Addictions, because of their nature, not only affect the individual, but affect our neighbourhoods, our schools, and every fabric of our society. It is just too costly at the bottom line to let this health issue get out of hand. In many ways, that is what we need to be able to bring to bear for the average Canadian. They don't need to be compassionate to want to have a more prosperous economy.

À (1055)

The Chair: Michel Perron.

Mr. Michel Perron: I have a couple of points. One is with respect to the self-induced nature you referred to, putting it on a par with breast cancer or what have you, and frankly, the fact that we're trying to marry up dollars and so on. I understand the argument somewhat, but I look at the children of Labrador sniffing gas. It's self-induced possibly, but look at the social conditions and social environment these people are living in. If you want to deal with a lot of the addiction issues, we have to back up to some of these, poverty, violence, sexual abuse, and so on. The whole perception by some that this is brought upon them is really one that has to be dealt with, because these are issues for a number of reasons, social environment, genetic, or what have you.

The other point I would like to make is that we have spent a lot of time talking about treatment. One of the things that is sorely lacking in this country is prevention and education. If you want to talk about dollars and cents and where your investments are best levered, that is certainly the area. The federal government does a great deal of work in tobacco reduction. We see Elvis Stojko skating around at the Olympics, and that is wonderful. We don't hear anything about alcohol or drug abuse prevention. There is absolutely no consistency of message, there is absolutely no consistency of application of message, or even of knowing that the messages that are going out there are being heard or being helpful. I would just like to remind the committee that prevention and education have to be part of our whole umbrella of issues.

Mr. Murray Finnerty: Can I just make one point to Mr. Sorenson? My mother still lives in Hanna, and Grandma doesn't have a clue what her grandchildren have been exposed to--I mean my kids--in high school. She would be the first one to think, God, I didn't realize marijuana use in grade 12 was at 50%, that 80% of high school kids drink, and in fact, a lot of them are binge drinkers on the weekend, which is leading to a serious problem. I'm picking up on Michel's point. We have to educate the public on the seriousness of this issue. I think Patrick dealt with the social consequences. We use numbers like 70% of petty crime. We were broken into a couple of years ago at the farm. The guys were drug guys looking for money. The societal impact because of abuse and addictions is unbelievable. Grandma doesn't understand that. She votes, and we need her to understand that.

Mr. Randy White: That doesn't happen in Mr. Sorenson's area, though, does it?

Mr. Murray Finnerty: No, not in Hanna, no.

Mr. Kevin Sorenson: Hanna is the least of my worries.

The Chair: Mr. Smith wanted to comment, and then Mr. Finnerty might want to clarify that those students are actually living in Hanna who are binge drinking at 70% and 80%.

Mr. Murray Finnerty: I did when I grew up.

The Chair: You did?

Dr. Patrick Smith: I think it's also important, and what we're saying is that Health Canada could be taking a leadership role. The fact is that your average Canadian doesn't necessarily see addictions on a par with other health issues, what the social consequences are and what the costs to society are. As with countries that have done a better job at public information, public education, and awareness and prevention for addictions and understanding it as a health issue, if Health Canada were to take the health leadership.... If not Health Canada, who will try to emphasize the health aspects of it?

Á (1100)

Mr. Kevin Sorenson: That leads into my next question. Mr. Finnerty, you've talked about the champion who is going to head it up. When we talked about addictions, Mr. Perron immediately went into the Labrador children and the social implications there. Although there is a huge health cost that is undeniable, social is probably as big a thing. As far as this champion or an entity to oversee the development of the drug strategy or implementation of the drug strategy is concerned, should it be Health Canada, should it be an ombudsman, should it be a drug policy commissioner, should it be a central special agency set up for addictions, should it be a standing committee of elected representatives, or should it be someone else who is federally appointed to make sure the provinces are fulfilling the mandate of the drug strategy? Which group should it be? Should it be the committee, with someone from social and health? What would you recommend?

Mr. John Borody: I don't think the intent of our coming here this morning was to actually give you an idea of who that could be, other than to suggest that what you are looking at is something like that. This committee may have some ideas on a recommendation, but the important thing to note is that any time we've been able to make a change in the health care system, especially when it's been socially driven, there's always been an individual tag to that.

I think back to the early 70s, when we talked about health care and how we were dealing with that. One report that comes to mind is the Lalonde report. Were all the things implemented? No, they weren't, but people always relate back to it. I think of the changes that took place in Saskatchewan on health reform at the time I was there with the MInistry of Health. It blew up 52 hospitals, it closed them down, it restructured into a health care environment. The government made some pretty dramatic changes, when it was told that if it made these changes, the likelihood of its not being elected in the next election was very high. The Minister of Health at the time, Louise Simard, stood up and took on the role for change, and hence, years later, we're still looking at a similar type of government that is operating. One of the reasons for that was that there was somebody who would stand up and say this change was needed. We needed to close down the hospitals.

There are lots of models we can look at. Consider the success of the tobacco strategy we talked about earlier this morning. Take a look at the change of attitude in alcohol and driving. A lot of that comes from the federal government and the coordination on the prevention and education side. That is one of the roles that can be played in leadership. It may not necessarily be at the delivery level, but it is on the other side of the equation.

Mr. Michel Perron: This is a question that has been perplexing us for some time, obviously, and I'm sure it has been bandied about your room and your in camera sessions. Let's try working it the other way. We know the provinces have an important role to play here. Can we be assured that Mr. Finnerty, in his capacity as head of AADAC, is representing the interests writ large of drug policy in Alberta? I ask the question solely.

Let's start at the provincial level. Each province needs to appoint a person--or two people, whatever--somebody who will be speaking on behalf of the province with respect to demand, supply reduction, who will take the lead in bringing together. I call it buying the first pot of coffee among the different agencies at a provincial level that have an interest in this. Without going to the 14 departments, go to the first three, the justice people, the police people, and the health people.

I think it should be incumbent upon the provinces to appoint one person. When we invited representatives to attend our workshop in Winnipeg, we wrote to each premier and asked them to appoint two people. We did that expressly because we wanted the premiers to say, who is responsible for drugs in our province? Because some provinces don't have the benefits of AADACs and AFMs. I think the provinces have to step up to the plate and appoint somebody. That's one.

Second, I think the federal departments that are crucial to this, Solicitor General, Justice, Health, each need to appoint one person. It sounds like a lot of people, a lot of committees, but you have accountability then. You are responsible for representing the views of your department. Within Solicitor General, do they know what correctional services are doing, do they know what parole are doing, do they know what the RCMP are doing? You are in charge at least of finding out what's going on. You don't need to run the show, but tell us what's going on. I think each department that is central to this has to have a role in voicing their intradepartmental work, strategies, priorities, investments, what have you.

How this percolates up to an ombudsman, a Canadian drug czar, commissioner.... In fact, the health and enforcement partnership network in Canada called for the creation of this drug commissioner a few years ago, somebody who can sit there and see over the top. That's a tricky machinery question, frankly. We can say, create an ombudsperson. Where does that person sit exactly? How do they interact with Minister McLellan, Mr. Cauchon, and Mr. MacAulay?

