EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, October 29, 1996

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[English]

The Acting Chairman (Mr. Murphy): Order.

Our first witnesses are from the Canadian Public Health Association.

I would ask you to introduce yourselves and proceed. After your opening statement we'll have questions from the members.

Mr. Ron de Burger (Director, AIDS Program, Canadian Public Health Association): Thank you very much, Mr. Chairman. Let me thank the committee for the opportunity to present here today.

The Canadian Public Health Association has been providing advice to government and other organizations on public health issues for the better part of the last 85 years. We are very pleased to have the opportunity to contribute to this particular discussion.

We would like to propose for the consideration of the committee that when you're looking at the issue of substance use you look at it also from a public health perspective and not just from the more narrow enforcement perspective that sometimes becomes dominant in these kinds of reviews and discussions.

When we talk about a public health perspective we talk about a holistic approach that demands a review and a consideration of all the issues that are important in this context - the social issues, the economic issues, obviously the public health issues, and the issues of enforcement, incarceration and so on.

If there is an interest in protecting the health of individuals and society at large, then obviously there is a need to look a disease prevention, health promotion, protection, education and what we in the Canadian Public Health Association refer to as ``healthy public policy''. Healthy public policy connotes looking at public health issues.

If I may use an analogy, in much the same way as environmental impact statements became popular in the 1970s we would propose that you look at health impacts in terms of the total effect on society. We can't look at drug use, for instance, only from an enforcement side. We have to look at the education components, the disease prevention, and the much broader context with the determinants of health.

The second area we'd like to stress is that we very strongly support the committee's focus on harm reduction as an important public health strategy. It's a long-standing public health strategy. Harm reduction was first introduced in the public health lexicon in the 1920s and has been evolving ever since. It is particularly appropriate today with the concern about the spread of HIV, and has taken on a new prominence in that context.

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We support the standing committee's focus on education, prevention and promotion and on appropriate treatments. Quite simply, it's good public health practice. We can't emphasize enough that the harm reduction approach needs to be taken much more broadly in this whole context.

One particular example of an effective harm reduction approach is the use of needle exchange programs in many of the cities and towns in Canada. Needle exchange programs have become very important in the fight to prevent the spread of HIV. They've become quite well established. The evaluations that have been done on needle exchange programs have been very solid in indicating that they are an effective public health measure to try to prevent the spread of HIV, hepatitis B and other diseases one might catch from using dirty needles.

A third area we'd like to stress in our opening comments is the necessity for a firm commitment to a strategic approach. In this particular context what we mean by a strategic approach is an approach that encompasses all of the various aspects I outlined earlier, but we're also looking for national leadership and national coordination. Above all, we're looking for national commitment to ensure that the issues are dealt with in the broadest possible context so that the type of public policy that emerges is a policy based on good information, on all of the considerations, and on making a difference in terms of actually improving the lot of people in society.

We're looking for a strategic approach that incorporates, as I indicated earlier, disease prevention, health promotion, protection, education and healthy public policy. In particular, we want to stress that there is no short-term fix. These issues are very complex. They require a complex and very well-thought-out approach to deal with them effectively in the long run.

As with any public health issue, we need sustained investment and commitment to deal with these problems effectively, particularly when we're talking about prevention and health promotion. You don't change social norms overnight. It simply doesn't happen. It hasn't happened with any public health intervention in the past and it won't happen with any public health intervention in the future.

We need to build the capacity of people to be able to make sound decisions based on good advice and on an environment that supports their right to make those decisions. We need to build on the positives. There are a lot of positives in terms of evolving public health policy in this area, and we want to make sure that in any review conducted we don't throw out the good stuff and pick up the bad.

We've moved forward. We've made some significant progress. One of the things we're particularly concerned about - and it's why we continue to ask for national leadership and coordination and commitment - is that if we expect that if the federal government withdraws from some of these areas the provinces and the municipalities will automatically pick up the difference, I think we're in for a delusion, if nothing else. Previous experience with other public health issues has indicated that. We would expect that this committee will be looking at that issue very closely.

In terms of a commitment to a strategic approach, we note with some concern that Canada's drug strategy is due to end March 31, 1997. Concomitant with that will probably be the death of the Canadian Centre on Substance Abuse because of the reduced funding.

Both of those initiatives, undertaken about ten years ago, have proven to make a difference. They're cost-effective. They're effective in terms of shaping public policy. They're effective in providing a forum to address some of these critical issues. Some of the work that has been done has been seminal in dealing with many of these complex issues we've referred to. It would be short-sighted public policy if we allowed Canada's drug strategy to lapse and the Canadian Centre on Substance Abuse to close.

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We think in the past decade there have been some good investments made in enabling these agencies and the strategy to operate. As indicated earlier, our concern about dealing with public health issues is that we're in it for the long term. There are no short-term fixes.

One other area we want to stress is one I've just alluded to, the continuation of funding. When we're talking about the continuation of funding we're also looking at the continuation of funding for not only specific programs or a specific agency - and I mentioned Canada's drug strategy and the Canadian Centre on Substance Abuse - but also a lot of other very worthwhile projects and activities that go on in this general area. There are a lot of very specific project areas related directly to youth, women, individuals on low income, persons living with HIV, immigrant populations, multicultural aspects - a series of issues we need to address in the broad context.

The Canadian Public Health Association over the last 20 years or so has been very active in dealing with many of the substance abuse issues. We've been dealing with the sociological as well as the public health context in developing resources and policy suggestions for the consideration of the various government bodies. We've developed videos, print materials and reports.

I might mention that a number of those resources have been tabled with the clerk of the committee for the information of members.

We are particularly concerned when we look at the area of continued funding for continuation of Canada's drug strategy, as I've mentioned, and for continuation of Canada's national AIDS strategy. The two are very much interrelated. If one looks at what's currently happening in Vancouver, Montreal and Toronto, where there's been an explosive growth of HIV-seropositivity in drug users, then one cannot ignore that one impacts on the other. We would make a very strong plea that when you look at Canada's drug strategy you also take a look at the cross-impact on Canada's national AIDS strategy. The two are very much related.

There are four recommendations I would like to table for the information and consideration of the committee before we get into a more generalized discussion.

The first recommendation is that Health Canada take action on the long-awaited tobacco legislation. An unconscionable amount of time has passed since the change in policy and approach, and we would urge that tobacco legislation be dealt with expeditiously.

We are recommending continued resources for Canada's drug strategy and for the Canadian Centre on Substance Abuse. It may interest members to know that the Canadian Public Health Association and the Canadian Centre on Substance Abuse are currently conducting a joint initiative on HIV and injection drug use. We've struck a national task force to take a look at how to deal with that very complex and very perplexing issue of trying to deal with some of these explosive HIV infection outbreaks among drug users in Montreal, Toronto and Vancouver.

Dr. Michael O'Shaughnessy from the B.C. Centre for Excellence has indicated that based on study results from the downtown east side in Vancouver, the rate of HIV infection among drug users is now approaching 30%. That's an epidemic in anybody's lexicon. We need to be very careful about how we deal with those types of problems. I would suggest to you that the consideration you have about Canada's drug strategy and Canada's national AIDS strategy certainly come together in this particular issue.

CPHA and the CCSA are working jointly to try to develop some policy initiatives and recommendations that we will then advocate that government implement to try to deal with this issue. As I indicated earlier, we certainly support the continuation of Canada's national AIDS strategy.

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With those opening comments, Mr. Chairman, I'll say that I'm delighted to be here, and I'll be happy to try to answer whatever questions members may have.

The Vice-Chair (Mr. Dhaliwal): Thank you very much, Mr. de Burger, and let me apologize for being a few minutes late. Our B.C. caucus went longer than it should have.

Mr. de Savoye, do you have any questions? Go ahead.

[Translation]

Mr. de Savoye (Portneuf): Your presentation was both interesting and informative. You referred to the harmful effect of drug use on health, and you also mentioned that the measures taken did not always achieve the best results. Among other things, you pointed out that the reduced grants could have a particularly negative impact on prevention and rehabilitation programs.

In addition, and I am taking this from your brief - the French copy which was distributed to us - , in 1993, the members of your association passed a resolution beseeching the federal government to decriminalize the consumption of illegal drugs. But a few moments ago, you said that

[English]

you just don't change social norms overnight.

[Translation]

How do you reconcile these two aspects of the issue?

[English]

Mr. de Burger: In 1993, when the Canadian Public Health Association passed the resolution on decriminalization, it did so in the context of a broader discussion on HIV and trying to control the spread of HIV infection.

It did so in the context of recognizing that someone who's addicted has a health problem and that health problem needs to be addressed in a broader context, not just necessarily in a coercive, enforcement-type of context.

So we've long been concerned about the resources, the public policy framework, in which many of these discussions have taken place.

Our members were trying to signal that in order to deal effectively with the spread of HIV, with the HIV-IDU connection, we needed to look at some different models. We needed to look at a different context and a different approach for dealing with this kind of issue.

We wanted to generate the discussion with the federal government and the provincial governments, for whom these resolutions are directed, to get them to start addressing this in that broader context.

You're absolutely right: you don't change social norms overnight. It would take a long, healthy discussion, I would suggest, with the Canadian public, with politicians and with everyone else to convince people that this would be an appropriate approach.

I have no hesitation to say, and I do not underestimate, how difficult that would be, because public sentiment seems to waiver between yes, we need to do something for the addicted in terms of their health status, and but, we also need to lock up those people who use drugs. That's a very difficult item to reconcile, as you correctly pointed out.

If members have not had an opportunity to read Dr. Vince Cain's 1994 report from British Columbia, I would urge you to do so. In chapter 8 of that report, he addresses the decriminalization/legalization issue in a way that I think is as good as any I've seen over the last number of years. He does so in the context of trying to explain the difference between decriminalization and legalization, and why he's recommending that these issues be considered as public policy options as well.

We would agree that this kind of approach needs to be explored much more thoroughly. That was the intent behind the resolution in 1993.

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[Translation]

Mr. de Savoye: Mr. de Burger, I have the feeling that many witnesses who will appear before us will suggest that we take a close look at decriminalization or legislation.

At the same time, I'm sure that neither the House of Commons nor the Senate will be able to follow up on such recommendations if the public does not express its opinion on the matter. It seems to me, therefore, that the real challenge does not lie in rewriting the Le Dain report, which was published more than 25 years ago and which aptly established the parameters of these issues, but in determining how to get the public to take a realistic look at the fact, based on statistics, and with a view to improving public health.

Mr. de Burger, could you suggest how we could wake up the public to this dimension where public health is the main concern?

[English]

Mr. de Burger: The decriminalization argument has gone on for a number of years. If we look at the experience in a number of other countries - in western Europe, in particular; in Australia and New Zealand; even in the United States to a certain extent - a number of very interesting approaches has been taken. I'm not aware of any jurisdiction that has actually decriminalized this type of activity.

