Skip to Content
 

Proceedings of the Special Committee on
Illegal Drugs

Issue 6 - Evidence for September 17 - Afternoon Session


OTTAWA, Monday, September 17, 2001

The Special Senate Committee on Illegal Drugs met this day at 1:32 p.m. to reassess Canada's anti-drug legislation and policies.

Senator Pierre Claude Nolin (Chairman) in the Chair.

[English]

The Chairman: Before I introduce you to the distinguished expert of this afternoon's hearing, let me inform you that the Senate has ordered that all proceedings of the committee registered during the 36th Parliament be included as an integral part of our proceedings. I also wish to inform you that the committee maintains an up-to-date Web site. The site is accessible through the parliamentary Web site at www.parl.gc.ca.

All the committee's proceedings are posted there, including the briefs and the appropriate support documentation of our expert witnesses. Also, we currently maintain more than 150 links to other, related sites.

[Translation]

This afternoon, we will be talking more specifically about public health. We shall first be hearing from Dr. Richard Mathias, who is a physician and a professor of health practice at the Department of Health and Epidemiology of the University of British Columbia; he will be giving us a new public health perspective on the use of drugs by Canadians. Second, we shall hear from Dr. Colin R. Mangham, Ph.D., the Director of Prevention Source B.C., who will address the issue of the real debate on harm reduction and the use of illegal drugs.

[English]

Richard G. Mathias, M.D., FRCPC, is a native of British Columbia. Dr. Mathias was trained at the University of Alberta in Edmonton, where he was granted his M.D. in 1968. He then moved to Winnipeg, where he completed a fellowship in internal medicine and infectious diseases in 1975. Between 1975 and 1983, he was appointed to Newfoundland as a field epidemio logist, to Saskatchewan as provincial epidemiologist, and to B.C. as provincial epidemiologist, infectious diseases. In 1983, he transferred to the department of health care and epidemiology at the University of British Columbia, where he has attained the rank of professor in the division of public health practice.

Along the way, he has published over 70 peer-reviewed papers and given numerous lectures and talks. In 1989-1990, he was on sabbatical to the Institute of Medical Research in Malaysia. In 1995, he accepted an interchange position with the Laboratory Centre for Disease Control in Ottawa as director of the newly formed bureau of surveillance and field epidemiology.

He returned to U.B.C. in September 1997. He was also the scientific editor of the Canadian Journal of Public Health until May 1998. He was a PAHO/WHO adviser in October and November, 1998. He has given evidence to the Keever commission, and before the Supreme Court in B.C. and Ontario, as an expert witness in public health matters.

This year, he was the Chair of the division of public health practice, department of health care and epidemiology, Faculty of Medicine, at U.B.C. As well, he is director of the community medicine residency program. His sabbatical project is to write a monograph on the public health approach to drugs.

Dr. Mathias, the rule is simple. You have, we say 30 minutes, but it could be 40, to present your brief. After that, my colleagues and I will have a few questions.The floor is yours.

Dr. Richard Mathias, Professor, Health Care and Epidemio logy Department, University of British Columbia: Honourable senators, it is indeed a pleasure to be here. I am grateful for the opportunity to present to you. There is always a risk that as a university professor, I will speak longer than I should.

I am grateful for the university protection of tenure at this point, which is in place in order to allow faculty to think through issues to what I hope is a logical conclusion. That is what I intend to do with you today. I hope that it will be of some interest to you.

First of all, I would like to define "public health". It is an organized effort by a community to protect, promote and restore the people's health. The key issue in this definition is, what is a "community"?

It is obviously a group of people, but at what level? In general, government efforts in public health are on a regional or city basis - in other words, a large community. However, there are groups at a much smaller level. For example, in Vancouver, there is the Downtown East Side Association, which considers its efforts to protect and promote the health of its citizens also to be public health, and we need to recognize that.

The goals of public health are stated in the World Health Organization definition, which you have seen many times, I am sure. The goals of public health focus on the achievement of personal aspirations and the ability to adapt to and cope with one's environment. That is basically what public health is trying to do. That is the rationale for what I am going to suggest we should do about drugs.

Such an approach, however, should be based on ethical principles. Certainly medicine is based on bioethics and ethical principles. The individually based ethical principle is respect for autonomy. That is, people have the right to make their own decisions. It is based on non-malevolence. I am not sure what the word is in French, but fundamentally it means you should not do harm to people. You should also, where possible, do good to people - beneficence.

Another element is that you should follow the principles of natural justice and that programs should be put in place with the full knowledge of the individuals affected by them. This is the individual, bioethical approach to medicine.

However, because we deal with communities in public health, we are still in the developmental phase of what an ethical approach to public health means.

Dr. Mann, for example, who was the head of the World Health Organization AIDS program until a few years ago, bases his view of public health ethics on human rights and social justice. Any public health approach must meet the standards of human rights and social justice.

I add that the ethical issue is one of shared community responsibility. Fundamentally, it means that you cannot put one part of your community at risk because of a perceived risk in some other part. I used air bags as an example in my paper. We all agree that the use of air bags has prevented many injuries to adults in motor vehicle accidents. Unfortunately, we have transferred the risk to children and infants. We have killed quite a number of them through air bags. That is unacceptable from a public health perspective. These people have now been asked to assume a risk for the benefit of others. We must be very careful about doing that.

The entire bioethical issue is that of informed consent, if you want to bring it down to basics. Informed consent allows an individual to make an assumption about whether a particular action has greater benefit than risk. We need to remember that virtually all of the things that we do carry some risk. To meet the requirement of zero risk, we must put a zero at the bottom of this particular equation. As you know, a zero cannot be in a denominator. There is nothing that carries no risk.

We want to maximize the benefit-to-risk equation. That is fundamentally what we are about. It is the issue of informed, individual consent. One of the issues, when dealing with drugs, is to define about whom we are talking. That includes the following definitions in the Institute of Medicine reports on which this has been based: A "user" is a person who has ever used a drug. Obviously, these can be current users, past users, and can include other definitions; an "abuser " is a person who has used a drug to an excess that has caused illness or personal, social difficulty. I do not know if I am speaking only for myself, but I can think of times involving alcohol, particularly during adolescence, when there were moments of abuse. A "dependent" is a person who uses regularly and at a frequency that is determined by the need to maintain a level of balance in the brain reward system. Although this is a biologically based definition, it includes the fact that, if a drug is not immediately available, the dependent will seek it out in spite of personal, social and financial costs of obtaining it.

It was pointed out to me, when I first presented this, that the definition of "dependent" is inadequate because there are two kinds of dependent individuals. The first are those who are compensated for their dependency - the drug is available, they can afford it, and it does not interfere with their personal, social and, in general, financial position. In particular, I believe that users of tobacco, as it is currently available in this country, meet the definition of a "compensated dependent."

The decompensated dependent is an individual who can no longer afford the drug, or who is affected by the drug's actions, such that it causes the person to fail at normal tasks, such as employment. It is that person, the decompensated dependent, whom we normally think of when we use the term "addict."

I will consider a number of different drugs within the public health framework, and this is broader than what we have talked about thus far today. I have listed two things behind those drugs where I was able to find the data. The first one is an estimate of the percentage of use in the population, which in the case of marijuana is 46 per cent. Of that 46 per cent, the 9 per cent is an estimate of the number of people who may be dependent on the drug.