I'm sorry, I'm not answering your question, but I am suggesting that we could at least start with each department stepping up to the plate, having the federal government ask each province to do the same, and I don't think that's out of order, frankly. We can then have groups such as ours, the CCSA, which is mandated and working with the provinces and with the not-for-profit and municipalities. Have FCM come to the table. At least get the right people there. And from there could come a process of who should step up to the plate.

But I think we are looking for one political leader--Madam McLellan, she is the Minister of Health--to stand up and say, here's what we are doing. If not her, then Mr. MacAulay or Mr. Cauchon. The three of them working together could then appoint an advisor, who would be working over the top. There are all sorts of schemes, of course, but I think we need to make sure we don't look at it as being solely the federal responsibility to appoint the person.

Á (1105)

The Chair: Merci beaucoup.

I now have Mr. Lee, Mr. Ménard, Dr. Fry.

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

Earlier on Mr. Finnerty used the phrase “exhorting government to cut the BS and get on with the job.” Then I ask myself what the job is. What is the job? From our point of view as a committee, there is a broad spectrum of challenges. Would you care to help us focus on what the job is? You may want to refer to the four pillars, but even if you do, we still have to focus better than that. We have to prioritize. I think we all accept that there is no victory in this. It's a public policy management thing forever, managing the issue of substance abuse and addiction. Could you take a stab at that? What is the job? What are the priorities? Is the priority drugs? Is the priority procedures?

Mr. Murray Finnerty: What we've got is a lack of focus nationally, a lack of national leadership, a lack of sufficient collaboration, unreliable resources to address this issue. My person opinion is that you need a recognized leader named at the federal level who is going to get on with this job. What's the job? The job is to try to bring those four things together. We need some focus in Canada that says, this is our national drug strategy. To use your words, here are the important areas, the important drugs, or however you want to define it. Here are the targets, here are the resources provinces need to bring to the table and the federal government is bringing to the table to address this problem. It's growing every day. Whatever focus you collaboratively agree to, someone's got to lead that process, because it's very fragmented right now. And that person has to be aggressive, on the job, and willing to get out there and do it. I don't know whether you can do it within the department.

You have a Canadian Centre for Substance Abuse, and I'm not an advocate of Michel or anything else, but they are a clearinghouse we all try to use now as a repository for research, what's happening at the national level, etc. Why don't you charge an organization like that to get on with it, with someone who's passionate, believes in it, knows what we want, or we think we want, bring us together, and let's go? Don't throw it into the 03-04-05 budget and hope something will happen.

Á (1110)

Mr. Derek Lee: I know Mr. Smith's going to answer that, but you've addressed process. Where are we trying to get to? What are the benchmarks?

Dr. Patrick Smith: I think the reason this is a really good question and it's challenging is that we do have different ideas about what the job is. I think what we're saying is that it should not be the job of this committee or of this structure to zero down and decide that safe injection rooms are more important than drug courts. That is other people's job. If I read in the newspaper that this committee did something, what would I want to read? I would want to read that they developed a structure and a strategy to leverage the existing resources and expertise in this country that already exist, but are not coordinated, are doing good work, but are not maximizing what they can do.

I know that isn't very tangible, but it's because I think it's very important that whoever the leader is, they have to leverage existing resources. We have provincial organizations. There are many experts you've heard from across the country who have their roles, and heretofore they've been fairly uncoordinated. The fact that this is just a new organization speaks to that. These are heads of addiction agencies across the provinces, and there hasn't been a forum for them even to come together to talk about what's happening in various provinces. We need the development of a structure, a strategy to leverage the resources and to clearly articulate what the indicators and the benchmarks are, so that it isn't possible for one province to be lucky that things are going well and another province to not be addressing this at all.

If you talk about the specifics of how to make it work, I think I agree with Michel that there have to be representatives from each of the departments. And it's not just so the department input comes, but it's the grassroots, the ideas for the detailed work of the job to address addiction issues across the country and drug and alcohol issues from a prevention, treatment, and education perspective. We're not asking for a leader in Health Canada to all of a sudden decide what the four pillars are and how to do it. It's to bring the people together who already have that in their job description, to do it in a coordinated fashion, and to ensure that the provinces and the municipalities are delivering on something that rolls up to some accountability. If I were running the country, I would want some level of accountablity, so it isn't just willy-nilly and what people want to do in local areas. Even when we get the nice document, I think someone was saying, it's not what's on the page. How can we make sure people deliver at all levels?

So the job is to outline what those deliverables are at each of the levels. That isn't going to come from this committee, but it could come from this process and this structure. The job of a national drug strategy is to clearly articulate what role each level has and what the deliverables need to be.

Mr. John Borody: We have a simple statement that we've been talking about quite a bit over the past few days, and I think it was to do with simply connecting the dots. If you take a look at what's going on in the country right now, I think there's a lot of good work being done provincially, as well as some work being done federally. What we need is some way of bringing all those bits and pieces together.

With all due respect to my cohort here, we've already allowed one person from Little Rock, Arkansas, to run a country.

Á (1115)

The Chair: Mr. Lee.

Mr. Derek Lee: One of your fields of expertise, your field of action for the most part, involves addictions, which is a harm. There's a social cost. It's a bad thing. It's something we have to address. They're harmful to society these addictions, or at least most of them. But there's a piece of this issue that doesn't involve addictions. There are substances out there being used and abused that do not necessarily create addictions. Can you give us any comment on how important or how unimportant those other substances are in the scheme of things if they don't cause addictions?

Mr. John Borody: I think it really depends on your interpretation of addiction. We treat addiction as being any behaviour that takes hold of a person's individual activities. It may not even be related to drugs and alcohol. For instance, there's gambling. So the definition we use for addiction relates more to behaviour than a substance. In the case of substances, let's take a look at youth. From talking to youth workers, my guess is that anywhere from 95% to 99% of youth we see on a daily basis are not addicted. They haven't been engaging in the behaviour long enough. But it is doing harm to them, so it is an addiction issue.

When we look at addictions, our approach is quite broad. When you look at education, prevention, etc., those considerations are brought into play. When you talk about other drugs people may be using that aren't addictive, in the sense that they use them every day, it's sometimes the combination of drugs. When we're looking at policies, even provincially, they are broader and include what you're saying.

Dr. Patrick Smith: I would just add that when you look at problem use, abuse, and addiction, if you look at the full continuum, obviously, there's some use that isn't creating any individual or societal harm. But when there is problem use or abuse that is creating individual or societal harm, that's the purview of our organizations, just to clarify. We don't deal just with addiction. The people we see have a higher percentage of actual addiction, but we deal with problem substance use. If someone comes in who is not physically addicted, but whose substance use is creating problems for the individual, the family, or society, then we address that.

Mr. Derek Lee: Technically, the issue of the legality of the possession of the drug is irrelevant to you. If it's a problem substance or behaviour, addictive or whatever, then it's on your list, it's part of your job. I just wanted you to confirm that.

Dr. Patrick Smith: Yes.

Mr. Derek Lee: Whether a drug or a substance is legal or illegal to possess is not relevant to you in your work.

Dr. Patrick Smith: No.

Mr. Derek Lee: Is the issue of the legality of possession or distribution a hindrance in your work?

