Proceedings of the Special Committee on
Illegal Drugs

Issue 2 - Evidence for May 14 - Morning Session

The Special Senate Committee on Illegal Drugs is meeting today, at 9:07 a.m., to reassess Canada's anti-drug legislation and policies.

Senator Pierre Claude Nolin (Chairman) in the Chair.

[Translation]

The Chairman: I wish to welcome you to this open meeting of the Special Senate Committee on Illegal Drugs. I would also like to welcome all of those who came to Ottawa in order to attend this meeting, as well as those who, thanks to modern technology, are able to listen in either on the radio, on television or via the committee's web site.

I will now introduce the members of the committee who are present today, senator Shirley Maheu of Quebec, Senator Eileen Rossiter of Prince Edward Island and Senator Tommy Banks of Alberta.

The Special Senate Committee on Illegal Drugs was originally established by the Senate during the 36th Parliament. On April 11, 2000, the Senate unanimously voted to establish the first committee on drugs and I was appointed as the Chair.

After several months of preparation, on October 16, we held an open meeting in the Summit room. Last October's general election marked the end of the 36th Parliament as well as the end of our proceedings.

In February 2001, the Senate commenced consideration of a motion to reestablish the committee and on March 15, 2001, the Senate unanimously accepted the continuation of the committee's proceedings under amended terms of reference.

[English]

The Senate Special Committee on Illegal Drugs has received a mandate to study and to report on the actual Canadian policies concerning cannabis and its context, to study the efficiency of those policies, their approach, the means as well as controls used to implement them. The committee must also examine the official policies adopted by other countries. We will also examine the Canadian international responsibilities with regard to the conven tions to which Canada is a signatory. The committee will also study the social and health effects of the Canadian drug policies on cannabis and the potential effects of alternatives policies.

[Translation]

The committee should be tabling its final report towards the end of August 2002. In order to satisfy its terms of reference, the committee has adopted an action plan in response to a three-fold challenge.

The first of these is the information challenge. We will be hearing from a group of prominent experts, both from Canada and abroad, academics, police officers, members of the judiciary, health-care professionals, social workers and government representatives. Our hearings will be mainly held in Ottawa but, if need be they may also be held elsewhere.

The second challenge, and certainly the most noble one, is the one that drives us to share the knowledge we've acquired. The committee would like people from all over Canada to seek out information and share in the information that we have gathered.

In order to rise to this challenge, we will ensure that there is access to this information and that it is distributed. We would also like to have the benefit of the public's point of view on all of this. To that end, in the spring of 2002, we shall be holding public hearings in various regions of Canada.

The committee's third challenge is to consider the basic principles which should underlie Canada's drug policy.

[English]

Before I introduce our distinguished experts for today's hearings, let me inform all honourable senators 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, which is accessible through the Internet Parliamentary Web site at www.parl.gc.ca.

All the proceedings of the committee are posted there, including the briefs, annexes and documentation of our expert witnesses. We also keep up to date with more than 150 related Internet sites.

[Translation]

I would now like to comment very briefly on the committee's meeting room. This room, called the Summit room, was furnished in 1982 on the occasion of the G6 Summit which took place in Canada. The leaders of the major industrialized nations met here for private talks.

We welcome this morning Mr. Jürgen Rehm, who holds a doctorate in psychology and methodology and is a professor at the University of Zurich. We also welcome Eric Single, who holds a doctorate in sociology and is a professor at the University of Toronto's Department of Public Health Science.

This afternoon we shall be hearing from Andy Hathaway, who holds a doctorate in sociology and is a researcher at the Drug Addiction and Mental Health Centre. We shall also be hearing from Patricia Erickson, who holds a doctorate in criminology and social administration and is senior scientist at Toronto's Drug Addiction Research Foundation.

[English]

I will now introduce you more precisely to Dr. Rehm. Dr. Jürgen Rehm finished his studies in psychology and methodology at Mannheim University with a Ph.D. After working for the German Federal Health Office for several years, as a vice-department head for epidemiology of risk behaviour, he specialized in substance use and addictions.

Dr. Rehm worked for the Swiss Institute for the Prevention of Alcohol and other Drug Problems, Lausanne, Switzerland, as a section head for epidemiology and surveys, and then for the Addiction Research Foundation, ARF, and several senior positions in research and administration. In parallel, Dr. Rehm had different university appointments at the University of Toronto and the University for the Applied Sciences in Hamburg, Germany, and acted as consultant for several WHO projects.

Currently, Dr. Rehm is director of the Addiction Research Institute at Zurich, Switzerland, a research institution with a staff of about 30, affiliated with the University of Zurich. He also serves as a senior scientist for the Centre for Addiction and Mental Health in Toronto, and is cross-appointed to the University of Toronto, Public Health Science Department.

Dr. Rehm, you are welcome to make your presentation. I see that you have a slide presentation. The floor is yours for 30 minutes. After that, my colleagues and I will ask you questions.

Before we start, let me tell you that we are very happy to hear from you this morning. We are proud of the interest that we are generating in the academic community. Thank you for being here this morning.

After your presentation, if there are more questions that my colleagues and I decide to forward to you, we will write to you. I hope you will agree to answer those questions. If you stay tuned to the work of the committee and there is more information you want to provide to this committee, please do so.

Dr. Jürgen Rehm, Chief Executive Officer, Addiction Research Institute, Zurich, Switzerland: I feel honoured to be invited to this committee. I am trying to sketch out the main results on the costs of public policies to fight illegal drugs.

When asked about speaking about the costs of public policies for fighting drug abuse, the most thorough study from Canada is the study by my colleague Eric Single, et al. There are several people in the et al.; one of them being me.

This study tried to outline the general costs for substance abuse in Canada, and it had three sections: alcohol, illicit drugs and tobacco. Overall, the costs for illicit drugs specifically in 1992 were estimated to amount to $442 million Canadian. There is some debate in the economic sciences on what costs are usually subsumed in figuring the costs of public policies. I have chosen to use a restricted definition to include for the costs for law enforcement - the vast majority of those costs - for illicit drugs, which is around 400 million. I have also included the cost for research and prevention, which is about one-tenth of that, and in 1992 amounted to approximately $42 million Canadian. Overall, for illicit drugs, the cost for the public policies as defined right there amounts to about one-third of the overall costs, the overall social costs, which Canada paid for illicit drug abuse in 1992.

What do these costs mean? How are they calculated? Overall, a human capital approach was used. This approach basically stated that resources in the society are scarce, and if you spend them on option A you have no longer money to spend on option B. This is the overall economic approach: It states that Canada could have devoted those millions to other resources if - and that is the counterfactual scenario - there were no illicit drugs in Canada.

However, those costs are by no means intrinsically linked to the drugs. The law-makers and the politicians who can influence drug law, and that means that overall costs depend on decisions by our government and policy makers.

These public costs are defined as so-called "direct costs." In economic cost studies, you usually separate between two broad categories. Direct costs are those related to the costs of illicit drugs, public health care and hospitals, for example.

Indirect costs are those relating to the consequences of drug abuse; these indirect costs include productivity losses to society - people can no longer contribute to society because they are either sick or dead. The productivity costs in all social cost studies around the world are greater than the direct costs.

How do those costs compare with other drugs? Overall, you will see that the costs for illicit drugs are less than the costs for legal drugs. This is true both for research and prevention as well as for law enforcement in Canada.

How does Canada compare around the world? I have chosen law enforcement because it is the largest category and because it can be defined comparably in social cost studies. I have converted all the figures from those countries that made a cost study specifically for 1992 into U.S. dollars, using the average rate as given by the American government. I then calculated the costs per capita. You will see that there are differences among the countries, with Canada showing the lowest cost for law enforcement and the U.S. the highest.

Comparable numbers can be found in other studies. I have chosen this rather limited definition because I think it is the most comparable of those figures. A French economist has standardized those figures to the gross national product, and uses slightly different definitions. However, no matter which definitions you use, all of the studies come to the same conclusion: The U.S. is spending, by far, the most per capita on public policies - both law enforcement as well as research and prevention.

For example, the National Institute of Drug Abuse, NIDA - the largest drug abuse research institute in the U.S. - is claiming in their letterhead that they spend 85 per cent of the money worldwide on research on this topic.

The best comparison in terms of GNP or others, I do not know. However, it is clear that countries like Germany would rank second after the U.S., and if you take the comparison of gross national product, all other countries except the U.S. would be much closer together. Canada is spending within the range of other established market economies on law enforcement and public policies, probably at the lower end.

There are different expenses. Do you get proportionally the same return? Clearly, if you spend two, three or four times as much per capita on public policies, politicians would expect some return. Do we know that there is a link between what countries spend and what countries actually get in return? We do not know that; this link does not exist. There is no indication that countries with a relatively high investment in law enforcement or in other forms of public policy have less abuse or less harm associated with illicit drugs.

There is another problem and this is the real problem: the relationship between policy, drug use, and drug-related harm. It is not only the public policies, as defined above, that are at stake here. These policies influence other costs related to both the prevalence and incidence and the effects of illegal drug abuse.

This is a complex environment where public policy is influencing other costs. It is not correct to separate out public policies and to disregard the effect these policies have on other costs. If we have a public policy that leads, for example, to an increase in the prevalence and incidence of illicit drug use and consequent hospitalizations, this public policy costs more than just its actual costs. It also costs us all of the costs for hospitals and medicare.