What has happened, though, in a number of jurisdictions is that the politicians, the law enforcement people, and so on, have adopted what they refer to as a pragmatic approach to dealing with this. In effect what they wind up doing is concentrating on dealing with the traffickers and beginning to look at the users in a different way. Some of that is practical reality, and over time that practical reality will change public opinion as well.

In a broader way, public opinion can be changed if people are presented with the facts after due research and due study. There has been a fair bit of background work already done in this area. I would suggest that the joint project I talked about between the CPHA and the CCSA, which involves a research component and bringing together a number of experts from across the country to address these issues directly, will also help to provide information to public officials and the general public.

It is certainly the intent of that joint project to get the findings from that particular national task force out to the general public. In that way we can inform people as to what the public policy options are. While it may not change minds overnight, it will certainly help to contribute to a very useful discussion on that topic.

The Vice-Chair (Mr. Dhaliwal): Mr. Hill, do you have a question for our witness?

Mr. Hill (Macleod): I certainly appreciate you being here and the good work your organization does.

I noted you used the term ``harm reduction'' in your opening comments, and you said you were glad to see that the committee was following that as a frame of reference. To my mind there is harm reduction, demand reduction and supply reduction. I'd like to know where you understood that this committee was focusing on harm reduction.

Mr. de Burger: Perhaps it was an overly generous interpretation of what the committee is focusing on.

Mr. Hill: Could you tell me then from your perspective what the committee is focusing on?

Mr. de Burger: The committee is engaged in a review of Canada's drug policy and the misuse and abuse of substances. In that context, harm reduction features rather largely in terms of the kinds of issues that need to be accommodated. In reading some of the background material, we certainly interpreted that harm reduction would receive that kind of due consideration and focus.

Mr. Hill: So this is your interpretation then of what you would like to see us study? Would that be too...?

Mr. de Burger: We interpreted that you were studying it, and yes, we would like to see you study it.

Mr. Hill: All right. One of your recommendations for this committee is that we continue with Canada's drug strategy and the national AIDS strategy as good public policy. Yet you said that we have an explosive seropositivity in Montreal, Toronto and Vancouver in drug users when it comes to HIV.

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We have a drug strategy now, we have an AIDS strategy, and the obvious question is, how are we doing? Your suggestion is that in this area we're not doing very well. Why would we continue on with the same strategy?

Mr. de Burger: On the contrary, I think we're doing very well. I think we would have had a much worse situation if we hadn't had Canada's drug strategy and some of the AIDS policy provisions, the focus on prevention and health prevention, in place over the years.

What we're seeing in Vancouver, Toronto and Montreal is a phenomenon that is being studied very carefully, because it obviously sends some danger signals in terms of what may be happening and the effect that might have on the spread of HIV.

We're seeing that heavy users who continue to put themselves at risk on an ongoing basis - at high risk... Once HIV gets established in that population - and it is a somewhat closed population - inevitably there will be an increase in HIV in that population as long as they continue to expose themselves to risk.

What has happened is that over the last couple of years, in particular - if I can use the Vancouver example - in Vancouver, there's been quite a growth in the use of injectable cocaine.

Part of the problem being experienced right now is that because of the market forces at work, there are a lot more risks being taken than there were previously. As a result, I think we're seeing a phenomenon where within that closed community of drug users, there's been this rapid growth of HIV. We now have to try to figure out how to stop the continued spread of that.

Mr. Hill: I think you've answered my question.

Finally, where would you put Canada in the world as far as our drug policy is concerned, in terms of effectiveness? If you ranked the countries in the world, where are we?

Mr. de Burger: I'm not sure I'm qualified to do that sort of ranking. Dr. Perry Kendall from the Addiction Research Foundation, your next witness, may want to comment on that.

Perry, do you want to comment on it?

The Vice-Chair (Mr. Dhaliwal): I can have a question for him to answer later.

Mr. Hill: As a fellow who has broad public health policy experience, where would you rank Canada in the world in terms of drug use and public health? I won't hold you to this. I won't quote you in all the publications.

Are we in the bottom third, in the middle third, or in the top third in terms of how we're doing?

Mr. de Burger: This is strictly guesswork. I would suggest we're probably in the middle third, not in the top and not in the bottom. We're doing some very positive things, but we think a lot more needs to be done.

Mr. Hill: We could improve?

Mr. de Burger: We could definitely improve.

Mr. Hill: In the middle?

The Vice-Chair (Mr. Dhaliwal): Thank you, Mr. Hill. Perhaps you could put this question when Dr. Kendall is before us on the other question.

Mr. Szabo.

Mr. Szabo (Mississauga South): Thank you, Mr. Chairman, and thank you, Mr. de Burger.

I found that your presentation was very credible in terms of the content and presentation. I think it's going to be very important to this subject matter to leave emotion and exaggeration out of the circumstances. I think you've done a very good job.

I want to also just note something, and thank you for including in your brief the assertion of your organization's support for health warning labels on the containers of alcoholic beverages.

I do want to concentrate on harm reduction strategy. I just want to ask one question, because I think for many members possibly, and I'm sure for many Canadians, to make a shift from today's approach to illicit drugs, which is dealing with an illegal product, to something less... I'm not sure whether we have the same definition of decriminalization or legalization.

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If you could respond to a scenario...any strategy or policy has to apply and work at both extremes, so I will take the extreme of the simplest, most softest drug - say, marijuana. If you agree with the general thrust that drug users usually start with something soft like marijuana, and maybe move on to try other things, the question is, if we were to change a policy from an illegal substance to something less like a decriminalized or legal product, do you have any evidence from other parallel situations, or from your own human experience, on the impact that would have on the number of potential users of that product?

Mr. de Burger: I'm not sure there's an easy answer to that, because when you look at the experience in other countries, it's clear that a number of other jurisdictions are wrestling with this problem. They're wrestling with it in a number of different ways, whether it's medicalization, prescribing some of these drugs, decriminalization, or whether it's what I would consider to be the kind of pragmatic response of police departments to focus their attention on drug pushers and traffickers as opposed to users.

I'm not sure anyone has yet come up with the perfect scenario that will indicate to us whether it has an impact in terms of increasing, reducing, or stabilizing drug use, or making it a safer environment in which to use drugs. By safer, I'm not just talking about the policing issue; I'm also talking about the public health issue. If the quality of the drug is assured, and the context in which you take it is assured, that can obviously have some limited health benefits.

I'm not aware of any jurisdiction in the world that has successfully dealt with this problem and come up with a scenario, a paradigm or solution - whatever the appropriate terminology - that says, this is the way to go.

Mr. Szabo: I have one last question then. In your view, is it possible to have an effective, or potentially effective, harm reduction strategy, as defined by you, while at the same time maintaining illicit drugs as an illegal substance?

Mr. de Burger: Yes, you can certainly do that. We're doing that to a certain extent now when you look at needle exchange programs. That doesn't address the issue of legality or illegality; it's simply looking at using a harm reduction approach to try to minimize the harm that somebody might cause to himself, to needle-sharing partners, or whomever.

Mr. Szabo: Thank you.

The Vice-Chair (Mr. Dhaliwal): Thank you very much, Mr. Szabo.

Mr. Scott.

Mr. Scott (Fredericton - York - Sunbury): Thank you very much, Mr. Chair.

We had a great hemp happening in Fredericton over the weekend, so I've been called upon to express myself on the issue a lot over the last couple of days.

I'm following up the questioning from my friend from Portneuf. I'd be one of those inclined toward more liberal drug laws and probably a harm reduction model. But I also recognize the considerable resistance that would be... The public has a sort of schizophrenic view of this. I think they do recognize that, as Mr. de Savoye said, there's a health issue. At the same time they also see this as criminal.

From my perspective, the hardest question put to me related to my 13-year-old son. How does one move in the direction of more liberal drug laws without signalling to my 13-year-old son that somehow it's less bad for him to do it than it was yesterday?

Mr. de Burger: We could have a very interesting discussion on how you address your 13-year-old son when you talk about alcohol use or tobacco use. I think we need to look at this in a much broader context. I think one of the reasons we are as schizophrenic as we are is that we consider some addictive substances as okay - under some sort of control within some sort of a context - and yet we consider other addictive substances as not okay.

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Where do we draw the line? How do we draw the line? Why do we draw the line?

That to me is a much more interesting argument, in terms of how we develop a good public policy context that enables us to deal with substance use and abuse if we don't consider all of that as part of the context. I would hope that the committee would concentrate on looking at the totality of the issue and not just on illegal drugs.

I understand the concern about illegal drugs, but the shift between being legal and illegal, that line, has moved over the years in terms of different substances and different societal tolerances. If we're looking at developing good public policy in this area, we need to look at the broad context of what we're dealing with.

Mr. Scott: I don't disagree. I'm not sure I'm going to get away with that answer.

Mr. de Burger: I'm trying to get away with it.

Voices: Oh, oh!

Mr. Scott: I should also apologize for my reference to schizophrenic; it was inappropriate.

You see, the difference isn't that there's something inconsistent with alcohol as against other kinds of drugs. I understand that. That isn't the point.

The point is that we are going from a mindset that would be in some fashion discouraging to a mindset that is less discouraging. That, again, is unrelated to the inconsistencies. I suspect that if we're going to show leadership about this in a national debate, that's one of the issues we're going to have to come to terms with. Again, I say I'm one of those who would probably be most sympathetic to more liberal legislation, but at the same time I would be quite concerned about any kind of signal to younger Canadians that this is something somehow we're less inclined to discourage.

Mr. de Burger: Thank you, Mr. Scott. I wasn't being facetious in saying that I was trying to get away with an answer. What I was signalling was that when my two sons were teenagers, certainly my approach was to deal with them on the basis of looking at the broader context of the harm it does to the individual and the harm it does to society at large if you use alcohol, tobacco, illegal drugs, and so on.

It appears to have worked in our household. I say, ``appears'', because who knows what happens in the long term, but certainly in the short term it appears to have worked in our household. They did get that message.

Whether or not they've experimented with various substances, I don't know; they haven't told me that. But I can tell you that in terms of the context, it was certainly the way we tried to approach it. We tried to convince them that there are harms and risks associated with all these substances. They ought to have the proper information, and they ought to be aware of that situation.

Mr. Scott: Thank you. I guess perhaps if you're ever in Fredericton, you can drop by and meet my children.

Have you any success with green hair?

Voices: Oh, oh!

Mr. Scott: Thank you, Mr. Chair.

The Vice-Chair (Mr. Dhaliwal): On behalf of the committee, Mr. de Burger, we want to thank you for your excellent presentation here today.

We'll just break for one minute to set up for our next witnesses.

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Committee members, we have Dr. Kendall and Dr. Room with us. I'd like to welcome both of them on behalf of the committee.

Dr. Kendall, welcome, and thank you very much for taking the time and effort to come to our committee. We're very interested in hearing what you have to say today. We'll let you make your presentation, and then we'll go to questions after you've completed your presentations.

Welcome, and thank you very much for coming.

