[Recorded by Electronic Apparatus]
Tuesday, October 8, 1996
.0939 
[English]
The Chairman: Order, please.
We now welcome, from the Department of Health, André Juneau and his colleagues.
Mr. Juneau, would you begin by introducing your team? We hope you have the briefest of opening statements, because we have some really juicy questions for you this morning.
Mr. André Juneau (Assistant Deputy Minister, Policy and Consultation Branch, Department of Health): Thank you, Mr. Chairman. I know the rules of this committee.
Let me introduce my colleagues. Diane Jacovella is the manager of the office of alcohol, drugs and dependency issues in the health promotion and programs branch, and Bruce Rowsell is the director of the bureau of drug surveillance in the health protection branch of Health Canada.
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I will make a brief presentation on how we think generally about the issues your committee is considering, and then my colleagues will make brief presentations on some specifics.
Let me thank you first, members of the committee, on behalf of Minister Dingwall, for your invitation to speak to you today on the issue of the drug policy. We're pleased to be able to have some input into your study of drug policy.
[Translation]
In this presentation Health Canada will attempt to provide you with an overview of the situation in Canada. We intend to address the issue of why an approach based on public health is the right focus and how it is applied and secondly, we will be giving you a general overview of Canadian policies and programs in this field;
[English]
and we will conclude with an overview of the new controlled drugs and substances bill.
I know many of you have already heard about the concept of a population health approach, so I hope my presentation won't be old news to all of you. I think it's important to get things off on the right foot, and I believe there's no better way to set the stage than by emphasizing the need for a population health approach to substance abuse.
What do we mean by a population health approach? Let me read from the text of the material we've distributed.
A population health approach is a framework for decision-making based on the determinants of health - the factors that contribute to the health of the population.
It's an ``upstream approach'' to improve the health of Canadians and reduce the ``downstream'' costs of poor health to individuals, families and the health care system.
One way to illustrate this concept is to tell the old story about an exhausted man who spent his days and nights pulling drowning people out of a river. When asked what was going on he said``I don't know; I'm so busy saving people I haven't had time to find out who's pushing them in upstream.''
In Health Canada's work on substance abuse issues we strive towards an approach that addresses the root causes of substance use or abuse problems.
Under our population health approach, policy and program decisions are based on where resources have the greatest impact on the long-term health of the population, often - and this is true in this area as in many other areas that this committee is familiar with - in the early years of life, ages 0 to 18, and perhaps even age 0 to some younger age.
Canada's drug strategy is a federal government initiative addressing substance abuse, and it has certainly focused on young people. You'll hear more about this during phase I of the strategy. Our effort is focused on raising awareness and educating youth about the adverse health effects of substance abuse.
In the second phase of the strategy we developed and implemented innovative approaches to reach youth at risk. Youth at risk - or populations at risk - is a phrase you'll often hear in this business, including street youth.
Because the determinants of health include not only personal choices and habits but also social, environmental and economic factors such as working conditions, social support networks and education, obviously a population health approach has to involve partners both in government and in the non-government sector.
A population health approach attempts to balance the current emphasis on care and treatment with increased emphasis on promotion of health and prevention of disease at key points in the life cycle, whether early life, mid-adulthood, or later life. For example, in a population health approach, obviously, as I've noted, a high-risk group for the consumption of drugs, tobacco, and alcohol is young people, and we need to have preventive programs targeted to address the risk factors and root causes associated with or faced by this group.
To move to more specific questions, then, if we take a population health approach to substance abuse, we need to address the following key questions. What is the pattern of substance abuse in Canada, and how and why has this pattern emerged and evolved? What aspects of this pattern have the greatest health impacts on society, especially young people? Are the current substance abuse approaches responsive in reducing adverse health effects?
With that brief introduction on how we think about substance abuse and in fact how we think about a lot of issues in the department and with our colleagues in the health community, I would like to turn over the presentation to Diane Jacovella, who will cover Canada's drug policies and programs and elaborate on what I've said on our approach to substance abuse issues.
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Ms Diane Jacovella (Manager, Office of Alcohol, Drugs and Dependency Issues, Health Promotion and Programs Branch, Department of Health): Thank you, Mr. Chairman, for the opportunity to address the Standing Committee on Health.
Canada's drug strategy is a collaborative initiative to reduce the harm caused by alcohol and other drugs to individual families and communities. The harm caused by substance abuse includes sickness, death, social problems, crime, violence, and economic costs to all levels of society. A study recently released by the Canadian Centre on Substance Abuse in which Health Canada participated estimates the cost of substance abuse in Canada for 1992 to be $18.45 billion.
Harm reduction is at the heart of the strategy, aiming to decrease the negative consequences and risk associated with drug use rather than solely focusing on reducing the use of drugs.
The definition of drugs is broad. The strategy includes efforts to address: alcohol; medications, both over the counter and prescription; illicit drugs; solvents; and banned and restricted sports drugs.
The impetus for a federal concerted effort to address substance abuse problems emerged in 1987 in response to mounting concerns in North America about increasing rates of drug-related problems. It became evident that drug-related problems posed a long-term and serious threat to the health and well-being of Canadians.
The Department of Health played a leading role by bringing together other federal departments, as well as many other partners, in order to raise awareness and educate the public about the problems associated with substance abuse, enhance the availability and accessibility of treatment and rehabilitation, energize enforcement and control, coordinate national efforts, and participate at the international level to promote a balanced approach to the drug problem.
By the end of the first phase of the strategy, it was evident that public awareness had increased regarding consequences of drug-related problems. We had successfully changed the norm regarding drinking and driving, making it totally unacceptable, and school prevention programs were being implemented all across Canada.
