Proceedings of the Standing Senate Committee on
Legal and Constitutional Affairs
Issue No. 6 - Evidence - April 14, 2016
OTTAWA, Thursday, April 14, 2016
The Standing Senate Committee on Legal and Constitutional Affairs met this day at 10:30 a.m. to study matters pertaining to delays in Canada's criminal justice system.
Senator Bob Runciman (Chair) in the chair.
[English]
The Chair: Good morning and welcome colleagues, invited guests and members of the general public who are following today's proceedings of the Standing Senate Committee on Legal and Constitutional Affairs.
As a reminder, earlier this year the Senate authorized the committee to examine and report on matters pertaining to delays in Canada's criminal justice system and to review the roles of the Government of Canada and Parliament in addressing such delays. This is our twelfth meeting on this study.
For the first hour today we have with us, to talk about the Ottawa Drug Treatment Court, Constable Craig Fairbairn, Drug Treatment Court Liaison Officer, Central Neighbourhood Unit of the Ottawa Police Service; Marion Wright, Clinical Director of Rideauwood Addiction and Family Services.
We appreciate you being here today. Mr. Fairbairn, I believe you're going to lead off.
Craig Fairbairn, Drug Treatment Court Liaison Officer, Central Neighbourhood Unit, Ottawa Police Service: Thank you. It is an honour for me to be here today.
Honourable senators, thank you for the opportunity to speak to you about delays in criminal proceedings. I am Craig Fairbairn, and I am sworn officer with the Ottawa Police Service. I've been with the Ottawa Police Service for eight years; two years in civilian positions as well as six years as a sworn officer. My experience includes working patrol, criminal intelligence, major case management as well as the Drug Unit.
I am the Drug Treatment Court liaison officer with the Ottawa Police Service, and I work in the Central Neighbourhood Unit. As the Drug Treatment Court liaison officer, I work directly with federal and provincial Crowns, probation officers, as well as with the Rideauwood Addiction and Family Services centre.
Today I wish to address the benefits of the Drug Treatment Court, or DTC, programs and, at the same time, encourage you all to expand this model across Canada. The DTC programs address the root causes of criminality through treatment, resulting in a lower rate of recidivism among participants, while alleviating delays within court systems and saving the economy millions of dollars.
The DTC has had a profound positive effect on individual participants and communities. Drug abuse, mental illness, alcohol addiction, socio-economic conditions as well as other matters pertaining to the determinants of health all factor into the problem this committee is addressing. These aggravating factors contribute to criminality, which further cause systemic delays in criminal proceedings. As you know, drug-related crime accounts for a large part of all the economic and social cost of illicit drug use, and it also contributes to a large share of all crime.
Our criminal justice system can be considered a four-stage process: First, root causes of criminality; second, the criminal acts; third, police investigations; and fourth, the overall judicial process. The DTC provides the support, tools and therapy a participant needs to overcome their drug addiction by closing the gap between the root causes and the judicial process. What we are essentially doing is streamlining the transition between stages and working towards eliminating the criminal act and the judicial process that follows.
For an applicant to be considered for admission into the DTC, four basic criteria must be satisfied. The applicant must be addicted to hard drugs such as cocaine, opiates or methamphetamines. They must be committing crime fundamentally to satisfy their drug addiction. Generally, the offences must be non-violent. Each case is evaluated on its own merit. And they are not subject to a conditional sentence.
Upon meeting the criteria, applicants must plead guilty to their charges, including, when applicable, agreed-upon charges from outside jurisdictions. The applicant is required to take responsibility for their actions and accept the consequences that may be imposed on them through strict DTC undertaking conditions.
You have all received a tab 1 in the package that I've handed out. That's a typical DTC undertaking condition release page that they will sign. Once accepted, the participant begins the DTC program, thus reducing the burden on the judicial process.
With the overview of the DTC program and process in mind, I would like to highlight some of the merits of this program.
The April 2015 Drug Treatment Court Funding Program Evaluation by Justice Canada concluded the average DTC impact was a reduction in applicant recidivism not only while on the program but for years to follow. The study found that after four years, 61 per cent of DTC graduates did not commit additional criminal offences compared with 40 per cent from a comparison group. By treating the addiction, we are able to reduce future criminal charges likely to cause further delays in court proceedings.
A multitude of issues relating to court delays can be attributed to root causes of criminality; however, there are administrative issues that also contribute to these delays. No longer is it only the mega-trials tying up court proceedings, but all the trials are becoming so convoluted they take days instead of hours.
In 2015, there were 950 federal statute cases received by the city of Ottawa, with 914 disposed. Eight hundred and seventy four of those cases were disposed at or before trial by way of guilty plea or other means, while only 40 of those cases went to trial. Although these cases only went to trial 4.4 per cent of the time, they averaged 160 days, with nine court appearances before disposition. I've included tab 2 as well. It has the 2015 statistics for the city of Ottawa.
These systemic delays in court proceedings amount to substantial financial costs that can be partially alleviated through DTC programs.
The April 2015 program report also found that cost savings varied from 20 to 88 per cent per participant when compared to an incarcerated individual. For example, the cost of processing one individual in a regular court system is $50,000 a year, while one year in a DTC program costs just under $30,000. Since 2011, based on these figures, Ottawa DTC has had 61 graduates, which has saved the economy approximately $1.2 million over this time period.
Government should focus their resources on treatment programs to stop the revolving door of addiction and crime creating logjams in the judicial process. There are federally funded DTC programs operating successfully across Canada. However, yearly funding for the DTC has been static at $3.6 million for many years despite additional DTC programs starting up. DTC savings well exceed the $3.6 million in yearly funding while maintaining a positive effect on communities and reducing acute delays experienced in court proceedings.
This success can be used as a template to expand and create programs to combat other issues, including mental health and alcohol abuse.
Thank you again for the invitation to appear before you. I would be happy to address any questions you may have.
Marion Wright, Clinical Director, Rideauwood Addiction and Family Services: Good morning, honourable senators. On behalf of Rideauwood Addiction and Family Services in Ottawa, I thank you for the opportunity to speak with you today.
My name is Marion Wright, and I am the clinical director at Rideauwood Addiction and Family Services. Rideauwood is the agency in Ottawa that provides the Drug Treatment Court and has so in this community since 2006.
From my perspective, with approximately 50 years of experience in Ontario in leadership roles for the addiction and mental health sectors and as a senior surveyor for Accreditation Canada, specializing in addiction and mental health across this country, I welcome an opportunity to speak about the problem solving specialized courts and their roles in the criminal justice and addiction and mental health services across this country.
You have asked that we respond to issues about delays in proceedings and our recommendations concerning a number of issues. The relationship between illegal drug use and criminal behaviour is well established and represents a continuing and costly problem in Canada. Research has concluded that those with substance use issues are more likely to have committed crimes, and those who have had contact with the criminal justice system are more likely to have substance abuse issues.
Drug-related crime is an ongoing issue as recent data on police reported drug offences show an increase in the rate of drug offences by 33 per cent between 1998 and 2012. This data is from Public Safety Canada.
Given the high cost related to illicit drug use, which has been estimated to total as much as $3.82 billion for one year, there is a need to find effective interventions to address drug-related crimes.
The Drug Treatment Court Funding Program is a contribution funding program that provides financial support and administers funding agreements to six Drug Treatment Court sites: Toronto, Vancouver, Edmonton, Winnipeg, Ottawa and Regina.
Evaluations support both the DTC model and the funding structure. DTCs, which combine a criminal justice and therapeutic response to drug-related crimes, were created in response to the high recidivism rates for drug addicted offenders, for example, the revolving door to the criminal justice system for people with addictions. Numerous studies have shown that Drug Treatment Courts achieve positive results in reducing recidivism, that revolving door. In addition, the program remains relevant as without its support, the Drug Treatment Court stakeholders believe that courts in Canada could certainly not expand and may even contract in terms of numbers of and capacity for admitting clients.