In regard to drug courts, there is a policy decision to establish drug courts that have certain effects. Some of those effects you can see in the costs on law enforcement - for example, the costs for the courts, the policing, and the penal institutions. We then expect drug courts to have a laudatory effect. We expect that they may have an effect on drug use behaviour and the associated harm. What does it mean for society if we have drug courts? Does it change the use of drugs in the user population? If we assume that, we must count into the public costs the direct costs for health care as well as the indirect costs for productivity losses. Any economic evaluation of the drug courts should consider all of the associated costs.

A second example more close to the core mandate would be cannabis regimes. There are several policy options for dealing with cannabis. You can choose to have a deep penalization, a complete legalization, or an aggressive enforcement of illicit drug studies. There are many policy options between those three options. What are the effects?

One of the most recent studies, which is actually one of the best control studies on the subject, has been done by U.S. economists. They say there is no difference between the aggressive enforcement and de-penalization in terms of use. That means, in terms of prevalence or incidence of cannabis use. If this is true, it would have concrete consequences in terms of costs. If de-penalization means a dramatic reduction of costs for court, for policing and penal institutions compared with the status quo, and if no other costs increase B this is to say that if incidence or prevalence of use does not increase - this could be a better alternative for society.

The authors of this study, in their evaluation of policy also stated that steps into a complete legalization, including commercial promotion and sales of cannabis, were shown to have an increase on prevalence of drug use. They stated that with de-penalization there would be no increase of incidence and prevalence of cannabis use. However, with commercialization, where there are advertisements, there is an increase of cannabis use. This may create more costs for related things such as cannabis treatment.

This kind of research gives us the basis to conduct cost studies and to estimate the associated costs to society for public policy in a larger sense, which I think we should adopt. There is still the consideration of whether these benefits can be realized. In economic cost studies it is usually assumed that if you have fewer problems, the costs can actually be realized. When the police have less to do with cannabis, historically they have not told the policy makers that they now need less money. They find other ways to preoccupy themselves and the costs may not be fully realized. Therefore, economic estimates of reduced costs for policing may not actually result in reduced budgets, unless of course there is an agreement that the money saved will be re-allocated. The same is true for other parts of the apparatus and therefore a lot of the costs may not be as flexible as they are in calculations.

The third example is the prevalence of HIV infection among injection drug users in Canada and selected jurisdictions in Western Europe. Those are preliminary data from a larger study we are doing. These data show prevalence rates among intravenous drug users under different policies. In the late 1980s, the three major capitals - Montreal, Toronto and Vancouver - started off with comparatively low prevalence rate of HIV among intravenous drug users. It increased in Montreal quite early and then stabilized. It increased more steadily in Toronto, and it increased quite dramatically in Vancouver. In the same period, HIV prevalence decreased in other established market economies such as city of Amsterdam and the whole of Switzerland, where population density is quite high even outside the cities. It also decreased in cities like Frankfurt and Hamburg.

Therefore, it is not that we are faced with a basic historical progression of HIV prevalence among drug users no matter what you do. Policies can influence and change those things. Our plea is to select policies that are associated with a reduction of drug-related harm and drug-related costs.

With regard to the number of deaths related to overdoses of illicit drugs in Canada and selected Western European jurisdictions, the former figures presented might be doubted because they were based on estimated numbers of intravenous drug or cannabis users. Those numbers must be estimated because the use of those drugs is illegal. Many people do not want to tell about their illegal behaviour and there is some problem in estimating it. Therefore, it may be that the science is not good enough in estimating those illicit behaviours.

The number of overdose deaths is uninfluenced by that. Overdose deaths are usually determined by coroners in most western jurisdictions. There are slightly different definitions of it, but the differences do not matter much. The trends show that overdose deaths in Montreal and Toronto have been more or less stable since the late 1980s. Vancouver has been skyrocketing, as you know. At the same time, overdose deaths in Amsterdam have been more than halved. They have decreased overall in Frankfurt, as they have in Switzerland.

If we compare those data with some other cities in Germany, we can see that overdose deaths have decreased in cities with certain policies and they have increased in cities with other policies. Therefore, the policy makes a big difference in such a hard indicator as overdose deaths.

There are a number of policies than can be used here. Frankfurt and Switzerland have established specific rooms where drug users can shoot their heroin or cocaine without fear of prosecution. Many other things are being done with regard to various kinds of therapies. With low threshold therapy, for example, a user can get methadone maintenance and this might explain the decrease in overdose deaths. All of these examples - taken from different areas B indicate that is an effect of different regimes on the use behaviour and the associated harm.

My conclusion is that the costs of public policies can be influenced by the policy maker. This is a trivial conclusion if you go just to the direct costs which policy makers can directly influence by saying that they want to put a certain amount into policing, et cetera. However, policy makers can influence the indirect costs by choosing policies that are associated overall with the lowest costs in terms of health care, law enforcement and productivity losses together. Policy makers should make informed decisions about those costs and about the consequences of what has been done.

Before I conclude, I will give you one warning. Unfortunately, there have been lots of new reports popping up that are trying to estimate those kinds of costs in a very quick way. For example, a report on British Columbia stated that a heroin trial in British Columbia would save so many millions. That number was calculated by multiplying the estimated amount saved from lower property crime by the number of people invited to join the trial; these estimates were based on Swiss figures. It is not that easy, for many reasons. The various considerations and assumptions must be carefully examined in order to arrive at those conclusions.

Even with that warning, it is possible to do this kind of research if it is the will of policy makers to lay out all the assumptions and all the evidence to get a clear indication of the consequences of their public policies.

The Chairman: Thank you very much, Dr. Rehm. The floor is now open for questions from my colleagues.

Senator Kenny: Thank you for a fascinating presentation. Each time you move on to a new paragraph or slide, many uncertainties and questions are raised.

I understood your last comment to mean that policy-makers can have unintended impacts on costs. Was that what you intended to convey to us?

Dr. Rehm: Yes.

Senator Kenny: Policymakers can have unintended impacts on costs. I understood you to say Aif one can keep the issue out of sight and off the streets, the costs will be much less. I am not sure that moves us very much farther ahead. One could reasonably conclude that, listening to your testimony.

How do you respond to that comment?

Dr. Rehm: Basically, the issue of "out of sight and off the streets" deals with questions that are often not really related to drug use itself. Let me give you an example. The famous Needle Park in Zurich and many other European drug scenes were closed not because of the associated harm and costs of a medical or law enforcement nature; they were closed because of the citizens, and because politicians wanted to be re-elected. "Out of the street" often has more to do with questions only indirectly linked to drug use itself. That is why those kinds of strategies are being chosen.

It is true that drug use, to a certain degree, responds to the same consumerist factors as other consumer articles do. Cannabis use is illegal in every country, but if one were to advertise it on television, its use would increase.

All of those substances, legal as well as illegal, have certain risks. One can reduce the risky use of those substances by de-penalizing the user, while attempting to reduce the profit of the seller and the producer. This is a nice theory. If one knew how to do that clearly, it would be very easy. That is what we are trying to do. We try to make the risks associated with drug use as small as possible. That can be achieved by putting some drugs in certain situations out of sight.

How far out of sight that must be will depend on the reaction of citizens. Safe injection rooms are out of sight. However, when people line up for hours to enter safe injection, they can be seen by citizens. Problems will arise. Citizens will call in and say, "We do not want to have that in our backyard. We do not want to have it in our quarter."

Much of the "off the street" has to do with citizens' reactions, and much of the "out of sight" has to do with the overall availability of certain goods. What is more important - as I do not believe it will be possible to get all those goods totally out of sight - is how we deal with the consequences. How do we deal with the associated harm?

Senator Kenny: It is a difficult question. How you get there depends so much on what you want to do. If you are not clear on what you want to do, discussing how you get there is tends to be a circular argument.

We are acting in a political environment. To be effective, any policy development must have the acceptance and broad support of the public. To ignore costs is not possible. I think the reason I reacted to your slides so much is because politicians almost always want to go to the least-cost solution. In fact, often they want to go to the least-cost short-run solution. That approach may not take into account full cost or full life accounting, but it may be what gets you through this fiscal year.

I wanted you to elaborate more on the other implications. You have elaborated by saying, "Well, yes, but if the public notices it, then it will not be out of sight, and if you do not do it in a way that is efficient, it is not really out of sight, and the public acceptance of the whole process will fail."

I guess this brings me back full circle. What are you really recommending to us? Where have you arrived at in this debate in your mind?

Dr. Rehm: Overall, I do not believe that we can transpose all the different policies directly from one country to another. I have been privileged in being able to spend some years in Switzerland, and the acceptance of the public in Switzerland can be very easily measured. Each drug law goes through a referendum. We know exactly what the public thinks on it.

Senator Kenny: At that moment.

Dr. Rehm: At that moment, we know what the public thinks. For example, when the Swiss voted to continue the heroin-as sisted substitution treatment, they wanted to see the figures and then there was are a referendum. Fifty-six per cent at that moment said, "Yes, we want to continue that."

That result had to do, I think, with four things. First, it could be shown that this kind of treatment was cost beneficial to society. Very clearly, that is important in Swiss referendums. Many other referendums have failed because people are afraid the state is taking more and more money.

Senator Kenny: Was the issue presented as short-term - this fiscal year B medium-term, or full cost accounting? Was it explained to them in the context that they will save money this year or they will save money over the full life of the addict's involvement?

Dr. Rehm: It was a cost study that has shown the costs over the first one-year period of the trial, which were all the costs available. It showed that in the first 18 months, the cost society saved by having fewer property crimes outweighed the cost of having those addicts treated in a better way than they were before. The main consistency was the difference between the direct cost for public financing and the lesser cost for property crimes. Some other minor costs were involved.