Dr. Patrick Smith: We know there are some challenges with regard to some of the more progressive treatments. We know some of the people who are coming for treatment are, by using the substance they are using, breaking the law. So we've had to work with the local police on their not sitting outside our methadone clinic to try to interrogate our clients. No, it doesn't become an issue.

It's no secret that there has been a debate on the decriminalization of marijuana, and it's clear that within that debate there's the sense of, is what we're doing now in response to possession creating increased harm? That's a whole other debate. That's how we look at it. Sometimes our way of working with things in our society adds to the harm.

Á (1120)

The Chair: Mr. Borody, and then Mr. Perron.

Mr. John Borody: Just to add to that, to give you an idea of the dilemma the workers face, as a harm reduction organization--and I think we all are in that mode--we find that most of our clients now have dual addictions, both drugs and alcohol. We may find clients who want to work on their alcohol, but not on their drugs, and we will do that, even knowing that maybe the drug of choice is marijuana or cocaine. We don't allow them, obviously, to participate in that activity on our sites. But there is a dilemma for our workers in knowing we are not going to be dealing with the other one. The way we work is that a client has to be ready to deal with their problem. Although we'll work initially with the alcohol, we will encourage them to consider the other. This is a dilemma the workers are facing all the time now. There's also tobacco. Probably 95% of our clients are heavy smokers.

Mr. Michel Perron: The point is quite right, Mr. Lee. As I go back to the children of Labrador, gas is available to everybody. The legal status of a substance is truly incidental, or should be, frankly, to what it is that we are trying to do for a national drug policy in Canada. There perhaps should be a national substance abuse policy, and therein lies another great challenge. You have semantics that you have to deal with. You have harm reduction. Frankly, I am sure we have four different definitions of what that means, and there are all these other things.

Yes, the legal status, I think, is not as important. I think the thing that is stalling a lot of the work in Canada, outside the chambers of this work, of course, is the disproportionate attention on the decriminalization of cannabis. That's the only thing that seems to matter here in public discourse, when, frankly, alcohol and tobacco have far greater daily impacts on our lives.

The last point is this. If we try to address harm, I think we need to be specific as to what harm. The point made by Mr. Smith with respect to decriminalizing cannabis might ease the social harm of having a criminal record. How do we compare social versus economic versus health harm? Again, I think this is not something where we are looking for you to come up with the Holy Grai. It's the process by which we can get to those answers.

The Chair: Thank you.

Monsieur Ménard.

[Translation]

Mr. Réal Ménard: I'll be honest and tell you that I am a bit surprised and a bit disappointed by your comments. I am surprised because, once again, after more than ten years of the national strategy—even though you remind us that the strategy was interrupted and that Canada is the only country among the G-8 without one—, it seems to me that the federal government does not deserve the trust that you have in it. It has not earned it.

Believe it or not, yesterday morning—it was broadcast—we spent three hours with federal officials, and there was not one of them, among all of those distinguished officials, who did not have subordinate duties, these were officials of the highest possible level, who were able to provide us with a pretty systematic and organized overview of phase one and two, yet in my riding of Hochelaga—Maisonneuve, when a group receives $50,000 from the PACE program, it must spend hours and hours doing assessments.

Furthermore, the responsibility of the federal government is very well established with respect to first nations, to whom it has a fiduciary responsibility. We are talking about $70 million, and we can all agree that the federal government has failed miserably when it comes to its policies regarding aboriginal peoples.

Can you believe that I asked the question? There is an office to coordinate the strategy, but theoretically, the seat of accountability that you are talking about exists. It has been identified. It has been named. Yet, no one could answer, and all of my colleagues and I looked at each other with a look of despair; but we are strong, we will get through this.

I do not understand that anyone would want the federal government to play a role that it has failed to earn. Let it show that I raised this question. There is also an office on the legalization of marijuana and the regulations. Regulations were tabled that would allow for access to marijuana for medicinal use. No one can provide us with impact studies. What does the use of marijuana mean?

I do not agree with you on the issue of the legal framework; it is not secondary. The legislative framework is not secondary because the entire Canadian strategy is based on prohibition objectives, and others, and the auditor general has reminded us that we have spent millions and millions of dollars of resources which could be used by the Canadian Centre on Substance Abuse, that could be put toward treatment if there were a different legal framework.

I would have liked it if you could have given us some more information this morning. You must certainly have some views on the whole legal framework question; the legalization, or not, of certain drugs is, after all, an extremely important issue for this committee and it is an extremely important issue when it comes to the resources that will be available.

What I find hard to understand—once again, my riding is Hochelaga—Maisonneuve, and in my community, drugs are a serious reality—is that it was the federal government that cut $42 billion from the provinces. Those who are in the best position to provide treatment are the municipalities, as Carole-Marie Allard pointed out, but so are the provinces.

It seems to me that the best role that the federal government could play would be that of ensuring accountability. I agree with the fact that someone needs to be accountable, but we have to take into account the available resources. The federal government will have a surplus that bears no relation to the services it is called upon to deliver. I would have like you to take a position on that type of debate.

In other words, I find that your brief stays fairly general. Coordination is all well and good, but in theory, it is supposed to be done; it has been identified. We have heard this for the past ten years. It seems to me that we need to move beyond this. I would have liked to have heard more specific views on what kinds of resources need to be invested, on the treatment that we need to provide and on an appropriate legal framework.

Á (1125)

[English]

Dr. Patrick Smith: We as an umbrella group have not discussed our perspective on the decriminalization. I know our individual organizations did present to the Senate committee, and we can make that report available to this committee. Speaking for the Centre for Addiction and Mental Health, I would agree with you that there are better ways of spending some of our dollars right now.

When you say we've been talking about a need for a new drug strategy for 10 years, so let's get beyond that, the reason we're not beyond that is that we're hitting our heads up against a brick wall. If you want to talk about the services on the ground that are needed, we would need more than a morning. We need a full range, a continuum, of services that any western world country would hope to be able to provide. That would mean an emphasis on public education, which we haven't seen in the drug and alcohol awareness field. It's been zero here, or slightly more. There are very specific prevention programs that have been demonstrated to work. We don't have the funding to carry them out in all schools. There are specialized treatments that have been demonstrated to work from a harm reduction approach, ranging from structured relapse, prevention, and evidence-based to the need for safe injection rooms, on one end of the continuum. That's not to say that we want everyone who uses heroin to have a safe place to shoot up.

[Translation]

Mr. Réal Ménard: All of these things you are mentioning, do you agree with me that it is not the federal government that will provide them?

[English]

Dr. Patrick Smith: No. Exactly. What I think we want to make clear is that we, the experts on the ground, have put forward the proposals to do these things. We have put forward proposals for the kinds of services we would need in a continuum. We're not scratching our heads still trying to figure that out.

If you're asking us what kinds of services we would need in a full continuum, that's a different discussion, and we could certainly provide that. I would agree that it's not the role of the federal government. When you say we're putting too much faith in the federal government that they haven't deserved or whatever--I won't try to paraphrase--we wouldn't be letting the federal government off the hook on any other significant health issue. So just to say that we haven't been completely satisfied with where we are right now doesn't mean we think, okay, let's just do it outside the federal government perspective. We really believe that on the ground we need the federal government to be on the same page. We're already on the same page. A lot of health care providers can get together and put together proposals ranging from safe injection rooms to a treatment program for women and their children at the same time. It's all there. We have it there. The reports are in the drawers. They haven't been funded or implemented. We do need, at the federal level--

Á (1130)

[Translation]

Mr. Réal Ménard: This is the French version of the federal provincial territorial report on harm reduction. There is certainly no shortage of reports.