I was unable to find data for khat or for coca, which refer to the original, non-processed product. There is also a group of processed products that includes hashish, opium, caffeine, tobacco and alcohol. These are all processed or manufactured and also taken by ingestion or smoking. In reference to tobacco, 76 per cent of the population has used the drug, so they are "users", but only 32 per cent are dependent. I found that somewhat surprising, actually, because I had expected that percentage to be higher.

In reference to alcohol, 92 per cent of our population are users, and of those, only 15 per cent are dependent.

I draw your attention to heroin. We often think that there are no "users" of heroin, but that is clearly not true. Although only a very small percentage of the population - 2 per cent - has ever used heroin, of that group, only 23 per cent are dependent. The number of people who have used cocaine is at 16 per cent, but only 17 per cent of those users met the definitions for dependency. Those are all U.S. figures.

One of the critical issues in thinking through this public health framework is that we have users, and we have people who are dependent. However, this does not tell us how many of the dependent group were compensated and how many were decompensated.

Bruce Alexander presented to this group some time back. I have addressed a group of dependents that Mr. Alexander put together who are compensated heroin users. They are long-term users who work, and they clearly fit into the compensated dependent group. We need to be very clear about what our particular goals are in trying to work out a legal framework, or, as I would prefer, to address it from a public health framework perspective. We have this change of use.

It is clear that, from a public health perspective, one of the groups that we are most interested in is the decompensated dependent group. These people have tremendous difficulties that encompass the personal, social and financial. All areas of their lives are being severely affected by drugs. These are people who require treatment. Since dependency is a chronic relapsing brain disease, and I will stay with the medical model to define this, one of the big issues in decompensated dependency is the prevention of relapse.

In my view, and I am sure you will talk to people who are more knowledgeable about treatment, any treatment program has to recognize that this is a chronic relapsing disease and thus they must not penalize people. Therefore, our programs need to be designed for people who will relapse. We will try to prevent that relapse, but it is the issue.

The second issue that would be a goal for public health is the prevention and reduction of the direct effects of the drug. I have labelled these "toxic effects" with some trepidation because "toxic" has come to mean many different things in our society - we speak of toxic air, for example. Nevertheless, I refer to those effects of the drug that result in harm to the user. Obviously, it is a goal of public health to prevent or reduce that harm where that is possible.

We can do that by preventing use of the drug. That is the prohibitionist approach that says, "Well, the way to achieve prevention or reduction of toxic effects is to just say no." The public health approach, though, is a reduction in dose to safe levels where we do not exceed the body's capacity for regeneration and repair.

Perhaps we can refer to alcohol in that context. It was mentioned earlier by Dr. Kendall that alcohol has a U-shaped curve, and that at low to moderate doses, alcohol reduces mortality overall. Thus, non-users have a higher mortality rate and heavy users have a higher mortality. Part of the reason is that at low to moderate doses, alcohol actually has beneficial effects on the body, both physiologically and in managing many other issues, particularly psychological ones.

Therefore, reduction to safe levels is a reasonable goal for public health. The body has quite a lot of reparative capacity. There may well be safe levels. This is also true of cigarettes. We like to demonize smoking.It is difficult to put forward smoking as a method of drug use, because in public health we have equated smoking and tobacco. However, there are users of tobacco who smoke irregularly or smoke very small amounts, and who would never be expected to have any of the adverse effects of heart disease, lung cancer, chronic pulmonary disease and these sorts of things, because their dosages are very low. Safe doses are also possible.

Another public health goal is prevention of harms to others. This is a very important issue for us. One thing that really stands out for me is the prevention of neurologic damage in fetuses and in youth. I think we can tolerate very little risk there. Having said that, of course we tolerate a huge risk. Alcohol causes fetal alcohol syndrome. Although it is not very common in some segments of our society, there are communities where fetal alcohol syndrome and fetal alcohol effect are terrible public health problems that desperately need to be addressed.

In the Institute of Medicine reports, marijuana, heroin and cocaine were not found to have long-term effects on the development of youth. When you follow the infants of mothers who are addicted out beyond five years, they are not detectably different from the general population. This, however, identifies a population at particular and specific risk. That is of great interest to public health.

Of course, we must also deal with the reduction of harm from the desired effect of a drug. We have heard that alcohol causes aggressive behaviour and that this is a desired effect of the drug. The release of inhibitions is the reason people take that particular drug. Therefore, it is reasonable for us to try to reduce the harm from that desired effect. This includes Ecstasy as well. One of the physiological effects of the drug is to cause difficulty with heat loss. It causes hyperpyrexia, very high body temperatures, which, if one takes in adequate fluids, is not much of an issue. Whether that is a part of the desired effect or a toxic effect, we can nevertheless deal with many of these kinds of issues.

There are a number of other goals. One of them, which will come up several times, is the prevention of exploitation of users by pushers. By "pushers" I mean people who stand to make a profit from drugs. I am sure many of you have read that the Canadian Medical Association Journal is now refusing to publish research done by drug companies because biases occur in those whose livelihood is dependent on people using these drugs. They have a particular view and they will see things in a way that is advantageous to them.

Many of the physicians who are doing this research find good things about these drugs, and it is because they have a bias that they do not themselves recognize. It is there. We must be very careful of that. Of course, the exploitation of users by pushers is one of the things of importance to me. We have been into advertising of tobacco and alcohol. We do not want to get into this issue with other drugs any more.

We have also discussed the fact that there are currently many pushers trying to get people addicted. It is a market for them. In the Downtown East Side, there are those who are actively trying to recruit people into their dependent population so that they maintain a market. This is not unexpected.

The role of enforcement in this particular public health model is directed at those who exploit and misrepresent the harms and benefits of use. We talk about informed consent, and that it must be truly informed. However, the people who exploit users may well be giving information that will abrogate that informed consent because that information is itself biased. We have seen that situation occur with other drugs. We need to be extremely careful about that.

This is probably the most controversial of the statements that I will make: People take drugs for a reason. There are beneficial effects from all of the drugs that people take. When we talk about people using drugs, we make it sound as if they have no will. However, if you talk to people who are dependent on tobacco, they will tell you that their first cigarette of the morning really tastes good. People who may be dependent on alcohol, or who are users, take it because they enjoy it. The same is true with marijuana. People who take marijuana do so because it has beneficial effects for them. Therefore, they are seeing the benefit-to-harm ratio from the perspective of people who are getting benefit from the drugs.

We ignore that at our peril. If we go to them and say, "These are all the harmful effects," and do not talk about the beneficial effects, we will not have any credibility whatsoever and we will not be contributing to informed consent.

One of the public health goals that I present is to facilitate drug use when it has physical, psychological or social benefits. One of the reasons, in my opinion, that we see much more drug use among adolescents and young adults is the tremendous amount of stress that those groups face. There are a number of ways of relieving stress, and one of them is the use of drugs, whether alcohol or marijuana. There are other ways of relieving stress that we as public health people would try to encourage, such as achieving at school and getting the approval of your peers. Taking up sports has been a tremendously potent way of getting adolescents and others to reduce tobacco use. We still need to recognize that there are benefits to use.

There are also some societal issues from a public health perspective. We know from the determinants of health model that one of the things that contribute to ill health is poverty. We know that there is a tremendous economic loss as a result of illegal drugs. In British Columbia, we can argue about what the number is, but the market for marijuana is at least in the billions. If we were able to tax that, say, $4 billion at a rate of 10 per cent, that is $400 million a year that could go into programs to assist in early childhood development. We would now have resources to use to ameliorate what we consider to be the harm done by these and other issues.