Despite the headway that had been made over the preceding five years, a number of challenges were still evident. It became apparent that a number of population groups were either not being reached by current initiatives, namely, street youth and aboriginal people living off reserves, or were not being adequately addressed since their substance use problems were often hidden, the case in point being women and seniors.
New drugs had surfaced, complicating the picture, and issues such as fetal alcohol syndrome were still presenting challenges requiring us to address a number of determinants of health. As a result, the government renewed its commitment to address substance abuse issues by merging the national strategy to reduce impaired driving with the national drug strategy and launching, in 1992, Canada's drug strategy.
The strategy wanted to capitalize on the momentum that had been achieved in the first phase, continuing to focus on prevention, especially with youth. At the same time, the strategy wanted to develop and implement innovative ways to reach those who are hard to reach, namely, street youth and repeat driving while impaired offenders. The renewed approach recognized the need to place a greater emphasis on equal accessibility to appropriate treatment for women and youth.
New partnerships were forged in an even stronger emphasis on collaboration, consultation and partnerships with provincial and territorial governments, national voluntary associations, professional associations, the private sector, community groups, law enforcement agencies and, most importantly, target groups themselves. The mix of partners ensured a balanced and comprehensive approach between supply reduction and demand reduction in reducing the harm caused by alcohol and other drugs.
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Health Canada's initiatives focus on demand reduction. That is, they aim to prevent the use of drugs by those not currently using drugs; to reduce the harm caused by drugs for those who do use them; and to treat and rehabilitate those who are affected by drug problems. The department attempts to meet these challenges by providing national leadership on substance abuse issues; by conducting research into the risk factors and root causes of substance abuse; by synthesizing and disseminating leading-edge information to health professional and community groups in the field; by developing innovative prevention programs, resources and models based on best practices; and by promoting and facilitating community action.
Some positive trends include: the release of Canada's alcohol and other drugs survey, which showed a drop of 5.4% points since 1989 in the percentage of Canadians who report drinking in the last twelve months; a decrease in the average number of drinks per week; and a decrease in the percentage of Canadians who drive after consuming two or more drinks in the previous hour.
The street lifestyle study informed us about the antecedents to street involvement and helps us to identify promising prevention strategies. As well, there was a project on rural women and substance abuse. It assisted communities in Newfoundland, Quebec and Saskatchewan to identify issues facing rural women and to develop ways to address them.
Another is the implementation across Canada of Ready or Not, a parenting program for low-income parents, and the development and pilot testing of a new parenting program for adult children of substance-abusing parents. An alcohol risk assessment and intervention program for family physicians was developed, and it was adopted by the College of Family Physicians of Canada. Finally, we saw the development of a joint statement on the prevention of fetal alcohol syndrome and fetal alcohol effect in Canada.
Health Canada works with a variety of partners to prevent substance abuse. Through the community support program of CDS, the department facilitates community action initiatives that strengthen the abilities of communities to address the substance abuse issues. Over 400 community projects have been funded to address local substance abuse issues.
A key element of our role in community action, of course, is making sure communities have an opportunity to learn from each other's successes. In phase II, the department worked closely with many communities across Canada to address local issues involving street youth by providing expertise and resources, by stimulating action, and by transferring key learnings and best practices. Youth in these communities played a fundamental role in planning and implementing local efforts, as well as in providing direction on a national steering committee with federal and provincial partners.
Through its medical services branch, Health Canada also provides funding to aboriginal communities for substance abuse initiatives, including the prevention and treatment of solvent abuse, especially among youth. The national native alcohol and drug abuse program provides a culturally relevant approach to aboriginal people to address prevention and treatment of other drug problems. In Canada, there are approximately 50 NNADAP treatment centres and over700 community workers working on substance abuse.
Health Canada coordinates federal initiatives on the drug file through an ADM steering committee of departments involved in drug-related programs and policies. The current strategy involves seven federal departments: Health Canada, Solicitor General, Justice, Foreign Affairs and International Trade, Heritage Canada, Revenue Canada Customs, and Human Resources Development Canada.
Health Canada also collaborates closely with multilateral organizations. The department plays a key role in promoting a balanced approach to the drug problem and in emphasizing the importance of demand reduction initiatives. Canada is a member of the Commission on Narcotic Drugs and has presented a number of resolutions on demand reduction that have been approved by the commission. Health Canada also collaborates with the Inter-American Drug Abuse Control Commission of the Organization of American States in the development of an hemispheric anti-drug strategy. Finally, the department participates in two international projects concerning substance abuse with the World Health Organization, one addressing the needs of street children and youth and the other addressing the needs of aboriginal people.
Canada is well respected internationally for its approach to the drug problem. It is seen as a model for its balanced approach, its involvement of multisectoral partners, and its commitment to helping those at risk.
Phase II of Canada's drug strategy will sunset in March 1997. Although we have made considerable progress in reaching high-risk groups, there are still some issues that require attention. As identified in Canada's alcohol and other drugs survey and other national and provincial surveys, more women than men use medication; there is an increase in the use of some drugs, especially among youth; and 7.7% of users of cocaine, LSD, speed, heroin or steroids report injecting drugs and sharing some needles.
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Health Canada is committed to continuing to provide leadership on substance abuse issues through its population health strategy. Therefore the department will place an even greater emphasis on initiatives to prevent young people from using substances while still addressing the needs of high-risk groups. We will continue to work collaboratively with other federal departments, provincial governments, non-governmental organizations, professional associations, and the private sector. The department will continue to play a leadership role in national coordination, development of new and enhanced partnerships, development of leading-edge knowledge, synthesis and dissemination of best practices, and international cooperation.
The Chairman: Mr. Rowsell.