However, I think that your colleagues may also want to speak.

[English]

Mr. Michel Perron: I'm not one who normally comes to the immediate defence of Health Canada, frankly, and I have ranted and raved with rage at the inaction and the lack of movement on this. I think we have to, though, acknowledge squarely and fairly that the department.... I used to work there, and I used to work for the drug strategy secretariat when we had a strategy. That was before the publication of the book that we now call our strategy. I used to work at Health Canada, and it was impossible, frankly, to do our work, because there was no explicitly agreed mandate for what it was we were supposed to do. I'm not saying they could not have done more and better. However, when the bureaucrats are not getting consistent signals from the political leaders, when the issue itself is not on the political front burner, when the whole issue is mired in semantic, political, and federal-provincial issues, it is exceptionally difficult to demonstrate the kind of leadership, commitment, and investment we would actually like from our federal bureaucrats.

I say that in complete defence of them, because it is not an easy job. I also start with the position that they try to do their best. I think we're asking that we put our faith back, if we can phrase it that way, in the federal government in respect to their appropriate role, and this is appropriate--I am speaking personally at this point--because the federal government must step up to the plate. If not, we cannot go at this alone. Whether they do the whole gig and run it all, that's a decision you might want to sort out yourselves, as to how you want to organize and make sure they do come to the plate, but I think that had to be said with respect to their work to date.

The Chair: Merci beaucoup.

Dr. Fry.

Ms. Hedy Fry (Vancouver Centre, Lib.): Actually, I am going to be the party-pooper, because I don't have any questions to ask. I think you have been pretty clear. Actually, I listened to you answer a lot of the other questions, and you have slipped into place certain pieces of the puzzle that I seemed to be missing. I want to thank you for coming, because I think you have put it into perspective.

Your last statement, Mr. Perron, was about the fact that we cannot be going into the nitty-gritty of prescribing exactly what is done. We have to be a lot more generic as the federal government. I think we can be prescriptive where we want to talk about what the federal government's role is. We can talk about the coordination. I think what we need to do, I'm hearing from you, is to talk about evidence-based, to talk about innovative thinking, to be able to build that big framework in which we feel everyone has already got a place, and to point out what is needed still, where the gaps are, as well as the bridges that are so necessary to pull those things together.

Thank you very much, because I think you have helped me a great deal.

The Chair: Before I turn to Mr. White, you mentioned that there needs to be coordination and collaboration across departments. There are, in fact, some interdepartmental committees, some FPT committees, and some departmental committees within the federal government, and FPT is obviously with the provinces and territories. What is the status of that work? Are there the bones of something to build on? Why don't I just turn it over to you?

Mr. Borody.

Mr. John Borody: My organization sits on the FPT committee for drugs and alcohol. I have only been on the committee, in this position, three years. Floundering would be a good word that I would use for that committee. We spent a great deal of time trying to figure out what the job, the role, of that committee is, which follows up on what was asked earlier by the member here. We've have spent the last four meetings trying to define that role. The awkwardness in that whole committee is the representation and has a lot to do with how provincial governments deliver the services.

To give you an example, two of the members sitting at this end of the table are not represented on that committee; that's why we decided to form CECA. In fact, I am not even sure the one that we were looking at from Montreal would be represented on that committee. It really has to do with who is needed, what is the representation, and what's the job. Until that is really clear with the group, I think it's a group that meets, shares nothing, and does nothing. We have still partnered with them, trying to encourage them along, but it is a group that is not going to give you what you are looking for.

Á (1135)

The Chair: What about the interdepartmental committees?

Mr. Murray Finnerty: If they are not effective, we don't attend.

The Chair: You wouldn't be invited to the interdepartmental committees, because that would be just within the federal government.

Mr. Michel Perron: Nor am I, actually.

The Chair: No, but what is your knowledge of their status?

Mr. Michel Perron: I have sat on the Solicitor General one, I have sat on the Revenue Canada one, and as a representative from Solicitor General, Health Canada and Revenue Canada. I am a little bit like Mr. Borody, I guess. I am moving along in my jobs as well.

Again, the interdepartmental committee is a good process committee sometimes, but it sits in a vacuum. It doesn't feed into anything. It is a little like the FPT committee on alcohol and drugs. It is an information-sharing network, and that might be good, but I think if you were to ask all the members of that committee what is their role and what is the purpose of the committee, you would get a number of different answers.

We used to have an interdepartmental committee for domestic issues and one for international issues. I think a dimension that is important to your work as well is how all we do here plays out when we go to the United Nations next year, when we have the ministerial segment looking at the halfway reporting on the United Nations General Assembly's special session on drugs. Who is going to say what there?

I think the people at that committee are there because they might represent a number of different areas, but they don't necessarily bring the view of the entirety of what they should be doing. I think those committees could, with the benefit of the right people, the right mandate, and the right positioning as to what they wanted to do, be considerably more effective.

The Chair: When you say that, I see why you also think there should be a vision, a goal, a national spokesperson to start making sure everyone is calling row on the right row, so that people understand what the mandate is and how their piece of a department or bureau of whatever fits within a national strategy.

We heard something about the dollars that are being spent. While Health Canada presented $104 million this year, $70 million of that is the direct delivery of health care. That would be comparable to AADAC or to provincial health programming in Manitoba, because it is direct delivery of services, so you have to take that $70 million. Some $4.5 million was to do analysis in support of drug convictions. It is analysis of drugs. It may be helpful if you get a new strain of cocaine on the streets, but it's not really an active programming thing. It doesn't make any difference in my community. That is some of the stuff Health Canada is doing. Across the national drug strategy it was $14 million. When it was first announced, it was $42 million a year.

You mentioned that there is a lack of resources for information gathering and for research, but is there also just a need for more activity? Yes, it has to be the right activity. It has to be evaluated, and they clearly mentioned that evaluation is not being done because if it is a choice between delivering a program and evaluation, you are going to deliver a program. Is there a base amount of money you need if you are going to accomplish anything? Could your organization come up with some figures about what that is? Mr. Finnerty has $58 million. I can only imagine what that would be if that money were spread into Ontario, for instance, or the number that proportionately was spent on Ontario. There is a base amount of money the federal government also must spend in order to accomplish anything. Do you guys have any figures on what that could be? It is something more than $14 million, I would imagine.

Á (1140)

Mr. Murray Finnerty: Even the $14 million, in a cost-sharing formula, goes into treasury. There is no direct connection on the recoverable from treasury with what they fund in provinces. Certainly, that is the way it works in Alberta. I think it works in most provinces that way. That is nice as kind of a base amount, but it is not enough to really have any effect. It might be more useful to target any federal dollars that were available to nationally agreed special objectives. Just don't dump it in a cost-share, but if all of us say, the drug court thing is really working, we need $42 million to do it in Toronto, Calgary, Vancouver, wherever, let's do that and really have an effect, rather than just cost-sharing it in. I use that just as an example. I think one of us at the table said, I didn't even know that was going to Ontario. That is the problem.