Also, one of the basic health goals is to return citizens to productive lives. People who are compensated dependent can often work if the drug they are using does not directly interfere with their ability to do so. I mentioned a group of heroin users that Bruce Alexander has put together over many years. The majority of people who use cocaine do so on an irregular basis and they do so to improve performance. Star athletes would not use cocaine if it did not stimulate and improve performance. Much of cocaine use in the United States is among middle-class people. It is among people who are the most productive, because it is a stimulant and does not interfere with mental processes.

On the other hand, we find poly-pharmacy when those people are trying to come down because they are attempting to balance various kinds of drugs. Public health can deal with whether or not they are doing that appropriately.

Next I turn to public health strategies. First is the regulation of supply and distribution. I will not take the time to go into the benefits of hemp growing, but there are many. Hemp used to be a fairly major crop in many places in the United States and in Canada and was used mainly in making rope. It has tremendous effects in terms of being able to hold soil, of being beneficial for soil.

I will leave that to an agriculturalist who is more knowledge able than I am.

I will talk about the specific issues of what we might want to include in a public health strategy. The first issue is point of sale. For oral and non-concentrated drugs you already have legislation. You recently passed a bill called the Natural Products Act. It is specifically stated in that act that it is not necessary for the people who are selling these drugs to do clinical trials. I do not understand why marijuana, khat and coca leaves are any different from other natural products that have been used either for a short or for a long period of time. These are natural products, they are not concentrated, and they have not been processed in any way, shape or form. I feel these should be included in the natural products regulations where purity is an issue, where non- contamination is an issue, where they are in concentration, and allowed to be sold.

Whether you wish to put in an age restriction will be a matter of great interest and debate. When I was 12 and I wanted cigarettes, they were not difficult to acquire. Do you want to put in a regulation that is so easy to get around that it puts all regulations into some disrepute? That is a matter for debate.

We would all like to see the age of use and the age of being able to legally obtain a drug considered carefully in terms of consent. When individuals are old enough to consent, they are old enough to buy.

For products that are processed or concentrated, we should be using a model that we have developed with alcohol that has worked reasonably well. These products are available through licensed establishments. Obviously, what is at a lower level can also be at a higher level.

The licensure would be based, much like it is with alcohol, on knowledgeable people who may sell drugs only when they are satisfied that true consent is being given; that is, there is material available on benefits and harms, and they are responsible for trying to prevent abuse.

Injectable drugs are another issue all together. They must be prepared under sterile conditions and there must be a single-use syringe and an accurate dose.

You have heard mention of inadvertent drug overdose deaths in British Columbia at the rate of approximately 300 a year until recently. We are now down to half that number. Compare that to the current tremendous public health interest in water supplies. The number of people who we have been killed because the dose of injectable drugs they were taking was not accurately known is many times the number killed by tainted water. We could essentially fix that tomorrow if you were to say: "Let us provide an accurate dose and let us provide a single-use syringe in places where 85 per cent of users are hepatitis-C positive. In looking at what has happened with transfusions, we have seen why the outlook for those people is grim. Fifteen per cent of them have HIV. This comes not from the drug. This is not an effect of heroin. This is an effect of injection use. This is directly due to the fact these drugs are illegal. In a public health model, if the drug were not illegal, I could eliminate 90 to 95 per cent of needle sharing virtually immediately. We must be careful that when we look at the harms, we decide which of those are caused by the drug and which by the fact that they are illegal.

I would say that injectable drugs should be supplied by a pharmacist. They are licensed and are more than capable of providing sterile conditions. I disagree with Dr. Fischer. I believe that if we do it by prescription only, we will lose the individual who is experimenting. The proviso is that we truly must be using single-dose syringes. There are syringes in existence with a flange that, once the drug is injected, it locks in place and that syringe cannot be used again. If that is truly available, then the prescription use can be revisited and debated again.

At this time, however, I would say that a prescription would not be needed for a pharmacist to give the drugs to people who are dependent, but that prescriptions would be available for the treatment of dependency. When physicians or health care workers make a diagnosis of dependency, they should have the ability to prescribe a drug to try to convert those individuals from decompensated dependency to compensated dependency. We can then work at treating the dependency itself. The first issue is to remove them from the decompensated pool and get them into the compensated pool.

Part of public health strategy is clearly the prevention of harm to others. This includes issues like prohibition of driving while impaired. That would at least be part of what we would expect of licensed establishments. Impaired people would not be permitted to drive, and we would hold the establishments partly responsibil ity in that, even as we do now with alcohol. There are already workplace regulations about working while impaired. I reiterate the practices of the prevention of damage to the fetus and infants, which must be a high priority for anyone who is thinking of how to prevent harm to others.

In the men's washrooms of bars there are signs that say drinking can cause harm to the unborn infant. I presume the same thing exists in the female side. It would be much more reasonable to have them there in the first place.

There are also warnings on liquor bottles. I do not know how effective those are. We need to do better and we need to conceptualize the problem as much larger, as drugs that cause harm, not just as licit and illicit. We need to deal with this. It would be far better to have those mothers on marijuana than on alcohol, particularly in the kinds of doses we are talking about, and we can identify the communities in which we can do that.

It is critical in this strategy to prohibit advertising. We know from tobacco that the companies that are making a profit from this have a tremendous record of being able to persuade people to take their drug. From a public health perspective, I do not think we want that. I believe we want information on benefits and harms to be there, but not biased by profit motives.

I wish I could be confident that governments could do that. I was more confident about that until I watched what has happened with gambling. Gambling is an addiction. It is a relatively small number. Approximately 5 to 15 per cent of youth who are exposed to video lottery terminals will become addicted in the classic dependency sense that I have given you. Yet governments are doing virtually nothing about that because they see the income. I wish I were more confident that governments will be looking after the public health of their communities and resisting the urge to become the pushers in the next generation. However, I still believe that is our best chance.

You probably cannot prohibit reasonable advertising such as they have in Amsterdam at point of use or point of sale, where you can go in and pick from your list of marijuana varieties. I believe they have 141 different varieties at the moment. They are probably not available at all outlets; nevertheless they are there.

What are the advantages to this? We can save lives immediately. We can prevent deaths virtually as soon as the drug is available at a known dose in single-use syringes in sufficient quantities that users are actually going to use them. Heroin users inject four to six times a day. They must have that quantity available to them. Inadvertent drug overdoses, as I have said, are a major public health problem that we are not addressing at this time as well as we should. Injection-associated infections are a major public health issue in all major centres.

I should point out that half of the inadvertent drug overdoses in British Columbia are not in Vancouver. They are in the rest of the province.

The concept that this is a downtown, east-side Vancouver problem is just not true. It is a public health problem. It is present everywhere. We have had epidemics of hepatitis C and hepatitis B in relatively remote communities and we have seen heavy drug use in some of those communities.

There are economic gains to be had. There will be direct economic gains in the hospitality industry. There will be direct gains in the taxation base. There will be a benefit if that money is used to assist people who need it. There will be a reduction, although not elimination, of enforcement costs, because now we will be enforcing issues around things that harm others, such as impairment and the operation of motor vehicles. There will be very quickly a reduction in health care costs, particularly in major centres.