In Canada, under the Department of Justice, the Drug Treatment Court model has continued to evolve to address community local contexts and population needs. Drug Treatment Courts are provincial courts. They target adult, non- violent offenders who have been charged under the Controlled Drugs and Substances Act or the Criminal Code in cases where their drug addiction was a factor in the offence.
Offenders who are interested in participating in the DTC are assessed to ensure that they meet the court participation criteria. Rather than being incarcerated, DTC participants receive a non-custodial sentence upon completion of treatment. The key elements of DTCs funding under the Department of Justice Canada's program include: a dedicated court that monitors the DTC participants' compliance and progress; the provision of appropriate drug treatment services and case management to assist the participant in overcoming drug addiction; community support through referrals to social services, such as housing and employment services, that can help stabilize and support the offender in making treatment progress; and complying with the conditions of the Drug Treatment Court.
Various sites across this country have different approaches. Some have most services provided in-house, as Rideauwood does, while others refer to other treatment organizations. The format and approach of treatment varies across Canada and the sites, but all involve group and individual counselling. All sites have phased programs that direct participants through different stages, such as assessment, stabilization, intensive treatment, relapse prevention, maintenance and then finally graduation.
For example, residential treatment is a key aspect. Toronto has developed permanent funded and unfunded partnerships with a number of community organizations. In Vancouver, the care team works in collaboration with the on-site employment and assistance worker to secure housing for clients, a very important aspect of the treatment, usually in recovery homes or in market housing.
In Edmonton, participants are referred to pre-existing day or residential treatment. In Ottawa, we have a contract with Ottawa Withdrawal Management for the provision of one bed for individuals who require residential treatment.
Two programs, both Toronto and Ottawa, adopted multiple levels of graduation from the program. Toronto has two levels. Ottawa has three levels, and this varies across the country. There are more details in the brief I have provided.
Length of treatment is another variable in how the sites vary. For basic graduation, five sites have a required length of time in the program. Abstinence varies by site. Complete abstinence for at least three months characterize the Ottawa, Vancouver and Toronto courts, and it is four months for the Winnipeg, Edmonton and Regina courts. Some sites require no criminal offences for a minimum of three or six months; other sites do not have this graduation requirement.
Sites vary in the ways of demonstrating social stability for individuals, but most sites have this requirement. Some require stable housing, some require active involvement in employment or volunteer work and others need an integrated plan of recovery as to how they will return to work.
The Rideauwood Addiction and Family Services program is administered by our agency, in coordination with the provincial court system. Rideauwood directs the program, and treatment representatives from the Drug Treatment Court are all from Rideauwood, including a program manager, a probation officer, three managers and administrative assistants and a nurse practitioner.
In order to be eligible for the program at Rideauwood, there are five specific criteria: the individual must plead guilty, accepting responsibility for their offence; the applicant must voluntarily consent to treatment; the individual must be charged with certain non-violent offences; offences must have been motivated by or connected to drug dependency; and the applicant must be approved by the Crown attorney, Rideauwood and the DTC judge.
Treatment activities involve the following: ongoing assessment; formal addiction counselling; group sessions; individual treatment sessions; residential and outpatient treatment; case management services; health and social services; regular and random urine testing; and training, continuing education and employment services. Program engagement in the Ottawa program will last for a minimum of nine months, and program requirements, number of court appearances or treatment sessions can be reduced at any point during the treatment period if, in fact, the individual's behaviour is required to reinforce those types of things.
Graduation requirements for Level 1 are at least nine months of participation in the program and abstinence from all substances for at least six consecutive months. They receive a maximum sentence of one-day probation. That's the highest level.
Level 2 requires at least nine months of participation and abstinence from all substances for at least three consecutive months. The graduate receives a maximum sentence of 12 months' probation.
Level 3 occurs after at least 16 months of participation, and the graduate receives a maximum sentence of 18 months' probation.
It's a graduated type of program with various levels of graduation.
While preparing their application for graduation, participants are required in the Rideauwood program to include what we call a "reintegration plan'' that describes how they will maintain abstinence, prevent recidivism and remain engaged in recovery activities following participation in the program in the rest of the community.
In summary, whereas data in many respects are very positive about Drug Treatment Courts, there remain a number of concerns about these courts.
First, pre-trial procedures assist to determine eligibility of clients, and these are very positive but still not non- compliance and recidivism rates are substantial and may be a reflection of the service or treatment model. There is about overall a 35 per cent graduation rate. These are with pre-approved individuals who are going to participate. That's something that I think we could work on to certainly improve.
Second, as in the case of the mental health courts, training for judges and pretrial assessment processes are critically important.
Third, dedicated and trained members of the judiciary will assist in more clients being assigned to the Drug Treatment Court, therefore there are better outcomes, and there are sanctions only where appropriate.
Fourth, as there many addiction and mental health providers across the country, expanding the support for specialized problem-solving courts, including the Drug Treatment Courts, would result in expanded use of these courts, obviously, and a reduction in lengthy court delays. More importantly, there would be an increase in positive outcomes for the individuals who are participants having engaged in criminal behaviours, received treatment and support and no longer offend.
Thank you very much for your time.
The Chair: We will begin with the committee's deputy chair, Senator Jaffer.
Senator Jaffer: Thank you very much to both of you, and I would like a bit of expansion from Ms. Wright. When you talk about training for judges, when you said training, what kind of training, what length of training?
Ms. Wright: It applies not only to Drug Treatment Courts but also to specialized mental health courts or problem- solving courts as well. Because of the unique nature of an offender and the fact that treatment has very good outcomes, it's really important to have a judge and members of the judiciary who understand that in many cases these are conditions that are treatable, and there needs to be appropriate sanctions, when in fact the individual has a positive urinalysis for drugs, for example. There have to be appropriate sanctions.
But there also has to be an understanding that these are human issues that individuals face, and how we can support them through treatment as opposed to incarceration. They have offended, and they need to take responsibility for what they have done, but how do we move them forward, back into the community, and the role of the judiciary and judges is really important to that understanding or training in what happens when somebody is drug-addicted, has a mental illness or both, and just a basic understanding of how somebody may recover. They don't go quickly from using daily illegal substances to not using successfully the next day. It takes a period of time.
One thing that is also very helpful, and the data support this, is if there is, as in all the Drug Treatment Courts, a requirement that the participant attend weekly at court, and their progress is reviewed, their urine screens are reviewed in front of the court, that has a very positive effect not only on that particular person but also on the other Drug Treatment Court participants who attend as well. Somebody may have been attending for nine months and they're doing very well, and somebody may be in the first month or week, and with the understanding and the sanctions that come from the judges, that first week person may not be performing as well, obviously, as the person who has been in longer. Yet, they are able to see that they can do that, that somebody else has done this. This is how the judge works in partnership to assist the individual.
Senator Jaffer: I have a question for both of you. You know that we are looking at court delays. In preparing for today, I was thinking that your work probably helps court delays. I would like to ask you both what should be in place to help us deal with this issue of court delays, especially with the people you are dealing with. It would probably be very difficult for the people you're working with and also harmful, I think, so I would like to hear your suggestions and the recommendations you think we should be making to deal with the issue of court delays.
Mr. Fairbairn: By expanding the program, it all comes to down more money. If we had more money, we could expand the program and have more participants come in. That alone will save future court delays. You're already taking the participants out of the regular court process and into a DTC program. You have to remember when they're in that program, they're not likely to be committing further criminal acts. Many of these people, especially someone addicted to crack cocaine, are using $150 to thousands of dollars of substances a day. They have to get the money from somewhere. It could be through break and enters, petty thefts from vehicles, but those are charges that will possibly get laid by police investigations. If we could limit that by having more participants enter DTC programs, we will alleviate further criminal charges from going to the court system. It will help with delays a lot.
Ms. Wright: The treatment piece is important. If in fact we're going to be reducing the number of offences that individuals have, we need to reduce their drug use, and the best way to reduce their drug use is through active treatment, so the more people we have who are involved in active treatment and the more interdisciplinary that is, the more likely we will have an impact not only on individuals but on court delays. But treatment for addiction and co- occurring mental health issues is provincial. It is a challenge. There are never quite enough treatment facilities, so that also impacts, I think, on what could be a better program with better results with respect to the judiciary when more Drug Treatment Courts occur across the country.