For the longer term, it is problematic, especially for economists because of all the discounting and what they do. It also asks the basic question of the value of a life, which is one of the main things in all the cost studies. How do you deal with someone dying, for example, at age 70 versus age 60? Depending on the approach, some people associate a value to life per se. Others say people who are dying at 70 are no longer in the productive workforce. Trying to do those long-range things creates many problems. With the short range of 18 months, the result was very clear.

Senator Kenny: Investment bankers have a phrase, "balloon payment," which means one makes very small payments in the first years of a loan, and then there is quite a large payment that one makes at the end. Is there any way of determining in the Swiss experiment whether a balloon payment was coming?

Dr. Rehm: Not yet. Science can only be as good as the underlying data. We are having experiences of seven years now. In terms of those seven years, there was no balloon payment. We do not expect a balloon payment to happen because, overall, the drug rate, the prevalence rate and the incidence rate of all drugs in Switzerland did not increase over the last few years. We have evidence that they probably decreased, but the degree of illicit behaviour is always a problem.

Switzerland at this moment has exactly the same questions as Canada. Their Parliament, after a long deliberation with all the stakeholders, drafted a change of the law for narcotics that deals mainly with cannabis. The Parliament has been inviting many experts from many countries with several of the same questions, just for cannabis. They came to realize that to have public support, all those problems cannot be dealt with in one law. The Parliament realized it should do it piece by piece. Therefore, it will have something for cannabis, something for heroin and then something to include alcohol and tobacco in the narcotics law. It will all be done piecemeal to give the people a chance to vote on every single bit of it.

Senator Maheu: I have several questions touching on several elements. You mentioned two things that intrigued me. Why do you think Canada is any different? When you talk about the re-election of politicians in Europe versus Canada, there is no difference here. The impact of legalizing drugs here would be just as great in Canada as you referred to it having been in Europe.

You mentioned something else that intrigued me, cannabis treatment costs. Could you elaborate a little on that?

Dr. Rehm: Cannabis drug treatment costs are seen, for example, in the cost study of Single et al. Perhaps I am not understanding the question. They are the costs associated with treating drug abuse itself as well as the costs of all the diseases associated with that drug. The abuse can be treated in a specialized treatment section, a general hospital or a psychiatric hospital

For example, costs associated with alcohol are the costs of treating alcohol abuse and dependence, which are usually specialized organizations in Canada, as well as the costs of treating, for example, breast cancer. The full cost of treating breast cancer is not taken, but only that fraction which is believed to be associated with or caused by alcohol - for breast cancer this amounts to 3 or 4 per cent. Therefore, of costs in treating breast cancer, about 3 per cent of those relate to alcohol. The same is true for illicit drugs.

Senator Maheu: We were talking about cannabis. You referred to cannabis treatment costs.

Dr. Rehm: In cannabis treatment, we have the costs overall for cannabis abuse and dependence. For example, KMH has specialized treatment sections and treatment just for cannabis use - people who are predominantly cannabis users. There are also the costs of other diseases associated with cannabis use. For example, a portion of the costs of lung cancers would be associated with cannabis, because most cannabis is consumed in cigarette form. It has a certain influence on lung cancers as with tobacco. Those would be the costs included in a calculation of the costs of cannabis use. In the Single et al. study, all the costs have been lumped together with the costs of illicit drugs.

Senator Maheu: I approached this subject because we have had witnesses who have declared that cannabis per se - marijuana, for example - is not addictive. I felt we were being led to believe there were practically no costs involved at all. I had read that soft drugs such as cannabis, become so soft after a time that it does not give its users the effective euphoria they need to feel good, which was probably the reason or the mind set they had when they started. Certain sectors of our society agree that the need to keep that feeling of euphoria leads to the use of stronger drugs. Cocaine is an example, and I am not sure where the users go after becoming addicted to cocaine. I do not remember reading anything about this impact in your report. I wondered what you thought about it, or do you feel there is any connection at all?

Dr. Rehm: If I may, there are two questions. Cannabis does have some harm and some costs associated with it. There is experimental evidence on both animals and humans that shows cannabis has effects on, for example, lung cancer in the same way as does smoking cigarettes. These are purely health effects. They are not necessarily associated with any euphoria. They come from the way cannabis is consumed in a cigarette form, either with tobacco, alone, rolled in or in a pipe, but all of those forms have some risks. None of those products, including alcohol and tobacco, have zero effects. We must look at those effects, try to quantify how bad are they and what to do.

In regard to your second question, there is a theory referred to as the "gateway hypothesis." That is, in what way can you say that cannabis use leads B overall, in some kind of necessary way B some people into other drugs such as cocaine and heroin - usually referred to as Aharder drugs. This is probably one of the most-researched hypotheses in the last 25 years. The evidence is not conclusive at this point.

People have stated historically that there is a clear succession of drugs in the life span. They say that you start with X, usually alcohol or tobacco, then comes cannabis, then cocaine, and depending on the culture, heroin. By all we know, in different countries, this is by no way a succession. There are cultures that start with a different drug to go on to other drugs. There are many people who do not go on to any harder drugs at all. There is no biological mechanism there. What we know is based on social and cultural evidence where a certain behaviour in certain persons has been shown to be associated with other drugs.

This is by no means an iron law or anything that you can say that we increase cannabis prevalence by 10 per cent, we can be sure to have 0.5 per cent more heroin users the next 10 years. It is not that way.

We believe that the statistical relationships are in some way linked to the behaviour or to the reactions of society. This means that in societies where cannabis is lumped together with all the illicit drugs in terms of prosecution and handling by society, those people are meeting the same drug dealers and do not find a way back into society. That is why this link is stronger in some societies than in others. According to the current research - which is not conclusive - there is no biological mechanism.

Senator Maheu: Do you have any way of explaining the increase in Vancouver in the number of deaths of HIV-infected users? I know that the committee is not studying HIV, but Vancouver always seems to be at the top of the list. Do you have any explanation for what could be the cause?

Dr. Rehm: We believe that it probably has a lot to do with the specific drug scene in Vancouver where a lot of the behaviours that can lead to HIV by needle sharing are still prevalent. All the established market economies, even the most restrictive societies, have needle-sharing programs. Sweden had the first needle- sharing program in 1987. Compared with countries where needles are given out by the state, the difference between Canada and Holland or parts of Germany or Switzerland is about 16-fold. While Canada has needle-sharing programs available, they are much more prevalent and much more easily accessible for the users in other jurisdictions. We believe those kinds of programs have an impact.

Senator Banks: In a few of your comparisons and in the charts that you used to illustrate them, you made comparisons between Canada and other countries on the one hand, and Amsterdam in particular and Switzerland on the other hand. I think that you demonstrated differences between those two comparisons.

You also referred to what we would call "decriminalization." You referred to it as "de-penalization." You spoke of that on one hand and legalization on the other hand. Would you tell us which of those regimes Amsterdam and Switzerland fall into? Are they decriminalized or legalized?

Dr. Rehm: None of those countries have full legalization because they all are in the international treaties. In compliance with those international treaties, the Dutch law states unequivocally that cannabis is illegal. However, in Holland, it is de facto legal. No one who is either using or selling cannabis would be prosecuted unless they violate some other rules. Those other rules would be things like overt advertising; it is forbidden to advertise on television, even though books listing the best types of cannabis and consumer reports for best buys are more or less allowed. There can be no hard drug sales on the premises, no selling to minors and no sales transactions.

Senator Banks: No sales transactions?

Dr. Rehm: There can be no sales transactions of a large number of drugs. There is a gram limit. You cannot buy two kilos or so.

Senator Banks: Retail, not wholesale.

Dr. Rehm: Exactly. The law stipulates no public disturbance, by the way.

The Holland situation basically says that consumption and selling is legal if you follow certain rules. In the Swiss situation, use is legal, and sales will not be allowed officially. However, sales under a certain gram amount will not be prosecuted.

You always must decide what to do about the users. You could, for example, make heroin use perfectly legal for an addicted person. That person could use heroin. He could not be put into prison for using heroin. At the same time, it might be illegal to sell heroin.

Both regimes are different degrees of decriminalization, however the degrees of such vary a great deal. The current knowledge states that the varying forms of decriminalization - decriminalizing use or private use or selling limited amounts - have not increased the overall prevalence of use and the harms.

Holland is the only country that has permitted cannabis to become a commercial product. In that country, the prevalence and the incidence of drug use and the harms increased. Part of those harms are of course the treatment figures.

In Canada there is a substantial amount of cannabis treatment occurring in the larger cities. I can provide you with the treatment statistics. In Toronto, at the institution where I work, there is continuing treatment for people who claim that cannabis abuse is their main problem. Only those numbers are calculated here.

There is much other cannabis use among people who are in treatment for the abuse of other substances such as heroin. Those numbers would not be included here.

Senator Banks: I presume that among the restrictions or prohibitions in Holland, is the sale of cannabis to children.

Dr. Rehm: Yes, that is correct. There are regulations concerning minors.

Senator Banks: We have heard, from another committee on which Senator Kenny and I serve, that children can purchase tobacco even though it is clearly illegal for a vendor to sell tobacco to minors and there are substantial penalties for doing so. We have heard from the children that they can get tobacco any time they want and anywhere they want. We know that there are horror stories about drugs being available to children in schools, particularly in inner cities, and elsewhere.