Mr. Bruce Rowsell (Director, Bureau of Dangerous Drugs Health Protection Branch, Department of Health): Thank you, Mr. Chairman. Since the subcommittee of this committee spent considerable time looking at Bill C-8, I'll be very brief in my overview of this bill.
Heroin, cocaine, morphine, amphetamines, diazepam - these are all very powerful substances that have a valid therapeutic use. However, they are also very powerful chemicals that are subject to abuse. I would like you to remember, though, that first of all, from a health perspective, they are medicines.
When we look at the abuse potential, some years ago, in an international vein, the United Nations undertook initiatives to try to approach this from a global perspective, to make sure what was being done in a global perspective would be maintained. In other words, the approach to dealing with substance abuse required a lot of partners around the world in order to deal with it. We couldn't have a loophole that would go around a program to deal with substance abuse.
So back in the early 1960s the United Nations convened the Single Convention on Narcotic Drugs. This was the first of the conventions that tried to deal with controlling supply. I'd like to emphasize that the early approaches to dealing with substance abuse focused on controlling supply. As Madam Jacovella has just mentioned, we have gone much further than that now, in doing a broader harm-reduction approach that incorporates supply control but also demand reduction.
In 1971 the United Nations felt there was a need to deal with other substances that had more of a psychotropic effect. So the Convention on Psychotropic Substances was convened.
Finally, in the 1980s the United Nations had the Convention on Illicit Traffic in Narcotic Drugs and Psychotropic Substances.
Canada is a signatory to all three of these conventions. Therefore we do have to meet those international obligations. Until Bill C-8 there were a number of areas where our Canadian legislation did not fulfil all our commitments. The Narcotic Control Act and parts III and IV of the Food and Drugs Act dealt with narcotics and many of the psychotropic substances. However, substances such as diazepam and the benzodiazepines were not covered by our legislation to the extent required, nor were precursor chemicals.
Let me briefly talk about the main features of Bill C-8, the Controlled Drugs and Substances Act. This proposed act will control the import and export of precursor chemicals. These are used by underground drug manufacturers. These chemicals include substances that can easily be changed into controlled substances. The bill also provides for control on the production, distribution, import, and export of anabolic steroids. That's an effect that came from the commission of inquiry by Justice Dubin after the 1988 Olympics.
The bill provides for control in dealing with designer drugs. These are developed by dealers specifically to evade the laws. Designer drugs are minor manipulations that have the same pharmacological effect, but go around the specific legislation as it has been written and provided in the schedules.
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The act also provides for enhanced provisions for search, seizure, and forfeiture of property used while committing a drug offence. These additions provide the Solicitor General with greater control over the enforcement procedures and also provide for the government to deal with taking away properties that may have been used or purchased as a result of the use of drug money.
There is also provision for an administrative scheme to enforce the regulations pertaining to health professionals. In the Narcotic Control Act and parts III and IV of the Food and Drugs Act we have not had adequate administrative procedures to give fair hearings to the health professionals and take a more up-to-date and modern approach. So everybody would now have a fair say and there would be an independent administration of that aspect of the law.
There are also enhanced provisions for the disposal of seized and controlled substances and enhanced enforcement of the law by the police and the courts. Many of the changes were to streamline the justice procedure so that both the person accused and the enforcement agencies would be able to streamline the process for enforcement.
In the amendments under the bill there has been a new offence for the possession of marijuana and hashish that places certain quantity limitations on the bill. It has allowed for a process whereby it's a summary conviction for possession under 30 grams, or 1 gram of hashish, and it has allowed us to streamline the process. It has also avoided the necessity for fingerprinting, so the records are kept only at the local level and are not put into a national database.
There are also new offences for trafficking in marijuana and hashish that include certain quantities and streamline the process. There is also a purpose clause dealing with the sentences and, more particularly, encouraging rehabilitation and treatment in appropriate circumstances. In other words, there is encouragement to the courts to look at rehabilitation and treatment as opposed to incarceration when circumstances are appropriate.
One of the real features of the bill is the inclusion of aggravated circumstances. This section has been expanded to cover where transactions may take place in public places usually frequented by minors. Originally, it was to deal with just those areas around school yards, but through the amendments made by the committee it was expanded to deal with other areas where minors use the facilities. This means that when an offender is convicted under those circumstances, a judge will have to give reasons for not imposing a jail term.
Finally, the amendments provide for the commercial cultivation of hemp. There are certain economic opportunities for the industrial use of hemp fibres for textiles, paper products and wood substitutes. This is a situation where a product was identified as cannabis when it was a variety of cannabis with low THC. It has commercial value but was caught by legislation that implied all forms of cannabis would be dealt with the same way. This amendment allows us to move forward and develop an infrastructure for the commercial cultivation of hemp.
I think those are the main features of the bill that I'd like to raise with you at this time.
The Chairman: Thank you.
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I was just thinking, kind of tongue in cheek, if ever I face the death penalty and I'm given an opportunity for a brief statement, I would want somebody from Health Canada to come and brief for me at the time. You have left yourself about ten minutes, nevertheless.
We'll go with Pauline first, then Paul.
[Translation]
Ms Picard (Drummond): Mr. Chairman, I'd like to give my time to Mr. de Savoye who worked on the subcommittee dealing with Bill C-8 and certainly will have more relevant questions than mine.
Mr. de Savoye (Portneuf): Thank you, Pauline. Mr. Juneau, Ms Jacovella, Mr. Rowsell, I'd like to welcome you.
About two and a half years ago, this committee charged a subcommittee under the chairmanship of Mr. Szabo with examining Bill C-7, which later became Bill C-8. I remember at the time I thought it was unfortunate, like a number of other members of the committee and subcommittee, that Bill C-7 dealt only with the problem upstream, that is in controlling supply. It was our opinion that the problem should have been dealt with from the downstream point of view.