We can also substitute safer drugs and methods of use. Heroin used to be smoked. It is very difficult to overdose when smoking a drug. If we can implement changes in terms of supply, we can do so in terms of methods of use.

There is a moral position that we have the right to tell people what their behaviour should be without knowing their stresses and strains, without understanding that they see benefits in their drug use. People do not use drugs because there is some magical issue involved. Many users see drug use as beneficial for stress relief or other reasons. However, there is a moral position here and I respect that. I think we need to carry on with that.

There are fears of increase in use, resulting in harm to users and others. We must deal with those particular issues.

One issue bothers me more than the others and I predict it will cause you the greatest problems. Those who make profits will defend those profits, and you will not know who they are. They will come to you with a wide variety of arguments, many of them extremely well articulated by people who are being paid. All I can draw on to explain this is the extreme effectiveness of the lobbyists for the tobacco industry - and you knew who they were. You will not know who the lobbyists are for maintaining illegal drugs. I wish you luck with that. That is one problem that you must address. You will face pressure from people whose livelihoods depend on drug use. The perceptions of those people may well be biased, though unintentionally so. I am not saying that any of those people are deliberately producing untruths. They are giving you truth, but from their perspective, which may be limited and biased in ways that even they do not understand.

The other issue is that people who see only decompensated dependent people come to believe very quickly that the world is entirely made up of decompensated dependent people. They can ignore the fact that there are many users out there and that those users deserve our protection as much as any others.

In summary, our public health goals include reduction in the direct effect of drugs, particularly those toxic effects. We need adequate surveillance for adverse effects. We need treatment for decompensated dependency. We need sufficient information to allow for informed consent associated with regulated access to safe and safer drugs.

The nitty-gritty of this is that I believe drugs should be legalized. This should be done urgently in order to save the lives of Canadians.

As far as I am aware, all of the treaties currently in place contain a statement that a country may abrogate this treaty if it is to save the lives of their citizens. I maintain that the moral and ethical position of the Government of Canada should be to adopt the primary goal of saving the lives of citizens and also improving quality of life for those of our citizens who are most at risk. The decompensated dependent group and the dependent-drug group are made up of people who are at extremely high risk and who deserve the protection of the Government of Canada. You have in your hands the power to give those people that protection.

The Chairman: At the end of the day, after the last witness, we will open up the discussion. You are invited to stay if you wish.

Dr. Mathias: Thank you. I will take advantage of that offer, Mr. Chairman.

The Chairman: Time is of the essence. We may have to shorten the period.

Senator Kenny: Are we at the point in this discussion where science really no longer counts in terms of the debate on public policy? Is the issue really a question of people's morals or people's prejudices?

Dr. Mathias: I have two answers to that. First, public policy must be based on evidence. If we equate evidence with science, I think we are making a leap; I do not believe they are quite the same. "Evidence" and "science" are not synonymous terms.

The evidence of harm is irrefutable. What we are now looking for is evidence of benefit. There is very little evidence of benefit from prohibition and a great deal of evidence of harm.

As you well recognize, as a scientist, I want all of the t's crossed and the i's dotted. However, public policy does not work that way. You cannot wait for that if, in the waiting, you are sacrificing Canadians' lives.

Public policy is the art of taking the evidence we have, of taking the political issues and the larger international issues, as you understand them, and putting them together. I cannot do that. I can only give you advice on my part of the question. Public policy is a political process precisely because of those extremely important elements that must be brought together. That is basically what you will do.

On the moral issue, Canada and western democracies in general have a moral perspective based on tolerance, and we have been working toward more tolerance, at least in this country, which I obviously know best. Tolerance needs to be extended to those people who are dependent on drugs and actually people who use drugs as well. Remember that they do so for a reason. They do so because their perception is that the benefit is greater than the risks.

One of the reasons for the tragedy of last week is intolerance. A group of people who believed that they were right carried out that act; they were moral by their own lights. In fact, some members of the extreme Christian fundamentalist movement agreed with them that the people who died were immoral, or amoral, or that what was done to them was done by God for moral reasons.

This is totally abhorrent to Canadians. We must be extremely careful of the moral argument when it becomes an argument for intolerance.

Canadians must continue their progress. I believe we have made a great deal of progress in upholding tolerance as the basis of our society. We must apply the evidence as best we can. When people are not harming others, we should be extremely careful of judging their behaviour in case those judgments put those particular individuals at higher risk of poor health outcomes. That is my stand on the moral issue.

Senator Kenny: Briefly, and almost as an aside, help me with some of the equations you had. I was never very good at algebra. I thought I understood the cost/benefit equation. You were talking about the benefit-to-harm ratio, and then you talked about a risk equation. If I were trying to evaluate risk, it would be the weight of the damage caused versus the likelihood of it happening. Is that one of these ratios you were talking about?

Dr. Mathias: They are very similar, except that I reverse them. I think a cost/benefit analysis is the wrong way to do it. First, you consider the benefits. You want to take the denominator and put it in the numerator. I personally talk about a benefit/cost ratio. We get the outcomes that we are trying for, that is, the benefits, and then determine the cost, rather than putting the ratio the other way around. Most of us are not as comfortable dealing with the denominator, that is, the second term, as we are with the first. That is why I have benefit/cost illustrated here, and here I had benefit/risk. First we determine what the benefits are, and then we determine what the risks are. Risks are a function of severity times incidence. That particular equation is also in the denomina tor, and it is within the brackets in your algebraic expression in the denominator.

Senator Kenny: You asked us to watch carefully for who is benefiting or who has an interest when they come before us. You said it would be very difficult for us to spot the people who benefited from drugs, although I do not recall any dealers coming before us, at least not yet. We have had people come before us who said they have used drugs. I would like some help on how we spot the people who benefit from drugs.

We do see some people who are in the "user-catching industry," if you will. We see signs of a huge industry in the States, although I am not sure if it starts with building more prisons and then they hire prison guards and then they hire police to fill the prisons and so on and so forth. We can spot an industry there.

Could you help the committee on how to determine the interests of the people before us? Perhaps start by telling us yours.

Dr. Mathias: First, I would have to declare an interest in that my son, Gordon Mathias, ran for the B.C. Marijuana Party in the last provincial election. He felt that the laws were wrong, and he felt that going through the democratic process was the way to express his opinion. As a parent, that is a potential conflict for me.

I personally am not a user. As a public health person, I think there are much safer ways to get the benefits, particularly as we get older. I think the stresses in our lives become different and we can manage them differently. That is certainly my perspective.

The fact that people's income, employment or security is based on the industry does not make what they say invalid. It does mean that you must look at the perspective from which they come.

Senator Kenny: Are you suggesting that we should have almost a short protocol for each witness? After we qualify them, should we ask them, "Could you please declare your interests, and then, once we know what your interests are, we will judge your testimony accordingly?"

Dr. Mathias: Certainly. In all peer-reviewed medical literature now, at the end of articles there must be a declared conflict of interest indicating whether you have received any financial gain. It applies even with the most honourable of people. I do not think anyone is trying to give you misinformation, at least not in this group. However, it needs to be interpreted from that perspective. I would suggest that that is not an unreasonable thing to do at all.