Has there been any experience in respect of that in Holland? Is the selling of cannabis or other drug products to children a problem in Holland? Is there an answer to that question?

Dr. Rehm: There are not always answers. We know that the prevalence rate of use of cannabis in standardized school surveys is not higher in the Netherlands than it is in Canada. However, that does not mean that minors in Holland do not have access to the drugs.

Senator Banks: However, it is not any worse.

Dr. Rehm: That is correct. Those surveys are comparable because actually, the World Health Organization is doing a survey of health behaviour of school-aged children and standardized protocols. Canada has been part of that for the last three rounds. Many European countries have been involved in this, and Canada is in no way any better at the upper end, than the European countries are.

Senator Banks: Taking that one step further, you have obviously thought about this a great deal and particularly its international implications. What would happen in a hypothetical situation where country A, which has strict anti-drug policies, aggressive enforcement, and no or low tolerance, is neighbouring on country B, which has the view to lessening crime by making drugs more available, and perhaps lessening the adverse effects of drug use and addiction by degrees of decriminalization? Is there not a danger that country B, by the process of osmosis will be inundated with many people it would rather not welcome?

Dr. Rehm: Well, the historical examples are clear. There is clearly a sufficient amount of drug tourism between different countries, as historical experience shows. This has led to provisions that for all the measures against hard drugs, the eligibility criteria are usually based on being a long-term citizen of this country.

For example, Switzerland closed the open drug scene and said that they would offer heroin-assisted substitution treatment, it was supposed to be offered in the place from which the drug addict came. Part of that was to remove people from cities like Zurich. Now, the treatment is offered in smaller centres all around Switzerland, in an effort to reintegrate those individuals to their local communities.

This has much to with historical reasons and the notion of a "home town" where a person is still a citizen. In Switzerland, one is first a citizen of a town and then a citizen of the country.

The same is true of Holland and Germany. Neither of those countries offers methadone treatment together with certain other forms of treatment to non-residents. That was one of the reasons to close the open public drug scenes, in addition to the reasons that I mentioned before. It was becoming a public nuisance; people were becoming afraid for the safety of themselves and their children. By closing the public drug scenes, they could rid the city of those who came just to get illicit drugs. People would buy their drugs and stay in the city, thereby causing much concern for the citizens.

There is still a considerable amount of cannabis drug traffic and tourism in Europe to those places where cannabis is decriminalized. There are different estimates of the number of people that go to Amsterdam just to purchase their supply of hashish and then return to surrounding countries. However, the problems associated with that kind of drug tourism, are judged to be not that difficult overall by most countries. The Dutch have internal calculations, which I do not think we can put a hand on, that they profit overall from that kind of tourism. People arrive, buy their 20 grams and then they leave.

Much of the public perception and many of the problems of those countries are about that drug tourism. Travellers go to another country where there is an open hard-drug scene. Often they will stay for a longer time, remain unemployed, and yet they need to find the money somewhere to pay for the drugs. In Canada you pay $47,000 per year and in Europe it is much higher. That is the kind of drug tourism that most countries try to avoid.

In all cases, you will not avoid all drug tourism. We know that whenever there are differing legislations in neighbouring countries, there will be streams of people moving from country A to country B.

Senator Rossiter: Following on with the Dutch experience, I believe that they will open cafés closer to the borders so that the tourists will not invade the downtown areas. Is that not true?

Dr. Rehm: That is true. However, they implemented a law known as the "decentralized implementation law." It stipulated that there should be more of those shops at the border. The situation is similar to that of the casinos. You pass the problem on to the neighbours and yet try to reap the profit.

Senator Rossiter: With the so-called "tourist trade", did that have anything to do with the lack of decrease in the use of cannabis at the cafés? Did it cause the use of cannabis to increase? Those people were not classified as non-residents when they went in to the cafés to buy the cannabis.

Dr. Rehm: Yes. The resident / non-resident rules are only for the hard drug provisions. You cannot receive treatments for the use of other drugs. Anyone can go into a coffee shop in Amsterdam and buy cannabis without a problem. They will not ask for your passport.

Senator Rossiter: Do the purchases that you and I would make, if we were there and so inclined, go into the statistics on drug usage?

Dr. Rehm: No. The increase in drug use in Holland has nothing to do with the tourism. It is based on surveys of the general population or of specific parts of the population, usually youth surveys or school surveys. Estimates are then made of the percentage of the Dutch population who would use cannabis.

Senator Rossiter: Have the cafés cleaned up the problem they were established to obviate? Cannabis cannot be used in public and amounts are limited. Have the cafés helped with public usage or over-usage?

Dr. Rehm: In terms of costs to society, people who patronize these cafés can no longer go to jail and destroy their entire career by smoking only 20 grams of cannabis in their life. Most patrons are less likely to have a police record. That is how the cafés have helped. Also, the cannabis activity was confined to one part of town. In the other parts, cannabis usage is not seen in public, so there is less nuisance. Citizens are not complaining about usage in front of the schools, for example.

The Chairman: Dr. Rehm, we have eight minutes to go but I have many more questions, so we will ask those in writing.

[Translation]

Is it possible to distinguish between the social costs of cannabis use and the costs related to other illegal substances?

Dr. Rehm: It is theoretically possible but you will not find much on that topic in the literature. In all the industrialized nations, you find, rather, a multiple drug abuse problem. This means that if in a Vancouver treatment centre, for example, you try to distinguish between heroin users and cocaine users, you will find that more than 80 per cent of heroin users also use cocaine at least once a week. It may very well be that the proportion is even higher than that. This means that one cannot really distinguish between these various substances. The least problematic of these distinctions is between those who use hard drugs and those who use other drugs. For example, 30 per cent of heroin users also have an alcohol problem. This means that you can distinguish between people who use hard drugs and those who do not. That is the only distinction you can make. But we do not normally make this distinction because at the research and prevention level we try to discourage any use of drugs. None of our programs specifically target heroin, for example. Our prevention programs focus on all drugs, both legal and illegal. You could make a distinction and focus only on cannabis, but some of the figures we have are rather artificial. There is a problem in deciding that some data apply only to heroin or cocaine users.

The Chairman: In the French version of the document posted on the web, we find a reference to a 1992 study suggesting that after having satisfactorily established drug addiction-related costs, there was a recommendation concerning the need to do three things. Were the three things recommended in that study ever done? If not, why not? If so, what were the results?

The authors of the study had to determine, first of all, which part of these costs might reasonably be avoided; secondly, to determine where it might be appropriate to invest resources in order to lower these costs; and, thirdly, do a follow-up study in order to verify the results of that investment.

I am asking you this because your name appears on this document. Let met quote a passage taken from it:

Only then will we be able to determine whether the policies and programs relating to substance abuse are justified in light of their benefits.

I have some problems with the financial terminology such as "investment benefit." Why are we not taking into account intangibles? Is it because they are too hard to calculate? Or is it simply because it would not be appropriate? I certainly hope that it is for this second reason, because if it is for the first, we should be able to find a way to include them. Most members of the public are concerned about these intangibles, these losses of life and these drops in the quality of life.

The three points that I raised are very specific recommenda tions drawn from your study of the various costs. Have those three research recommendations been taken up? What were the results?

[English]

Dr. Rehm: It is easier to respond to this question in English. I will certainly respond in writing.

The question of costs that are avoidable versus costs that are associated with the drugs is something that has been developed on a scientific basis over the last four or five years. Under the direction of the WHO and the Global Burden Study of Disease, guidelines were developed to distinguish between avoidable and unavoidable costs for risk factors, including illicit drug use. Previously it was not possible to apply such data cross-culturally. This recent scientific methodology allows us to make comparisons. I suspect a lot of the future research will stem from the WHO research. It takes time to develop this kind of knowledge.

Monitoring can only be done if there is a political will. Repeated cost studies must be supported by someone, by one of our funding agency. It would be supported by CIHR nowadays, but, overall, there must be a political will by the state of Canada to monitor those things.

A researcher can apply for money, but generally funding is only available for "one shot" B one cost study, for example. To establish a monitoring system is outside the realm of researchers, because it is a continuous effort. This effort must be made by policy makers.

With regard to intangible costs, there are many things we can discuss, but basically there are certain methodologies that allow us to measure many more intangible costs than we could have measured in 1992.

By the way, loss or death is not an intangible cost in that way. In the human capital approach, not all deaths are intangible; they are valued by how long those people could have worked and so forth. What is intangible is what the loss of a person means to their neighbours and families. That is what was intended in our calculations. Methodologies exist which could go further to incorporate those.

The Chairman: Thank you very much for your testimony this morning. Feel free to follow your testimony with other papers if you think it would be of interest for us.

Senators, our second witness today is Dr. Eric Single. Dr. Single obtained a Ph.D. in sociology from Columbia University in 1973. He is a professor of public health sciences at the University of Toronto. He is a research associate for the Canadian Centre on Substance Abuse and honorary professor at Curtin University, Perth Australia. He is president of his own consulting firm.

Dr. Single has 29 years of experience in research on addiction issues and has authored or co-authored 18 books, 27 chapters, 60 journal articles and numerous reports and other publications.

Dr. Single was the first research director of the CCSA and founding director of the Collaborative Program on Addictions at the University of Toronto. He has been a participant or director of eight WHO projects. In 1996, he completed a major study estimating morbidity, mortality and economic costs attributable to alcohol, tobacco and illicit drugs in Canada, which study we referred to earlier this morning.