I am very pleased that the Health Committee decided last spring that it would begin the present process focusing on education, prevention, treatment and rehabilitation.
Mr. Rowsell, I am sorry to say so but this committee will be attempting to reduce your workload. I realize that the consumption of drugs is not simply a matter of supply. Personally, ifI were offered some drugs, I wouldn't take them but are there so many people who want to try them or who are actively looking for them?
A number of risk factors have been mentioned like age, gender, socioeconomic situation, ethnic origin, geographical location and of course these risks factors are mentioned because there is a correlation between the amount of drugs consumed by people and the number of these characteristics. But these characteristics do not explain why the need arises. It is not because you are a male or female that you will be automatically inclined to take drugs. Gender may come into play in certain situations where a person will be tempted to look for comfort in drugs, which is an illusion of course.
Ms Jacovella, you mentioned that you were concerned with these matters and you also quoted a number of figures. Does your Department have any data demonstrating a correlation not only with risks factors but also with underlying causes? Do you have any information that could help the Committee to obtain a clear focus during the course of its investigations so that we have a better understanding of the root causes, either direct of indirect, which may predispose people to take drugs and with respect to which we might consider certain types of action?
Ms Jacovella: In the past we conducted a number of studies on determining risk factors. We are not completely sure but we have a good idea of certain risks factors leading to the consumption of drugs, especially among young people.
I mentioned the study on the involvement in street life. We talked to people who were on the streets previously and who came back to mainstream. We asked what cause them to turn to life on the streets and what helped them to go back to a more stable lifestyle. We have a good deal of information on this, it is of assistance to us in deciding the prevention programs that we can put into place to help such people. Our report will soon be concluded and should be distributed shortly. We will send it to the committee once it is approved.
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We also did a study about a year and a half ago on the notion of psychological resiliency. We talk a lot about risk factors but we also have to know what keeps people in good health, what kind of resiliency is required. These documents might be useful to the committee. We can give a copy to the clerk. I think that these two documents in particular would probably give you an idea of the factors involved and what type of measures can be helpful in prevention.
Mr. de Savoye: Are you familiar enough with these documents to tell us whether there are certain elements that recur quite often and which we should be particularly attentive to? Can you give us some advice on this?
Ms Jacovella: One thing we've observed in the public health approach is that all factors must be considered at the same time. One cannot restrict one's attention solely to the matter of drug consumption. One must also take into account a person's social environment and the type of support available, whether it be at home or at school.
We advocate a holistic approach. There will be prevention programs in schools for those who have not yet started taking drugs. We will also have programs for drug users. They must first of all be identified and helped so that their drug taking practices can be made as safe as possible. I'm thinking here in particular about the sharing of needles. Help must be given to those who need treatment by bringing them to the hospital. So there must be all three aspects, including prevention and treatment.
It is also necessary for us to continue our research because although we have a great deal of information now, trends evolve and can change. We must always be up in the latest information to know what is happening. So there are different aspects. An effort must be made to reach young people who are at risk without overlooking those who haven't started taking drugs. That is what we intend to do in the future.
It is also important to involve those concerned in decisions and planning relating to programs. We learned a great deal this year on the way to encourage young people at risk to become involved in programs, this is far preferable to allowing bureaucrats to make decisions about what is good for them.
Mr. de Savoye: We know that surveys have been done in various areas. Political surveys are quite popular to find out how people react to such and such a thing. I'd like to know whether you have conducted any surveys among the population on the questions we have been discussing in order to estimate the number of persons involved, the type of problems they are facing, whether it be tobacco, alcohol, soft or hard drugs, the length of time they have been addicted, the way in which they cope with it and the resources they have access to at the present time? Do you have any statistics on these things?
Ms Jacovella: Yes. A national survey on alcohol and other drugs was conducted in 1994. So far just a small report came out last year but the technical report is expected to be ready this fall. It describes in great detail the typical characteristics of persons who are most inclined to consume alcohol, people at risk. There's information about the province they are most likely to come from, the language they speak, their marital status, gender and age group. In this way we've been able to obtain a profile that helps us better target a number of our prevention programs.
Mr. de Savoye: And will we be able to obtain a copy of this?
Ms Jacovella: Yes, this Fall. Certainly.
Mr. de Savoye: I believe my colleague would like to share the time allotted to us.
[English]
The Chairman: I ask the witnesses to keep the answers very brief, please.
Paul first.
Mr. Szabo (Mississauga South): Mr. Chairman, in view of the time, I would like to table some questions, with the witnesses undertaking to respond appropriately.
Number one, could the witnesses provide us with an explanation as to whether or not there will have to be special regulations with regard to commercial production of hemp, and will there be fees involved, etc? This issue came up during consideration of Bill C-8.
Number two, I would like to know what the current position of Health Canada is with regard to the decriminalization of marijuana and whether or not at this point the health department is thinking of recommending a change to that current policy.
Number three, targeting of programs. The Brewers Association of Canada states that 99% of Canadians are aware that you're not supposed to drink and drive, 99% recognize the health impacts of...and 95% know you should not drink during pregnancy. Do you agree with that? If you do, why are we having awareness programs?
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In the last report on the national drug strategy, Health Canada reported that 69% of Canadians supported the introduction of health warning labels on the containers of alcoholic beverages. Have you updated those numbers, and if so, could we have them and your recommendation as a result of those numbers?
This is another question -
The Chairman: I have three other interveners.
Mr. Szabo: I understand, but I'm just asking....
Could I have an assessment on the U.S. health warning labels? Have you done an assessment of the effectiveness of U.S. labels in terms of the style of labelling?
Finally, could you tell us, in terms of your strategy, whether you have focused...? Is education awareness or behaviour changing? I think it's a very important question as to where Health Canada is coming from in terms of education programs.
