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APPENDIX B: TERMS OF REFERENCE
INTRODUCTION
On 17 May 2001, the House of Commons gave the Special Committee a very broad mandate to study “the factors underlying or relating to the non-medical use of drugs in Canada” and to bring forward recommendations aimed at reducing “the dimensions of the problem involved in such use.”
To date, the Committee has reviewed a sampling of the relevant literature and received briefings from various government departments responsible for implementing Canada’s Drug Strategy. As a result of this preliminary work, the Committee is aware of the potential breadth of the study to be undertaken. In addition to the problems relating to a wide variety of illicit drugs such as heroin, cocaine and marijuana, to name only a few, a truly comprehensive study of the non-medical use of drugs could also include tobacco and alcohol, as well as the misuse of “licit” prescription and non-prescription drugs. Indeed, studies have shown that the overall societal costs of tobacco and alcohol use outstrip those of all illicit psychotropic substances combined.
However, the Committee is keenly aware of the urgent need to address some of the worst problems associated with substance abuse in Canada and the significant time constraints under which it will be operating in order to table a Report in the House of Commons by November 2002. Therefore, rather than undertaking a detailed review of selected drugs and the people who use them, the Committee believes that a more generic approach is necessary. Consequently, this study will examine substance abuse in its various contexts, with a view to determining the ways in which it interferes with the health and security of users, their communities and society as a whole, in order to suggest appropriate responses. Bearing in mind the need to harmonize policy with domestic laws and international commitments, the Committee will also note which, if any, legislative reforms it considers necessary to achieve that end.
While the Committee has no wish to limit the scope of its recommendations, there are factors that may influence the focus of its final report. For example, the Senate Special Committee on Illegal Drugs is mandated to examine laws and policies respecting Cannabis and to table its report by August 2002. Depending upon the scope and substance of that report, the House of Commons Special Committee on Non-Medical Use of Drugs or may or may not find it necessary to elaborate further on matters relating to marijuana.
The following issues are intended to focus discussions with expert witnesses, stakeholders and the public at large. Although the Committee expects to address many of these issues during the course of its study, the list is not intended to be exhaustive or limiting, since other worthwhile approaches may yet be identified. However, the Committee anticipates that the following will act as a guide to assist interested parties in the preparation of submissions.
CANADA’S DRUG STRATEGY
According to its own description, Canada’s Drug Strategy reflects “a balance between reducing the supply of drugs and reducing the demand for drugs.” Its stated goal is “to reduce the harm associated with alcohol and other drugs to individuals, families, and communities.” Direct responsibility for the implementation of Canada’s Drug Strategy is shared among numerous federal Departments and Agencies, with Health Canada taking the lead. For example, Justice Canada is responsible for drug prosecutions, while the R.C.M.P. enforces the laws intended to reduce the supply of drugs and Correctional Service Canada administers drug-related sentences and provides treatment to offenders with substance abuse problems. In light of the challenges involved in coordinating the efforts of so many different groups, the question arises whether a more centralized approach within the federal government could achieve better results in the long run. The Committee anticipates that this year’s Annual Report of the Auditor General will help to answer that question, given that it is expected to include a review of Canada’s Drug Strategy and, more particularly, the federal government’s role in reducing the harm caused by illicit drugs.
In consideration of the efficacy of Canada’s Drug Strategy thus far, the Committee welcomes comment on the following questions.
| | • | Does the office of Canada’s Drug Strategy monitor efforts in research, education or pilot treatment projects undertaken by partner federal agencies, provincial governments or non-governmental organizations? Does the office of Canada’s Drug Strategy compile data on related program expenditures by partner federal departments and agencies? Is there a single entity that could act as a source of information on all federal programs currently funded as part of Canada’s Drug Strategy? |
| | • | What financial resources are dedicated to the implementation of Canada’s Drug Strategy and are there areas where more money needs to be invested? What is the appropriate role for the federal government in implementing drug policy? Are there areas where greater federal intervention would be welcome? |
| | • | Does the current administrative framework of Canada’s Drug Strategy lead to a fragmentation of effort and results? Are there conflicting interests among responsible departments and agencies? Could Canada’s Drug Strategy be more effectively administered by a single, dedicated agency, operating independently of other government departments? Alternatively, could a higher profile and a more focused approach be achieved through the appointment of a national spokesperson for Canada’s Drug Strategy? Is Canada’s Drug Strategy working? What has it accomplished to date? |
EXPANDING THE KNOWLEDGE BASE
In the short time that the Committee has had to consider the scope of its mandate, members have become aware of the absolute necessity of having reliable data on which to base the myriad policy decisions necessary for developing and administering a cohesive and viable drug strategy in Canada. At the same time, the lack of up to date reliable national data on usage patterns has also become apparent. Without such data, timely reaction to developing trends may be difficult if not impossible. The Committee will consider the current situation in Canada as it relates to the conduct and funding of research and data collection, to determine whether additional resources are needed to facilitate and support informed policy choices.