Mr. Michel Perron: I can say that as a CEO--and I think my colleagues would agree with me--when I submit a request for funds to the Minister of Health as part of an MC with regard to a drug strategy, I have to put that forward on a business case basis. What are you going to do with that money, and what's it going to bring us back? While $14 million might be a little, or might be a lot--I'm sure if you ask anybody in the municipality they'll say they have never even seen that much money--I think we need to say, what are you going to do with that? I think we have to divide the roles of Health Canada, if we're asking them to play a supra-coordination role, and ask, how much money do you need for that? We can look at different countries, for example the UK and Australia, to see what they are spending per capita for coordination alone. I think we have to be careful not to mix the budgets of Health Canada for the implementation of cannabis for therapeutic purposes, which was brought on fairly quickly, to say the least, vis-à-vis their coordination aspect.

Underlying all this, and one thing I've learned in my time at CCSA, is put your money where your mouth is. What are you doing with that? Are you prepared to be accountable for it and evaluated against it? I think we need to instill that sort of accountability.

The Chair: That's a very good point. Part of the challenge of the numbers is that Health Canada was presenting what they spend on health care. Some of those activities would be within the $14 million. Some of that $14 million is being spent in the solicitor general's office, the justice minister's office, and what have you. It's quite difficult to tease out exactly what is deliverable.

Talking about the drug czar, national champion, or whatever, it was incorporated into your comments, I think, Dr. Smith, that there needs to be a general raising of the awareness of substance abuse as an issue in our country. The federal government does have a leadership role in terms of national campaigns to educate people about eating better or to give them the latest information on the prevention of colds or whatever it is. We need to identify that substance abuse is a problem in our country or could be better addressed in our country and then get provinces and the federal government to apply resources to deal with it appropriately. Did you want to comment further?

Dr. Patrick Smith: I think that in most of the provinces you do have experts and resources to leverage. So I think that the federal government could play a leadership role but also work collaboratively with the people who are out there slugging away trying to do some of the work.

Just to tie that in with the last point, there's no cap on the amount of dollars that go into treatment. There's no idea of what provinces are putting into direct health care, such as addiction services. It's much easier in Alberta because there's one organization with $59 million and it's focused on this.

What do we spend per capita in Ontario? We don't have that data, because of the way it works. There again some leadership can come from the federal government. If I'm the health minister of Ontario and I see that the whole National Drug Strategy has $70 million for direct service, how important do I think this is in my province and how much do I have to pay attention to it? One of our challenges is that there's no one telling them that this is a priority for the country.

Á (1145)

The Chair: Thank you.

Next is Mr. White, followed by Madame Allard.

Mr. Randy White: I would like to know if there's anything problematic with this statement: Canada's drug strategy should include treatment on demand.

Dr. Patrick Smith: No. We have an eight-month waiting list, and people can't find the door. We would say in the provider field that treatment on demand means--just to define it so that I can make sure this isn't a trick question--that when someone needs service, they should have access to that service. That includes an assessment and then a triaging to the most appropriate service based on what they need. I don't go in and say, I want you to take out my heart, and you have to do it. There is the professional expertise to say, you need your heart taken out. So treatment on demand means having the services available. Then I think there does need to be that expertise brought in.

Mr. Randy White: I would have thought that one of you might have said it is not achievable.

Mr. John Borody: Just to follow up on what Patrick is saying in the content, right now in Manitoba we could answer that to say, yes.

When somebody comes forward, an intake assessment is made. We do start working on a plan. Does that mean they get right into a rehab program? No, they may not. There may be a waiting list of two to three weeks, but the contact has been made and we have started to work with the client.

I don't think there would ever be the expectation that just because you came to the door you would automatically get into a rehab centre. I think our expectation is at least that we do talk to you right away. There is an intervention. We do start to work on a care plan. That care plan may require residential treatment, but you may not get it right away.

Dr. Patrick Smith: With all due respect, I think there is a learned helplessness that is set into the addictions treatment field in Canada. I would say I have higher expectations. Treatment upon demand is what we all are going for.

I don't think you are saying that we like a three week waiting list. When you need treatment, three weeks from now you may be in a very different stage of motivation. We don't wait three weeks for the medication and treatment we need for sinusitis or an infection. We should be able to expect treatment on demand and when you say it is not achievable, I think it is not good enough. There is no other health issue where we just say, “Oh well, we can't treat everyone with this infection so we are going to triage”.

Strictly from the treatment perspective, appropriate treatment on demand is something we think people should have and we think it should be immediate. Is it achievable now? No, and that is why we are here. It is a significant problem, but it is a bit disgraceful that it is so unavailable across several of our provinces.

Mr. Murray Finnerty: It is part of the whole health care debate. Certainly in Alberta in response to Mazankowski, addictions is being put into “Is it affordable? Can we do it?” You have to put it in that whole context of what can you do in terms of setting priorities before the system crashes. Certainly in our province, addictions is at the table with that whole response to health care.

Treatment on demand? It is just not going to be feasible down the road.

Mr. Randy White: In terms of selling your importance to the public, to the politicians, to the fundraisers and all that sort of thing, if you go in many areas of this country today and say, “We are real advocates of harm reduction”, immediately safe shoot-up sites, heroin maintenance come to mind. It does in my community. You talk harm reduction and immediately the doors close.

How do you overcome that? You must have it too.

Á (1150)

Mr. Murray Finnerty: Certainly in Alberta that is a great subject of political debate. I am sure my friend from Alberta would agree.

You have to work around it and you have to use some logic. With the treatment on demand example, just because a guy got addicted to drugs, that was self-induced, that is his problem, forget him, what an idiot, why did he do that? People smoke. That is self-induced. Half our patients in hospitals have heart and lung problems resulting from smoking. Guys drive too fast on the highways. Accidents in hospitals. What do you think the percentage of that is?

It is a difficult one. The immediate reaction and even my old conservative reaction immediately is that he did it to himself, but wait a minute. Let us look at really what we are talking about here. In a lot of cases you have to deal with harm reduction, but it is a huge, huge issue for debate. The whole 12-step community doesn't believe in it at all.

The Chair: Mr. Smith and Mr. Perron.

Dr. Patrick Smith: I would say also that one of the things we do is try to stay away from terms that mean many different things to many different people. We go straight for the data.

I'll answer the first question: how do we get people on board with how significant a priority this needs to be? How we sold drug treatment court when we wrote the proposal wasn't that “we have to be compassionate because these people need help”. It was about how much money it was going to save us, about how much we were spending on the untreated need, the untreated cocaine and heroin addicts in the criminal justice system who kept going through the revolving door, never getting their addiction addressed. It was about how much drug treatment court would cost, the outcomes from south of the border and other places in Europe for these people in terms of their reduced recidivism, and the overall financial impact on the country.

Now, we recognize that public awareness and information--and again, the federal level can take that leadership--can start to help people have a broader understanding of it, but we also know that we have to do the research and show the data. People aren't going to warm up to and cosy up to the idea of a safe injection room because it just makes logical sense and it's a great idea, but when you show how many people who were not able to be treated in any other capacity start off with a safe injection room and end up remaining abstinent, and when you show the social costs that have gone down because you've set up a safe injection site, those financial facts ring true to people who don't like the idea of it.