Dr. Perry Kendall (President and Chief Executive Officer, Addiction Research Foundation): Thank you very much, Mr. Chair. On behalf of the foundation, I'd like to express my appreciation for the invitation to comment before your committee.

You have a written presentation before you. We also submitted a much lengthier brief, from which the presentation is being condensed, and we can circulate copies of that to anybody who wants it.

In the interests of time, I'd just like to touch on the highlights of our presentation and leave you time for asking questions and getting around to answering the questions about where Canada ranks internationally. I would be happy to try to do this with Dr. Robin Room's assistance.

I'd like to congratulate the committee for this review. This is the first time in more than 20 years that a legislative body has actually considered all psychoactive substances, both licit and illicit.

Touching on the earlier discussions and questions, I'd like to point out that the CCSA estimate of total economic costs - and it's a conservative estimate - in 1992 was that the use and misuse of alcohol, tobacco and illicit drugs cost Canada and the Canadian economy about $18.5 billion.

Alcohol costs about $7.5 billion, tobacco about $9.5 billion, and illicit drugs only $1.3 billion or 7% of the total. So from the public health perspective and a coherent policy perspective it's very appropriate that you deal with all of these issues in one forum.

The federal drug policy focus in recent years has been provided or assisted by Canada's drug strategy secretariat with assistance from the Canadian Centre on Substance Abuse. It's perhaps ironic that both the drug strategy wind-up and the Canadian Centre on Substance Abuse wind-up are on the table for the end of this fiscal year. We'd like to talk about that, given the crucial integrating elements these two organizations have provided for Canadian drug policy.

The loss of this strategy in the CCSA means, in effect, that the effort devoted to alcohol, tobacco and other drugs in Health Canada is being reduced to a level lower than at any other time in the past 20 years. While this is happening, the use of psychoactive substances in our population, particularly among youth, is on the rise. The use of some drugs among adults is also rising. As a concomitant of this increase in the coming years, we might expect to see the rates of problems associated with substance use rise as well.

For example, I'd like to talk a little bit about the harms associated with psychoactive substance use. They're not only on the individual; they're also on the user's family, friends or strangers, on the community as a whole.

The harm from psychoactives can be intrinsic to the drug itself, or can also result from societal reaction, overreaction or inaction. The harms from societal reaction or inaction include the social costs of law enforcement and criminal punishment on the one hand and increased health care costs and workplace costs on the other, depending on which of the two areas one is looking at.

In this context, I think that demand reduction, which is the focus of this committee, is a necessary policy pillar but in itself is insufficient. It is not a sufficient policy pillar for you to be considering. We believe that the overall goal of national policy should be to reduce the level of harm resulting from the consumption of all psychoactive substances.

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Clearly, demand reduction through primary prevention is a major contributor to this, but so also are effective treatment, substitute medications, and non-hazardous use. In this context, I think it's important to look at some of the major trends in substance use and think about some of the policy alternatives that are available.

Cigarette smoking in Canada, which had been declining steadily from the mid-1960s... The decline has halted in recent years, and there's good evidence that smoking is increasing. I would submit that we need a much greater effort towards effective prevention and cessation programs. We need to develop pharmaceutical interventions. We also need to look at alternative, lower-risk, nicotine-delivery systems. The ARF will be hosting a conference early next year to talk about the implications of that.

A strong, coherent, multidimensional tobacco policy must be a cornerstone of the new focus on population health determinants that I believe Health Canada is working on. In this case, I would echo the call from the Canadian Public Health Association that the tobacco blueprint is long overdue.

If we turn to alcohol, while more than 70% of Canadians aged 50 and older drink alcohol, young men in particular are more likely than others to drink in a hazardous way. We have some evidence from our Ontario surveys that the rate of hazardous drinking is increasing.

Moderate alcohol consumption, however, also has benefits, among them a reduction in heart and stroke deaths for those in their 50s and older. Our focus, therefore, should be to reduce the rates of hazardous drinking predominantly among younger people while capturing the benefits for the older Canadians.

I would submit that the federal government has a role - it might include warning labels, among other initiatives - in developing national policy around that. This is true particularly as, from our perspective, alcohol policy is taking on an increasing patchwork design across the country. A strong federal leadership role in this area would keep public health concerns in the forefront and would also fit in well with the government's focus on population health determinants.

Let me talk just a little about the use of illicit drugs. It's been stable over the last decade, at comparatively low levels, when compared to the U.S. The most frequently used illicit drug is cannabis, with about 7.5% of Canadians reporting use in the last year.

Use among youth is considerably higher than that, but most of that is sporadic or experimental and it's not associated with major harm to the individual or society. We believe programs in that area should focus on reducing overall use and harmful use, and perhaps should target users who are most at risk.

I would like to emphasize that law enforcement has not been particularly effective in reducing cannabis use and should not be the major policy response in this area. I'd be happy to answer questions later about the ARF's position on that.

Although it's low, the death rate from illicit drug use in Canada is rising. This relates mostly to heroin use. However, as Mr. Ron de Burger noted in the CPHA brief, there is a growing proportion of AIDS cases and new HIV infections related to injection drug use. There is an obvious and urgent need for programs to prevent the further spread of HIV.

The ARF believes that the federal government can and should initiate and support pragmatic harm reduction efforts in this area. For example, substantial expansion of treatment programs, including methadone maintenance, are a priority, or should be. All injection drug users should have access to clean needles and syringes, and this should include people in correctional facilities, where levels of needle use and risk of infection are high.

Both methadone programs and needle exchanges are of proven efficacy. However, research is urgently needed into the issue of cocaine injection or cocaine substitution. I would suggest that the federal government could score points and make a very powerful public health agenda were it to develop a coherent research program in the area of injection drug use and HIV prevention.

Finally, I would like to just urge the federal government to carefully assess the extension of controls on drugs indigenous to immigrant populations. The recent criminalization of kat may turn a relatively innocuous drug into a potent illicit substance. One is attempting to reduce supply. To my knowledge, there are no prevention programs and no effective treatment programs in the Somali community. Therefore a drug that is used by 70% to 80% of this community has, with a stroke, been criminalized. There is no police presence where you could deal with that. The community is largely unaware of it. There are potential problems there.

I'll skip the discussion on pharmaceuticals, which is in the brief, and just focus on our recommendations.

In closing, I'd like to underline that a variety of approaches and interventions are needed to reduce the harm caused by drugs. We should not be afraid of trying and testing new approaches, but neither should we eliminate approaches that have worked.

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The ARF would like to make three suggestions: for the short term, continue the funding of Canada's drug strategy and its programming; continue to fund the Canadian Centre on Substance Abuse, which is one of the better bargains you have; and develop a strong federal presence with a new, coherent, multi-focused national strategy to reduce the harms from all kinds of psychoactive substance use and abuse.

Thank you.

The Vice-Chair (Mr. Dhaliwal): Thank you very much, Dr. Kendall.

I have one quick question. You made a comment about immigrant populations, and I wonder if I can just clarify that. One of my concerns is perhaps that some of our policy is more broad-based. Do we miss out certain communities that may require different ways of dealing with a drug problem? Have our drug policy changes really dealt with the changes we've seen in Canada in the last ten years, and should our drug policies be changed so they also deal with some of the specific problems and provide access to those communities that may not have the access to our services?

Dr. Kendall: As the short answer to your question, I would say, yes. While Canada's drug strategy and the programming as well as the policies of multiculturalism have tried to focus very much on working and understanding individual multicultural, multilingual populations, the policy as it works out, particularly in relationship to Bill C-7 and Bill C-8 - which was recently passed as the Controlled Drugs and Substances Act - did not take into account the effect of a particular drug or the criminalizing of that drug in a particular minority community.

The Vice-Chair (Mr. Dhaliwal): Thank you very much.

Mr. de Savoye.

[Translation]

Mr. de Savoye: Your presentation was extremely interesting. You immediately pointed out the economic cost from the use of certain drugs, alcohol, tobacco and illegal drugs. You also mentioned that illegal drugs represented only 7% of the total, which lead you to suggest, in your brief, that the first objective of public health should be to reduce smoking.

Indeed, we know that approximately 40,000 people die every year because of smoking-related causes. Many things have been done to counter smoking addiction, and some have worked better than others. Do you have any new approaches or recommendations that would enable us to improve significantly the approaches that we are already using? The floor is yours.

[English]

Dr. Kendall: Thank you for the opportunity. I think Canada's tobacco strategy was vitiated by two occurrences. One was the rise in smuggling during the late 1980s and the early 1990s and the subsequent reduction in the cost of tobacco to the consumer. The second was the striking down of the advertising bans by the Supreme Court.

The tobacco blueprint that has been around for discussion is a comprehensive package of initiatives that, with perhaps some minor fine-tuning, would reinstitute the policy framework for reducing tobacco consumption, particularly among young people. If it was coupled with a tax increase, which I believe it could be... Tobacco is now slightly more expensive in some contiguous U.S. states than it is in Ontario, and therefore one could sustain an increase in the tobacco taxes and the price to the consumer without, I believe, running a significant risk of incurring a fresh onslaught of smuggling.

The price and the controls around advertising, marketing and sponsorships would be very significant policy and practical approaches to reducing tobacco consumption.

Dr. Robin Room (Vice-President, Research, Addiction Research Foundation): Canada also pioneered in taking Nicorette, nicotine replacement gum, off prescription, and the lower strength was made available over the counter.

Now the U.S. has moved to make both strengths of Nicorette - I'm using the trade name, but it's nicotine gum - available over the counter, and also to take the nicotine patches...they've been made off-prescription south of the border. These are matters that could be taken into consideration in Canada.

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In general nicotine as a substance is not entirely harmless, but the harm from smoking cigarettes is not primarily from the nicotine. Anything we can do to wean people away from the tar they get in their lungs from cigarettes is arguably a public health advantage.

[Translation]

Mr. de Savoye: You are suggesting that we set up something akin to a methadone program for nicotine, using a substitute product?

[English]

Dr. Room: Absolutely.

[Translation]

Mr. de Savoye: My second question concerns alcohol. In your brief, you mentioned that there is decrease in uniformity amongst the alcohol policies of the country's various regions and that strong federal leadership in this area would enable us to put public health concerns into the forefront. Could you explain the differences that exist between the various regions of the country and tell us how they are having either a positive or negative effect on alcohol-related problems?

[English]

Dr. Room: I'm going to give the first answer if that's okay.

You might say that there was a Canadian model of alcohol control. It was pioneered in Quebec at the end of the short prohibition in Quebec in the early 1920s, and it was a model of the province monopolizing the sale of spirits and wine at least, and of a relatively low availability of on-premises alcohol. This model was very successful, in fact, in legalizing what had been an illegal substance and maintaining controls in such a way that there was little access by under-age people and consumption levels were relatively low.

We've shifted from that policy over many decades. The changes have accelerated in recent years with the partial privatization of wine sales in Quebec and the full privatization at the retail level in Alberta. In all other provinces there has been substantial further liberalization in the availability of alcohol.