Senator McIntyre: Thank you both for your presentations.
There's no question that the abuse of alcohol and illicit drugs is rampant in our communities, and once again, congratulations for the good work that you are doing.
Following a guilty plea, on illicit or illegal drug charges, a Drug Treatment Court imposes conditions of release. Ms. Wright, I know you answered a question of Senator Jaffer regarding the training of judges, but what about parole board members and other authorities? Are they receiving appropriate training with regard to imposing conditions on persons with addictions?
Mr. Fairbairn: I can't particularly speak with regard to the probation officers, but from an Ottawa Police standpoint, as a Drug Treatment Court liaison, what happens when someone is released on those conditions that I gave an example of in tab one, they go back to the community. They attend their weekly court appearances. They go daily to the Rideauwood drug treatment centre, but remember, these people are at a high risk of reoffending. They will be stopped by police officers very often. It is possible they will use again. Within the Ottawa Police, I'm trying to train officers so they can recognize that this person is a DTC applicant. They are on DTC conditions, which include not attending areas like the ByWard Market, which we know is highly rampant with drug abuse, not to be using and things like that. So when an officer sees they are a DTC participant, they will report the behaviour to me through email or a report, contact me, and I will forward that information to the federal and provincial Crowns, which will eventually get to the Drug Treatment Court.
Part of the undertaking these participants are released on is to be completely truthful with the court. They are required at the next court meeting to inform the judge that "I was stopped by the police; maybe I was using; maybe I was breaching my curfew; maybe there's reasons why I was stopped.'' Maybe they're just stopped by the police to say "hi.'' They have to report that to the judge. I'm able to confirm by sending that information ahead of time and will know if they're lying or not telling the truth.
Senator McIntyre: Is it harder for offenders to comply with conditions requiring them to abstain from alcohol than from illegal drugs?
Mr. Fairbairn: Honestly, it depends on the participant. We tend to see the drug abuse people focus on drugs and the alcohol people focus on alcohol. Generally it does not cross over as much, but it does happen.
Ms. Wright: I will support what my colleague is saying, although it is not really an either/or. In many cases, there is multiple drug use, alcohol and illicit drugs, and teasing apart what is going on within the individual from a health or neuropsychological perspective is very challenging.
Senator McIntyre: Ms. Wright, you mentioned the six treatment centres. In your opinion, could other Canadian cities benefit from Drug Treatment Courts?
Ms. Wright: Absolutely. In fact, in eastern Ontario, there are two new Drug Treatment Courts that are starting up, one out of Brockville and one out of Kingston. They are not part of the funding program but are trying to put together, within the treatment agencies and partnership with the judiciary, all the components of a Drug Treatment Court, and therein is an opportunity to really increase the impact.
Mr. Fairbairn: There are cities — including London, Ontario; Calgary, Alberta; and Kings County, Nova Scotia — that are starting up pilot projects as well for DTC programs.
Senator Baker: Thank you to the witnesses, and congratulations on the excellent job you're both doing in your respective positions.
I'd like to ask you what appears to be a simple question on the face of it. We are, of course, dealing with federal law, and section 720(2) of the Criminal Code allows a judge to delay sentencing in order to allow the accused to apply for an admission into a drug court program. Section 10(4) of the Controlled Drugs and Substances Act says practically the same thing.
These are two federal laws — one the Criminal Code, the other the Controlled Drugs and Substances Act — that reference Drug Treatment Court programs. What would be your suggestion on a change we could make in both the Controlled Drugs and Substances Act and the Criminal Code to be fair to all accused?
The problem I see with it in the Criminal Code and in the Controlled Drugs and Substances Act is that an application must be made by the accused prior to sentencing to enter a Drug Treatment Court program. If the accused's lawyer is not performing as well as he or she should be performing, then the person loses that opportunity because they do not apply prior to sentencing in the criminal court proceeding.
Would you suggest to us that we recommend a change in the law to allow a judge, upon hearing evidence that a person is addicted to a hard drug, because that's all you deal with, hard drugs — that's coke, not marijuana, not any of the lesser drugs. Maybe we should be changing that. I do not know. But on the face of it, should we be giving the courts the authority, without having the accused, because some of them are not represented, to enable them to apply, with the Attorney General's permission, because that must be sought, to the court to automatically allow that individual to apply for admission to a Drug Treatment Court program?
Mr. Fairbairn: Personally, I can't speak on the legal aspect as far as a change in law and the Criminal Code. What I think would help is if more judges and courts were aware of the program and the benefits that could come to the program. It means more awareness.
And outside of the courts as well. These offenders are generally going to be going to the court system a fair bit. They should already know or have people who know about the program who can suggest it to them so that they're aware at sentencing or when they first go to trial.
It is a good idea to have judges that are aware of it and say, "I am seeing something here. This person appears addicted to hard drugs. They're not a violent person. Maybe there is something I can suggest, that you apply to a DTC program.''
Ms. Wright: May I add? Not only am I not someone who could comment on changing of the laws, but strengthening the pre-trial procedures in partnership with the key partners, that is an opportunity up front.
These are meetings that occur, that are very interactive between the treatment providers, the judge, the Crown, and they're sometimes quite heated. If we have more of them and strengthen that, then you're really diverting into treatment more appropriately, as you have quite cogently noted. If the right people know the right thing, then the person will get the right kind of treatment. If you strengthen that, it will certainly strengthen the results of the program as well.
[Translation]
Senator Dagenais: I heard you talk about the Drug Treatment Court; you have personnel working at the DTC, specifically judges and Crown attorneys. Are they newly appointed people or do they come from the traditional system? If they do come from the traditional system, this means that there must be a shortage of staff somewhere. You do a kind of pre-trial, but if you assign your personnel to the DTC, does that mean that there is a shortage of staff in the traditional system? Unless these are new recruits — are they?
[English]
Mr. Fairbairn: Are we speaking specifically to judges and federal Crowns? I don't think it would be an issue, because in Ottawa alone we have approximately four Crowns that deal with the DTCs, and we have one federal Crown, as well as a provincial Crown, that are dealing with this. There are not very many people dealing with this program. It's really only one federal and provincial Crown in Ottawa.
[Translation]
Senator Dagenais: The DTCs were established, I think, in 2004 or thereabouts, and according to the witnesses we heard, the delays do not seem to have decreased, as such. If anything, the opposite happened. How do you explain that? Has there been a spike, an increase in the number of cases?
[English]
Ms. Wright: For one thing, I believe that there is an increase in drug-related crime. So that may offset the resultant decrease in delay of court procedures, because the volumes have certainly increased.
We've seen, certainly from the treatment side, a substantial increase in treatment needs for people with multiple addictions over the past 10 years, even since the Drug Treatment Court process was begun in Canada.
Senator White: Thank you to both of you. It's great to see you again.
My question refers specifically to comments that were made in relation to costs. It costs about $118,000 a year to keep someone in prison or jail. Could you tell me how much it costs per year to have a full-time residential bed and treatment? Not for the individual but for the bed itself.
Ms. Wright: If I understand you correctly, you're asking for a component of the treatment that would be —
Senator White: No. As an example, Harvest House has a number of beds. Do you know what a bed costs per year?
Ms. Wright: A bed costs about $30,000 a year.
Senator White: The difference for a bed there and at Innes Road would be $118,000 compared to $30,000.
Ms. Wright: You have to add to that, senator, the supports or treatment that is involved around it.
Senator White: Psychological, psychiatric or whatever else.
Ms. Wright: Absolutely. That would probably boost the cost up. The bed is one part of it in a residential facility, but by the time you have the appropriate supports, it probably increases. It's certainly less than $100,000. I believe it's in the order of the 60s by the time you add treating professions: nurses and social workers, et cetera.
