|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.
|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.
|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.
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|Dr. Mathias: Thank you. I will take advantage of that offer,
|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
|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
|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
|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
|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
|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
|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
|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
|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
|Senator Banks: I am not sure that taking heroin is a growth
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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
|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.
|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
|The committee is adjourned.