We recognize that we would not have a drug treatment court today in Canada if we didn't sell it on the social cost implications as well as the financial cost implications.

The Chair: Mr. Borody, and then Monsieur Perron.

Mr. John Borody: I have just a quick response. In relation to Patrick's example, if I were a bureaucrat sitting in the health department and somebody came forward with a drug court proposal, I think it would come down to a question: it's not my vote and why would I put more money into it when I don't get a saving in the other vote, i.e., in the other department.

By having a national leader, somebody who can coordinate and integrate the discussion, hopefully we get away from that. I know that right now even provincially I have those arguments with other departments when we're putting forward proposals that we can actually show will save money in other areas. Even within the health department we have trouble because they say it's not the vote, they can't transfer money. It's the whole financial process.

I think what we're trying to do is move outside those boxes. Patrick's right. It's a social issue. It's a taxation issue. It's going to save money in some way, shape, or form. You need the vehicle to have those discussions without arguing about transferability of votes.

Mr. Randy White: I know it's a small thing, but there's a lot in terminology. In this world we've gone from terminologies like crazy, nervous, retarded, handicapped, and special needs. That has changed along the years. I think that now people somehow associate that term, “harm reduction”, with the negatives. I think your organizations would be well in place to try to move it from that to something where people just don't get their hackles up.

Thank you. You've had a heck of a presentation, I might add.

Á (1155)

The Chair: Monsieur Perron.

Mr. Michel Perron: Basically I support the point you just made, Mr. White. For the purposes of your report, if you are going to use the term, I would urge you to specify what it is you mean by harm reduction. Ideally you might want to call it something else, because it's going to be so loaded that people will only see that forest and forget about the trees.

Our organization spent a lot of time defining what harm reduction means. I think that was a worthy exercise of understanding the user as opposed to the use and talking about the types of responses we could put in place. Frankly, I think it's more important that we talk not about whether this program is a harm reduction program, but whether that program actually meets its objectives and goals as originally stated and agreed to by the variety of partners around the table. That to me is more important than being able to correctly label or categorize a program as being harm reduction.

My sense is that it's such a viscerally charged term. If you can, avoid using it and describe precisely what it is that you want to do. That would be my recommendation.

The Chair: Like keep people healthier.

Madam Allard.

[Translation]

Ms. Carole-Marie Allard: I wanted to ask if in your communities—I know that you do, in a way, represent your provinces—you have felt the effects of the national housing strategy, launched by the federal government, and if it has had any effect in your communities?

[English]

Dr. Patrick Smith: I can give an example. Again, Mr. Borody used the example of how when you have an idea about drug treatment court you have to sell it, that if you spend an extra dime here it's going to save an extra dollar over there. Someone who has both pockets has to make sense of this.

We work in partnership with the local aboriginal community for urban aboriginal addiction and mental health issues. We have stepped up to the plate and worked in partnership to try to have our large mainstream organization, which was four organizations coming together into one in Ontario.... It's the largest addictions and mental health service provider in North America, yet we weren't doing good work for urban aboriginals.

When we went to people to say, “this is the new service we want to develop”, everyone loved the idea and no one could quite figure out the right door for us to walk into to get that to happen. We've funded it from several small grants, from the SCPI initiative, starting with working with shelters and local aboriginal agencies, but that's time limited.

This illustrates our problem. No one says, “This issue is mine.” For the health issues of aboriginal people in urban settings, everywhere you go someone else says, “you might want to talk to him, you might want to talk to them”. That's one example.

We also have youth outreach work. We have some things that will be sustainable because we have an outreach van for the aboriginal services, but we have other things where it's been staff members to get this piloted. As you know, this is pilot funding, so the concern is, what happens when that's gone? No one is stepping up to the plate and saying, “I'll take that on and I'll fund you long-term.” Even if it's demonstrated, with an effective evaluation, and with good outcomes, there is no strategy right now to say, “Who picks that up?” That's something that we would hope for a national drug strategy to outline: even when there are good demonstration projects, what do you do afterwards?

The Chair: Mr. Perron.

Mr. Michel Perron: I think the only point it's important to make here when we're asking for a drug strategy in Canada is that it not be independent of other government priorities. Therefore, as we talk about intra-departmental, interdepartmental, and intergovernmental, where does intra-strategy fit? Where does a national drug strategy lever off the investments of homelessness? Of youth employment? Of better health care for the aged, who are maybe abusing pharmaceutical products unbeknownst to them? So on and so forth.... I think we need to make sure that this ombudsperson or whoever is running this truck also knows the other trucks in the lane and makes sure they're working together.

Mr. Murray Finnerty: Yes. There's a really good example of that, just two quick examples. One is the relationship between addictions and the homeless strategy in Alberta. First of all, it created more shelters. When people leave our detox, they need somewhere to go, so we were very much part of that. One of the things that we stepped up to the plate with in terms of the homeless shelters is that we put some addiction workers in homeless shelters, with help from the homeless strategy.

Just to reiterate Michel's point, what we need is to bring all this stuff together so that it has a synergy.

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Ms. Carole-Marie Allard: My point is, would it have been better to put the money for... We went for homeless, but we left aside all these people, the sick people in the streets. I don't know. There is a lot of money there.

The Chair: But I think your point was that the money was leveraged to address a whole series of addictions needs which--

A voice: To address it, yes.

A voice: SCPI has been effective in that.

The Chair: Mr. Sorenson.

Mr. Kevin Sorenson: This is just a very small question and maybe it's a little off the wall. It's more for Mr. Finnerty.

You're with AADAC and you deal with a lot of addictions and a lot of individuals whose lives have been ruined, whose families have been ruined. In this approach of education, of instructing young people about the negative effects of addiction, one program that's come into question around this table is the program with children, the DARE program. I just want to ask you about it. Although it's not a perfect program, it's part of, as I view it, the overall education of young people. It's not the be-all and end-all, for sure, and nobody is questioning that. Do you think there is a place for the DARE program?

We have the RCMP, the Canadian Police Association, and the Ontario Provincial Police all saying yes, there have to be some changes, but it still should be part of this. I get testimonial letters from kids whose parents are addicts, or alcoholics at least, and who loved the program. In Alberta, it seems to be working, doesn't it?

Mr. Murray Finnerty: AADAC's position on DARE is that anything that is done to make parents and children aware of problems with drugs, alcohol, etc., we totally support. Any initiative, whether it's the RCMP going into schools, public education programs of any kind, we have no problem with that.

What we've found, particularly with the young people, is that having an RCMP constable come in to see younger children has an immediate and dramatic effect. Older high school kids are a little more cynical, etc.

Certainly, evaluations done in the States show that the problem with DARE is that there is no connection to follow-up, to longer-term effect. Because we have offices in 40 communities across Alberta, we are trying to make those connections with the RCMP when they go in--and we know a lot of the DARE officers--because what it will invoke, 9 times out of 10, is that afterwards somebody will sidle up to the officer and say, “You know, I've got a problem, or my friend, I think I'm really concerned.” To be able to have them direct, in our case, to us, to do the intervention and a follow-up.... A lot of times they will go in and there is no connection to the actual follow-up, so then you have to question the cost benefit.