Senator White: I have a question as a result of your comments on non-violent offenders. In other jurisdictions, certainly in some Scandinavian countries and in Australia, they've had greater success treating the drug abuse of individuals involved in violent offences and their ability to get through a treatment program. Is there a reason we don't use that for violent offenders here?
Ms. Wright: Quite honestly — and it's a very pragmatic answer I'm going to give you — the funding through the Drug Treatment Court Funding Program is really quite limited. We're only able to provide certain kinds of support with the funding that we have. In that case, we've defined that we're taking individuals who are non-violent offenders.
Should you be looking at violent offenders, I think you would need to have a somewhat different program that has a variety of other aspects to it. As you rightly mentioned, in other countries, it is quite possible to do. We have not moved in that direction.
Senator White: Constable Fairbairn, often police are identified as people who don't support programs other than putting bad guys in jail. What do you think the support for DTC and other similar programs, like mental health court and other treatment options, is in the Ottawa Police Service?
Mr. Fairbairn: Police officers are mostly A-type personalities, and like you said, we like to put bad guys in jail. Especially being a drug court liaison, the more I'm able to educate other officers on the benefits of the program and understand that although someone has committed a criminal act, it doesn't mean they're a bad person. They're addicted to drugs. It's an addiction like alcohol or gambling. It's something they live with. We have to address that first.
A lot of officers are opening their eyes to the fact that, yes, this person is addicted to drugs. There is no need to treat them like a criminal. We can treat them as human beings and try to help them from that standpoint. I think it's starting to get a little bit of play in the police.
Ms. Wright: May I add a comment to that? From a treatment perspective, most of us see the police as key partners to be able to get the kinds of results that we need to have. In Ontario, there are even some evidence-based programs like Coast in the Hamilton-Wentworth area that has a common marrying of police and mental health and addiction workers, which has demonstrated good results.
Ottawa Police Service has a special unit, as well, that is very helpful. The knowledge and understanding that comes through the partnership is very good.
The Chair: Based on the offence-based statistics you provided for last year — according to Justice. You're the court liaison, so that means you're working with the Crowns, you're scheduling the appearances of witnesses and police officers and that sort of thing. Is that the role you play?
Mr. Fairbairn: My role is as follows: Once an applicant puts the application in, it will be put through to the Crowns. The Crown will forward that information to me as well as a probation officer. We will review the individual to see if they fit the criteria that we talked about: that they're non-violent, addicted to hard drugs, et cetera. Then I will forward my opinion based on that as to whether I support the applicant.
Sometimes it's in the middle, and it's honestly about whether we're able to provide this person with treatment and they're willing to go to treatment and follow the rules, which they might not have done on previous probation releases, then I will leave it up to the Crown to decide.
The Chair: But these individuals are on remand as a rule? How does this work?
Mr. Fairbairn: There's a different scale. Sometimes they're released; sometimes they're in custody. It really depends on the individuals themselves.
The Chair: I'm looking at the drugs possession statistics, for example, with the average appearances to disposition is almost 7 — 6.9.
Mr. Fairbairn: Correct.
The Chair: Withdrawn or stayed — 178 cases.
Mr. Fairbairn: Correct.
The Chair: I just wonder if you could speak to those two, because it ties into what we're trying to come to grips with. How does this work in terms of your operation? That's what I'm really trying to get an answer to.
Mr. Fairbairn: As far as the Drug Treatment Court liaison, I don't have too much input regarding the amount of times they have to go to court before they get the dispositions.
From the Ottawa Police Service standpoint, the issue we're having right now is when the defence and Crowns are getting together for a case, they're scheduling court dates based on the presumption of a guilty plea a lot of times. They say that in six months, they'll show up for court and have their guilty plea.
Then they show up in six months and there are two to six other cases in that courtroom and there's no way they can do that trial that day. Defence knows this and say, "Okay, we're going to either push the court day to another day'' which will be another three or six months down the road and the federal Crown knows that if that happens, there will be an 11(b) Charter argument and they have to plead it out right away. Otherwise, there will be no jail time.
That's what's happening in our court system, in Ottawa specifically.
The Chair: Where would you lay the responsibility for trying to straighten that system out?
Mr. Fairbairn: It has to be on the administration — the specific courts themselves and how they schedule things. I know a lot of it at the end of the day comes down to funding, and if there were more judges and more Crowns, I'm sure we wouldn't have these issues, but there is only so much funding to go around and so many judges and lawyers. It really has to be examined at the court system.
The Chair: I guess the trouble is that some of the testimony we've heard has tried to lay this all on the funding. The judges obviously have a critical role to play, as well.
Mr. Fairbairn: Absolutely.
[Translation]
Senator Boisvenu: I congratulate you on your work. I have a major concern with respect to decreasing delays, namely the goal of reducing the rate of recidivism. We know that in many cases, when it comes to crime, substance use leads to recidivism; there is a direct link between the two. What is the male-to-female ratio in your work, in terms of substance use? I was informed that in recent years, there has been an increase in women offenders. What is the percentage of people you successfully treated over a period of about five years? Or at least, what is the percentage of those who will no longer use over five years or so?
[English]
Ms. Wright: In terms of the gender issue, we certainly see an increase in women offending. We also see a strong need to have an Aboriginal focus, both men and women, in our drug treatment facilities and in our Drug Treatment Court. That's another area that needs to be strengthened, as alignment with Aboriginal culture is very important. We need to be able to treat more men and women with the appropriate treatment that they need.
Mr. Fairbairn: I think last year, it was about a 2-to-1 male-to-female ratio. I think it was 65 male applicants to 36 female applicants.
Ms. Wright: But it is increasing.
[Translation]
Senator Boisvenu: Regarding your performance in preventing recidivism, namely the people who stop using, what percentage of people do you rehabilitate?
[English]
Mr. Fairbairn: Since 2011, we have had 161 applicants in the Ottawa DTC program. We have had 61 graduates. That puts us at a 38-per-cent graduation rate. If you compare it to the 2015 April study, the national average is about 27 per cent. So it's putting Ottawa at about 10 per cent higher than the national average.
The Chair: We have a few minutes. Are there any additional questions?
Senator Fraser: I have supplementary. To get people through to the point of graduation is already a major accomplishment, and I have to congratulate everybody — not just you, but everybody behind you who makes it work.
But how many of those people stay rehabilitated? Do you have any information, even anecdotal evidence?
Ms. Wright: I don't have hard data for you, but I do know that for a Level 1 graduate from the DTC program, they're typically reintegrated into the community, not offending and abstinent, which I think is the key aspect. Even when they might have a relapse, the likelihood of that resulting in criminal behaviour is reduced because they have community supports already in place to help assist them. They also have a better understanding and some tools as to how to maintain their abstinence.
It's a diminishing number, because, unfortunately, it's a very challenging situation. Even though we in Ottawa are looking at a fairly high completion and graduation rate, when we look at everybody who comes into the program, 35 to 38 per cent is still not very high. I don't have any follow-up data. I have only anecdotal data.
Senator Fraser: Anecdotally you believe at Level 1 it takes hold. Do we have any idea about level 2 or level 3?
Mr. Fairbairn: The April 2015 report put the average at about 60 per cent of graduates who did not recommit other criminal acts. That's pretty high. That was after four years. Obviously there is an improvement going on.
I deal with people who have graduated from the program, or people that have been removed from the program, on a daily basis. Once removed from the program, there is little support Rideauwood or the treatment programs offer. They're right back to living in areas where there's high drug abuse. Their friends are addicted to drugs. Although they're trying to become employed, they're still unemployed, sometimes possibly homeless. There are a lot of disadvantages once they come out of treatment. So it's a little bit tough, but I think 60 per cent not committing criminal acts is a great figure after four years.
Senator White: Thanks to both of you for being here. Ms. Wright, I was at Rideauwood giving a talk about drug treatment. I used the six to eight crimes per day that street addicts will commit. Two of your clients tell me they were committing 20 to 30 crimes on some days. What is the wait-list right now in the city of Ottawa for residential drug treatment for someone wanting to get off the street and off of drugs?