Senator Kenny: Let us talk about the police for a moment. We have had police groups come before the committee. They do not see themselves as an industry involved in catching drug users and locking them up. They do not see themselves as being motivated that way. They see a social problem that they are confronting on an ongoing basis, and it worries them. It worries them a lot. They come to this committee and say, "Look, our laws are important. They send a signal to people that this behaviour is not accepted by society, so do not mess with those laws." Not all the police say that, but there is a group that does.

Dr. Mathias: And there is a group that does not.

Senator Kenny: And there is a group that does not.

Dr. Mathias: Let me just point out that this is much like being a physician. A policeman deals with criminals. In dealing with such people, their environment is basically criminal. They start to see much of the world from that perspective. One of the reasons, for example, that they move policemen among various squads is so that they do not start thinking that the entire world comes from a particular perspective. It is extremely difficult for them to back away from that.

I respect their opinion, but if they are talking about a social problem, then they are talking about my field. Then they are talking about public health. They are talking about something quite different. They do not have the mandate or the skills to deal with that issue. I think their perception that the law is the way to deal with a social problem is very much part of the milieu from which they come.

Senator Kenny: With respect, sir, they feel that they are on the pointy end of the stick, and they see you as way back in the tail somewhere.

Dr. Mathias: Except they are entirely wrong. We feel ourselves at the pointy end of the stick because we are in the emergency rooms where these people come. When it is "Welfare Wednes day" in Vancouver, where do these people go? They get picked up by the paramedics after their overdoses and are taken to St. Paul's Hospital. We have wards full of people with whom we have to deal.

Believe me, I greatly respect them. We would not have a society without the police. However, it is my view that they should be dealing with harm to others. In fact, their role in protecting the people who are decompensated and dependent is extremely important, but they should not be trying to get the decompensated dependent people who are ill. They should be trying to get the people who made them that way, or assisted them in becoming that way, or who are preventing them from getting appropriate care. They have a major role to play, but I am not sure we agree on what that role is.

Senator Banks: Thank you for being here. I admire anyone who holds strong opinions and speaks about them firmly.

This is a bit of a reach, but let me make this comparison anyway. Let us say there is a cliff from which people skydive, and many of those who do so make it. However, it is known - widely known, inescapably known, irrefutably known - that there are some weird updrafts on this cliff. More people die or get badly injured from jumping off that cliff than any of the other surrounding cliffs, but people keep doing it. They know that there are dangers involved.

No one on the face of this earth, certainly not anyone in North America or Western Europe, can claim that they do not know what the dangers are, but they keep doing it. Then they land on the ground and get busted up, hurt, or, God forbid, killed. It seems that you are characterizing these people as victims of something or other, or as being ill. Have they not brought that illness entirely on themselves? Should that not somehow be taken into account? It is not the same thing as walking out on the street and getting hit by a bus.

Dr. Mathias: The way you posed the question implied that the people doing the skydiving were doing so with informed consent.

Senator Banks: Yes.

Dr. Mathias: In my model, then, go to it.

Senator Banks: Sorry, let me stop you. Does that mean that we say to people who want to shoot heroin, "Just try it out"?

Dr. Mathias: Absolutely, as long as it is safe.

Senator Banks: However, they know it is not safe because people are dying from overdoses.

Dr. Mathias: I can make it safe. I can provide a known dose. If they can only get this drug from a pharmacist, the pharmacist can say, "Have you ever done this before? If not, then maybe you should have half a dose," or whatever. Heroin is an extremely safe drug. It has virtually no toxic effects.

Senator Banks: What are its upsides?

Dr. Mathias: Euphoria and relief of pain. It has some downsides. It can be associated with constipation and a few other things. However, it is not toxic in the same way that alcohol is. If you take alcohol, you kill a few liver cells. There is nothing you can do about it; that is what the drug does to you. However, you have lots of those cells, and they regenerate. If your intake is moderate, then that is not much of an issue. If you take a lot, you will kill your liver. Heroin will not do that to you. However, if you take too much heroin it will suppress your respiration. If you suppress your respiration and you stop breathing, you are toast. The safety factor involved in the process is to ensure that individuals know exactly what they are taking and that they do not share with someone. The worst thing is to have people experiment with someone else's rig. What they will do is put in the needle and draw back the blood if that rig has already been used. They will inject the other person's blood into themselves. They will become infected with hepatitis C. That is why there is an infection rate of 85 per cent in the downtown east side. Just a few years ago it was 3 to 4 per cent.

If they want to experiment, then I want them to have the information they need to be able to say, "Yeah, I will try that. Cool. Go ahead."

If individuals are occasional users, they will not do themselves very much harm. I would prefer to say, "We can do this better. The reason you are injecting it is so that you get the maximum hit before the police catch you." This stuff is damned expensive. That is why injection has become so popular. Heroin used to be taken by smoking. What if I say to this kid, "Look, this is high-risk stuff you are doing here. Injecting is messy. You might miss. There are all kinds of problems with that. If you want to experiment, experiment with something that is safer. Here is a cigarette; smoke it. You will get the same hit, although it is a little slower. It does not have the risks. I do not know if it is more likely to make you dependent or not, but this is what you have to be really careful of." We have data on pharmacies as to what and to whom they are selling. If we start seeing that person popping up in our records, then we can try to get that person into treatment. You cannot treat someone until they consent to it. That is a fundamental issue of health care. There are things we can do to help prevent people from killing themselves on the rocks.

Senator Banks: There is a fundamental issue now that we do not handle too well with some legally prescribed drugs, but that is another question.

I gather, then, that you are in favour of some kind of controlled injection situation, so that if someone who is 19 gives informed consent for a half dose, for example, we can be reasonably assured that he is not walking out the door and giving it to someone who is 14; is that right?

Dr. Mathias: Yes. The idea of safe injection rooms can be expanded to include the idea that if these drugs are legal, then that is where you can buy them.

Senator Banks: Do you propose that every pharmacy will have such an injection room?

Dr. Mathias: There may be a public health nurse there. This may not be a little room at the back of the store. This may be the main room. You can go there and talk to other users about what is good and bad about the drugs. We will be there as public health people to say, "Look, what you are doing is risky. You may see some excitement in this, but these are the downsides of what is going on." In this way, we can ensure that the consent is as informed as possible. We can try to get them on a safer drug. We can say, "If you want to try this stuff, then try smoking opium. It is much less of a risk than using heroin." Why do we use heroin in this country? Remember that many of the people who built the CPR were Chinese coolies. They used opium regularly while they were building the railway. Every time you drive over that railway, you are driving over a lot of blood from these people. They were able to work during that. It might be that we will say, "Look, injectable heroin is nowhere. It is a bad drug, but smoking opium is safer." If people are going to use these things, then they should use the safest drug in the safest mode possible. It is very hard to overdose by smoking.

Senator Banks: Would you be prepared to accept the unknowable, but not unperceivable, risk of substantially increased use in the regime that you have just described?

Dr. Mathias: A requirement of this regime is that substantially increased use is a possibility. If we allow advertising, and we allow this to go public, and we have the opium equivalent of Coke, for example, then we will be in trouble. However, if kids, in talking back and forth, decide that they want to do something, then, as a parent, I want it to be as safe as possible. The public health approach is to make this as safe as we can for those people who wish to experiment, for those people who have their own perceived problems and stresses.