Finally, could you answer the question, is it true Health Canada is in fact doing its own study or review of the national drug strategy with a report due in February 1997?
The Chairman: It's 10:15 a.m. and we have another set of witnesses. May I suggest, withMr. Juneau's indulgence, that the other three interveners put their questions and Mr. Juneau respond to the questions in writing. Is that fair?
Mr. Juneau: Yes, sir.
The Chairman: Okay.
[Translation]
Mr. Dubé (Lévis): I have a very short question to which I do not expect an answer today. It concerns programs and services targeting specific groups. Let me give you an example I know of, namely that of the Centre Jean-Lapointe pour adolescents in Quebec City whose funding for this year has been cut. Does this policy apply across the board to all such centres or was this a special case? I would appreciate having this information but you do not need to give me the answer today.
[English]
The Chairman: Mr. John Murphy.
Mr. Murphy (Annapolis Valley - Hants): Thank you, Mr. Chairman.
You mentioned in your report your relationship with the Canadian Centre on Substance Abuse. I'm just wondering what that relationship is, what interaction you have, and what the future interaction and collaboration with that body will continue to be.
The Chairman: Harb.
Mr. Dhaliwal (Vancouver South): I have two quick questions, Mr. Chairman.
You talked about specific groups. I'd like to know if you've done any study on which groups have a greater problem in terms of drug abuse and specific studies done directly on whether there's a problem with certain regions or ethnic groups that have a greater problem with certain types of drug abuse. Is that possible?
Just as a comment, when I toured some of the prisons I was told 75% of all crime is drug related and that we need to have a much more bold initiative, unconventional initiative, to deal with drug abuse. I'm wondering if Health Canada has really looked at some of the bolder ways of dealing with drug abuse, because obviously our current strategies aren't working. Can you give me information or other things on that issue, having a much more bold, aggressive view of trying to deal with drug abuse? Obviously, we're losing the battle on it.
The Chairman: You and your colleagues will be aware the committee has only now begun its study of Canada's drug policy.
Our purpose this morning, I think, has been well served. We wanted first to hear from the department to get an overview of where you are as a department. We thank you for giving that, particularly for this document to which I draw the committee's attention. It's a discussion paper. You might want to bone up on this one for future meetings.
I hope, Mr. Juneau, you'll give us your responses sooner rather than later, because it will help us at this end of the table. I've got to keep my researchers happy.
I welcome to the committee Roy Cullen, member for Etobicoke North, and welcome back our former colleague as a member of the committee, Pierre de Savoye.
We'll just make the transition now to the new set of witnesses. Thank you very much.
I want to acknowledge the presence of Janet Davies with whom I worked when she was a legislative assistant and I was the parliamentary secretary for Environment. It is nice to see you. She now has a big job over at Health Canada and they're paying her the big bucks, I hope.
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Some hon. members: Oh, oh!
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The Chairman: Order. I welcome Mr. Ed Fitzpatrick, the vice-chair of the Canadian Centre on Substance Abuse, and his colleagues.
Mr. Ed Fitzpatrick (Member, Board of Directors, Canadian Centre on Substance Abuse): Bonjour. Good morning, ladies and gentlemen. It's a pleasure to be here today to support the presentation by the staff of the Canadian Centre on Substance Abuse.
Normally this position would be filled today by our chairman, Mr. Bill Deeks, but unfortunately he had business commitments that could not allow him to be here. We feel from the board perspective that it is important to have representation here to support Mr. Jacques LeCavalier, the chief executive officer of the Canadian Centre on Substance Abuse.
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Both the volunteer board and the staff of the centre fully realize how important a task this House standing committee has for the future of the citizens of Canada. We wish you well in your deliberations, and we certainly hope we will be able to participate in a meaningful way and assist you in this momentous task.
I will now ask Jacques to begin his report.
[Translation]
Mr. Jacques LeCavalier (Chief Executive Officer, Canadian Centre on Substance Abuse): Thank you, Mr. Fitzpatrick.
Allow me, first of all, to give you a very brief historical overview of the drug demand reduction strategies first put in place, as you know, in the early 1970s, with the Le Dain Commission. This is the third major study of this important question. You will also recall that the study carried out by the Standing Committee in 1986-1987 led to the launching of the Canadian strategy in 1987 and to the creation of the Canadian Centre on Substance Abuse in 1988.
In doing an historical overview of these strategies, it is important to point out that the 1987 and 1992 strategies set out no specific objectives and this, obviously, will make it difficult to evaluate the results. In the coming months, the committee will have to keep in mind that the results must be targeted in order to give Canadian taxpayers value for money.
I've heard questions on opinion polls and trends. As the spokesperson for Health Canada told you earlier, there has been Canada-wide polls done on adult drug consumption, by that among Canadians 15 years of age and older. Indeed, I have pulled out for the committee, polls done in Ontario since 1977, especially among young students from grades 7 to 13, in order to see what the trends are.
In the case of alcohol, there has been a decline in the number of drinkers. Since the early 1970s, there has also been a sharp decline in consumption per capita. However, you will note on the graph that the downward trend for young drinkers recorded at the end of the 1970s and early 1980s ended in 1994-1995.
Yet, even when the number of young drinkers was declining in the 1980s and 1990s, the number of episodes of heavy consumption among young drinkers, that is five drinks or more per episode, increased steadily.
Let us go now to trends in tobacco use. First of all, as is the case for alcohol, we note a constant decline in the number of adult smokers. However, since 1991 in Ontario the number of young smokers is on the rise. The trend with respect to tobacco use seems to be sharper than for alcohol. We are also noting a phenomenon quite different from that of the 1970s and 1980s.