Ms. Wright: Basically it's far too long. It's six to nine months.
Senator White: Six to nine months at 20 crimes a day. We know what happens if we don't do something about this. However, I could buy treatment this afternoon if I had money, right?
Ms. Wright: Unfortunately, that's correct.
Senator White: The rich go to treatment and the poor go to jail.
The Chair: Two more questions.
Senator Baker: Why did you say no to conditions? You've got four criteria to meet. The fourth one you mentioned was that they were not under conditions. We're dealing with federal law. They've been through a court proceeding or they pled guilty or prior to sentencing, and you say one of your criteria is under no conditions. Could you explain that to us?
Mr. Fairbairn: Non-conditional sentences. It's a non-conditional sentence they have to be on, not on no conditions.
Senator Baker: They have to be on a non-conditional sentence, but they haven't been sentenced.
Mr. Fairbairn: That's one of the criteria, they haven't been sentenced.
Senator Baker: For something else.
Mr. Fairbairn: That's correct.
[Translation]
Senator Boisvenu: That means that 60 per cent do not reoffend. I congratulate you. This is the way to go to reduce recidivism, so that these people do not end up in "revolving doors'' in courthouses.
What is the percentage of people treated relative to the needs? You probably only reach a small percentage of people with alcohol and criminal behaviour problems. What percentage of people do you manage to treat and what would the needs be to ensure you could treat as many as possible?
[English]
Mr. Fairbairn: In Ottawa we have room for about 20 to 25 applicants in our DTC program. That's specifically related to hard drugs. We don't have an alcohol addiction program in Ottawa. We don't have anything for impaired driving. We all know that impaired driving is a huge issue clogging up court systems.
I don't have any numbers. There are no statistics. No studies have been done to answer the questions that you're looking for. Just using our common sense we can see that if we had more programs for people who suffer mental illness and alcohol abuse, especially for impaired driving, it would help. There are some collaborative things going on in B.C. collaborative justice programs. I think that would help alleviate further court delays as well.
Ms. Wright: There are some good, well-focused programs for individuals who drive under the influence out of the Manitoba Health Sciences, alcohol and substance abuse division. They have some very good programs. They have a very strong Aboriginal cohort who benefit quite substantially from that kind of program as well.
[Translation]
Senator Boisvenu: Congratulations and thank you.
[English]
The Chair: Thank you both again for being here. We appreciate it, and we appreciate your assistance with our deliberations. All the best.
For our second hour, we have with us Dr. Keith Ahamad, Clinical Assistant Professor, at the University of British Columbia; and, from the Canadian Centre on Substance Abuse, we have Rebecca Jesseman, Senior Policy Advisor.
We're looking forward to your presentations and welcome you both.
Rebecca Jesseman, Senior Policy Advisor, Canadian Centre on Substance Abuse: Good afternoon, Mr. Chair and members of the committee. My name is Rebecca Jesseman, and I am a director and senior policy advisor with the Canadian Centre on Substance Abuse, or CCSA.
I would like to thank the committee members for recognizing and exploring the complex relationship between substance use and the criminal justice system.
For those of you unfamiliar with CCSA, we were created by an act of Parliament over 25 years ago. We have a legislated mandate to provide national leadership in reducing alcohol and other drug-related harms. Promoting evidence-based advice to shape policies and programs is a core part of our mandate.
To begin, we know that the relationship between substance use and the criminal justice system is complex. Illegal drug use is associated with acquisitive crime such as theft, whereas alcohol use is more strongly associated with violent crime. The majority of offenders in Canadian prisons have histories of substance use, and many have experienced trauma and mental health disorders.
As you have heard from previous witnesses, substance use also plays a role in administrative offences. Imposing bail or probation conditions requiring abstinence from alcohol and other drugs without ensuring access to services has been deemed setting people up to fail. Relapse is part of the recovery journey, and early identification of a return to risky behaviour can paradoxically be an indicator of success, rather than failure.
Problematic substance use is a criminogenic risk factor, meaning that its presence predicts recidivism. Targeting specific criminogenic needs is a relevant and effective means of enhancing public safety and reducing reoffending, which brings me to my second topic, services and supports.
Providing an evidence-informed comprehensive continuum of services is an effective way to address substance use and to reduce recidivism. To provide such a continuum means ensuring access to early identification and intervention services, such as validated screening tools, treatment options ranging from opiate substitution to cognitive behavioural therapy and follow-up services, such as peer support. Services that are targeted to gender, age and culture, including the needs of women, youth, First Nations and Inuit and those with concurrent mental health disorders are required and services should also respond to complex needs that might include physical health, housing and unemployment.
This brings me to my third topic, gaps and challenges. Canadians involved in the criminal justice system face significant barriers to navigating a complex treatment system. Many of these barriers are associated with limited resources, system-level silos and the compounded stigmas of substance use and criminality.
The use of diversion and alternative measures relies on the availability of community supports. However, there are significant gaps in access to appropriate evidence-informed substance use services, particularly outside Canada's urban centres.
The challenges are greater still for those in provincial or territorial custody, with short stays, staff shortages and lack of program space significantly limiting program accessibility and availability.
I would like to conclude by highlighting some promising practices. The committee has heard about the hub model in place in Prince Albert in Saskatchewan. This is an excellent demonstration of the value of early intervention and a comprehensive wraparound approach and it is spreading to other locations in Canada. Other options include specialized support teams, such as assertive community treatment or correctional transition teams. Non-medical detoxification centres and low-threshold supportive housing provide alternatives to the revolving door of the justice system.
The committee has discussed the value of treatment courts with earlier witnesses. These courts can play an important role, but they are resource intensive, both for the courts and for the individuals involved, and, again, rely on the availability of appropriate and evidence-informed services in the community.
In conclusion, I would like to emphasize that substance use is a health issue and that the justice system should never be looked at as the best available option for accessing treatment.
Providing opportunities for diversion and alternative measures and promoting access to a continuum of evidence- informed services and supports are proven cost-effective approaches to reducing the impact of substance use on the criminal justice system and on Canadian society as a whole.
Thank you for your attention to this important issue, and I welcome the opportunity to address your questions.
Dr. Keith Ahamad, Clinical Assistant Professor, University of British Columbia, as an individual: Good afternoon, and thank you for welcoming me here today and having me speak on this very important issue. My name is Keith Ahamad. I'm an addictions physician working in Vancouver, British Columbia, doing in-patient and out-patient addiction work. I've worked in Vancouver city jail, and I spent half my time doing addiction-related research in the way of clinical trials and addiction-related epidemiology.
Today I will take the opportunity to tell you about the huge evidence base to support addiction as a chronic relapsing brain disease and the fact that there is a huge evidence base of science that's way out in front of the clinical care we're providing. The majority of clinical care is lacking and not keeping up with the science, and the care being provided in the correctional system is also indeed not evidence-based. Our patients that are being discharged to mandatory treatment are often non-evidence based, leading to relapse and often re-incarceration.
I prepared some slides to show you the exciting science. You can't really see it here, but I'm trying to show you dopamine, a chemical that is released in our brain in response to things that are important and that reinforces behaviour important for our survival. Dopamine is released in response to food and sexual cues. Scientists were able to measure the amount of dopamine released in the brain. We can see that drugs of abuse release dopamine in huge amounts and for longer periods of time than natural, making them inherently a risk for being abused and leading to risky behaviour. There is a term called salience, which means we put more value on those drugs of abuse than other things we would normally put a great amount of emphasis on.
We are really here to talk about the fact that most people can use drugs and alcohol. When I say "drugs,'' I include alcohol because there is no distinction because one is legal and one is not illegal. They are all drugs. The vast majority of people can use substances with no problem except for that smaller proportion of people who we are here to talk about today, namely those who become physically dependent and lose that ability to appreciate that they're using compulsively despite major serious health and social harms. This graph shows that we initially start using drugs to feel good but then, over time, our brain changes and to feel normal we need to continue using those substances.