Since 1980 the alcohol consumption level has actually fallen across Canada, while for 50 years before that it had risen. In my view, it's clear that Canadians reacted quite appropriately to the increase in problems with alcohol that they saw around them or were experiencing in their own families. But as we remove these controls, which served us very well - it was a very successful model - we create a circumstance in which when people have forgotten about those problems, we could easily see a substantial rise in consumption.

The pressures on governments, both at the federal and provincial level, tend to be all in the direction of increasing availability. For instance, lowering the taxes is a strong argument of the Canadian distillers. In general it's a ratchet mechanism of the market that always pushes things in one direction. In our own province the LCBO will be open on Sundays in the run-up to Christmas. This is a small matter, but it's one among hundreds of small changes that have happened all in one direction. We've ended up with a very successful model being essentially dismantled in very small steps.

The federal government has a role in alcohol. It has a role from the point of view of collecting federal taxes, controlling smuggling and controlling advertising through the CRTC. The CRTC, in our view, is to a considerable degree abandoning that role, and we are very concerned about that abandonment or great lessening of its role.

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The provinces complain quite strongly that the federal government does not do an effective job of controlling smuggling of spirits, particularly from the U.S., and that this undercuts their ability to run successful alcohol control policies. Alcohol smuggling has not been a priority except with occasional specific investigations. When I come across the border it's rare now for me to be asked how much alcohol I'm bringing back. So there's really a de facto abandonment of that control.

The other role of the federal government, of course, is that of looking for best practices and diffusing them and bringing them across the country. That's a role that the Canadian Centre on Substance Abuse has played very successfully, and there's the threat now that there will be an abandonment of that federal role in the diffusion of best practices.

The Vice-Chair (Mr. Dhaliwal): Thank you very much, Mr. de Savoye.

I'd just like to clarify something about your comments for my own mind and perhaps for the committee. In terms of alcohol, you're saying that nationally, even though there's been a greater access to alcohol, in fact it's been dropping. You fear this may in the longer term create more drinking and more use of alcohol than it has in the past, even though the past record has shown that with greater access to alcohol in terms of more availability, it's actually gone down.

Dr. Room: Well, it's been going down in the last 15 years. In the period before that consumption went up as availability went up. There was a very substantial increase in availability between the 1940s and the 1980s, and consumption has risen more than it's gone down. We haven't yet balanced out that very large post-war rise in consumption.

In the data we're now seeing from our high school surveys in Ontario, there are signs of a turnaround. The kids are starting to drink again; the rate is going up. We are concerned. I think we are at a point of inflection, where things may change again.

The Vice-Chair (Mr. Dhaliwal): So you fear that opening Sundays and having longer hours, creating greater accessibility, will in the longer term create an uprise, and you think there's a role for the federal government to deal with some of those issues.

Dr. Room: I think there are limited roles for the federal government. Alcohol controls are primarily a provincial matter, but the federal government can be facilitative and helpful around issues of smuggling and spreading best practices, for instance.

The Vice-Chair (Mr. Dhaliwal): Thank you.

Mr. Hill.

Mr. Hill: My immediate question is about where Canada stands in the world. If we were looking at a country in terms of licit and illicit drugs, what country should we look at? What country has better policies than we do?

Dr. Kendall: We'd probably agree that Canada is somewhere in the mid-third, probably not at the top. It ranked very well at one time for tobacco. As Dr. Room has said, it would have ranked very well at one time for alcohol, but by our criteria it would have slipped in its public policy control of both of those substances.

In the area of illicit substance use, clearly the foundation would rank us well ahead of our neighbour, the States, but in certain areas we are perhaps not as advanced. There are some other European countries, or perhaps Australia in some particular aspects of its illicit drug control policies, that have more successfully managed to medicalize and treat as medical problems the issues of individuals with addictions and abuse problems. Those countries have managed to minimize the harm that can occur through the criminal justice system to younger experimental users without apparently encouraging youthful experimental use.

Mr. Hill: I heard you say that tobacco prevalence in Canada has dropped over the last 30 years, that alcohol prevalence has dropped over the last 15 years, and that illicit drug use is climbing among the youth.

Dr. Room: Legal is as well.

Mr. Hill: Fair enough. If we were concentrating on the most productive area for society in Canada, where would we focus as a committee? Would it be on alcohol, tobacco, or illicit drugs?

Dr. Room: Do you mean in terms of reduction of economic costs?

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Mr. Hill: With limited resources and tight economic concerns, where would we concentrate those limited resources?

Dr. Kendall: Your shorter-term gains would come from reducing hazardous alcohol consumption among the younger drinking cohorts. The economic cost studies clearly show that the majority of the costs from alcohol come in the working population aged 20 to 45 as a result of accidents, motor vehicle accidents, etc. You would recoup the savings from that immediately if you were to cut the hazardous drinking patterns in the workplace, in the home or on the street.

In the longer term, your larger savings will be in reduction of tobacco consumption. The delay in recouping those costs comes from the fact that heart disease, chronic obstructive lung disease and lung cancers have a fifteen- to twenty-year period before being evidenced in the population.

So the two strategies for the best economic return would be to come up with ways of cutting hazardous consumption in the younger age cohorts in the short term, and cutting tobacco consumption across the population with a longer-term payback starting in about ten years.

Mr. Hill: I hope the committee heard that very clearly.

Dr. Kendall: I would also suggest, however, that the third area where urgent action needs to be taken is the area of HIV, particularly injection drug use. We have a crisis of epidemic proportions in that particular population, which is growing in significance as a conduit to the more general population. They're not specific injection drug-using populations.

Dr. Room: There are also things that can be done that are not costly. They sometimes require political will. You can make a good argument that there would be savings to the Canadian economy, for instance, from the decriminalization of possession of marijuana, because you would save the policing costs. There is evidence from studies of the U.S. states and other jurisdictions that have not legalized but have decriminalized, have reduced the penalties essentially to a parking ticket. It still sends the signal that Mr. Murphy was concerned about; it's still an illegal substance. But consumption did not rise when that was done, while enforcement costs of course dropped.

The Vice-Chair (Mr. Dhaliwal): Mr. Szabo.

Mr. Szabo: Gentlemen, on behalf of the committee for the ARF, it's always important to hear your perspectives because of your history of extensive work and the network you maintain. I know you're very supportive of the Canadian Centre on Substance Abuse, as am I.

I want to start by thanking you again for your continued support of health warning labels on the containers of alcoholic beverages.

Dr. Kendall, the economic costs were your first inclination as to whether you are going to get the biggest positive impact of a strategy. Your immediate reaction was to deal with the success of something in terms of reduction of economic costs.

In the Canadian Centre on Substance Abuse report released this year - and you've used these numbers - alcohol costs were $7.5 billion. My reading of that study, however, is that those costs relate to direct costs of alcohol. Their 1995 report stated that 50% of spousal abuse, 65% of child abuse and one in six family breakdowns were all caused directly or indirectly by alcohol.

The bilateral Canada-U.S. health forum said that spousal abuse cost Canada $1.4 billion in the last year reported, whatever year that might have been. Fetal alcohol syndrome, on which there was just a joint statement by Health Canada and the Canadian Paediatric Society on October 16 of this year, cost Canada $2.7 billion per year.

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If 50% of spousal abuse is due to alcohol, that means half of the $1.4 billion is due to alcohol. So there's $700 million. If FAS is in fact all due to alcohol use or misuse during pregnancy, that's another $2.7 billion. There's $3.4 billion. That's half again what the current direct cost is.

If you add those alcohol costs, which I don't believe are in the Canadian Centre on Substance Abuse figures, even though the number of lives involved is much more in terms of tobacco than it is in alcohol, it would appear that the cost of alcohol, in terms of the negative impacts on the economics of Canadian society, is far and away greater than it is in terms of tobacco.

The Vice-Chair (Mr. Dhaliwal): Before you answer that question, I would just ask that both the questions and the answers be brief, because we are behind in the schedule. We have a number of other witnesses to come forward today.

Go ahead, Mr. Kendall.

Dr. Kendall: Some of the social costs are included in the economic cost study, but not all of them. The costs for all of the substances - alcohol, tobacco and illicit drugs - are probably underestimated. They're conservative estimates.

The relative risk for tobacco is lower than some of the larger studies would suggest. So in all of them they're conservative.

Yes, I would agree that the cost of alcohol would be more.

I would guess, however, that programs to reduce hazardous consumption in the ages from 20 years to 45 years would have a significant impact as a corollary, both on fetal alcohol syndrome, given that there's hazardous patterns of use in women of childbearing age that directly contribute to this, and also to the spousal violence and family disruption problems we're concerned about. The evidence is showing more and more the linkage between alcohol consumption and physical violence.

The Vice-Chair (Mr. Dhaliwal): Thank you very much, Mr. Szabo.

Mr. Murphy.

Mr. Murphy (Annapolis Valley): Thank you for your presentation.

I'm always very interested in strategies and what we might do in terms of education and prevention. As the federal government, we have all kinds of information out there about the harms of smoking, for instance, and what that does to people.

If we were to personalize or individualize our approach to talking to people about tobacco...let me tell you what I mean. I frequently write people a note, and I don't do it in a putting-down way. I just say I'm concerned about your smoking and what it does to you and I just want you to give a second thought to stopping it.

A woman who was seven months pregnant was serving us in a restaurant the other day. She would take off and have a cigarette. I went back to the kitchen and spoke to her. I shouldn't have been interfering, but I do that a lot.

I don't know if it's effective or not, to tell you the truth. When we personalize our education in a non-threatening, non-putting-down, unpreaching fashion, I wonder if that would make a difference. If we as the federal government were to say to individuals to take some responsibility in helping or bringing it to the attention of another individual, I think it's another approach.

Dr. Kendall: My colleague, Dr. Room, would like to answer that. Before he does, I would like to suggest that individual approaches are probably very effective. However, a supportive social environment that says as a society, we think it wrong to smoke in restaurants, schools, universities, or wherever, certainly aids the concerned individual in making that approach.

Dr. Room.

Dr. Room: We actually looked at how much people report they've said something to their family members or to their friends about smoking or about over-drinking, and you're not alone. A strong majority of Canadians have said something to someone about smoking. In fact, a majority have also suggested that someone might drink less.

It is a good approach to think about what can be done in the way of government programs that might support that kind of interactive approach.

The Vice-Chair (Mr. Dhaliwal): You can have a short final question, Mrs. Hickey.

Mrs. Hickey (St. John's East): Would the price of alcohol help in any way? Is it realistic that if you raise the price of alcohol, people drink less? What is the best prevention for keeping youth away from alcohol? Do you have any suggestions?

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Dr. Room: First of all, we have a quite effective system for controlling youth access to alcohol in the provinces that still have retail monopolies. Many places in the U.S. would love to have a system that was as effective, where you can't go into the 7-Eleven and buy alcohol from someone who's as young as you are.