The debate we're having in Alberta is that the RCMP wants the province to pay for DARE. We're saying, “No, it's great that you guys are doing it. It's great for the RCMP image. Carry on, but we're not going to fund you.” It's a funding issue there, but there is a real debate about DARE. Particularly in rural Alberta it's very popular, no question about it.

We don't have a problem with the program. Anything that helps, helps, but whether it's cost effective...?

Dr. Patrick Smith: We've talked a lot about accountability and we're talking about it at a federal level and how we want greater accountability. That trickles down to every level. What we would say is that any prevention program needs to be clearly evaluated and outcomes clearly demonstrated. I think that's been the debate with DARE: that it hasn't been able to do that in the face of some other programs that have been able to demonstrate outcomes.

So if I were again to go back to that money issue and how you can only put money in certain places, I would have to challenge DARE and any other program to have that level of outcome data, with an evaluation. We all agree that if something is doing good, we want it to keep doing it, but I think we would also all agree on making sure that we're not just saying, “Okay, I have heard someone say that was good and so...”. We don't do that with any of our other programs, so I think it needs to be evaluated, as other prevention programs are. Then, I think, the people looking at their limited sum of money can make their investments based on the database, the evidence base.

That's all we would say about it. It's not, “Do you like this program or do you not?” It's like any other thing we're doing here. Let's make sure it's evidence-based and let's evaluate that effectiveness.

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Mr. Kevin Sorenson: It's sometimes difficult to do an evaluation of a program when you're dealing with grades 4 and 6, because you aren't dealing directly with those who are primarily addicts. It is part of a bigger picture and a bigger program. I'm not saying there are no addicts in grade 6. They are in families of addicts. As far as being cost-effective is concerned, the individual who is dealing hands-on with addicts can always make an argument, but I think it has to be part of a bigger picture.

Dr. Patrick Smith: There are people whose expertise is to evaluate the effectiveness of prevention programs in grades 4 and 6, so there are mechanisms to do it. It's not, did you use drugs the next day? Rather it's looking at some of the attitude shifts and things that we know are prerequisites to.... There are people who make it their career to do that type of evaluation. The prevention program called Opening Doors in grades 4 and 6 in Ontario is very well documented in terms of outcomes. I think we should be able to use what we know in terms of best practices for evaluating prevention programs and make sure that all of our prevention programs are looked at with the same level of scrutiny.

Mr. Murray Finnerty: Eleven per cent of children in Alberta start smoking regularly before the age of 10. Doesn't that blow you away? Where are their parents? Anyway, that's just an aside. Amazing stuff is going on out there that the public just doesn't realize.

The Chair: Just to clarify, Mr. Finnerty, are they all urban children or all rural children or, like everything else, is it right across the population?

Mr. Murray Finnerty: I would suggest that in a lot of cases it may be more prevalent in rural areas.

A voice: Out behind the barn.

Mr. Murray Finnerty: Exactly, like you and I did.

Some hon. members: Oh, oh!

The Chair: Dr. Fry.

Ms. Hedy Fry: Sorry. Having said that I didn't have any questions, I do have one, and it's completely aside from the others. What I wanted to ask is if we wanted to look at setting measurable goals, would you suggest a 5-year and then a 10-year period for setting those goals?

Give me some examples of measurable goals. Would you want to say, for instance, we would like to see HIV and hepatitis-C in intravenous drug users decrease by 50% within five years? Is that too much to ask for? Or would you ask for 10%? Could you give me an idea of some of your measurable goals?

Mr. Murray Finnerty: That's a really interesting question. One of our problems right now is that we wouldn't be able to tell you what the baseline is.

In Alberta we're going for 10-year projections. It's just coming in new. So I've been asked for a 10-year projection on alcohol, drugs, gambling, and tobacco. We're having a hell of a time getting a baseline. Smoking we have. As we were indicating, things are pretty good there. If it's at 28% in Alberta, we're saying that in 10 years we want to move that to 18%. But there's a lot of movement on tobacco. You can affect that. As far as problem drinking is concerned, we're predicting that if we can hold it at 19%, which is the baseline we have now, we'll be lucky.

I would suggest it's even worse for drugs. We don't have a baseline on drug prevalence in Alberta. I'm being very quiet about that, because my boss will say, are you saying you don't know what the cocaine use is in Alberta? Sorry, sir, I don't. So how can I give you a projection? Even if I knew that number we would struggle, even though we're well funded. We're going to have a heck of a time keeping it at, I don't know, 2% or 3%. We're just running to stay ahead of the game. We have Ecstasy and all these new drugs that are going into high schools. It blows your mind. People don't understand what's happening out there.

If you get into long-term projections, you have to be really careful. If you throw out 50%, forget it. We're not going to be able to do that.

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Ms. Hedy Fry: That's why I wanted to ask you what is possible.

Dr. Patrick Smith: I also think it goes back to this: what is the job? We know that we have certain treatments whereby we can demonstrate that when people have access to those treatments they're effective. I would say that for this committee we would be looking at what we do have baseline data for.

We have baseline data for what the waiting lists are around different provinces of Canada in terms of getting access to treatment. We have baseline data on what our per capita funding is from different provinces for health. If you could say that in five years funding for addictions would be at x% across the provinces, I think that is something you could have as a measurable goal because we know where our baseline is and we know where we would need to be if you could say that waiting lists for access to treatment would reduce by x%.

We have to remember what the job is. Is it the job of this committee to go down and say, okay, they're very specific? I would leave that to the next level, to the people doing this work. I would say that this group can look at what deliverables you would like to have, so as to say in five years that your committee did its job, and it would be that provinces are much more uniform in terms of their addressing addiction issues, substance use and misuse issues, and how much funding they are putting into it. What is the access to services? What are the waiting times? Do you still have to go down to the United States to get treatment for youth when you are living in Toronto?

There are things we do know. Those are the higher level measurables that I would put in there. Then, during the process, let the people closer to it come up with the more specific goals of measuring it on a population base.

The Chair: Michel Perron.

Mr. Michel Perron: I think, Dr. Fry, that some of the other types of measures you might want to look at as well are prevention related. One of the measures we might want to have is a consistent message based on evidence, evaluated on a regular basis, and continually evolving with the latest literature. We have to be mindful whenever we look at prevalence data. That's the “gee whiz” figure I always use; it's the “so what?” that's important. What is the impact of that prevalence?

Impact, data, impact: in other words, if 80% of people in Canada drink, so what? The negative impacts associated with that 80% drinking are where we should be focusing our efforts: reducing problem drinking, reducing binge drinking, and reducing driving while impaired. I think we have to be very specific on impact as opposed to just use, necessarily.

The Chair: Mr. Lee.

Mr. Derek Lee: Just to follow up on the question, I don't want to be seen to be negative on the DARE program because we all support efforts to dissuade the “dissuadable”. To the extent that police can accomplish that, it's fine, but do any of you have a comment on the fact that in that particular program you have what is essentially a presentation coming from a law enforcement perspective rather than a health care perspective?

Coming just from law enforcement, you have a focus on what's legal and illegal, whereas if it came from a health care perspective you might also be able to address tobacco, alcohol and, generally, legal substance abuse and the whole health care issue, so that the outcome, the impact, the thumbprint left on the brain of the young person, would be broader and perhaps more useful in other life experiences.