One of my kids rock climbs, which is not safe. It is like hang-gliding, although, hopefully, less risky. Nevertheless, it is risky. Do I say, "Don't do it"? No. I say, "If you are going to do this, know how to do it, use the appropriate safety gear, and climb with people who are experienced." That is all I can do as a parent. If I remove an element of my kids' ability to grow, what is the point?

Senator Banks: I am not sure that taking heroin is a growth experience.

You mentioned some benefits of this new regime to the hospitality industry. Do you mean people coming from all over the place to where they can legally obtain this?

Dr. Mathias: First, I mean that the people who are now running bars and similar things may well be the ones who expand into the equivalent of the Amsterdam cafe. That industry is well understood by public health, particularly in terms of the restaurant trade and in managing the risks, et cetera. It will open an opportunity for legitimate businessmen to become involved in this. Now it takes place through other means altogether. Those means are very unsafe. There is no one who is trained to monitor what is happening to people, et cetera. We know from experiences with alcohol that that is far from perfect. However, I think it is the best we have to offer under legalization of drugs.

The Chairman: We will stop there, sir. I have a few questions that I will send to you. We will post your answers to my questions on the Web site. Thank you very much for your presentation. It was very bold and frank.

Our fourth witness today is Dr. Colin Mangham. Doctor, I will not read your entire bio because it will be printed, like all the others, on the Web site. For the sake of saving time, we will go directly to your presentation. We will have to terminate the hearing this afternoon by 3:30. Dr. Mangham, we will give you the full time until 3:30, and we will send you our questions and you can answer them in writing. Like the other questions and answers, they will be posted on the Web site.

Dr. Colin R. Mangham, Director, Prevention Source B.C.: First, I would like to express my thanks for being allowed to present this brief to the committee. Since your inception prior to the election, I have had an interest in seeing this issue talked about and certainly all sides aired. I have watched with interest the committee, the testimony to the committee, and the issues you are considering, which we believe are of real importance. I know you have heard from many groups already.

Since this is, I assume, a public health day, I will just say one thing about public health, and that is that it is a broad field. We take a public health approach now to drugs. Some testimony that I have read seems to imply that harm reduction is a public health approach, but no other approach is. That is simply not true. Public health is a broad-spectrum approach in which the law plays a very important role. I work in prevention, where the law plays a particularly important role, and is one of the social controls or one of the key ways of reducing availability and acceptability of the substances in use.

I come before you as one who has worked in the prevention field for many years in Canada, over 20 years in British Columbia, and on various national and multinational projects. Prevention is probably the most misunderstood and often neglected and inconsistent area, but I think you would agree it is the most vitally important facet of any drug response.

These views are mine, and I do not pretend to represent an organization or government. Indeed, I think that all of us who testify need to speak for ourselves and allow governments and organizations to make more reasoned and democratic choices.

I have been concerned that this issue be brought out into the open and that there be open debate and discussion of it. As I have reviewed the testimony, my views do differ from those of many of your presenters so far. The fundamental message that I will be speaking to today is that I believe that if we change our view on drugs, we will be opting for a baser road for Canada and selling ourselves out.

I looked for a picture. I will reveal any biases I have. The joy of my work, and I think we all should have joy in our work, is interacting with young people and with children. Throughout the years, and at the end of the day, if I have felt that I have done something to help a young person make a healthier and a happier choice so that families and communities will be better off, then I feel good about what I have done.

I think we all care about our youth. Every one who has testified I am sure is a loving member of a family and cares; we have different views. Yes, I am biased. Everyone has biases. Once, in an article promoting what I would call the "large H" harm reduction, someone indicated that harm reduction was values neutral.

It is not values neutral. There is no such thing as "values neutral." We have to reveal our values, and they are implicit in everything we do as a nation. We cannot squeeze those out, and we cannot dehumanize or medicalize issues to the point where we devalue what people think if they are not experts in a particular area.

Thus, people, not drugs, must be protected. We have no reason to protect drugs, to extol drugs, or to talk about drugs in any other form. We are here to talk about people. My message is that we must never lose sight of the truth. The truth is, undeniably, that recreational drug use hurts people. Drug use does not do anything good for people. Drugs hurt families that form the very basis of our civilization. Drugs entrap through addiction and divert from productivity and productive lives. They lead to anti-social acts, breed crime, and attract, in particular, the most vulnerable among us - the young at risk and those who are vulnerable emotionally or socially.

The preponderance of evidence and common sense itself tells us that if we let our guard down and somehow accept certain drugs as safe enough to decriminalize - de facto to legalize - to increase the acceptability and availability of substances will, if nothing else, increase consumption and send the very wrong message to rising and future generations. We could do much better than that.

I urge the committee, rather than to foster or to encourage a drug policy that would decriminalize cannabis and renege on international treaties, to raise harm reduction as an ensign calling for an increased emphasis on primary prevention of drug use; for increased efforts to reduce the incidence of drug use; for a renewal of rejection of drug use as an acceptable, viable or sensible lifestyle; and for renewed efforts to improve the availability and adequacy of drug treatment in this country.

I will direct my remarks to the key areas that the committee is considering. The first is cannabis decriminalization. Cannabis, or marijuana, is not harmless in any way, shape or form. Any fair search of the literature that does not key in on research that belittles or waffles will show you that it is a mind-altering intoxicant with distinct risks and special ramifications for youth. I will cite from a few, easily-found studies that belie claims that imply it is relatively benign. I have been surprised by some of the testimony that has certainly defended the drug.

I will limit this to empirical studies and I will point out that this research, when done properly, is humble - it does not make claims based on a few studies. We certainly do not reach conclusions and then look for information to support them.

I have one resource from the Center for Substance Abuse Prevention in the U.S., where recent marijuana research and a number of studies indicate some of the risks. We already know and accept that cannabis has negative effects on many systems - respiratory, motor skills, memory and immune - and that it creates drug dependency and tension.

In addition, we now know from numerous research studies that there is a definite and acute withdrawal syndrome associated with chronic cannabis use. A withdrawal syndrome is a marker for physical dependency and for treatment, because it is a strong indicator that a person could continue use to avoid those symptoms. This is no surprise to anyone who has read stories of young people, particularly, who have tried to stop using. I have seen this so many times and personally witnessed the pain of people who have decided they wanted to stop. I have found it extremely difficult.

Keep in mind as well that the cannabis today, as you have heard, is many times stronger than it was in the 1960s. That is a fact because of creative propagation and cultivation.

There is research that suggests there are effects on the developing fetus. I point to specific studies that look at the ways that use during pregnancy may negatively affect intelligence and development of children. The American Academy of Pediatrics expressed concern this year about the dangers of the drug, both in pregnancy and when used by young people, based on neurotoxic ity studies.

I will speak to visual scanning, specifically, attention dysfunc tion in the form of impaired visual scanning and related functioning. Visual scanning develops particularly in early adolescence, so earlier onset is associated with some concerns there. We do not know all those possible impacts on mental health. We need to be fair and to look seriously at that area.There are studies that suggest some relationships between some people with mental health problems and the use of the drug.

We find that very seldom do people appear with a simple diagnosis of a drug problem. There are dual-diagnosis issues and we do not know for certain to what extent those are pre-existent and to what extent exacerbated by the depressive, and other, effects of the drugs themselves.

It is clear that, despite people speaking to the contrary, it is a gateway drug. Most people who use other drugs started with marijuana. There is a time-order relationship, a strong, consistent correlation between first use and an order of substances.