In 1997, Dr. Single conducted an evaluation of the Australian National Drug Strategy on behalf of the Australian government. More recently, Dr. Single co-authored the WHO Alcohol Monitoring Guidelines and he coordinated a major review underpinning new drinking guidelines for Australia. He is currently evaluating the Alcohol Advisory Council of New Zealand and conducting a survey of problem gambling in Ontario. Perhaps he should do the same in Quebec.

Dr. Single chairs the CCSA National Working Group on Addictions Policy and regularly consults with international agencies on methodology, epidemiological monitoring and policy issues.

Welcome, Dr. Single. Please proceed.

Dr. Eric Single, Professor, Department of Public Health Science, University of Toronto: Honourable senators, I have been asked to comment on the National Drug Strategy of Australia, which I recently evaluated on behalf of the Common wealth government there. I was also asked to summarize a comparative analysis concerning the impact of cannabis decrimi nalization measures in Australia and the United States and discuss the implications of these two experiences on the Canadian situation.

In 1996, The Australian government asked me to evaluate their drug strategy B an evaluation that they do on a regular basis. They wanted to have an external evaluator. I was teamed up, sight unseen, with the head of their police college, Professor Timothy Rohl, and it turned out to be a very productive partnership.

The full copy of this report has been given to your director of research, Daniel Sansfacon. It is also available on the Internet and the reference is in the written version of my presentation.

At first blush, the key features of the National Drug Strategy are twofold. First, it is based on harmonization principles rather than a zero tolerance war on drugs approach. Like the Canadian strategy, it is a comprehensive approach. It includes both licit and illicit drugs under the same policy umbrella.

We found in it quite an impressive record of achievement in terms of the number and variety of prevention and treatment programming. In particular, they have created a very sound infrastructure for research. A decade and a half ago, Australia was not thought of by addictions researchers as a place to go for information. They were not well published and did not participate much in international fora, if at all. They created two national research centres; one in Sydney focussing on treatment and one in Perth focussing on prevention and epidemiological monitoring. Both of these centres have become world class organizations.

Perhaps the major feature of their drug strategy is that they have a very strong partnership between health and law enforcement. Over 90 per cent of the funding goes to health. Only a small proportion goes to law enforcement. However, health and law enforcement work together. The law enforcement community there has embraced harm reduction as a way to improve their community relations, as the epitome of community policing.

Law enforcement in Australia does not enjoy the high public esteem that it does here in Canada. Perhaps that is due to their history; law enforcement was, after all, the convict guards. As a result, the traditional police role of catching the bad guys and just enforcing the law has not helped them much in regard to their relations with the community. They really like the notion of community policing working with the community to deal with underlying problems that lead to crime. For that reason, rather than resisting harm reduction programming they have been very much an ally with health. That has been one of the key features of the drug policy in Australia, and that is not often seen from the outside.

When we looked at the objective indicators of outcomes of the drug strategy, we found that they had done an excellent job of identifying performance indicators and what should be looked at. They focussed on drug-related harms rather than drug use per se.

The balance of evidence showed that that had been reasonably successful. Smoking rates have declined. They have clearly become more moderate in their use of alcohol. There had been some increase in marijuana use over the previous five years at which I was asked to look, but there was no trend with regard to other illicit drugs such as heroin, amphetamines or cocaine. They were going up and down with no major changes in either direction.

However, many concerns emerged during the course of the evaluation. First, there was much confusion about the conceptual basis of the strategy. It was not entirely clear what "harm minimization" meant. To some people, it meant anything that it can be shown reduces harm, so it would include abstinence-based interventions such as therapeutic communities or the enforcement of drug laws that were presumed to reduce harm.

Other people saw harm minimization as being limited to use-tolerant strategies to reduce the likelihood and severity of harm among people who cannot reasonably be expected to stop using drugs it the present time. That is a somewhat different concept.

Therefore, one problem was that there was not a clear consensus of the conceptual basis of the strategy, which meant that it lacked a certain sense of strategic direction and how to prioritize things.

The targeting of interventions had some problems. There was relatively little attention given to high-risk groups such as the homeless, people with physical disabilities and problems with drug use among the aged. There was a lack of coordination with other strategies. There was a national strategy on hepatitis C and a national strategy on AIDS, for example, and I heard community groups saying that every time they asked for help they were told to go to another national strategy. They fell between the cracks.

The non-governmental groups felt that they were not being involved in the process as much as they could be. It was an interesting strategy and very different from Canada's in the sense that it was governed by a set of committees under which the majority of votes on the decision making bodies were given to the states even though the funds came from the federal government. It is an interesting idea.

The NGOs were not as involved. They did involve drug user groups even more than we do, but it was clear that even more could be done. Drug users groups are often people who are in treatment on methadone. In other words, they are usually not active illicit drug users at the present time. They are highly motivated to keep their friends from dying on the streets. I do not think we consult with them enough here either. They can tell you immediately whether a proposed policy or program will work. We can avoid mistakes if we check things out with them. I am not saying that we should necessarily put them in key decision making roles, but at the very least we would consult more closely with those groups.

There was also complaint in Australia that the strategy lacked leadership. It seemed to have no central office. If you asked a question, it could go to any one of 14 desks in the health bureaucracy.

There was also a sense of a lack of accountability. In the course of the evaluation, after a considerable period of time and effort we discovered that about half of the money was going to ongoing provision of services. This was explicitly against a resolution of the ministerial council on drug strategy that was running it. It was basically a SNAFU and a lack of accountability. The states wanted to give money to therapeutic communities, which, after all, are very deserving and for which there should be funding. However, the drug strategy was not meant to be a source of funding for them; it was meant purely for new and innovative programming. Like Canada`s strategy, it was meant to be the rudder that would steer the ship. A national drug strategy with special funding typically is not the whole response to drug problems on the part of government. The general response will be to involve law enforcement, health programming, the health care system, and all the things that are funded through normal channels. Special drug strategy money is usually meant to be devoted to new and innovative programming, which should be seen as the rudder that steers the ship.

Those were the problems that we uncovered and attempted to document. We thought about having a large amount of detailed recommendations. They had done an evaluation five years earlier, which was an excellent evaluation called "No Quick Fix." It was done by a blue-ribbon panel of about 12 experts, and they had 18 months and a larger budget than we had. They came up with an excellent report. The one big problem was that they had some 130 recommendations. The very first question that I asked when I got there was, "What did you do about those 130 some odd recommendations from the last evaluation?" They gave a report with some arm-twisting, but as expected, on the first 15, there was something done, on the next 15, a little bit done, and that was it. They ran out of steam and budget.

We decided early on that we would limit ourselves to a small number of strategic recommendations rather than a large number of specific ones.

There were seven. We recommended that they strengthen the partnerships and expand them to the local level; that they create a dedicated unit to provide leadership, or help provide it, and a better ability to manage, particularly to improve the accountability within the strategy; that they do more to train mainstream health and law enforcement community people at the ground level about specialized training in alcohol, tobacco and drug issues; that they improve the cost effectiveness of treatment and prevention in research, having a required minimum amount of evaluation studies for their programming so they do not do things without evidence of effectiveness; that they make new developments more readily available, which involved a suggestion that they create a national clearinghouse much like we have here; that they enhance the involvement and effectiveness of law enforcement, and particularly that they have a lot of harm reduction programs done jointly with health and law enforcement officials; and that they redirect cost-sharing funds from ongoing services to the development of new and innovative programming.

I have not been able to monitor it; it was not part of my job to monitor what they did afterwards. However, I have been back a few times for other reasons, and it appears they have done a reasonably good job of following up on the recommendations. They did make a commitment to renew the strategy for five years. They had planned to sunset it at three at that point. They created a specialized national drug strategy unit within the Commonwealth Ministry of Health, and it is my understanding that they are doing a better job of monitoring how the money is spent and making sure that there is accountability. For each of the others, they actually have action plans with deadlines and people responsible and so forth. It was gratifying that they really did something about it. I do not really enjoy doing things that lead to nothing.

That contrasts somewhat sharply with the evaluation of Canada's drug strategy that was conducted when the second five-year period ended in 1997. That evaluation was purely a process evaluation. It did not look at any objective outcome indicators about whether or not the strategy was a success, and it was commissioned through a private research firm after a political decision had already been made to end the strategy. It seemed to me like a bit of waste of money. I suppose that would be is instructive if and when the government decides to develop a new strategy. It seemed like a funny decision to have an evaluation conducted after you have already made a decision to end the program.

The Australian experience has implications for the develop ment of a clear sense of strategic direction priorities in our drug policy - whether we have a new drug policy or not. As you know, the Red Book promises to have a new drug strategy, and I understand it is being given strong consideration right now. Currently, we certainly lack a clear sense of direction about where we are going in the drug area. I am sure that is very much shared by you; otherwise this committee would not have been created.

From its inception in 1987 until it ended in 1997, Canada's drug strategy really lacked that clear sense of direction. It certainly did not have as clear a sense of direction as it might have. It was nominally based on harm reduction; its goal was to reduce drug-limited harm. It sounded like a harm minimization strategy. The concept was an all-encompassing concept of harm reduction, that is, anything that aims at reducing drug-related harm. All drug interventions, all drug programs and policies, aim at reducing drug-related harm. In a way, you almost need to have that conceptualization for a national strategy - at least, we have thought so up to now - because you do not want to exclude drug enforcement or interventions like therapeutic communities. They are an important part of how society needs to deal with drug problems. Certainly an argument can be made that therapeutic communities do reduce drug-related harm. We just do not have the evidence regarding drug enforcement. However, if you are saying our goal is to reduce harm and everything attempts to do this, it gives you no sense of where the priorities are or where your strategic direction should be.