There are many evidence-based treatments we can use, including medications, to normalize behaviour to reduce and eliminate that craving. There is a huge evidence base to treat addiction there. The major problem is that the majority of people within North America — and, in particular, within Canada — providing addiction treatment are unskilled lay people and our medical and healthcare professionals are not trained to recognize, prevent, diagnose and treat addiction in an evidence-based way. I am sure you have heard of medications like suboxone, buprenorphine or methadone that have a huge evidence base when used appropriately to prevent the harms associated with opiate addiction.
In addition, there are evidence-based medications to treat alcohol use disorder, which are hugely underutilized within North America, being prescribed in addiction treatment settings less than 10 per cent of the time, with a huge evidence base to decrease heavy drinking and increase abstinence despite that evidence not being delivered to the bedside.
In addition to that evidence, there is a huge evidence base to support using these medications and other evidence- based interventions in preventing relapse and re-incarceration both for alcohol and opiate use disorder and even stimulant use disorder.
The current system of care that we have outside of corrections is not operating in an evidence-based way. My experience in working with my patients that have been incarcerated is that the physicians within that corrections system are not only not operating in an evidence-based way but they are not particularly as concerned with long-term health outcomes as I would be as a physician working on the outside with, let's say, cardiovascular disease, which we should treat no different than addiction which is a chronic, relapsing brain disease. Many medications are either not being started or patients are being tapered off them and are not being appropriately dosed to prevent the craving, the relapse and the harms associated with addiction.
In addition to that, with the conditions of their release, they are often being set up to fail. Mandated with non- regulated or evidence-based treatment, many of the treatment centres throughout the country are acting as housing, taking their social assistance away from them and forcing them off evidence-based medications. In fact, other people living in these housing situations also continue to use drugs.
In summary, before taking your questions, there is a huge body of evidence to support that addiction is a chronic relapsing brain disease. Evidence-based practice is hugely lacking in the community as well as in the corrections system. Corrections patients are discharged and mandated to treatment that is not evidence-based and the current system is setting patients up for failure, with huge relapse rates and re-incarceration rates.
Thank you for your time.
The Chair: Thank you.
Senator Jaffer: Thank you for your presentations. They certainly have enlightened me. I wanted clarification from you first, Dr. Ahamad. If I understood you correctly, you said that people who are being treated by doctors when they are incarcerated are looking at the short-term and not the long-term health of the person. Can you expand on that, please?
Dr. Ahamad: My understanding is that much of the health care being provided throughout the country in the corrections system is private and many physicians are more concerned about safety rather than long-term health outcomes. Rather than taking and building the resources necessary to treat, let's say, an opiate use disorder, where it may take a little more time to spend with these patients than it would for other patients to induce them on to these medications and ensure that they are not being diverted within the prison system, patients are being forced off these medications rather than being treated. Patients are contracting HIV in the prison system through drug injection use. There are no harm-reduction measures — despite the fact that there are huge amounts of drug consumption within the prison system — and patients aren't increased or titrated to a dose that would be considered evidence-based with follow up in the community with a physician. Furthermore, there is no planning during their time in the criminal justice system thinking about their trajectory and health outcomes when they leave the criminal justice system.
Senator Jaffer: The Canadian courts have held that addiction can be a disability. With the chart you showed, are you saying that the continued use of drugs can disable you? Is it that your brain changes?
Dr. Ahamad: It does, indeed. The science is remarkable. We can now scan brains to show that various parts of the brain are impaired, including the frontal lobe. The frontal lobe is the part of the brain used in judgment and decision making. We can show that the glucose uptake — that is, sugar used for energy — in the frontal lobe is significantly reduced in those cocaine and alcohol users who have been using for a significant period of time. If that part of the brain is impaired, the likelihood of making good decisions is also impaired.
Senator Jaffer: The study we are looking at is specific in the sense of looking at how to find ways to stop delays in courts. We've heard all kinds of evidence of how long the delays are. Yesterday, we heard dates were being set in 2019 and people were in custody, which is troubling. We heard that here, in Ottawa, somebody who was still in custody three years later committed suicide. This is all troubling. Could the three of you make suggestions or recommendations that we should make as to how to prevent the court delays with the work you do?
Ms. Jesseman: I would draw the committee's attention to intervening as far upstream as possible. The example of prolific offenders comes immediately to mind, where we know that, in most urban centres at least, there is a minority of offenders who are responsible for half to a majority of offences. Many of those offenders do have substance abuse problems. There are opportunities to divert those individuals to community support programs — I share my colleagues' concern with ensuring those programs are evidence-based — early in their involvement. That can be at the stage of arrest. That includes working with police officers and making sure that they have the tools that they need in order to do basic assessments to determine whether an individual does in fact have a substance abuse problem and whether a referral to services might be of benefit to that individual. In many cases, in terms of prolific offenders who are clogging up the systems, there are multiple needs that might encompass substance abuse as well as housing, employment, mental health, et cetera. It's the availability of the resources and capacity to identify those needs and to provide someone with the community supports that they need to effectively put a stop to the revolving door.
Dr. Ahamad: I agree completely. The need for us to go upstream is hugely important, to intervene in a way that's evidence-based, to provide treatment for a medical condition that has manifestations in behaviour. It's a totally treatable disease, and we need to, as my colleague said, go upstream.
We need to train all health care professionals and ancillary services to appreciate that this is a chronic relapsing brain disease and that there are evidence-based approaches to significantly reducing the harms that are associated with this.
As my colleague mentioned, housing and other social supports are hugely important in triggering my patients to relapse and that relapse behaviour will lead to reincarceration.
[Translation]
Senator Dagenais: Several countries and even some American states have decided to legalize marijuana and decriminalize certain drugs. Are you aware of the impact of these reforms on the administration of justice?
[English]
Ms. Jesseman: I would be pleased to speak to that. I've been doing considerable work in looking at the impacts of the legalization of marijuana in the United States in terms of impacts on the criminal justice system.
My first answer would be it's too early to make any conclusive decisions as to the outcome. The legalization has only been in place in Washington and Colorado since 2014, and it is only just being implemented in Oregon and Alaska.
One thing that we do know, in looking at our court statistics versus our police arrest statistics, it's not cannabis possession charges that are clogging up the courts. So in terms of impacts on justice delays, I'm not sure that's where we're going to see a huge impact.
One thing I heard anecdotally from some of the partners in Washington and Colorado was that there has been increased attention from the police to black market interventions. Depending on whose research you look at, that could be because there is an increase in black market activity or because there are more resources available to do so.
Regardless, we can't look at the legalization of marijuana as a magic wand that will eliminate the need to invest police and justice resources in marijuana enforcement. There will still be a black market, and we're also going to be looking at the issue of drug-impaired driving.
In terms of decriminalization of other substances, I would refer the committee to the case of Portugal. You might be familiar with it. Portugal, several years ago now, introduced decriminalization of all substances, including drugs such as opiates and cocaine. If you are charged with simple possession — possession for personal use — of any of those substances, you are referred to a dissuasion committee. The dissuasion committee consists of a social services professional, a justice system professional and a health professional who will determine whether you have a substance abuse problem that is best dealt with in the medical system, whether you have a complexity of problems that need a comprehensive community case management plan, or whether you should proceed through the criminal justice system.
That approach has seen, from the evaluations that I have reviewed, some fantastic success in terms of making tangible differences on some of the more significant health harms associated with substance use and also in terms of criminal justice burden and just the relationship and respect in some of the stigma, particularly in the justice system, for people who use drugs.
[Translation]
Senator Dagenais: People who abuse alcohol or use drugs have conditions to follow. This is a simple question: which ones find it harder to comply with the conditions? The ones who abuse alcohol or those who use illicit substances, such as drugs?
[English]
Ms. Jesseman: Short answer: I do not know. I honestly do not have that information. I'm sorry.
[Translation]
Senator Boisvenu: Thank you for being here with us, Ms. Jesseman and Dr. Ahamad. I listened to your presentation, and it made me very pessimistic about the rehabilitation programs in our prisons, especially since in provincial prisons there are very few treatment options for substance users. Often the reason given is that their time in custody is too short to allow for treatment. One wonders what prisons are for, if they can't provide treatment. Have you had any discussions with Canadian correctional system officials on the performance of their programs, particularly with respect to drug addiction and alcoholism?