| | • | Is there a need for more and better data collection on drug use in Canada? A number of provinces conduct regular surveys of drug usage by secondary school students, some more frequently than others. Are there comparable data respecting drug use by the population as a whole? Do we have reliable data on drug use among other population sub-sets who may be at greater risk for some of the harms associated with substance abuse? Are there sufficient data to enable timely identification of trends or shifts in drug use? |
| | • | Who is currently conducting research on the use and abuse of psychoactive substances in Canada? How much of the funding for that research is provided by the federal government? What level of funding comes from each of the provincial governments? Are there any other sources of support? |
| | • | The Canadian Institutes of Health Research (CIHR) is a federal agency comprised of thirteen different institutes, each of which funds research and training in a particular area. The Institute of Neurosciences, Mental Health and Addiction allocates research funds to a vast array of health concerns that currently include mental health, neurological health, vision, hearing, and cognitive functioning. They also support research to reduce the burden of related disorders through prevention strategies, screening, diagnosis, treatment, support systems and palliation. Addiction prevention policies and strategies is one research area among many others that the Institute supports. Given the scope and consequences of problems relating to substance use and misuse in Canada, is there an argument for creating a Research Institute within CIHR, dedicated solely to research on addictions? |
DEFINING AND ENHANCING HARM REDUCTION
A “harm reduction” approach to the treatment and management of substance abuse gained popularity during the 1980’s, when the spread of HIV/AIDS came to be viewed as a greater threat to individual and public health than drug use. Although initially directed toward injection drug use, many jurisdictions have since adapted the harm reduction approach to other illicit drugs, as well as legal substances like alcohol and tobacco. According to Canada’s Drug Strategy, harm reduction is a “realistic, pragmatic, and humane approach” to substance abuse, “as opposed to attempting solely to reduce the use of drugs.” However, there is a distinct lack of consensus on whether harm reduction is limited to reducing the adverse consequences of drug use, or whether that approach can extend to policies aimed at preventing or reducing the use of drugs. In an attempt to take the broadest possible view of this ongoing debate, the Committee will consider the following questions as they may relate to harm reduction.
| | • | How much does criminalization contribute to the harm associated with drug use? Are there ways to mitigate those adverse effects? If prohibition doesn’t eliminate drug abuse, does it at least discourage use among the general population? Are Canada’s drug laws and policies in need of review and reform? What role should law enforcement agencies play in harm reduction? |
| | • | Is treatment for drug addiction or dependence readily available in all jurisdictions? Are there barriers to access for those in need of treatment? Are treatment programs available in correctional facilities? Can existing social programs provide the additional supports necessary for individuals involved in drug treatment or rehabilitation? |
| | • | What kinds of educational programs are aimed at preventing or reducing the consumption of illicit drugs in Canada? How does the level of funding and scope for those compare with programs devoted to the prevention of smoking or alcohol abuse? What has been the role of the provinces in education and prevention? Are there promising innovations in other jurisdictions that Canada should consider? Is there realistic and honest drug education focused on health and well-being? |
| | • | Canada’s Drug Strategy espouses elements of “harm reduction” in the management of substance use and abuse. How much does the success of that approach rely on the support of a well-informed public? Has Health Canada or any other federal Department or Agency undertaken public education initiatives explaining the benefits of the harm reduction policies it currently supports? |
ADDRESSING INJECTION DRUG USE
It is apparent from the debate on the motion leading to the formation of this Committee that injection drug use is a major concern for members of the House of Commons and their constituents. The scope of the problem of injection drug use and its consequential health effects was the subject of a recent Federal/Provincial/Territorial Advisory Committee Report entitled Reducing the Harm Associated with Injection Drug Use in Canada. Among other findings, the Report confirmed that injection drug use is a major risk factor for HIV/AIDS and Hepatitis infections, carrying potentially disastrous consequences not only for infected individuals, but also their communities and Canadian society as a whole. Those consequences are particularly apparent among incarcerated Canadians. In addition to recommending steps that could be taken immediately to address the problem, the Report also suggested “a close examination of Canada’s drug law, regulations and policies related to injection drug use and to drug misuse in general.” Bearing in mind the need for a review of existing legislation and policies, the Committee will consider the following questions concerning injection drug use in Canada.
| | • | Among other recommendations, the aforementioned report calls for enhancement of needle exchange programs and increased access to treatment options including methadone maintenance. The report also advocates clinical trials of prescription heroin and urges consideration of a pilot or research project involving a “supervised injection site.” The Committee would like to hear submissions on those recommendations in particular. For example, what, if any, negative impacts are associated with existing needle exchange programs? Do service providers agree that there is a need for prescription heroine trials? Do law enforcement agencies have particular concerns about supervised injection sites? Is there community support for implementing these and other recommendations made in the report? If so, what other barriers are there to implementation? |
| | • | How much is known about the extent of injection drug use in all areas of Canada? Are there any groups that are at greater risk for the harms associated with this kind of drug use? Is there a need for enhanced data collection to better monitor trends, as well as outcomes of any new treatment or harm-reduction initiatives? Are there harm reduction, prevention, treatment, or law enforcement strategies that have been successful in other countries? |
| | • | The rate of injection drug use among incarcerated individuals is known to be significant. Are there prevention and treatment programs that could be better adapted to correctional facilities? Are there innovations in other jurisdictions that have proven successful within the prison environment? |
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