[English]
The Chairman: Is there some reason why the statistics are for Ontario only?
[Translation]
Mr. LeCavalier: I will explain that in English.
[English]
The reason is that the national polls taken on this focus on adults, people 15 years and older, whereas the Ontario statistics have concentrated on students from grade 7 to 13. Unfortunately we don't have the same set of data for all of Canada that we have for Ontario, but I can answer that question at the end of the presentation a little better, if you wish.
[Translation]
I was referring to the fact that, contrary to earlier trends, we cannot distinguish between the consumption of female and male students whereas in the 1970s young men obviously smoked much more than young women.
With respect to cannabis: we have noticed an increase in the number of users over the past few years. There was a dip between 1991 and 1993.
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In 1989, the rate of cannabis use in Canada was around 6.5 per cent. That rate went down to4.2 per cent in 1993, but went back up to 7.4 per cent in 1994. We also see a very significant increase in cannabis use among youth. In fact, cannabis use has doubled in Ontario since 1991. Those upward trends in cannabis use can also be seen in heroine, speed, LSD and cocaine use.
Moreover, such trends are similar to those in the United States where, since 1991-92, young people have been using cannabis more and more, as well as other drugs. I also want to point out that the results of some surveys which will soon be published in other provinces, including Nova Scotia in a few weeks, will show the same trend.
Let us now talk about international trends and the responses with regard to the drug abuse phenomenon. First, we have seen a marked increase in drug abuse worldwide since the market globalization, the advent of free trade and the break up of the Soviet Union. We also note the growth of organized crime which takes advantage of that free trade to increase its drug trafficking and money laundering activities.
A new international trend that we may not have yet seen in Canada is the use of synthetic stimulants like MDA, or Ecstasy, which has become in some Asian and European countries, as common as cannabis use. In fact, the United Nations Organization is so worried by the situation that I was asked recently to prepare for an international meeting to be held soon, in late November, some proposals for controlling those substances.
You are certainly aware that in the United States, President Clinton launched a 10-year program against drug abuse and committed $15.3 billion a year to that program. Finally, internationally, drugs remain a priority for the UN, so much so that in June 1998, the General Assembly of the UN will hold a special session to deal with the drug issue.
Let us now come back to Canada. I will now switch to the other official language.
[English]
In 1995 the Canadian Centre on Substance Abuse launched a major study of the social and economic costs of substance abuse. The first step in this study was to look at how we can quantify the harms to Canadians from the consumption of alcohol, tobacco and other drugs.
This finding first started with the fact that 6,700 deaths in 1992 were directly attributable to alcohol. For tobacco the number of deaths attributable was 33,498, and for illicit drugs the number was 735. Remember, of course, that the deaths from alcohol and illicit drugs were young people, whereas with tobacco the deaths were older people. In all, this made up 10% of hospital days across Canada.
One point to remember here is that 1992, as you saw from the previous graph, was probably the bottom year in terms of substance use. So these figures are very optimistic for 1992.
The cost in terms of percentage of gross domestic product is 2.7% in total for the three substances. It was $9.6 billion for tobacco, $1.4 billion for drugs and $7.5 billion for alcohol, for a total of $18.45 billion. Again, I remind the committee that this was in a year when we saw a bottoming-out of substance abuse.
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I also remind the committee that there were certain things we couldn't quantify or count. I'll give two examples. The first was misuse of pharmaceuticals. It's totally ignored in this figure because of the complexities of the frontier between judicious use and misuse. The second point...someone asked a question earlier about crime. We know that people who use cocaine and heroin commit property crimes to be able to purchase these substances, but we don't know what proportion. We had to ignore that altogether. So you can see that this figure is extremely conservative.
There is one more point I'd like to add to put this in perspective. In 1992 these drugs cost Canadians $18.5 billion. The federal government gets in excess of $4 billion in revenue from the collection of excise and duty taxes, not to mention the forfeiture from proceeds of crime. It is our allegation that the re-investment into programming and policy is but a very small fraction of that$4 billion.
Let us look for a minute at issues and opportunity. The first question that comes to mind is drug policy: do we have it right? I heard questions earlier about this. Should we legalize?
The first question we should ask ourselves in answering that question is how many intoxicants our society needs. Have we not learned a sufficient lesson from the devastation of alcohol and tobacco? Having said that, however, it's quite clear that it is neither cost-efficient nor effective to put people in jail who are consumers of these products.
There are better ways of doing it. Research shows that particularly in the United States, for each dollar invested in treatment, up to $7 or $10 is saved in other social costs. It's our belief when we look at this equation of investing in prevention and treatment that no amount of tinkering with enforcement or control will generate the value to Canadians that investment in treatment, rehabilitation, prevention and education will generate.
The second point I'd like to raise is a focus on youth and high-risk groups. I was delighted to hear the representative from Health Canada mention these groups as important targets. Youth in particular, even before the onset of drug use, is the most critical issue - even the parents and the whole environment where children grow and learn, in the family, in the school, with peers, within the community.
It's important also to focus on a continuum of cost-effective interventions. There is no one solution that fits everyone. There is no magic bullet in treatment or prevention. We must focus on a continuum of intervention, and rather than fit the people to the programs, we must fit the programs to the people.
It's particularly important for the federal government, in this time of scarce resources, to focus on decision-making that is based on evidence, on facts, on research, on things that we know work.
Finally, it's equally important to focus on enhancing the private sector and involving the community.
I don't need to tell you what the federal role is, but I'll cover it very briefly. Traditionally, of course, the federal role has been one of policy, legislation, taxation, cost-shared programs, enforcement and control, and obviously that will remain. But I would like to stress the importance, in these days of scarce resources, of investing in knowledge development, of ensuring that knowledge is available, created and disseminated. I stress the importance of supporting networks of stakeholders, important interveners in this field, so that they can have access to knowledge and can share information. Finally, I stress the importance of leadership and coordination to ensure that what is available to the residents of one province is shared with the others in a cost-effective way.