A second problem with our drug strategy in the past is that when special funds were made available, as they were for 10 years during the period of Canada's drug strategy, all the decision making was still placed in the hands of the federal government. It was a top-down strategy. "We have this money, and here is how we want to spend it. We want to share some with you. We will consult with you, but we make the decisions." Priorities among interventions that were competing for funding were never made clear. The NGOs and other interested parties often expressed that they did not feel they were meaningfully involved, and there was not a clear consensus of where the strategy should be going, where the priorities should be set, and what the performance indicators should be. There was no research strategy attached as well. There was only the commissioning of an external evaluation process only after the decision was made to end the strategy.

Since then, of course, we have had no funding whatsoever from the drug strategy. The situation is even worse now. You have funding cutbacks not only at the federal level but also at the provincial level, and the research infrastructure has been badly damaged. There are very few senior people left. I do not know how some other people in the room feel about that, but I am feeling a little lonely. It was nice to see Dr. Rehm again. He used to be here full-time, and he has gone back to Europe. Worse yet is that many of promising, new, young researchers are moving into other fields or other countries. There has been a lot damage done. We were once one of the leading countries in the world when it came to addiction research. That certainly is no longer true.

I offer three suggestions, if we move towards a new national drug strategy, on how we might develop a better sense of strategic directions and priorities in the future. We should make sure there is full participation by all the key stakeholders, better than what it was in the past, and not just in terms of being consulted but actually having decision-making roles. The kind of structure they have for the Australian drug strategy may not be perfect and it might not be exactly right for Canada. However, it does have a feature we should try to emulate in some way or another, which is that you get a meaningful involvement of the partners in the strategy. Australian health and law enforcement ministries at the state and federal level are included in the two major committees that make the key decisions on the strategy. The federal government actually has a minority of the votes. I am not saying that should be replicated here, but we should find ways to more actively engage the key partners. That brings a political buy-in, and it ensures that it is being considered at different levels and appropriate places.

There are other aspects about the way they involve them that are really worth looking at closely. Every five-year phase of the strategy for the last two phases has been kicked off by a national conference. Special expert working groups meet in preparation for this conference. The key purpose the conference is not simply to showcase what we are doing here as opposed to there - which is how our conferences tend to be, although we have not one been since 1989 in Canada on drugs. Our purpose should be to agree on what should be the guiding principles, the goals, and the major activities of the drug strategy, and to define specific performance indicators that would allow us to assess whether or not those interventions were really working and paying off the investment that government was making in them.

As a result, by identifying performance indicators they also lay out a research strategy designed to monitor those performance indicators. As a companion to our document, they publish a special volume analyzing the trends in the key performance indicators. I will leave a copy of this with your director of research.

Before we begin anything, let us develop a consensus about the priorities. We must decide what should be the major activities and approaches, and what will be the performance indicators.

A second way to improve drug strategy - particularly if there is a new national drug strategy - is to base it on harm reduction. Everyone agrees with that approach, but we should have a clearer sense of what that means than we have had in the past. Rather than assuming the all-inclusive sense of harm reduction, meaning anything that attempts to reduce harm, or the more specific traditional meaning, including the use of such measures as syringe exchange aimed at preventing drug-related harm among people who cannot be expected to cease their drug use at the present time, we should base harm reduction on a different conceptual vision altogether. It is an empirical concept. Something would be considered harm reduction only if the weight of evidence - we cannot be strict about this because we do not have much evidence - indicates that it will produce a net reduction in drug-related harm.

There are some drawbacks to that approach. This is not the way people normally think of harm reduction. You would need a communication strategy to address that problem. You do not want this approach to become a barrier to innovation. New things will not have supporting evidence. You must give them some time to develop; you must create special innovation funds and incentives in other ways.

Perhaps the most important drawback to it is that we simply do not know. We have been flying in the dark for a long time. We have been putting most of our resources into interventions with unknown effectiveness. Because of that, we then need a commitment to research and evaluation. We must research and evaluate at least the key major approaches and get a sense of whether they are doing what they are intended to do, if only to fine-tune them if they are working. Then we can raise the issue that perhaps we should not be investing so much in something if it does not appear to be working.

Although recognizing that we will be lacking evidence, that is a good long-term solution, but it is a long term. With regard to the short and medium term over the next few years, it will take a long time to develop the information needed to have a more reasonable empirical basis for judging between alternative strategies and interventions.

In the meantime, a third way we can give the new strategy a better sense of direction is to get a broad consensus around the principles guiding these priorities until we have better evidence. This is very much in the tradition of harm reduction.

I think the first principle should be to do no harm. It is part of the Hippocratic oath. Certainly, medical doctors would agree with that. It points to the need to consider not only immediate impacts but a full range of impacts, including unanticipated consequences such as stigmatization of users and barriers you create to outreach. You must consider all those things when you judge the extent to which you are producing harm.

It should be a consensual process that leads to the developing of principles. Another principle might be the focus on harms caused by drug use, not just use per se. Another might be to maximize the intervention options available to the front line health care and law enforcement workers, including the officers on the street, when dealing with someone with a drug problem. Very often these workers' hands are tied. They have but one option and that is not necessarily the most effective one.

One must choose appropriate outcome goals, giving priority to the programs that have realistic, practical goals.

Harm reduction programming should not be regarded to be in conflict with abstinence-oriented programming. Very often harm reduction becomes outreach. Most drug users dependent on the use of drugs want to get off their dependency. Just ask any smoker. The vast majority of those who are dependent on drugs want to end their dependency. Very often harm reduction measures such as syringe exchange becomes outreach; they become ways of getting people into counselling and into the treatment system. Those who are not ready to make that big step are moved along the way. Harm reduction does give priority to immediate realizable goals but does not conflict at all with the eventual goal of abstention.

Harm reduction programs have generally been shown to be successful. They have not led to increased rates of use, as many people had reasonably feared. A big reason for that is likely that as people were brought into treatment, the numbers of users was reduced.

A number of other principles along those lines are mentioned. As I said, it is not so important what I think the principles should be. I would suggest that they should come from a consensual process among key stakeholders involved.

I come to the second part. I have also been asked to discuss a policy analysis that I conducted with Paul Christie and Robert Ali from the Drug and Alcohol Services Council in South Australia. We published recently in a policy journal an article on the impact of cannabis decriminalization measures in Australia and the United States.

This is somewhat different from the topic of the national drug strategy. I did not try to merge the two together because Australian states have a fair amount of leeway in how they deal with drug policy issues. They have not decriminalized every where. They have done so in South Australia and the Australian Capital Territory. In Western Australia now they have an expiation system in place and they are considering it elsewhere, but they have not done it everywhere.

The experience in both the U.S. and Australia has been quite successful. There have been clear benefits with very few adverse consequences. They have not been without problems entirely. I should point out that the term "decriminalization" suggests it is not against the law to possess cannabis in these places. That is not true. I do not know where the misnomer began. I think it began in the United States in the 1970s. At a certain point, in the press and even among researchers, we began to see the term "decriminalization" used to refer to measures that eliminated jail as a sentencing option and that reduced cannabis possession to a fine only. It depends on how one defines "criminal offence." There are still criminal offences that may be called misdemeanors or violations that are handled by the criminal justice system. Persons are still subject to arrest and penalties, although the penalties do not include incarceration. It is an important point to bear in mind. We are not talking about true decriminalization; we are talking about de-penalization - eliminating jail penalties.

In Australia, South Australia particularly, there is an expiation model of decriminalization where offenders are given the opportunity to pay a small administrative fee to expiate an offence. They are detected by a police officer and are given an expiation notice telling them to appear in court on a certain date or to pay that fee, which ends the process. The fee is around $100, and up to $150 in several jurisdictions now. It effectively ends the criminal processing before it begins, so there is no criminal record created. It reduces criminal justice costs and brings in income in the form of these expiation fees.

It was intended to reduce the adverse individual consequences arising from a criminal conviction for cannabis possession, which was felt to be too severe a penalty for the crime.

However, the police apprehended a significantly greater number of users when the expiation notice came in, suggesting they were holding back from enforcing the law because they themselves felt it was too severe. As soon as the expiation notice came in, the number of people apprehended for cannabis possession more than doubled.

At the same time, about 48 per cent - slightly less than half of the apprehended offenders - expiated their notice. Less than half sent in the fees. There was an increase in the burden because more cannabis possession cases were being thrown into the courts. The criminal justice costs were still reduced by the introduction of this measure, and we have the detailed data in the policy journal. Clearly, there were some implementation prob lems. They are correcting that now and giving out information with the notice about the criminal record consequences if offenders fail to pay the fee. For example, 10 years down the line they might not be able to enter certain professions that require good character. They are getting a higher rate of expiation as a result of that.

In Australia, they had these problems, it did not go smoothly and they had to fine-tune and improve it. There was no increase in drug use attributable to the decriminalization measures, and there were cost savings. The measure was generally successful and viewed as a success by the public.

In the United States, they did not have such implementation problems. In those states there was a change in penalties but - while the evidence is not as good as it could be - rates of cannabis use did not increase in any way attributable to these decriminalization measures and there were significant savings, particularly to the criminal justice system.

Ironically, it is not viewed as a big success in the United States. No state has decriminalized, one state has recriminalized and no other states have decriminalized cannabis since the 1970s. The results suggest something about the limited role empirical evidence has to play in public perceptions on these issues.