There is the fact that, in very recent studies - and this is tentative - by the National Institute on Drug Abuse in the U.S., it was reported that neurotoxicological research suggests that marijuana may alter the brain in ways that increase the susceptibility to other drugs. Many question marks remain. Do these findings mean that these things will always happen? Am I saying that these are cast in stone? No, no more than claims that are made to the contrary.

We are dealing with a serious substance and we are also dealing with these polarized views. I am sure that you have had some difficulty in finding someone who is a true automaton, who is able to be factual, because we are people. I am surprised by the number of fairly educated and sophisticated people who defend this drug as though it were somehow misunderstood and maligned, almost as if it were a person who was being picked on.

I do not know where that way of thinking comes from. Perhaps some of it comes from personal use, or perhaps from the civil libertarian. I do not know what that is about. I have my own biases, which you will hear. However, we need to look simply at what drugs do socially, emotionally, physically and spiritually.

Some people point to the fact that alcohol and tobacco cause more problems. That is a common theme from people who are promoting harm reduction. It is a fact, and common sense tells us, that because those drugs are legal and therefore more available and socially acceptable, five times as many people smoke and ten times as many people drink than use cannabis, even with energetic efforts to control them.

Thus, there is no question why those two substances carry such high relative cost, which is limited to what we can measure. There are many costs that cannot be evaluated easily, but we should consider them as well.

If we add cannabis to that endorsed substance list, and decriminalization will send such a message, it seems ludicrous, when we weigh the facts.

The key difference in consumption is produced by the role played by the law in influencing the dual factors of acceptability and availability. This brings me to the second implication. When I say a "harm reduction drug policy," I do not mean as we have already initiated in the response to drugs so far. We have tried many things such as needle exchanges and we have tried a harm reduction approach to drinking and driving. I have developed many programs for youth, which is my specialty. If I were called upon to develop a program to teach youth with any certainty about how to use drugs that are now illegal in a safe and moderate way, I do not think I could do so. Drugs fundamentally have effects. They do affect us. For example, it may be the cleanest heroin in the world, but is the person functioning in the family and at work, and are they able to pay for the habit that they will develop? Those are questions that need to be answered.

When I use the term, I mean harm reduction as it has been promoted. The term has become sullied, unfortunately. It began as a noble thing, but has become a key code word for decriminaliz ation or legalization of substances. I would caution you against using the term as it is. It has become somewhat tainted in that way.

First, it does not work better than other approaches. One implication of a shift is there is no evidence it works better than others. For example, in European countries that have adopted it, there appears to be an increase in the drug's availability. It makes a great deal of sense that in the Netherlands, where cannabis is now spoken of as a soft drug and separated from the others, that there is a great increase in availability and in that form of drug use.

I can speak specifically of a comparison between the Netherlands and Sweden, which have very opposite drug policies. Sweden had for some years a very open harm reduction policy and turned about face based on negative results, according to the Ministry of Health, to a very stringent drug policy whose focus and idealistic, acknowledged goal is a drug-free society. That is a strong statement, and I do not think they believe that is necessarily what will result, but they have set that as a goal. In those comparisons between the two countries, which have just been published this year, there is no benefit, such as more reduction in HIV, as a result of the policies in the Netherlands than there is in Sweden, which has accomplished the same result through treatment. The number one way of reducing HIV seems to be successful treatment.

Second, it increases availability and acceptability. I would like to speak to that because it gets philosophical. If we believe that drugs can hurt people, then we do not want to increase their availability and acceptability. If we think they are just another lifestyle, then we do not particularly care. We believe that somehow we can play with them and control them. The availability and acceptability of drugs play an important role in consumption. The drugs that are used most are those that are the most available and the most socially acceptable, and the least used drugs are the least socially acceptable and the least available.

Less than 2 per cent of Canadians 50 years and over used heroin in the last year; 7.5 per cent of all Canadians aged 15 and over have used marijuana in the last year; slightly over 80 per cent have used alcohol in the last year, and depending on the province, 28 to 35 per cent of people have smoked in the last year. With alcohol, a good example of reduced physical availability is raising the drinking age in the U.S., where consumption decreased immediately after that law was passed.

The other important part to remember is acceptability in terms of how drug use is perceived. Even more than availability, acceptability is affected by legal sanctions. When we have sanctions against drugs, it reduces social acceptability and helps hold consumption down. Two aspects of acceptability are perceived risk in using the drug and perceived social acceptance of the drug. Those are two tools we have to keep consumption down. When we look at the actual figures in Canada, we have been quite successful as compared to not having those tools.

Therefore, a key determinant of both availability and social acceptance is the level of sanction against drug use. I have pointed out that the Netherlands distinguishes between hard and soft drugs, and soft drug use has increased, especially among the young. There was a prior low rate of cannabis use and it quadrupled. It is still less than in Canada, but it shows all the cultural differences that disallow a comparison between Canada and Europe.

There are also availability spin-off problems such as drug tourism. I would refer you to the Hassela Nordic Network Web site that monitors government documents, testimony and newspa pers and gives a good idea of the dialogue in Europe, which is anything but unified on the concept of harm reduction. I have pointed out that Sweden has also reduced HIV with a completely different policy.

With respect to cannabis use in Canada, an even better example is the 1990s comparison of cannabis use here and in the U.S. Throughout the late 1970s and the 1980s - I witnessed this personally in the field - we enjoyed a gradual downturn in cannabis use among young people that resulted in a low in 1992 in the U.S. of 27 per cent, and a low of 25 per cent in B.C., by high school students.

By 1998, the figure in both places had risen, to 40 per cent in B.C., according to the McCreary study, and 37 per cent in the U.S., according to the "Monitoring the Future" longitudinal observation that is carried on there. Since 1988 and 1989, when we had the Really Me campaign, we have had no federal or, in B.C., provincial campaign speaking about drugs. We have been consistent and comprehensive in our messages about smoking and about drinking and driving. Both those behaviours have declined substantially to the order of 50 per cent since the 1970s, and, in the case of drinking and driving, since 1980.

When there was a decrease in consistent prevention messages and the National Drug Strategy ended, I witnessed numerous community coalitions and task forces on drugs that dried up and went away and no provincial funding followed it. I watched in Nakusp, Penticton, the Sunshine Coast, Whistler and many other places as excited people were no longer able to keep going because the attention in the country turned to the population health bandwagon. There was a loss of interest, funding levels and prevention, and at the same time, an increase in messages about hemp, "medical marijuana" and other ideas. Recently, I was at the Vancouver Sun with the international editor because it had printed a large series of articles promoting legalization, speaking about the U.S. war on drugs, and juxtaposing Canada with the evils of the U.S. I and two other credible people, a member of the RCMP and the head of a treatment service in Maple Ridge, were told the paper had no interest in our views, and it did not publish any rebuttals. When you have this going on for years, common sense would tell you we would have some erosion in the gains we had made in consumption. With that, and with some of the changes in drug sentencing and enormous growth in cannabis availability, certainly in British Columbia, it is no wonder we see these changes.