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Ladies and gentlemen, the Canadian Centre on Substance Abuse is prepared to generate and disseminate knowledge on the nature, extent, consequences and cost of substance abuse in Canada, and on the nature and impact of Canada's response. What works, what doesn't work and with whom? We have been doing that for a number of years and we are prepared to continue to do that.
We are also prepared to create and support - and have created and supported - multisectoral networks that can intervene in a cost-effective way and exchange information. We're certainly prepared to continue to advise government and assist in coordination.
In closing, Mr. Chairman, I'd like to state that CCSA is able and is committed to this contribution, but we - we and all Canadians - need the leadership of the federal government. We particularly need the long-term commitment of the federal government to these issues. We know we're not going to resolve this in one generation, so we need the long-term commitment.
I'd like to turn to Mr. Fitzpatrick for a short wrap-up of our presentation.
Mr. Fitzpatrick: Thank you, Jacques.
Members of the committee, I think you can see the significance of the statistical background on drug use in Canada and of the role the centre has been playing. To support a comment made by Jacques, the situation in Nova Scotia is certainly not dissimilar to what's occurring here in Ontario.
Our report is released every five years. This year it's going to incorporate all the Atlantic provinces. It will be released in November of this year during drug awareness week. The indications of what's happening in Ontario that we've heard this morning are certainly shown in the comments I have on the early information in the report.
I didn't have the opportunity to check personally with the other Atlantic provinces, but I'm quite sure from what was indicated to me yesterday in Halifax that it's going to be the same situation there. So I don't think, unfortunately.... I've been involved in the field of addictions for the past thirty years. I've retired as a director of the Nova Scotia commission on drug dependency.
I've watched the development of programs in Canada and particularly in our own province of Nova Scotia, and I was very happy to be associated with Mr. Murphy in some measures over those years. I think he knows about my dedication to the work that we're trying to do on drug dependency. As far as the state of drug use in Canada goes, I just wish that today I was hearing things other than what I'm hearing.
The Chairman: Thank you.
Pauline, you're first, then Roy.
[Translation]
Ms Picard: Mr. Chairman, I have two short questions and then I would like to share my time with Mr. de Savoye.
Mr. LeCavalier, you gave us some statistics. You are telling us that in the last two years, there has been a decrease in alcohol use by adults, but oddly enough, there has been an increase among young people. There is also an increase in cigarette smoking and use of illicit drugs like cannabis among young people. Have you done some research do find out why the use of such substances has dropped among adults while it has gone up among young people? What factors come into play?
Secondly, if you were in our place, in what direction would you take the study the committee is about to embark on?
Mr. Lecavalier: Thank you, Ms Picard.
First of all, there is always a gap between the general prevalence of a phenomenon and its increase among young people. Thus we can expect to see the curve go downwards for adults, but when young people become adults, there will be an increase if the trend holds.
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You ask me why there is an increase in use among young people. That is a very good question. Several factors may come into play, but we cannot determine which one is the overriding factor.
First, young people who use drugs today are in most cases children whose parents used drugs in the 1960s and 1970s. Those were the postwar baby boomers, and now we have the children of those baby boomers. That may be considered to be a factor.
Second, in Canada's Drug Strategy, which was launched in 1992, phase 2 focused on very high risk groups, such as street youth, etc., but we may have forgotten the new generation. I am not pointing a finger at anyone, because I was part of the group that advocated such a strategy.
With drugs, it's a bit like with an immunization program. You wouldn't think of cutting back on such a program simply because the occurrence of the disease has diminished. In every generation, we must start all over and try to give young people the necessary strength to do the right thing, make the right choices.
Thirdly, in our community in Canada, we have noticed that in several provinces, in 1990, 1991, 1992 and 1993, provincial groups that specialized in drug addiction have disappeared. Six of them disappeared in that period; that is why today intervention programs are very fragmented. These are at least three explanations or answers to your question.
I think there was another question but I can't remember it.
Ms Picard: If you were a member of the committee, on what would you focus your efforts.
Mr. LeCavalier: On young people, there's no doubt about it. First and foremost young people. Then, I would focus on the creation of a knowledge base to increase the effeciency of our interventions and I would follow up on these efforts over the years. I cannot give you a simpler answer.
Ms Picard: Very well. Thank you very much.
Mr. de Savoye: Mr. Chairman, I'm sharing Ms Picard's time. How much time do I have left?
[English]
The Chairman: There's really no need for that. We'll hear Roy and then come back to you, okay?
[Translation]
Mr. de Savoye: Very well, thank you.
[English]
Mr. Cullen (Etobicoke North): Thank you very much, Mr. Chairman. Thanks for allowing me to ask a question and say a couple of words. I'll make it very brief.
You referred to a study that the centre completed not too long ago on the social and economic cost of substance abuse, which is 2.7% of GDP. That has a number of impacts in the workplace and on our competitiveness worldwide. It seems to me that's an area where there's a lot of scope for improvement.
I saw some of the statistics. In the short run, some are a little more encouraging, but as you say, that may be a temporary blip. As for the numbers for youth in Ontario, I'd like to be able to blame that on the Harris government, but I'm sure it's not quite that simple.
I'm aware of the work that the Canadian Centre on Substance Abuse does and of some of the people involved. Maybe Mr. Fitzpatrick and Mr. LeCavalier could comment on the status of the centre. I gather certain critical decisions have to be made shortly. Funding for the centre is sort of hanging up in the air and the board of directors is in a difficult position. We have a body of knowledge and an expertise here that we don't want to lose.