I have offered a few observations from the work I have done in evaluating the NDS in Australia and in doing research on the impact of decriminalization measures. The decriminalization evidence clearly suggests that removal of jail penalties for cannabis possession is likely to reduce enforcement and other costs without leading to increases in rates of use. There will be a need for fine-tuning, depending on the option that is used. There should be a comprehensive research plan to monitor the impacts and there should be communication strategies to ensure the public does not misinterpret the new policies as indicating any less official concern about the adverse social and health consequences that can arise from cannabis use.

With regard to the Australian evaluation, we should be thinking about how we can make our drug policy more inclusive of the stakeholders, whether there is a new national strategy or not. We should agree on guiding principles to set priorities and adopt, as best we can over time with increased investment, research and evaluation, an empirical concept of harm reduction. Let us invest in the things we know are working.

The Chairman: Thank you for your testimony, and I already have a list of senators who wish to ask you questions.

Senator Rossiter: Dr. Single, I have read your treatise last week. First, let us try to get finite definitions for decriminaliz ation, depenalization and legalization. They seem to be confused, and they have been used a great deal.

Dr. Single: No central authority dictates the meaning of these terms. The way I use them, and I think the majority of researchers would agree, is as follows. "Decriminalization" refers to measures where a particular behaviour, in this case, cannabis possession, is not subject to criminal penalties. It is not a criminal offence.

"De-penalization" would be a less extreme measure compared to the status quo, where there may be a criminal offence but it is not subject to a penal sanction such as incarceration and be subject to a fine only or community service or other forms of non-incarcerative options.

"Legalization" would be a decriminalization situation where there is a legal source of supply. Of course, another complication is whether you are talking about de jure or de facto. The Amsterdam situation that Dr. Rhem spoke about is a de facto legalization because there is a legal source of supply. It goes beyond decriminalization.

Senator Rossiter: Using the word "possession" in this context is possession for personal use. What about possession for the purpose of trafficking?

Dr. Single: That is another way to make distinctions. You could decriminalize possession, but not other offences, such as possession for the purpose of trafficking or trafficking itself. It is another wrinkle.

Senator Rossiter: With respect to public perception, I do not know which one people would dislike more, decriminalization or legalization. In a way, they both mean almost the same thing.

Dr. Single: Yes, strictly speaking, there is not a big difference. I cannot think of a historical example of a decriminalized situation without some legal source of supply. Usually they go together. This confusion arose in the 1970s in the United States when de-penalization measures got called decriminalization. I always used to put decriminalization in quotations whenever I used the word because of that. That was confusing people, too.

Senator Rossiter: Is there any other terminology that would be less confusing?

Dr. Single: Once in a while people have proposed new terms, but they have never caught on. Those three are the major options, the status quo. De-penalization would have milder penalties. Decriminalization would make possession not subject to criminal penalties at all but not have a legal source of supply. Legalization would have a legal source of supply. That is how I think of it.

Senator Banks: Continuing along Senator Rossiter's line of questions, the non-penal option is like a traffic ticket. You can pay this money, and if you do not pay, you must show up some place. It is putting it into almost that category. I would have a hard time explaining or justifying that to someone who is opposed to illicit drug use on moral as opposed to practical grounds. That is a comment, not a question.

To what extent is Canada constrained in its freedom of motion or options by international conventions or treaties or obligations to which it is committed?

Dr. Single: It is not as constrained as many people may think. I looked into that in some detail in a project I did with others for the Parliament of Victoria in Australia. The Parliament asked whether reforming its cannabis law would lead to possible violation of international treaties. It depends on the extent to which the Parliament reformed the law, but, clearly, the removal of jail penalties would not be a violation of any international treaties. There is no difficulty with that.

The removal of all criminal penalties where there was not even a fine, that is, decriminalization, is a somewhat contentious measure. Some interpretations suggest that is permitted and even that has been recognized. The Dutch option keeps it de jure decriminalized. It is against the law in the Netherlands to possess cannabis, and yet they sell it in coffee shops.

A difference is made between de jure and de facto. That is against the Canadian way of doing things, so it is not a realistic option here. That is the way that some countries have dealt with the treaty issue. They say "We are agreeing with the treaties because we keep the law on the books." However, at the same time, in a de facto way they have changed the policy entirely.

Senator Banks: Wink-wink, nudge-nudge.

Dr. Single: It is the wink-wink, nudge-nudge approach.

Senator Banks: There would seem to be a terrible danger if a country were to either legalize personal possession, decriminalize personal possession or de-penalize personal possession without a commensurate change in the application of the law to persons who were trafficking. One assumes that there would be more users of cannabis. As you have made this distinction, there is no legal source then the source becomes by definition illegal, and that is a criminal activity that has all sorts of other implications.

I am assuming that that is a sort of conventional wisdom. Are there any countries in which possession is okay but the book will be thrown at you if you are caught trafficking, aside from Canada?

Dr. Single: I cannot think of a historical example of true decriminalization where it is not against the law to possess but there is no legal source of supply. There may be in some exotic place. In Australia and the U.S., they removed the criminal penalties that included jail. However, it is still an offence. In the U.S, for example, there is no legal source of supply. Australia, recognizing this problem, included cultivation of up to 10 plants as an expiatable offence. That became a problem. They have reduced it now to three. It is still not legal but if there were fewer than three plants, the charge would not be the serious offence of cultivating with the purpose of trafficking.

Senator Banks: Is there not some sophistry in Canada currently? Is there not some sort of elaborate dance of illusion happening in Canada? We do not put people in jail for simple possession. We do not prosecute someone for the charge of simple possession, if it is for his or her own use.

On the other hand, we go as hard as we possibly can at people who are providing these people who are in the wink-wink, nudge-nudge category. The fellows selling it could be put in jail forever.

Dr. Single: In fact, we do put people in jail for cannabis possession in this country, in fairly substantial numbers. Members of the press think of their friends, and they cannot think of any one who has gone to jail. However, it is usually the poor people who cannot afford to pay fines who go to jail.

We are still arresting 30,000 to 40,000 people a year on drug charges. There has been a clear change in police priorities. It once was that 90 per cent of drug charges were cannabis possession; now, cannabis possession is only about half. I do not have the exact figures but it is around that order now.

Clearly, the police have moved their priorities toward the harder drugs and trafficking offences. I do not mean to criticize them in that regard. They are doing their job, but we are still arresting thousands of cannabis offenders each year. A portion of those are not able to pay the fines and end up in jail. I have not looked at the detailed numbers but in the late 1980s and early 1990s, there were 1000 people to 2000 people being jailed each year for cannabis possession. That is the answer to the first question.

The Chairman: We will have a witness this afternoon who will address that situation specifically. He will have the exact numbers.

Dr. Single: In regards to the second question, even if we were not jailing any offenders, does it not make sense? That is, if it is de facto policy, why do we not make it the real policy? If there is a good reason why we should not be enforcing this law, maybe we should not be having that law? I do not like having things being done by government bureaucracies rather than by govern ment policy.

Senator Maheu: Dr. Single, I think that I understood what you were saying about decriminalization and de-penalization versus legalization. I was surprised to hear about the expiation fee being applied in Australia. It does sound like a traffic ticket. I agree with Senator Banks on that one. That would be under the de-penaliz ation issue.

We were talking with Dr. Rehm about the re-election of politicians in Europe who were hesitant to legalize or decriminalize the use of cannabis or the possession of cannabis. I think that the same thing would apply in Canada. The day that any of our politicians dare come out with a rule like that, the newspapers would twist it to the legalization of drugs in any event. It is a very touchy issue.

I wonder if you could share with me two things. I would like for you to discuss the gateway hypothesis. Also, there are 11 states that have legalized or decriminalized the use of cannabis. What about the federal laws intervening over the state laws because the federal government has not taken that route? What would happen with the federal laws predominating over the state laws?

Dr. Single: I am not a lawyer or legal expert. In the United States, when you break a law you might be breaking a municipal, state or federal law. All three jurisdictional levels are allowed to make criminal law. In Canada, criminal law is purely in the realm of the federal government.

In the States, generally, the lower level of government takes precedence in terms of enforcement. The higher level steps in if serious constitutional issues are involved. Even a municipal law could over precedence over state law.

One of the important pieces of evidence about the impact of decriminalization comes from the community of Ann Arbour, Michigan. They went through major changes in a short period of time. They had a $5 fine for possession of cannabis. University of Michigan students had control of the town council and passed this incredibly lenient law about cannabis. The townspeople regained control of the town council and instituted a tough law against cannabis possession. A referendum was held which brought the severity back down. This all happened in a short period of time. During that same period, a study happened to be underway. The study was not on the topic of decriminalization, but it did ask if the persons used cannabis.

They found that during each of those changes in the law, there was no change in the rates of cannabis use. Basically, it was demonstrated that the law is not having the deterrent effect that we think that it is. No matter the penalties, the law is not having a deterrent effect.

Senator Maheu: Are we right in assuming that no matter what the consequences, we are not seeing a decrease in the use of cannabis?

Dr. Single: Decriminalization measures are not really designed to decrease use. They are designed to reduce costs and reduce the adverse consequences to individual users. You would not expect use to decrease. You are hoping that it would not increase use. That appears to be what has happened generally.