Third, it violates treaties and follows poor examples. I think we need to be careful about doing things that violate treaties. They exist for reasons. The International Narcotics Control Board of the UN has routinely criticized Canada for about the third report in a row for drift and apathy in drug policy. Reducing the flow of drugs is an international effort. I grew up in the United States. I lived in Texas in 1968-69 before I went into the navy. There a person could have a seed of marijuana in a matchbox and technically go to prison for life. That was certainly what could happen, so I am aware of the potential for becoming so aggressive and so consumed with enforcement that you would do that. Canada is not like that now. It is unfair to say that we are like the U.S. now, but we need to be cooperative. We need to assist in reducing the flow and acceptability of drugs.

The Netherlands has isolated itself on drug issues. European Cities for Responsible Drug Policy, a body of cities signing the Frankfurt Accord - we hear that being much extolled here - calling for decriminalization of cannabis and controlled distribu tion of heroin is under stress. In a meeting in 2000 at the host city in the Netherlands, the alderwoman chairing the meeting indicated they were losing ground, and that the European Cities against Drugs, signatory to the Stockholm Accord stressing a strong and unequivocal rejection of drugs, which includes many of the continent's premier cities, is gaining ground.

Alaska, Sweden, and other countries in Europe have had experiences with aspects of harm reduction, and all backed away from it. This committee needs to consider the possibility that this approach, like many fads, may be rapidly becoming a "been there - done that" kind of idea.

I would suggest that you reach out and listen to voices of dissent from Europe and also not make the mistake of assuming that all people who work in public health in Canada are on board on this.

I have been guilty of this. I did a major project when I was at Dalhousie University on resilience in health promotion. We went out and spent considerable months, effort and money to do this. We did a follow-up project with another grant to study resilience in Atlantic Canada fishing communities such as Île Madame, Chéticamp, and a small community in Newfoundland, only to find out that resilience had been visited before. We were not new to the area. It had been looked at for some years and programs developed around it. It is a useful concept, but for some time it was all there was. Likewise, I am concerned that perhaps this idea of changing drug policy may be something we are grabbing onto as a panacea. It has been my experience, and I hope of some of you as well, that often, at the end of the day, what is needed is to do a better job at what we are already doing.

I will make three recommendations to the committee. First, put a prime policy focus on prevention. I speak particularly of primary prevention. That is engaged in reducing or delaying the actual onset of drug use. That area has been neglected, inconsistent and marginalized in comparison with other elements. We know that it can work. We have seen it with tobacco, drinking-driving and other health-related behaviours. We also know that we have treated it unfairly. We have expected much from single programs such as grade six and seven programs, some of which I have developed. We are working on another program for grade eight. Somehow, these are expected of themselves to reduce drug use. Unless a child has a powerful moment in that program, we know that it is unlikely that something of that nature will have the power to affect his or her whole life.However, we also know that the accumulation of messages that are consistent and comprehensive, coming in various forms but not contradict ing each other, and of significant duration, can affect the way these substances are looked at and their use. That is what will have the impact of reducing consumption. If we do not, then our silence is, I fear, tacit approval.

I believe that we should make prevention the policy, not harm reduction.

As far as vested interests are concerned, I will say I probably make less money than most people who have appeared before the committee. If I am in this for the money, I am in the wrong area. There are many things I could do with my degree and skills that could make much more money. I could hire myself out tomorrow as a pharmacy rep and double or triple my income. I am not doing that, and would resent any implication that I, or the people I work with, are somehow benefiting from a problem. That is like saying police like crime because it gives them a job. I think that is a dangerous assumption.

Recommendation number two, we need to vastly improve adequacy of treatment. In Europe, and I will speak of Sweden, youth treatment is open-ended, with education and training. It lasts over a year, not just 30 days. Thirty days was an idea that came out of insurance in the U.S. Anyone who has visited downtown east side would laugh if someone said, "Can I take this person in 30 days and create someone who is participating and functioning and is able to move away from drugs and move on?" We would not be able to do that.

With regard to increasing accessibility to treatment, we do not have enough beds. Europe has more beds per capita.

Sweden's slogan is that it should be difficult to use drugs. We talk about tolerance. The roots of tolerance are compassion and charity. Compassion and charity can just as much mean harshness and firmness as it can mean simply tolerance. Anyone who is a parent knows that. I love my children unconditionally and with all my heart, but my compassion does not allow me to be so tolerant that I will watch them self-destruct. We need to improve youth treatment.

For recommendation number three, I would suggest that we be careful with the very term "harm reduction." It has come to be used primarily as a word for a much broader policy change than just the specific kind of actions that it involves. It shifts emphasis from prevention of use or continued use. There was one document printed by the Canadian Centre on Substance Abuse, and I do not believe it was their policy, but it was by one of the major authors who have articles cited on your Web site. It said specifically that primary prevention stigmatizes drug users and treats them as deficient. I have worked in prevention probably as long as anyone in the field in Canada, and that is a lie. It is not true. Prevention emphasizes that it is better not to use, and if you use, it is better to stop. It does not say anything about users.

We need to work to reduce the acceptance and availability of drugs. If we are going to change laws in our desire to be sensitive and tolerant, we need to focus on first-time offenders and the indiscretions of youth, and be careful we do not wreck lives. I do not think we are. Already we have a de facto system where that does not happen and where we may create some alternatives that help a person to change more than simply, as the U.S. is focused on, a matter of putting people in prison. There are other things we can do.

I am an immigrant to this country. I want to say how very, very proud I am to live in Canada. I am very proud of Canada right now. My wife is a third-generation Canadian. My children were born in Vancouver. We are privileged to live in what I believe is the world's best country. Even so, we do have many problems to address. Many of our children and grandchildren are seeking rewards that they innocently assumed they would receive when they went off to school and through the system and felt, "Okay, I will do this, then it will pay off," and many of them are having a great deal of difficulty in getting those rewards. We have internal divisions provincially and federally that are wrecking us, and they cause other countries to wonder what in the world we are doing about this, because we are such a good country. Families are under enormous stress. There is a huge need to improve child development and ameliorate the effects of poverty.

We have a growing population of seniors that will continue to require a strong, productive tax base to ensure the care they have earned for their old age and are entitled to for their lives of service in this country.

It is my view, based on all that I know and have experienced, that with all these things considered and all I have said considered, and as I read and study the issue, we have no need to be making such gross changes in our national drug policy. Instead, I believe we owe it to our children to take a strong stand and strengthen our resolve to reduce drug use through a very earnest and concentrated focus on prevention, treatment and supply reduction.

To the extent that what I have said reflects values, I can only say that all of us, if we care about our work, if we care about people, are not able to be computers. I exhort us all to accept that and not try to pretend we are going to be squeezed of all emotion. Anyone who has compassion in his or her heart at all will have a view, and this is a view that is impossible to discuss in a mechanistic way.

I applaud the committee for its time and interest. I respect everyone's opinion on this. I am being compassionate in putting mine forward, but I respect you all and respect your work.

The Chairman: As I told everyone before, for the sake of saving time, we will send you questions and wait for the answers. We will post both questions and answers on the Web site, as we do for all our witnesses.

Thank you for your time and for accepting our invitation.

[Translation]

Before closing these proceedings, I would like to remind all those who are interested in the work of this committee that they can read about illegal drugs and get information on our Web site at this address: www.parl.gc.ca. You will find there the briefs of all our witnesses as well as biographical notes and all the supporting documents they provided to us. You will also find over 150 Internet links on illegal drugs. You can use this address to send us your E-mails.

On behalf of the Special Senate Committee on Illegal Drugs, I would like to thank you for your interest in our important research.

The committee is adjourned.