Basically, across the country the legal drinking age is either 18 or 19, depending on the province. This means we have to recognize that most Canadians begin to drink when it's illegal. An approach in terms of education has to take account of the realities that it's typical that kids will start to drink younger than the legal age. That's a circumstance in which we would certainly be talking about the problems, while also seeking to reduce the harm.

The Vice-Chair (Mr. Dhaliwal): I would like to thank both of our witnesses, Dr. Kendall and Dr. Room, for their excellent presentation and the answers they have given us. Thank you very much on behalf of the committee. We look forward to any further contribution you want to make to this committee.

Our next witnesses are from the Assembly of First Nations. Royce Wilson could not be here today, but we have Mr. Keith Conn in his place, and Ms Marylin Van Bibber.

Would you like to start, Keith? Perhaps you can introduce all your members and then you can have the floor. Once you've made your presentation we'll go to questions.

I ask my colleagues to keep their questions brief and to the point, and the answers as well, because we are running behind schedule. It would be very helpful to me if you could do that.

Mr. Conn.

Mr. Keith Conn (Director of Health, Assembly of First Nations Health Secretariat): The national chief extends his warmest greetings to the committee.

Also with me today are Ms Brenda Thomas, a registered nurse and adviser to the AFN Health Secretariat, and Miss Marylin Van Bibber, a founding member of the Aboriginal Nurses Association of Canada. She has a background in nursing and midwifery and has extensive knowledge of FAS and FAE. She is currently a treaty manager for the Tsleil Waututh peoples in British Columbia. Both Brenda and Miss Van Bibber will provide some supporting submissions.

I submitted the brief. I'll just go through the highlights as opposed to reading the whole brief, and we'll go from there into the recommendations and the discussion.

I would like to thank the committee for the opportunity to present.

First of all, the government's invitation for the first nations' participation in the review of the policies on the misuse and abuse of substances is an appropriate action for the development of recommendations on future policy, actions that will affect society as a whole, including first nations peoples.

Our basic premise is that open dialogue and discussion with first nations is essential in addressing the many crucial factors that have resulted in substance abuse in our communities. The examination of the effective measures to reduce the demand for use and abuse of alcoholic beverages, tobacco, legal and illegal drugs, and solvents is only the beginning. A forum with participation of first nations representatives is necessary so we can take steps to eliminate the precursors that cause substance abuse and affect our quality of life.

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In terms of substance abuse in first nations communities, according to an expert panel devised by the Canadian Centre on Substance Abuse, as recently as 1993 addiction specialists had limited knowledge about substance abuse among aboriginal peoples because of the complexity of problems associated with substance abuse in comparison with the mainstream society.

It was determined, however, that substance abuse in native communities not only contributes to the social problems but is also the result of conditions it creates. This is a situation that's been known for quite some time among first nations peoples who lived in these conditions and are living with substance abuse and its issues on a day-to-day basis.

First nations children, for example, who are subject to these conditions are severely affected. The situation has been documented to some extent to show that in comparison to their mainstream counterparts aboriginal children under the age of 14 are 27.5 times more likely to begin using alcohol, drugs and solvents at an early age and thus commit suicide.

In some communities children as young as 5 to 8 years old have been using solvents. Among first nations youth the prevalence of inhalant abuse has gradually been increasing. Since the 1980s, between 1975 and 1983, inhalant abuse in many communities has more than doubled. Recent studies conducted in northern Quebec and Ontario have indicated that up to 62% of first nations under the age of 20 are involved in sniffing gasoline and other solvents.

Other provinces, such as Manitoba and Saskatchewan, have also found extremely high rates of solvent abuse among the first nations population. Studies have also indicated that among the youth population the aboriginal youth have a higher ratio of occasional to regular users of tobacco products than the youth of the mainstream Canadian society.

In 1991, when the aboriginal peoples survey was conducted, it was found that 61% of the aboriginal people surveyed identified alcohol abuse as one of the major social problems affecting their communities.

Prescription drug abuse and misuse is another serious problem that is affecting all sectors of Canadian society, including first nations populations. Recently a working group, including AFN representation, was struck by the medical services branch at Health Canada in an effort to begin addressing the problem of prescription drug abuse amongst the first nations population.

Although this is only one of a number of initiatives taking place in an attempt to curb this type of practice, it is clear that this type of abuse, as all other forms of abuse, is a symptom of a much greater underlying problem. Hence, developing policies that focus on the demand for these substances is an attempt to address the substance abuse issue and may impact to some degree. However, this approach is much like crisis intervention, and much work needs to be done to focus on why the phenomenon is occurring. This is particularly true in the instance of substance abuse among first nations.

A number of currently existing initiatives have focused primarily on intervention and treatment modules, and more work needs to be done in the areas of prevention and after-care. Strategies must be developed that explore the root of the problem and the socio-economic factors faced by the first nations that result in the abuse of the substances in the first place.

Naturally, poor economic conditions, low educational levels, welfare dependency and extreme social pressure have been identified as contributing factors by experts in the field and are only a few of the issues faced by many first nations on a daily basis. Recent studies have also suggested a number of root causes for substance abuse among the populations, including poverty living; substandard, overcrowded housing conditions; loss of language and culture as a result of imposed systems on the residential schools; racism; lack of social, educational and economic opportunity; and overall feelings of hopelessness and despair due to a combination of these factors.

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It's been said time and time again in various fora, meetings, conferences and standing committees that in order to address issues such as substance misuse and abuse, the major underlying factors resulting in poor overall health conditions among first nations communities must be considered. We can function together in working groups and participate in council discussions on policy development. We can examine the specifics of substance abuse and look at the effects of substance abuse on individuals, families, communities and nations.

We've made recommendations in four different areas: policies and legislation, information and education, research, and programs and services.

In terms of policies and legislation, policies must be devised by first nations themselves to frame an inherent right to self-government, to base policy on a process driven by first nations, which would include all facets of health as an underlying foundation. The full federal recognition of aboriginal treaty rights to health services must be reaffirmed and then implemented with first nations. The implementation of health policies must reflect first nations' traditional values and approaches to health and well-being. An investment in first nations' economic development through a variety of initiatives must be undertaken.

In terms of information and education, we are suggesting that the committee consider the establishment of comprehensive community educational workshops on solvent, drug and alcohol use by local people. The regeneration and reinforcement of culture and language initiatives should be supported so that first nations communities ensure that these aspects play an integral role in the healing journey. Specific efforts should be made to increase funding and funding flexibility for National Addictions Awareness Week for first nations' projects. Currently it's rather restrictive, in our assessment.

The last recommendation in terms of information and education is that efforts should be made to increase and improve awareness and education on grieving and loss, sexual abuse, family violence and the inter-generational effects of residential schools, dysfunctional families and mental health.

In terms of research with a specifically first nations focus, an analysis and evaluation of existing programs should be conducted by first nations for drug, alcohol and solvent abuse with respect to their effectiveness and options for redesigning them. Efforts must be made to support research and to document various traditional healing methods used by different first nations groups and nations. Research should be conducted to document the various ways in which first nations peoples have traditionally dealt with loss and grief, with a view towards healing and preventing reoccurring incidents.

Research should also be conducted specifically on preventive measures and treatment methods for solvent abuse, particularly gas and solvent sniffing. This is a real issue facing treatment centres, both native and non-native, in terms of their capacity to deal with these areas. We'll elaborate on that.

In terms of programs and services, long-term, stable funding must be secured for programs that have been proven effective. We're seeing an erosion of programs that have proven to be effective.

Canada's drug strategy must target aboriginal youth as a priority.

Another recommendation is that an examination should be undertaken of the prevention programs on solvent, drug and alcohol abuse for their appropriate use in the school curriculum. There are some gaps there.

Strategies should be developed to give the elders of our communities an active role in all areas of the transmittal of language, values and life experiences in order to re-establish inter-generational teachings and communication among first nations peoples.

Efforts should be made to address the issue of welfare dependency and its impact on and role in substance abuse. The future of first nations social services must allow for alternatives, flexibility and opportunities to liberate first nations from the vicious cycle of dependency and abuse.

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I wish to close by saying that we consider this a preliminary submission with some broad overview issues and some specific recommendations. We hope the opportunity to interact with this committee is provided to other first nations organizations and communities. Thank you.

The Vice-Chair (Mr. Dhaliwal): I've been informed that the 11 a.m. meeting has been cancelled, so that gives us a little more flexibility.

If you have any further comments, I'll let you conclude and then we'll go to questions. Are there any other comments from the other panel members?

Mr. Conn: Ms Van Bibber would like to add a few comments in terms of our submission.

Ms Marylin Van Bibber (Technical Adviser, Assembly of First Nations): I'm going to speak about fetal alcohol syndrome and fetal alcohol effects. I would like to make a few points and then go through some recommendations with regard to fetal alcohol syndrome.

The most important thing to note about this is that it is a very complex public health issue, and a main reason for that is the damage that's done to the brain. As you know, prenatal exposure to alcohol does a lot of damage to many of the organs and systems of the body, but the most striking damage is that done to the brain. This damage can range from severe mental retardation to someone who has normal intelligence but has difficulty with learning, such as learning disabilities and behavioural problems.

Research is now showing that the alcohol may be affecting the organization of the brain and the internal communication. This presents quite a marked handicap to an individual. A lot of the individuals are very aware of their shortcoming and are very aware of the social isolation caused by the particular behaviour that is characteristic of fetal alcohol syndrome. As a result, many of these young people suffer low self-esteem, anxiety, depression, and suicide ideation.

A recent report from the University of Washington, which has been a centre of excellence in working in this area, has shown a number of secondary disabilities that have come out. Some of those are mental health problems; disrupted school experience; trouble with the law; confinement, which means in-patient treatment for either mental health or alcohol problems; inappropriate sexual behaviour; and alcohol and drug problems. Of the people surveyed, 80% were still living dependently; in other words, they were not able to live on their own and had problems with employment.

So there's a whole host of secondary problems that come about. They also looked at the factors that positively influenced people with this disability, and two very important ones were early diagnosis - that is, before age 6 - and a stable and nurturing home environment.

We raise fetal alcohol syndrome as an issue in this presentation because in Canada, as far as we know, the incidence is 1 to 3 per 1,000 births. These are figures taken from American and European studies. There has not been a lot of research done in Canada in this regard. The studies that have focused on aboriginal communities show an extremely high rate. I have to say that this cannot be concluded to be in all communities at this point, but we do know for sure there are pockets of very high incidence. I believe more research needs to be done to really determine the full extent of this particular problem.

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Cost was mentioned in the earlier presentation. The figure I have here - and this comes again from the United States - is $1.5 million per child per lifetime. That is what it costs society in dollar figures. We can't determine the full cost, because the cost to the individual, to their family, to the community and certainly to overall society, is very difficult to measure. When you look at these communities that have pockets of high incidence, it is extremely costly to that particular society and to that particular culture.

Just in terms of prevention, we support the joint statement that has just come out from the Canadian Paediatric Society. It recognizes that this is a very complex public health issue and that there's a need for a broad-based, multisectorial response, including from all levels of government.