The Chair: I have Mr. Borody, Dr. Smith, and Mr. Finnerty, I think, so yes, some of them have an opinion.

Mr. John Borody: In fact, I can give you an example,because we just finished a youth prevalence study last year, taking a look at drug use, and more than drug use, attitudes towards drug use. We broadened the survey last year. It was done in high schools, some 26 schools in the province, so you have to be careful in the representative sample, because we have workers in many of those schools. What we found is that the DARE program seems to work for an age group where there is that respect for law enforcement. As the kids start getting older, it's not maybe necessarily that they respect less, but their risk factor goes up. So when you take a look at one of the statistics Murray mentioned about smoking, in Manitoba we found that most kids start smoking, as an average age, just before 12. At the age of 12 they were already experiencing alcohol, and by the end of 12, going into 13, drugs. Within a very short period of time, almost a year--that's when you get into the high school years in Manitoba--kids had already decided that they were going to engage in that behaviour.

So the program we are looking at doing now is focusing on the middle year schools for prevention. What we're thinking is that probably the DARE program works better with the younger kids. As kids start being a little more riskier, it's behaviour of youth. Who's going to be the ones doing the bungee-jumping? Probably not Patrick and me. Probably people that are younger. Recognizing that it's going to be a behavioural thing, what we are trying to do is impress upon them the public health, the risk factors--understand what the behaviour can result in. So it's not just taking the enforcement perspective of “it's illegal, it's bad, and you will go to jail”, because that means only if you get caught. It's to also understand that if you are going to do this, there are health implications.

So we have a project in place this year that's actually working in that environment. We are taking kids that have been through DARE. We are now going to apply a middle year school project that is going to be talking about prevention, and we are also going to be working with the same group over time in high school. As Patrick said, it's doing that research to figure out what's working and what's not and to be able to come to groups like this and say “our experience has shown”, rather than “we read somewhere”.

I think it's all still too new to us to be able to come up with a finite answer. We do know it works for some groups, but it doesn't seem to work with other groups, as was mentioned earlier on, that seem to be older.

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The Chair: Do the others need to comment?

Dr. Patrick Smith: I would just say that I wouldn't want to give an opinion, because what you are suggesting is a really viable hypothesis and all we are saying is, let's evaluate. That's what we're talking about. We would be much more comfortable coming to you with data to say, well, we have measured, and this is when health care providers did this program, this is when law enforcement officers did this. But we also want to emphasize that we do want everyone to be at the table. We applaud the efforts in coming to the table to try to make this kind of thing work, so it's an example of the kind of partnership. But let's measure, let's see if there are differential benefits that happen at different ages. That's the kind of thing we should be studying. My opinion shouldn't be any more important than that of someone who has gone through the program's. The data are what we really need to look at.

The Chair: Thank you.

As part of that, on page 5 of your presentation you say “Prevention strategies are intended to increase protective factors and reduce risk factors....” That's also harm reduction. If a student is going to binge drink, you want to make sure that they don't get behind the wheel or in the back of the car of another binge drinker. So what we want to do is increase the protective factors. Mom, I need a ride home, or, I think I'm going to stay the night, or, this situation is getting a little out of control so someone needs to risk calling a parent and getting in trouble for everyone. In Nova Scotia we were told about kids who realized that they were going to get in trouble for having had an off-site party on graduation night but who knew that a kid was going to die if someone didn't get that kid to a hospital. So that's increasing the protective factors. It's not necessarily stopping all binge drinking or smoking behind the barn, but it is trying to help them make better decisions.

Having worked a lot on young offenders' issues, I think it's about helping enhance the decision-making abilities of young people. It involves choices about criminality and risk when it comes to harming yourself. If you're going bungee jumping, make sure that the company is reputable and that your parachute is going to open. It's about making better decisions on whether to use substances, how to use them, when to use them, and under what conditions.

Clearly, research would be an important factor in helping community organizations develop programs that are appropriate. If the only thing going is a police officer who can do a DARE program, that's great. It's not going to be enough across a young person's life or an adult's life, but it is increasing the protective factors for those kids.

We need to understand that it has an impact on our productivity as a nation, that substance abuse is making a difference. If you've been binge drinking and you can't show up at work on Monday morning, that's going to affect all of us.

In Tuesday's paper and certainly in this city everyone has been talking about the cuts to education. There has been a lot of discussion about special education. But until our amazing researchers brought it to my attention--and no one is talking about it in the national or local media--I wasn't aware that they had cut the amount of substance abuse support for students in this city. We know that's where you can make the biggest difference. Those are the kids who are getting the exposure and don't necessarily have the protective factors we want them to have. Yet it didn't hit the national media because somebody else raised the issue of special education, which is, of course, an important issue. But across all students substance abuse is a challenge.

But how do you justify it? It's going to be someone else who pays if the police force comes in and does an inspection of the lockers. It's not the board of education's issue.

How do we make sure people understand that there are costs and benefits and that there are investments to be made? It may not be in your envelope of money that the cost savings are realized. Earlier this week we had someone say that if you were to decrease the use of benzodiazepines in seniors, which the province pays for, you would get a savings in hip fractures and associated care costs in another area's envelope along with quality of life issues.

It's a real challenge, and you've given us lots of food for thought. I think my head is spinning. I'm sure that all of us as committee members appreciate what you are doing in your communities and provinces and your passion and energy, We wish you luck with your new organizational structure. Thank you for the guidance you've given us.

I said a lot, but I'm not sure I really raised a question. But if you do have any comments, I will let you offer them.

Dr. Smith.

Â (1220)

Dr. Patrick Smith: I would say that your summary says exactly why we feel we need some leadership at a high enough level so that they're not thinking about their little pocket but about the big picture. We can't get people to think about the other pockets where the savings are really happening. What you said is why we feel, based on the last several years of hell it has been without it, that if the leadership were high enough, then someone would be able to see a big enough picture to say, it's okay to spend an extra dime here to save a dollar over there. Then someone somewhere can do the right allocation. So your closing statement is exactly why we feel that the leadership needs to be at a high enough level.

The Chair: Mr. Perron.

Mr. Michel Perron: Briefly, on behalf of the council, given that this was our first appearance together, and we'll debrief thoroughly afterwards--

A witness: And we don't like you.

Some hon. members: Oh, oh!

The Chair: I'm not sure where that came from.

Mr. Michel Perron: All these revelations in front of cameras and esteemed members of Parliament.

Thank you very much for accommodating this group to meet with you. I know you have met with many people. We do hope that our comments resonated. Perhaps they disappointed some, but we certainly came with what we wanted to say. The offer that was made in the presentation, which I hope you will carry through on, was that we are at your disposal individually and collectively. We are most prepared to serve and help you. We wish you the best of luck in your deliberations, and we look forward to your report.

The Chair: Thank you.

It also strikes me that when we make our recommendations and people are looking to try to understand where those came from, we are going to need your support in helping to communicate to people, to your grandmother--

A witness: My mother.

The Chair: --sorry, your mother--why we actually need to make that investment of 10¢ anywhere across this country, because it is going to save us dollars. You're going to be our partners in communicating that message. Thank you and good luck.

The meeting is adjourned.