[English]
Dr. Ahamad: Thank you for your question. We have recently engaged with the health care provider in British Columbia about providing evidence-based care for opiate use disorder, and we have engaged heavily with the Ministry of Health in British Columbia to address these issues.
You should be optimistic that in 2016, we are going to make some major changes in changing the treatment system within our country to be evidence-based. We have currently created an addiction medicine training program in Vancouver, through UBC and St. Paul's Hospital, which is now the largest addiction medicine training program in North America in just three years.
As many of you will know, we have a very big injection drug user population in the Downtown Eastside. The reality is that, similar to HIV in 1997, we need an evidence-based strategy. HIV in Vancouver is now a chronic disease. In many other parts of the world it is still an epidemic. We need to do the same thing with addiction.
I hope that 10 years from now we look back and think about the changes we put in place now. They need to be scientifically supported in a major evidence base. We have the evidence. We just need to put our policies in place and train all of our health professionals to attack this issue in an evidence-based way, and I guarantee you that in the next 10 years, we will make a huge difference.
[Translation]
Senator Boisvenu: Will the changes made to the correctional system also affect the post-sentence period, when people are released from prison? Will the treatment approach during that period be different from what we have today?
[English]
Dr. Ahamad: Yes. I would say that both in corrections and upstream, currently it's not being evidence-based and our patients — some people call them inmates — are being discharged to a system that's not ready to receive them. They're not receiving the care they need.
Imagine being admitted to a hospital for treatment of a heart attack and being discharged from the hospital to a system of care where you cannot get the medications that you need to get your heart to heal. That's exactly the system that we have right now.
This disease manifests as behaviour which leads to criminal behaviour because our system is not trained well enough to treat these patients. The treatment they receive right now is not evidence-based and, in fact, mandated for some types of treatment that are actually associated with more harm than good. For these patients, certainly it needs to start within the criminal justice system receiving the best evidence-based care we can, and we need the wraparound services for these patients as they are discharged into the community.
Ms. Jesseman: To add to that, we know that a lot of the charges in the courts are administrative and some of those administrative charges are associated with people who are breaching their parole conditions due to substance use.
If we provide those individuals with treatment within the institution or ideally connect them also with effective treatment post-incarceration, they will be less likely to breach their conditions and clog up the courts due to administration of justice offences.
Senator Baker: Thank you to the witnesses and congratulations on the excellent job you're both doing in your respective fields.
Let me just carry that one step further with what you said and ask you a question, Dr. Ahamad. You're absolutely right, we had statistics given to us a few moments ago for the province of Ontario that showed that 31 per cent of all court cases in Ontario are on administrative charges. These involve violating a condition of release or violating any of the conditions during the adjudicative process.
Now, here is my question to you, Dr. Ahamad: You were pretty definitive in your description. You called it brain disease, a disease of the mind or a mental disease, and, in those administrative offences, violating conditions and so on, there are two elements. One is actus reus and the other is called mens rea, that is, intent. That is knowledge that you are doing something, that you intended to violate your condition. Would you suggest to us that perhaps that 31 per cent in this province and, I imagine, a similar high percentage in your province, all of those court proceedings, should perhaps take place outside of a courtroom setting for all non-violent violations of administrative conditions and that perhaps a defence should be put into the Criminal Code similar to 16? There's a section 16 of the Criminal Code that says that, if you have a mental disorder, it can be an excuse for a criminal offence. So when the laying of the charge takes place, when the Crown or the police officer is laying the charge, if we have something in the code that says there is a defence here — not just an excuse but a defence here — maybe the charges would not be laid and would be dealt with in another way. You'd save court time.
Do you have any thoughts on that at all? I was struck by your terminology. You said "brain disease.'' Do you have any thoughts on what I've just said and how seriously we should be taking this in recommending changes to the Criminal Code and other federal acts?
Dr. Ahamad: Thank you for your question. It is difficult for me as I'm not an expert on the legal system.
Senator Baker: You're an expert on the brain.
Dr. Ahamad: Indeed. I'm a physician, but I'm not an expert on the legal system. It is a public health issue, not a criminal justice issue. If my patients are not receiving evidence-based care and are so intoxicated that they're breaching their parole or in such severe withdrawal and so overwhelmed by their cravings and their social circumstances that they're led to crime because of their ongoing drug craving, I feel like we're failing these patients. So specifically how that's worked through the legal system, I don't know, but I can tell you specifically that there is a huge scientific body of evidence that supports this as a health issue, not as a criminal justice issue.
Senator White: Thanks to both of you for being here. Doctor, some of the commentary around drug addiction in particular, timing I guess of addiction treatment, has been used by some facilities — there is one in Ottawa for youth, for example — that have identified that the closer to the addiction and the younger somebody is and the earlier they get them into treatment, the less likely they are to relapse. If they become an addict at 15 years of age and they have them in at 15 years and four months, versus 15 years of age and 18 years of age, the opportunity for relapse is multiplied by 10, in some cases, the older they are. Is this correct as well?
Dr. Ahamad: Yes. Youth is the biggest risk factor for developing addiction, early onset.
Senator White: Thanks for that because we had someone here earlier — I'm not sure if you were sitting in the back — who talked about eight or nine months to get somebody into treatment. It absolutely flies in the face of any science. You should be in treatment within days of asking for it.
Dr. Ahamad: It should be on demand. There's this concept of stage of change. We need to engage this patient population where they are. The whole point of addiction treatment and harm reduction is to reduce the harms associated with it, health and medical and psychosocial, and, if we intervene early upstream, with harm reduction measures, we'll decrease all the harms downstream that are associated. Having evidence-based treatment available for this patient population is critical.
It is a very heterogeneous disease. The factors leading to addiction are complicated, and we need to intervene, as my colleague said, in an early way so that we can prevent all the harms that are associated downstream.
Senator White: In fact, last year, I spent almost five months doing some research on crystal methamphetamine in Australia, and we looked at some of the transmitter issues around crystal methamphetamine, specifically around ice, and the fact that, if you got someone within the first 30 days of use, there's actually an opportunity, if not to reverse, to get people back to normal. Is that true as well?
Dr. Ahamad: We're learning so much about the brain. It is plastic; it does heal. But for some people not as well. And for some people we can't reverse the changes that we're seeing. The brain continues to develop well into our 20s.
A little bit off topic here, but the war on drugs has failed. The war on drugs has led to an increased potency and an increased availability of drugs. We talked about the legalization of marijuana. We look at a public health success story in the regulation of tobacco, where it used to be unregulated for profit and so many harms associated with it.
Young kids are smoking marijuana more frequently now than tobacco. Obviously, different substances have different harms associated with them. Alcohol is a carcinogen. Opiates are not, but, specifically, if we regulate these substances appropriately, we can reduce the harms that are associated with them.
Senator White: The last point is that we're still not even close to spending. You and I probably don't agree on whether we should legalize or decriminalize or anything else, but I think we do agree that, right now, we're not spending near enough money actually allowing these people to access treatment in this country. Not even close.
Dr. Ahamad: Not even close. The wait times are astounding. For every dollar we spend on evidence-based drug treatment, we save $4 to $7.
Senator McIntyre: Thank you both for your presentations. As you know, there are six Drug Treatment Courts across Canada — Toronto, Vancouver, Edmonton, Winnipeg, Ottawa and Regina. Ms. Jesseman, in your presentation, you touched briefly upon the Drug Treatment Courts.
In your opinion, are Drug Treatment Courts providing an effective model for promoting rehabilitation of offenders?