The statement also recognizes that it is important to address determinants of health that are critical to aspects of prevention in aboriginal communities. Fetal alcohol syndrome in aboriginal communities is linked to the history of Canada. The social, economic, cultural and political changes that have occurred with colonization, with alienation of land and resources, all have had a cumulative impact on aboriginal communities.

As we work across Canada in different ways and different speeds in recapturing the once-held self-governance we had, what we really are taxed to deal with are the community health problems, including fetal alcohol syndrome. We are looking at community-based action that deals with this. This is key to overall human resource development. In turn, human resource is key to self-governance.

In terms of recommendations, we support the recommendations that came out of the Canadian Paediatric Society joint statement.

Second, we must look at policies that will be developed to ensure the prompt and fair settlement of outstanding treaties and inherent right to self-government. Although this is not directly a health issue, it is a Canadian issue that needs to be dealt with. It will have direct results with regard to this particular health issue.

Substantial effort should be made to protect and enhance funding levels for community-based programs, including special needs education, which has recently been cut.

We need to look at a national strategy to be developed in terms of prevention of fetal alcohol syndrome. As I mentioned before, funding needs to be set aside for research in this area.

Thank you.

The Vice-Chair (Mr. Dhaliwal): Thank you very much for that presentation. I can assure you this is a very important matter for this committee. I know at all levels of government we have to do a better job of dealing with drug and alcohol abuse within the aboriginal communities. So I think your presence here and your input have been very important for us. Having toured some of the areas where there's a problem with drug and alcohol abuse, it makes me very sad to see the problem within our aboriginal community.

We'll start with Keith. Once again, I ask members to be brief so that we can get back on schedule.

Mr. Martin (Esquimalt - Juan de Fuca): Thank you, Mr. Chairman.

I thank all three of you for coming here to make your interventions to us.

I have a few brief questions. I'll preface them by saying that I had not seen since I had last worked in Africa the awful medical problems affecting your communities. I had not seen malnutrition and untreated hypothyroidism and an enormous range of diseases since I had worked in a third world country. The time is long overdue for talk. We need action. I'm sure you would more than agree with what Rosemarie Kuptana said when she originally came to this committee some time ago.

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A few quick questions. Do you believe integration, not assimilation but further integration, into Canadian society, with an improvement to the economic welfare of aboriginal peoples, would decrease the problems of substance abuse within your communities?

Second - and perhaps Ms Van Bibber would be able to answer this one - would a gentle reintroduction of the matrilineal, matriarchal structures that existed in some aboriginal communities in British Columbia help to improve the organization within the reserves by enabling the people to be more empowered and to have more decision-making with regard to what goes on in some reserves? In my experience some of them have been fraught with internal rancour and internal problems that are leaving the aboriginal people in the trenches dislocated from their aboriginal leadership.

As well, do you think making aboriginal reserves dry helps in dealing with the alcoholism problem on reserves?

Finally, do you know of any early intervention strategies being employed by aboriginal people on reserves?

Thank you.

The Vice-Chair (Mr. Dhaliwal): Let me just say that I know some of these questions are very hard to answer in a brief form. If we can get a brief answer, fine, but if you feel you need to answer in a more extensive way, we'd appreciate a written response back to the committee.

Mr. Conn: We shall do that.

In terms of integration versus assimilation, the assimilation policy hasn't worked across the board in this country. It's quite evident. I guess ``integration'' could be considered a code word, but I'm not sure how that would work entirely when basically the issue of lands and resources and self-government must be fundamentally resolved in the hopes of establishing healthy communities with the land base and resources to sustain themselves and look towards coexistence. That is in large part the basic premise for first nations, from my experience, in terms of their policy advocacy in this area.

So integration is not particularly on the agenda. Parts of society are already integrated and are doing fine. I guess you'd call them bicultural in terms of society. I think it's more or less to do with, to a large extent, urban-rural situations. But I think the key is this whole area of coexistence. We'll be glad to elaborate on that in a further brief.

In terms of dry reserves, I'm not sure. To a large extent, from my experience and exposure to the issue, communities that have passed by-laws to have a dry reserve have not effectively reduced alcohol consumption. People find a way of getting it in. But generally it has been curbed. It brings the issue out in terms of a community dealing with it head on, perhaps, but it varies from community to community.

There has been little or no research done in that area. I'm just talking from personal experience. We can probably research that issue a bit more and get back to this committee.

Ms Van Bibber: Your question on matriarchal societies and early intervention was not very clear.

Mr. Martin: Working in northern British Columbia, some of the aboriginal RCMP officers have done a really good job of gently reintegrating the matriarchal structures back into some of the reserves. This has actually empowered the people there. They've noticed quite a diminishing in some of the terrible socio-economic problems facing these reserves. I'm wondering whether or not there was actually a move within your committees to do that and whether or not you found it to be an effective endeavour.

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Ms Van Bibber: I certainly think the matrilineal, and in some situations the matriarchal, structures of society are part of the traditional structures and are very valuable. I think you need to be careful to not just take bits and pieces. It certainly is part and parcel of self-governance. With self-governance, communities and nations, the structures that are useful in today's society will re-emerge to deal with the issues with which they are faced.

Mr. Martin: That's a municipal style of self-government. Is that what you're referring to?

Ms Van Bibber: No. I'm talking about first nations self-government; I'm not talking about municipal style. It very much depends on the community. I know you're probably thinking about the Sechelt model of self-government. But there are different approaches that go back to more traditional structures of governance. What you're speaking of is part of a traditional structure of governance.

Mr. Szabo: I want to thank you for raising the issue of FAS, particularly.

The National Crime Prevention Council came before this committee. One of their spokesmen who dealt with FAS children and their parents made a statement that, sadly, very few of these clients were aware of the risk of alcohol consumption during pregnancy.

I have two questions.

First, how do you assess the awareness level within the first nations people with whom you've had encounters in this regard?

Second, the Northwest Territories and the Yukon have had health warning labels on the containers of their alcoholic beverages since 1991. Do you support that approach in terms of awareness or behavioural change, and do you have any other knowledge of whether or not that has been a positive step to take?

Ms Van Bibber: Speaking about labels, I would say that, yes, it would have a positive effect. I believe there needs to be more information out there.

I have had the opportunity to travel across Canada recently to talk to different people with regard to fetal alcohol syndrome. In the communities, there is very little public health information. There are not a lot of posters and brochures and that kind of thing. Even though this issue has been in the forefront for the last few years in Canada, we still have not spent a lot of effort on education.

I certainly give a lot of credit to parent support groups. Certainly in British Columbia they have done a lot of work in education. They get calls constantly from all over British Columbia, Canada, and in fact North America.

People are desperate for information. There has been a lot of misinformation. For example, fetal alcohol syndrome has been seen as something very hopeless, so a lot of people are very much in denial. I think there needs to be a lot more education.

I was involved in a study that was looking at awareness about fetal alcohol syndrome. There was a fairly high amount of awareness with regard to the fact that alcohol did affect the baby, but not a lot of awareness of the actual damage and how long it lasted. There was a belief that they would sort of outgrow it and that it wasn't something permanent. I think that information really needs to be out there.

The Vice-Chair (Mr. Dhaliwal): Thank you very much for your presentation. I know this is a very important matter for this committee. It's something in which I have a tremendous amount of interest personally.

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I think that, in a lot of ways, we've failed as governments to deal with alcohol and drug abuse in the aboriginal community, and we have to work a lot harder to deal with those problems.

So once again, thank you very much for coming forward to make an excellent presentation to this committee.

While we are waiting for the next witnesses, we have a couple of housekeeping items that we have to put through.

One is a budgetary item. It's for the committee to adopt a proposed budget in the amount of $17,321, and that said budget be presented to the budget subcommittee of the liaison committee for its approval as soon as possible. This will keep us going until December in terms of the costs for our witnesses.

I wonder if I could have a mover and seconder so we can pass this.

Mr. Volpe (Eglinton - Lawrence): I so move.

Mr. Murphy: I second the motion.

Motion agreed to

The Vice-Chair (Mr. Dhaliwal): Keith has put a motion forward. Do you want to pursue this now, Keith? Do you want to speak to this motion?

Mr. Martin: I'm glad this motion, which you all have, came today after the earlier interventions.

I move that this committee recognize the findings of the U.S. Food and Drug Administration with respect to tobacco products, namely that nicotine and cigarettes do affect the nature of many functions of the body because nicotine and tobacco products cause and sustain addiction, cause other mood-altering effects, including tranquillization and stimulation, and control body weight.

There are numerous other justifications below that.

This motion comes from the almost total inaction from the government despite repeated promises about having some kind of an effective tobacco strategy put forward in the House of Commons. I want to give this committee an opportunity to recognize what this substance really is along the lines of what has been done in the United States.

The Vice-Chair (Mr. Dhaliwal): Thank you. Are there any further comments?

Mr. Szabo: I have a point of order.

I have not seen or had an opportunity to look at the U.S. Food and Drug Administration findings. I would just raise with the committee that I would appreciate being able to see this document, or a report on the document from someone, so I could participate in any debate and maybe even vote on a motion. So possibly this motion is premature.

The Vice-Chair (Mr. Dhaliwal): I presume you want to table it or use it as a notice of motion until the next meeting.

Mr. Szabo: I want to table it until such time as the information is available.

The Vice-Chair (Mr. Dhaliwal): Would you be willing to have your motion tabled or put as a notice of motion for further meetings?

Mr. Martin: It depends on when they were going to do this, Mr. Chairman.

The Vice-Chair (Mr. Dhaliwal): Our next meeting is next Tuesday. I will be happy to put it on the agenda for next Tuesday. Maybe you could provide further information for the members so we could have a more constructive debate on this issue.

Mr. Martin: I'll provide it to all the members. So we will debate it next Tuesday?

The Vice-Chair (Mr. Dhaliwal): We can put it on the agenda for next Tuesday.

Mr. Martin: That's fine.

The Vice-Chair (Mr. Dhaliwal): The motion is withdrawn until next Tuesday. Is that acceptable to everyone?

Some hon. members: Agreed.

The Vice-Chair (Mr. Dhaliwal): Thank you very much. I'm glad that was done.

Our next witness is from the Canadian Cancer Society.

I apologize for being a little bit behind schedule, but we had some very good questions and very good answers. We're not going to rush you because of that. We'll try to keep all members here as long as possible.

We have Dr. Gerry Bonham, Maurice Gingues, and Robert Cunningham. Thank you very much for coming forward. We look forward to your presentation.

Dr. Bonham, you have the floor.

Dr. Gerry Bonham (Chairman of the Emerging and Public Issues Committee, British Columbia and Yukon Division, Canadian Cancer Society): Thank you very much, Mr. Chairman, members of this committee.

I am Dr. Gerry Bonham. I am the chairman of the emerging and public issues committee of the Canadian Cancer Society's B.C. and Yukon division. I come from the west coast like yourself.