Could you comment, Mr. Fitzpatrick and Mr. LeCavalier, on where the centre is in terms of funding?
Mr. Fitzpatrick: Thank you very much, Mr. Cullen.
The unfortunate situation right now as far as the board is concerned is we are working towards a target date of closing down the operations of the Canadian Centre as of March 31, 1997. We are certainly looking for direction at the board level as to whether there is reconsideration or consideration being given to continuing the work of this group.
It certainly has been most difficult, as a board member, to say nothing. I volunteer on the board, but our concern is for the status of the staff we have and the staff we're losing. You've hit on a very significant point there. The expertise of that staff, if we do lose them.... We need to bring them back so we can continue to build what is a tremendous database for the whole country. We're certainly using it in our province of Nova Scotia.
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So we are concerned, sir, yes.
Jacques, do you have anything to add to that, on the budgets?
Mr. LeCavalier: I might only add perhaps the accountant's view of it, which is the numbers. Ed has covered all other aspects very well.
When the centre was first created in 1988 there was a commitment from the government at the time to fund the centre to the extent of $2 million a year, with a direction that centres should seek other sources of funding. Over the years this commitment has eroded to $1.4 million, and last year we had to undertake a cut of 50%, $750,000. Of course that has quite significant impacts on operation.
The other perspective of this is we were told at the time that given that the strategy was sunsetting in March 1997, there could not be any further commitment beyond that on April 1. So the point Mr. Fitzpatrick makes about closing down at that time and keeping the competent staff we've had over the years is extremely real.
We're also concerned that the committee's deliberations, we've been told, are going through to June 1997. It's apparent to us that by March things may have changed significantly.
The Chairman: Pierre.
[Translation]
Mr. de Savoye: The thing I appreciate the most in your organization is that it is truly targeting its efforts properly. You are not the Canadian Centre on alcoholics and drug addicts, but you are the Canadian Centre on substance abuse. I've always enjoyed reading your material.
You mentioned earlier that it is difficult to evaluate results since there are no specific and measurable goals. I conclude that the committee might, at the end of its meetings in June, identify the results it's looking for and this would help us define the goals and objectives.
This being said, with your graphics you have given us a picture of the fluctuations in the use of alcohol, tobacco and illicit drugs. You have also pointed out that there might be some explanations for these fluctuations. But I don't think we can be satisfied with trends and explanations. We must identify the relationships between the curves and trends that you have presented us as well as the underlying causes. For example, is it not possible that the decrease in drug, alcohol and tobacco use is due to an aging population? Finally, the increase that you have noticed in the last period might simply be due to specific causes arising from the current economic situation, even though you say that these trends have been identified in other countries. It is all very nice to say that some causes might explain the situation but its far more difficult to prove that a valid correlation exists, a valid and credible correlation between causes and effects. Have you studied the issue or do you know of any group that has studied this aspect more specifically to identify any correlations?
[English]
The Chairman: Please make it a very brief response.
[Translation]
Mr. LeCavalier: Thank you, Mr. Chairman.
[English]
The Chairman: Or mail it.
Some hon. members: Oh, oh!
[Translation]
Mr. LeCavalier: We could give you an answer in writing. Several organizations are doing research in that field. To answer your questions, the causes of drug abuse fall into three categories: the causes linked to the individual, and by that I mean risk factors; the causes linked to the environment in which the individual lives and finally the causes linked to the substance. Under each of these headings, there are several causes that will vary from one individual to the next. That is why it is difficult to say that one specific thing is the principal cause or that there is a causal link at all. I can assure you that as long as that type of research will be done in the world we will try to find the real cause; moreover, as long as the federal government will be willing to subsidize our work, we will continue that research.
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[English]
The Chairman: There's another committee coming in here in a matter of minutes, so we just have a minute or so.
Paul.
Mr. Szabo: I just want to table some questions with the Canadian Centre on Substance Abuse.
First, do you continue to support the introduction of health warning labels, and if so, why?
Second, you point out in your literature that labels must be part of an overall strategy referring to pregnant women. Your commentary seems to indicate pregnant women are not being addressed now. How is it that we know there's a problem but it's not working?
Third, have you done any qualitative assessment of the U.S. experience on labelling?
The most important question I have is about education. It appears from the statistics on alcohol that attitudinal changes have been brought about more by social pressure and programs for the public at large, which have changed attitudes and behaviour. If that is the case, why do you agree with a targeted approach to substance abuse in general?
Fifth, last year, in 1995, you reported 43,000 deaths from alcohol misuse. This year you're reporting 6,700. Could you explain the variance?
The Canada-U.S. forum on the health of women said that 50% of spousal abuse is caused by alcohol and it costs Canada $4.2 billion a year. Why is that $4.2 billion not included in your cost of alcohol?
Finally, fetal alcohol syndrome, which I know you're very concerned about - it causes about 5% of birth defects - has a cost to Canadians, I understand, subject to check with Health Canada, of $2.7 billion a year. Why are those costs of alcohol not included in your costs of substance abuse?
The Chairman: Jacques, maybe you could take those questions and respond to us in writing.
John, you have a quick question.
Mr. Murphy: I will quickly follow up on what Roy was saying on the whole issue of continuing funding for the centre. I know the good work of the centre and I've watched the budget go down. I think the federal government needs to continue its leadership in funding the centre.
The other thing I wanted to mention, and you can tell me the answer later, is about your partnerships with the provinces and the private sector and income-raising as a result of some of those endeavours.
The Chairman: I thank Harb for agreeing to pass for now.
Witnesses from the Canadian Centre on Substance Abuse, thanks for your input. We'll be back to you, I'm sure, as we continue our study.
We stand adjourned.