Ms. Jesseman: I think, as the previous witnesses stated, there are several different drug treatment models in place in the courts, and I think that there are practices within those models that are definitely effective. I think that there's a strong evidence base that allows us to draw out what those effective components are. For example, making sure that you are targeting the services appropriately. Drug Treatment Court participation is a very intensive process. If you're looking at the biggest bang for the buck, to be honest, it's investing in higher risk offenders, who are going to be a greater draw on the justice system in the future and who are facing greater sanctions associated with the offences that they commit. That's why I'm very interested in exploring further one of the committee's final questions with regard to the application of Drug Treatment Court eligibility to violent offences, as well as nonviolent offences, because there is research done in other countries that has shown that it can be beneficial as well.
Certainly, again, I keep coming back to the need for a continuum of evidence-based services in the community to support the role of the Drug Treatment Courts because that's really what the success is dependent on.
I think we need to look carefully at the efficiency of using court personnel. Their area of expertise is applying the law, not providing treatment. There are some offenders — and the evidence does support this — that do respond well to — I'm going to get the term wrong, so I won't even bother — basically, having an authority figure who is kind of standing over them and promoting their access to services and doing that check-in in terms of the urine screens and the reporting on progress, et cetera. That is an effective component for some people but not for all offenders. I think it is a question of the extent to which we are looking to the justice system to address a health issue.
Senator McIntyre: Some Canadian courts and tribunals, such as the Human Rights Commission, have recognized that drug addiction constitutes a disability.
Do you agree that addiction is a disability?
Ms. Jesseman: I would concur with my colleague in terms of the evidence that we have of the physical impact of substance use on the brain.
Senator McIntyre: Doctor, you agree with that; you've covered that ground.
Dr. Ahamad: Yes, I agree.
The Chair: We have some additional time, if there are further questions.
Senator Joyal: I apologize to the witnesses; I was caught in another presentation.
This is an issue that my colleagues are very familiar with. It is essential that a person who finds themselves in prison have access to proper support to go to talks, especially when the person suffers from a condition that has been already considered by the court in previous decisions. We've seen — and this is one of the issues before this committee — to try to alleviate the burden of courts with people who come back all the time. There is a percentage of people going back to court, because they are addicted to alcohol and/or drugs.
What is your estimate or your appreciation of the services available in the court when a person is diagnosed by proper authorities as suffering from a syndrome — that the person will take proper care and won't, in fact, be treated as a permanent criminal to the point whereby the person will never see the light at the end of the tunnel and will become a permanent customer of the judicial system? What is your opinion of the system and how it works now in relation to that?
Ms. Jesseman: There are examples of excellent practices in Canada, but for the most part, there are significant gaps in the system, particularly for offenders. If we look at current trends in the justice system, those gaps are even higher for First Nations and Inuit and also for women. We know those are populations increasingly being seen by the justice system.
Senator Joyal: Anything to add, doctor? I requested — I'm sorry to put that on the record, but I might seek the authorization of the committee. I have statistics from other witnesses that show the percentage of people who suffer from mental health or addiction. It's astounding to realize that most women in the system, for instance, suffer from mental conditions or addiction of some sort, or have been abused. In other words, they are social problems more than criminals I would say.
May I seek the authorization of the members of the committee to table those two answers that were provided to me by other witnesses we have had? I requested those statistics, so that we could try to understand the sociological phenomenon of the justice system. Who are the people who are clogging the system? I think those statistics show it very clearly. It's quite obvious that large segments of those who come back all the time are the same people — if they are the same people — because they didn't have access to the proper treatment. Otherwise, they would be in a different kind of service than the judicial service.
It seems that the system is not addressing that properly to make sure that, at a point in time, there is an answer to that situation that will keep repeating and adding, as a matter of fact, because if we don't address the problem at its roots, it will just become bigger. The proportion of the population is getting bigger; we all know that. Statistics Canada census showed it clearly.
Who has that responsibility to make sure that such a situation is properly addressed?
Ms. Jesseman: Strictly speaking, treatment is under provincial and territorial jurisdiction, with the exception of federal offenders who are under Correctional Service Canada's authority, as are members of Canada's defence and national enforcement.
I would like to say that it's everybody's responsibility. It's not just a single sector. It's not just a health issue, as this committee has clearly heard; this is also a challenge to the justice system, to housing, to employment and social services. I think there is also a public challenge in terms of recognizing substance use as a health condition and taking away the barrier that stigma poses to those who are accessing treatment or trying to access treatment.
Senator Fraser: Dr. Ahamad, first I have a request and then a question. This is a little bit away from clogging the courts, which is why I didn't do it until the chair said we had some time. The request is: Could you make sure the clerk gets copies of your charts?
Dr. Ahamad: Yes, I can email those.
Senator Fraser: That way they can be circulated to us.
In the matter of treatment, you not only know a great deal but are passionate about it. You said two things that struck me. One was that there is now available medication that can make a big difference and contribute to a person's recovery. I was wondering whether you're talking about a finite course of medication or the kind like the thyroid pills that I take every day that you take every day for the rest of your life. The latter would have cost implications for people who are "down the wrong.'' That would be the first question.
Dr. Ahamad: My opinion, and the opinion our research group presented to our Ministry of Health, is that all addiction treatment, including evidence-based pharmaco-therapy and medication-assisted therapy, should be of no charge to anyone, irrespective of their economic and social standing. That's the way we've treated HIV in British Columbia: Everybody has access to those medications, because treating the consequences is extremely expensive. Also, I believe that, ethically and morally, we have a responsibility under the Canada Health Act to provide and remove all the barriers to life-saving —
Senator Fraser: So this is longer term.
Dr. Ahamad: Yes. The evidence shows that for some medications, to avoid the health and social harms that go along with certain addictions, some people will need to be on medications for the long term. For other people, that may not be true. But we need to stay in close contact with our patients over time and if they relapse or if they're at risk of relapse we need to re-engage them.
We do that with all other areas of medicine. If I were to treat your blood pressure and start you on a medication and your blood pressure started to go up again, it wouldn't mean that you failed or made any mistakes. I'd re-engage you with your goals of care and try and move forward to improve your long-term health outcomes. We need to do the same thing with addition. It relapses at the same rate as other chronic relapsing diseases, like heart failure, asthma and COPD — 40 to 60 per cent.
But when patients relapse, it is a failing of theirs rather than re-engaging in an evidence-based way to treat them to prevent long-term health effects.
Senator Fraser: I have one more question and I know the chair is going to cut me off because he always does.
When you were talking about the treatment programs in the correctional service, I think I heard you say that, by and large, they are not as great as they should be much of the time. I think I heard you say that there was even some treatment that was — this is not your word, it's my word — counterproductive. Can you tell us more about what that implied?
Dr. Ahamad: Some mandated treatments — rather than voluntary treatments — like AA have been associated with worse outcomes. So if you were to randomize people to mandatory AA versus voluntary, some of those mandated to AA might have a worse outcome.
Evidence around AA is debatable and suspect, and, unfortunately, ubiquitous as the mainstay of treatment because it's free and peer-supported. The evidence for it is not great; when it's mandated, some people get better and some don't. It doesn't change; other people get worse and it's harmful.
There was an interesting systemic review on meta-analysis done last year which I would be happy to forward and share with you.
Senator White: My last question refers to remand prisoners. I think, probably, half of the people in our institutions in Ontario are on remand, often for months at a time, and have no access whatsoever to any treatment or programming.
Based on our earlier discussion about "earlier in, better luck, better chances and lower likelihood to relapse,'' do you also share that same feeling when it comes to people who, even though they may not be using, still are not getting treatment? Is there a necessity for governments to look at that differently as well?
Dr. Ahamad: At every stage of care. You would never withhold treatment for any other medical condition and we need to treat these patients no differently if they're incarcerated or if they're living amongst us. There's absolutely a continuum of care, as my colleague said, but also access to evidence-based care through every stage of the system.
Ms. Jesseman: I think that when talking about remand, one of the ways that we can look at potentially reducing the remand burden is ensuring that we have the capacity to identify and provide services to offenders that would hopefully enable them to have supervision in the community, rather than in the institution.
The Chair: Thank you both again for appearing and providing a very helpful and interesting contribution to our deliberations. It's very much appreciated.
(The committee adjourned.)