Rob Cunningham is a lawyer and policy analyst with the Canadian Cancer Society and the author of a book that has just come out this week, Smoke & Mirrors: The Canadian Tobacco War. He is here to answer questions that Maurice and I can't.

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With me is Maurice Gingues, who is project manager responsible for the minors project with the national public issues office of the Canadian Cancer Society. He will briefly address the committee on the matter of sales to minors and taxation.

I will be brief. You have my background on the material circulated. Has that been circulated?

The Vice-Chair (Mr. Dhaliwal): Yes, everybody has a copy.

Dr. Bonham: I won't repeat it all, but as you can see I've had senior experience in public health. I've held professorships at two Canadian medical schools. I've undertaken research - most recently I was the senior author of this document that just came out in June on Canada's largest follow-up of newborn health. Part of this study was directed towards the question of smoking mothers and the negative effects on infants. I've also been a consultant to the Royal Commission on New Reproductive Technologies as their person on the prevention of infertility, so I've been active on that front, too.

Briefly I would like to make a point that often gets missed about the impact of tobacco on the health of Canadians. I think we all know and understand the well-advertised lung cancer epidemic that we have due to tobacco and the very large proportion of heart disease that's also attributable to tobacco. But things that get missed are the large burden of chest diseases that prevail in the community that are tobacco-related. Tobacco can cause and aggravate asthma. I'm sure you've all seen somebody in a wheelchair carrying a tank of oxygen - you can be pretty darn sure that person has been a lifelong smoker. One of the other areas that gets missed is there are a lot of other cancer sites that are attributable and increased dramatically by the smoking behaviour of people.

Could I also stress the question of reproductive health. This is not often discussed. There are a lot of women who find that they are infertile, because women who smoke have lowered rates of fertility, and those who do conceive often can't retain a pregnancy. There are very high rates of spontaneous abortion in women who are smokers. This causes a great deal of anguish and concern.

Another factor, of course, is the one that I was involved in studying - the negative effects on the infant born to a smoking mother. These infants are measurably smaller and they go back into hospital with various illnesses in the first 18 months of life. They often have respiratory illnesses in childhood, particularly if their parents continue to smoke, and there is a lot of evidence of learning handicaps later on. It's not a very pretty picture; it's a very serious one.

The thing we have known for 10 years now is that non-smokers can be negatively affected by tobacco smoke. This has given stimulus to policies on smoking in public places. Certainly this is measurable and serious, and something that should concern us all.

The main point I want to make this morning is to show some perspective on things that don't work. The first thing we should be skeptical of is whether we can solve this problem by education. Education has done a wonderful job to date. A lot of people know that smoking is bad for you; they've been able to get off the weed. But now we're down to the hard-core nicotine addicts, and it is increasingly difficult to make a serious reduction in the smoking behaviour of adults.

It's getting tougher and tougher, because these are the people most addicted to nicotine, and simple education programs are not working. Some physicians in their practice make smoking a big issue with their patients, and they have to be content with relatively modest gains for all their efforts. The same is true of all the organized quitting programs that are out there - a lot of them try and fail.

Another thing that we have to be concerned about is that there isn't an effective screening program for tobacco-related diseases. This is true. We have good screening programs for cancer of the cervix in women, and some useful programs for breast cancer. They did try X-ray screening for lung cancer but that didn't work and it has been abandoned; there are no screening programs.

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The last thing we should keep in mind is that treatment programs for tobacco-related illnesses are really not very effective. We can't rely on treatment programs to cure the problem that it's been established over decades is smoking. I refer specifically to the disappointing treatment results from trying to treat cancer of the lung, which is serious and usually fatal. The treatment objective is very often to get the person and their family through another Christmas; it tends to be palliative in nature. The same is true of the heart disease that relates to smoking. It's really not easily treated, and those poor people who end up with their oxygen and chronic obstructive lung disease really can't look forward to a cure either. We're dealing with something that you can't screen for, that education may have its serious limitations for. There is no easy expectation of further quitting on the scale that we saw in the early days of tobacco education, and treatment doesn't hold out, as yet, any great promise.

We are down to one statistic that really matters, and that is, what proportion of teenagers are smoking? We know that nearly all smokers start before they're out of their teen years. Depending on whose statistics you believe, something between 5% and 20% may start after the teen years, but most of the smoking habit is established and fuelled and maintained by addiction to nicotine, which is indeed a very powerful addictive drug.

I could mention that after the Vietnam War, a lot of the American servicemen who came back had an addiction to heroin, and some three months later 95% were off the heroin. I don't know of an equivalent story to tell you about nicotine addiction. I don't think we'd ever see that kind of result, no matter what the circumstance.

So the proportion of teens smoking is the most important statistic to look at of all, and that of course, as you all know, in the last two and a half years has gone up in Canada. Ever since the tax roll-back, we've seen a 30% or 40% increase in teen smoking rates - not a very pretty picture.

We also have the spectacle of the return of tobacco advertising since the Supreme Court did its thing with the Tobacco Products Control Act. Vancouver papers have the full-page ads for Jacques Villeneuve, tying it in, in the minds of young people, to what they're going to be able to see on television. Jacques Villeneuve has practically become a walking billboard for Rothmans.

Sponsorship advertising is particularly pernicious because it really gets to where the kids are, and that's in front of the television set. So we shouldn't ever look upon sponsorship as something that is on the periphery. It's very much at the core of what we have to do to reduce smoking in children.

The last thing I want to say is to pass the buck to you, because the health community, as I've explained, has run into a brick wall, with small gains expected in education, small gains in cessation programs, no gains on the horizon in treatment programs, and no screening available. Public policy and government action at all levels is what's going to control this terrible scourge, with its huge health burden, now and in the future.

I'll now ask Maurice to speak on the topic of taxation and also on the sale to minors.

[Translation]

Mr. Maurice Gingues (Project Manager, National Public Issues Office, Canadian Cancer Society): I apologize, however I will not discuss the issue of taxation and tobacco sales to minors, but I will be available to answer any questions on this issue a little later on.

However, I would like to clarify a few points. Canada has been the world leader in the fight against smoking simply because it has adopted a comprehensive approach including education, legislation, stop smoking programs, etc.

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This must continue and we must also adopt long-term measures. However, we must understand that the legislative framework with respect to tobacco is not suited to the nature of the problem. Currently, Canadian legislation tells manufacturers that they can do anything that they want, unless it is not allowed, when in fact it should be telling them: ``You can do nothing unless we give you permission to do so.'' This is what we have asked the current government to do and we are waiting for this piece of legislation. This law will be a formidable weapon because, every time the tobacco industry wants to change the rules of the game, the government will have the tools it needs to deal with the demands made by the industry.

Accordingly, we have to give ourselves the means that allow us to do so. The legislative framework does not give the federal government the wherewithal to truly fight against smoking addiction, from the legislative perspective, namely, the ability to control manufacturing and sales. Right now, we are not able to control how, where, when and under what conditions tobacco is manufactured and sold. This is why tobacco is sold to young people. Our message completes what Dr. Bonham said, namely that, if we are unable to control the epidemic from the medical side, we have to take a look at the legislative side. We must establish the parameters for this product so that we can control it and minimize the access of young people to these products since most people become addicted before reaching the age of majority.

I will conclude with these remarks and we will answer your questions.

[English]

The Vice-Chair (Mr. Dhaliwal): Thank you very much for the presentation. Let me say this is a very important matter. I offered a solution to my caucus members on how to deal with tobacco smoking. I told them that 300 years ago my ancestors realized some of the problems you're talking about and they said no Sikhs are allowed to smoke.

My solution was that if the Minister of Health would start conversions to become Sikhs and take the leadership role, we'd solve the problem. He hasn't listened to me yet, but we're still trying.

Dr. Hill, do you have a question?

Mr. Hill: Thank you, gentlemen, for your appearance. You've spoken eloquently of focusing our efforts on youth, and you touched on the price sensitivity of youth, that in fact over the past 30 years there's been a nice drop in Canada of smoking - a wonderful drop - and then at a specific time an uptake. That's evident in every single graph I have seen on smoking.

The pricing issue was done supposedly to get around smuggling. If smuggling were present, those kids should have been smoking smuggled cigarettes. Why do we have the uptake? Why is there the price sensitivity for these kids?

Dr. Bonham: As far as price sensitivity is concerned, it's always been known that if kids can buy one cigarette, they will buy one cigarette, or they will buy ten cigarettes. They have a limited amount of money and their smoking behaviour will go with this.

I'm not sure smuggled cigarettes were a big factor during the period of decline. It was a very brief episode of smuggled cigarettes between 1992 and 1994. Smuggled cigarettes were certainly freely available at that time. But from 1994 smuggling has been unnecessary for kids to access cheap cigarettes.

Mr. Hill: They've been able to buy those cheap cigarettes right here.

Dr. Bonham: Yes, they don't need to buy smuggled cigarettes. They can buy the regular ones at a lower price than they were before.

Mr. Hill: This is my second question. There's been a fair amount of discussion as to whether or not the blueprint on tobacco control is in fact the way to go versus a strict control of cigarettes as a drug delivery system - nicotine recognized as an addictive controlled substance and an attempt to change the whole focus. Can you comment on those two approaches?

Dr. Bonham: I think the blueprint was very soft on sponsorship. I made that point earlier - the importance of sponsorship.

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As far as the blueprint is concerned, you're suggesting an opposite direction, just zero in on the nicotine as a drug delivery system. That's essentially the direction in which the Americans appear to be going. They've rolled that into their food and drug law.

We could do that. Hopefully, if that were to be the case, we don't allow cocaine and heroin to be advertised. So there would be absolutely no point in expecting nicotine products to be advertised under those strict controls. It would be a way of viewing the potential freedom to advertise.

Mr. Robert Cunningham (Policy Analyst, National Public Issues Office, Canadian Cancer Society): Just to elaborate on that, the Canadian Cancer Society made a submission to the Food and Drug Administration in the United States endorsing their scientific conclusion with respect to nicotine as a drug and that cigarettes are drug-delivery devices.

In Canada, we have the legal opportunity if we choose to make the same decision under our Food and Drugs Act. Nicotine is already regulated as a drug under that statute when it's found in the patch and when it's found in nicotine gum. In fact, the advertising of nicotine patches is prohibited. Yet the advertising of cigarettes is unregulated, which from our point of view is clearly unacceptable and needs to be addressed.

We could accomplish the measures outlined in the blueprint by regulations under the Food and Drugs Act. We could also accomplish it under a separate statute, which so far has not been introduced by the Minister of Health.

The Vice-Chair (Mr. Dhaliwal): Thank you very much.

Mr. Volpe.

Mr. Volpe: I want to thank the witnesses for coming to share their views with us. I guess they've been touching a topic that's very sensitive for everybody. I think society as a whole would agree with the general principles you have outlined.

I have a couple of questions notwithstanding and maybe you could help me through them.

Your entire presentation is based on tobacco and tobacco strategy, and there's obviously some political direction there. I'm just wondering, and perhaps this question is directed to Mr. Cunningham more than the others, whether you think legislation that would come forward sooner rather than later, but that wouldn't fit within the parameters of the Supreme Court decisions, would be legislation worth bringing forward.

Mr. Cunningham: The Supreme Court of Canada decision is something we've analysed a lot. The Supreme Court gave lots of room for government to move forward. For example, you have a complete ban on lifestyle advertising, which is more than 90% of the advertising you see out there today. They concluded that, yes, it increases smoking.

They also said - it was very close, 5-4 on other kinds of advertising - they would uphold that if there was just a bit more evidence. Our view is that evidence exists today. Presented well in court, you could have a ban on tobacco advertising, a ban on sponsorship.

Sponsorship is pure lifestyle advertising. That's a non-issue. You could ban sponsorship and immediately it would be a no-brainer practically to win that in court. Of course, it's about how many would very strongly oppose it. We feel we're on very strong legal grounds.

I am not sure I'm answering your question sufficiently.

Mr. Volpe: You've taken a shot at it and I think you've done fairly well. I am wondering if you will apply the same figure to this next question, and I hope I'm not misinterpreting what previous witnesses have offered.

I thought I heard earlier on in the morning that perhaps the question of decriminalization of illicit drugs be considered part of a larger strategy for dealing with this social ill. If you were to agree with the inference I drew, what implications would that have for the kinds of legal legislative approaches you'd like to take with tobacco?

Mr. Cunningham: The Canadian Cancer Society does not have a position advocating the legalization of current illicit drugs. My area of specialization is tobacco, in terms of tobacco policy.

If we were to have some other drugs that were more openly sold, I don't think you would have much impact in court. The same test to have a reasonable limit on an infringement of the freedom of expression, for example, would remain unchanged. I don't think there'd be much changed in court.

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The Vice-Chair (Mr. Dhaliwal): Mr. Szabo.

Mr. Szabo: I want to thank the panellists for the very useful information about the current state of affairs with regard to alcohol or tobacco.

I noted in your brief that you did make some comments on labelling. That's an issue I'm very interested in, vis-à-vis alcohol. I guess maybe the generic comment would be that it appears you support labelling in terms of one aspect of education, etc. The issue, though, is the linkage between awareness and behavioural change. I'm wondering if you can comment on the propriety or the usefulness of health warning labels on any product and the role that plays in the linkages between awareness and behavioural change.

Dr. Bonham: I don't think those warning labels are viewed as effective by themselves, but as part of a comprehensive approach it could be reinforcing.

I would like to make one comment about labelling. This business we've seen in the States about warning people about drinking and pregnancy to the same extent as warning people about smoking and pregnancy has a serious flaw in it, which is that by the time people know they're pregnant, you're eight weeks into the pregnancy and the embryonic period is past.

If you're going to do anything about preventing birth defects - and there's a lot of literature suggesting increases in birth defects from smoke exposure - that happens in the embryonic period. Smoking later in pregnancy has more impact on the placenta. It tends to interfere with the free flow of nutrients and oxygen to the baby and tends to cause this reduction in birth weight. So the labelling is kind of useful, but it has serious limitations.

Mr. Szabo: I think that's an extremely important point. In terms of responding to the issue of FAS, women don't go to the doctor for their pregnancy until maybe the twelfth to sixteenth week, and by that point the damage is already done. So relying on health care providers to educate may be doing it after the horse has already left the corral.

I have one last simple question. The issue of targeting those at risk seems to be a driving force in terms of the strategy of dealing with misuse or abuse of substances. Yet every marketing course I ever remember taking tells me that the best, most effective communication is face to face with someone who is your peer. I'm wondering whether we're making a mistake by targeting all youth as being the problem as opposed to embracing responsible youth who are open to the messages to become part of the solution by intervening with their colleagues who are in fact the misusers.

Dr. Bonham: I think you make a good point. I've been part of programs that have non-smoking senior high school students interacting with the younger ones. You're right; there is a value in doing that.

I do think, though, that the whole peer pressure that drives a lot of tobacco use is nourished and fed by the promotion of the product. The two act in combination. I think depressurizing our children from tobacco advertising is a very important ingredient. Peer pressure could really be diminished by that as fewer and fewer kids smoke.

Mr. Gingues: I'd like to add to that. I understand this question, but I'd like to turn it on its head. Why don't we responsibilize those who manufacture tobacco, who go through the whole distribution and the sale? Those are all adults. We're asking kids to do something that we adults are not ready to do. I think that's very important.

Mr. Szabo: Their objectives are to make money, not to improve health.

Mr. Gingues: Yes, but government's objective in health is to protect the health of Canadians. We would hope this law would change the requirements so that we could responsibilize tobacco on the street down to the retailers.

The Vice-Chair (Mr. Dhaliwal): Mr. Murphy.

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Mr. Murphy: I want to revert to the previous question. Also, Doctor, how can we get at some of the things you were talking about? What should we as a government do about the fact that nicotine is a harmful, addictive substance? You're telling me, and I agree, that we have to have more education, etc., but a lot of the time that doesn't work. We have to pursue the banning of advertising. That's fine, but we still have an addictive drug here.

On the one hand, what we were saying earlier is that people have come to us and told us to decriminalize the use of illicit drugs. On the other hand, I'm saying we should do the opposite with nicotine. How do we do that? I'm concerned about these young people. We can tell them about the issues and so on, but once they're addicted, we've got a problem. I don't know whether you understand my question.

Dr. Bonham: It's extremely complex. The kids, of course, think they're going to live forever, and education that says you're going to get lung cancer at age 50 isn't going to register. So there are real problems with that.

As far as zeroing in on the control of nicotine, I think that, because of the historical accident of having this drug around for 300 years and having 7 million or 8 million addicts in the country, we haven't got the tool that would normally be available, which is that a new product could be viewed for its threat to humanity and banned at the beginning. We haven't got that choice here, and we're struggling, as many people have, with the question of free speech and the right of people to in fact deal with it on a free speech basis.

I think the best comment about free speech came from the parliamentarians of Finland when they studied this for 14 months - the longest debate ever in their parliament. They came to the conclusion that the essence of free speech was the freedom to criticize government itself, not the freedom to market a deadly product. That sort of puts it into perspective.

I think governments have a responsibility to limit in every way open to them a deadly product, because they haven't had the opportunity. They choke it off at the beginning. You'd have to go back and beat Sir Walter Raleigh over the head, and that's pretty hard to do now.

Mr. Gingues: I'd like to add that in tobacco addiction control, there's no golden bullet.

When we talk about a comprehensive program, it means everything you've been talking about - decision programs and education programs - but the right legal framework has to be there. Otherwise, you can sell it where you want, when you want.

The Vice-Chair (Mr. Dhaliwal): Mr. Martin has a quick, final question.

Mr. Martin: Dr. Bonham, do you think putting tobacco under the Hazardous Products Act would be a good initial step to providing a legal framework to enable the suggestions you've made in your brief?

Dr. Bonham: It would require a lot of regulatory support by putting it in there. It's entirely appropriate to go the route that the present government seems to be going, which is having separate legislation. You can come to the same end either way. It is in the Food and Drugs Act, but it's exempt. There are many ways, legally, of getting at it.

Mr. Martin: Would that be the easiest way?

Dr. Bonham: The issues become more complicated. Maybe it's a simple way to go at it, but some countries have enabled tobacco companies to be zapped for setting out funds for the sponsorship of arts and sports. You get into a lot of those things. I think it would be more flexible, in a way, to have it under its own legislation.

Thank you.

The Vice-Chair (Mr. Dhaliwal): Thank you very much. I want to thank you for an excellent presentation and for giving us very specific recommendations as to what we can do.

I want to ask you one quick question on the tobacco taxation in terms of your recommendation to increase the excise tax. I'm wondering whether there is an effort on the part of your counterpart in the States, the American Cancer Society, to try to increase also. As you know, part of the problem is that we share a huge border, and when there's a huge difference in cigarette prices we get a lot poorer. If we could somehow convince them to equalize and have a North American policy on taxation, it would make our job easier.

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I agree with you that we have to do more. I wonder if you can give me a response on what they're doing and what we can do to try to increase there, so we can equalize it and make our job a lot easier.

Mr. Gingues: We'll give you an idea of what we've been doing. In 1991, after the 3¢-a-cigarette increase, the Canadian Cancer Society set up what we call a joint committee between the Canadian Cancer Society and the American Cancer Society to deal with the issue of tobacco taxation and smuggling.

They've met sometimes twice per year. Actually we even had a session where we had all the representatives from all the border provinces and states. The problem is that it has led to the one-page ad in The Washington Post asking President Clinton to increase his tobacco tax awhile ago in 1994. That's what we've been doing. We've been able to put the tobacco taxation issue on the agenda of the American Cancer Society and then on the agenda of President Clinton.

The problem, you will notice, is it's not only a question of federal levels of taxation. Right now, the state of Michigan and the bordering American states have higher taxes than Ontario and Quebec.

So we believe there could be some kind of mechanism where we could equalize, but we don't believe governments are there right now. But we do have hope. I think Minister Dingwall has announced some initiatives with the American government - it was announced with people like Ms Bégin - whereby they'd be sharing some knowledge and data and all that stuff, but I think it needs to be pushed farther. That will require us to do a little bit more work to convince the government, and right now our goal is to convince the government just to get the law into the House of Commons and adopt it. That's what we've been doing.

There is great difficulty in getting coordination between different levels of government and even between our government and our embassy, and it's the same thing on their side. So it's quite difficult, it's a challenge, but we're ready to take it up. We've already started, and we have launched the invitation to the Canadian and American governments.

The Vice-Chair (Mr. Dhaliwal): Thank you very much. I think all of your efforts are greatly appreciated in this area. I want to thank Dr. Bonham, and Robert and Maurice, for coming forward with an excellent presentation and giving all the details.

There is no doubt we need political leadership in this area, and I'm going to ask all my colleagues in the House who are smokers to stop smoking. Can you imagine if we can say ``all MPs are non-smokers in the House of Commons''? That would set a real leadership role and attack this problem right from here.

Do you have a question, Mr. Szabo?

Mr. Szabo: Mr. de Burger referred to a report or some sort of study on decriminalization -

The Vice-Chair (Mr. Dhaliwal): Yes. Would you like a copy?

Mr. Szabo: I would like one.

The Vice-Chair (Mr. Dhaliwal): Can we ask that this be circulated to all our members. Thank you very much.

Yes, Mr. Hill.

Mr. Hill: I'd like the terms of reference of this committee at the start of our next meeting, please. They have never been circulated. They have never been discussed. I'd like to have them so that we don't go through this idea that we have different terms of reference. We need to have them specifically laid out.

The Vice-Chair (Mr. Dhaliwal): I'll pass those on to the chairman so that he can deal with that issue.

Mr. Hill: Just an agenda item, please.

The Vice-Chair (Mr. Dhaliwal): Thank you very much. The meeting is adjourned.

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