With regard to the gateway theory, there does not seem to be a causal connection to the use of other drugs as well when this is happening. I have been involved in the gateway controversy twice in my career. Once was in looking at whether drug use is a uni-dimensional phenomenon. That is, does it fit a scale gram analysis. Does it show that people who are using hard drugs started with marijuana or started with something else? It determines the route of substances that were used. This analysis is used to test if a phenomenon is a uni-dimensional phenomenon. Is it sharing the same root causes, and so forth? Marijuana use does indeed scale with the use of various types of psychedelics and other so-called hard drugs.

However, alcohol use among adolescents scales even better. There is no biological mechanism; it just shows that the use of any psychoactive substance is correlated strongly with the use of something else. If there is a progression, it does not start with cannabis; it starts with children watching TV advertisements that show people popping pills to make them feel better. It all starts with legal drugs, not with illegal drugs.

A second personal research in which I was involved concerned the gateway theory. We did an empirical test of what is called the socio-cultural theory about drug escalation. That theory suggests that it is not cannabis that leads to an escalation to other drugs, but rather it is the fact that by making it illegal, the user is being introduced to an illegal drug subculture.

I did a certain degree of empirical testing by looking at whether adolescents got involved in dealing. That is, they got involved with buying greater quantities of drugs than they needed for personal use, and so they distributed to friends or sold the drugs commercially.

The heaviest marijuana users were the ones most likely to move on to other drugs. If you controlled involvement in buying and selling, that relationship disappeared. It was not that the level of marijuana use led to the use of hard drugs, it was that the level of marijuana use led to buying and selling. It really suggested that the illegalization of cannabis, by forcing users into the illicit drug market, was promoting drug escalation. It does not say what would happen if it were not that way.

Again, the simple fact is there is no causal connection shown in the statement that the more you use marijuana, the more likely you are to use hard drugs. The same thing could be said about alcohol or tobacco.

Senator Banks: We know that a youth tobacco reduction program, which is now in place in California, has been extremely effective. It has reduced youth smoking from above 30 per cent down to 6.9 per cent, which is a substantial reduction. The program requires certain critical mass funding and must be entirely comprehensive program to achieve that. Similar results are being achieved in other places that have that same critical mass of funding. This has nothing to do with decriminalization because we are talking about tobacco. It has to do with changing mindsets, lifestyles, and the rationale of spending that amount of money is based on the assumption that if someone does not start smoking before the age of 18 years, they will never start.

These things are, obviously, equally addictive. We create deterrents, but I still buy cigarettes. Once I commented that if cigarettes ever got $1, that would be it. None of those things have stopped people from smoking this comprehensive program does.

Do you think that changing mindsets would have an equal application to other addictive drugs?

Historically, what is the rationale between the legality of tobacco and alcohol on the one hand, both of which kill many people every year, and the illicit drugs, which kill far fewer people every year? The general harm - the comprehensive harm - of the illegal drugs is far less than the two legal drugs, which we have arbitrarily deemed to be "just addictions" and so they are acceptable. The illicit drug addictions, which do not kill as many people, are not acceptable. What is the rationale behind that, historically? How did we reach this point?

Dr. Single: Exactly. I believe that it is a historical question, and I will deal the second one first. I have estimated alcohol and tobacco morbidity and mortality. It is striking how these "acceptable" substances receive much less attention in public policy than do illicit drugs. Tobacco, for example, gets far less attention in public policy, despite the fact that it kills in the order of 40 to 50 times more people each year in Canada than illicit drugs. Tobacco accounts for one in five deaths in Canada each year.

That is a substantial burden, and yet we spend relatively little on prevention and research in that area. Yet, we spend $400 million in drug enforcement for something that kills fewer people. This is an almost universal phenomenon; it is much the same in other countries as well. It has to do with the history and the politics of the problems - the smokers die quietly. They do not create a big ruckus, commit crimes on other people to support their habit, create public messes and they are not embarrassing testimony to failures in our social system. When you see a drug addict in the street, it is an embarrassing testimony to our social failures.

In doing cost studies, the estimates of morbidity and mortality must be done to estimate costs. These findings are politically neutral. They show, on the one hand, that something is out of balance. Why are we giving so much attention and spending so much money on a drug problem that does not seem to cost society that much? On the other hand, if we go too far in terms of reform, we could make it too readily available.

Look at the cost when you have a legal substance. It is policy neutral. The results of cost studies inform both sides of the issue, but they do not come down heavily on one side or the other. That is the kind of research that I like to do.

In respect to the prevention of smoking in California, I am not familiar with that program. I know they have had successes with alcohol, where they invested huge amounts of money that we do not have in Canada. It was very comprehensive.

I am not sure that you would have the same kind of success with illicit drugs as you would have with smoking, for a number of reasons, even though smoking is more addictive. It is hopeful though. In the adolescent subculture of California, smoking is not the thing to do. It has lost its appeal and glamour. That has not happened with us in Canada - particularly among young women. However, there is hope that it could happen.

Particularly for cannabis users - not so much for other users, because a higher proportion of them are dependent - it is hard to convince people that they really need to give it up. It is not like smoking cigarettes where you see pictures of black lungs on the packages that you buy. There is a general acceptance that smoking tobacco is really bad for your health.

Many cannabis users do not really believe that. Prevention must work on that. There are realistic risks to health involved in using cannabis. We must emphasize that with realistic informa tion, not scare tactics, because these just produce interest in drugs and higher rates of drug use.

The Chairman: Dr. Single, I wish to talk about the situation in Australia. One of the comparisons with Canada is the Aboriginal population. In Australia, the overall number of Aboriginals is about 350,000, or 2 per cent of the population, located mainly in two northern territories. In your examination of the evaluation of the strategy, what is your appreciation of the effort toward that community in Australia?

Dr. Single: They are very similar, unfortunately. It is a very sad situation in both places. There are high rates of alcohol and drug problems and smoking. The average native Canadian lives 10 years less than the average non-native Canadian. There is a huge rate of accidental death. Probably a fair portion of the lower longevity is simply because of alcohol and drug use and smoking rates.

The situation is almost identical in Australia and other countries see similar problems with their Aboriginal populations. Illicit drug use is less of a problem than petrol-sniffing and alcohol, although their rates of illicit drug use are higher than the rest of the population.

The apparent lack of effectiveness of attempted intervention has been frustrating. They have moved toward a model wherein Aboriginals design their own programming and are in charge. They focus on training the Aboriginal community to use the tools available to them. A model of outsiders coming in has not worked. Community-based efforts work better. That is the thinking in Canada as well.

I did not attempt to make any recommendations there. An appropriate balance of effort exists for the dedicated resources thus far. The problem is humbling. It stumps me. Most researchers would agree that the native communities themselves must point the way in dealing with native problems.

The Chairman: The Australian experience is interesting for the partnership aspect. Canada could learn a lot from that partnership. I am not just talking about law enforcement and the medical field. I am also talking about governments. Was the Aboriginal community a part of the community partnership in the beginning? Is it now?

Dr. Single: Special funding is given. One the world's leading researchers and program developers in that area is a woman named Maggie Brady. She works closely with the Australian government. She wrote a great book, The Grog Book: Strengthening Indigenous Community Action on Alcohol, about how to deal with alcohol and drug problems in the community. Perhaps the models she offers would be useful for native Canadian people trying to deal with the native Canadian substance abuse problems. The exchange of ideas is important and the Aboriginal communities hold regular international conferences.

The Chairman: Were they around the table when the strategy was developed in Australia?

Dr. Single: No, but they did receive a fair share of the money. The ministers, cabinet-level people, were at the table when the strategy was developed by the state and the federal governments. The Aboriginal were not excluded any more than anyone else.

The Chairman: So there were ministers from three levels of government. Can you give some kind of sketch on how the strategy was started and its structure?

Dr. Single: That is in chapter 2 of the report.

The Chairman: I will look at that. The territorial ministers at that table had responsibility over Aboriginal people?

Dr. Single: Yes.

The Chairman: What was the concern discussed around the table on Aboriginal affairs?

Dr. Single: The main concern was the health problems associated with prolonged heavy alcohol use and petrol-sniffing. That was the big problem, the major concern that I am aware of.

The Chairman: We will try to read the reports that you referenced. We may hear from that person to help us understand and make recommendations to our own communities.

In Australia, they have one three-prong strategy including tobacco, alcohol and illicit drugs. Should we do the same in Canada?

Dr. Single: That is a good question; definitely alcohol and drugs should be together. There are so many cost-efficiencies and so many commonalities involved. There are common underlying personality correlates and common, underlying needs. There is a lot of multiple drug use; almost everyone who is requires treatment for dependency on illicit drugs is also a heavy alcohol user. So it does not make sense to deal with them separately. There may be some advantages to distinguishing, but a comprehensive approach is more cost-effective.

Traditionally, tobacco has been split off. I have not decided, personally, whether tobacco should be under the same policy umbrella. Tobacco and drug use involve different problems but they do overlap to some extent. A good argument can be made for putting tobacco in the same strategy, but it would not bother me if they were kept separate for the time being. In the long run, the cost-effectiveness calls for inclusion of drugs, tobacco and alcohol. Pharmaceutical misuse also tells us a lot about illicit drug problems and vice versa.

Senator Kenny: The witness very quickly moved on to answer the concern that I had. I would observe that tobacco use is often a precursor to illicit drug use. One of the principle differences is that tobacco use happens sooner than alcohol abuse or drug use but, as it moves down the road, the same family of people seem to move with the pattern of usage. I was very interested in the answer.

Dr. Single: We are now developing a policy discussion paper by the National Working Group that I chair for the Canadian Centre on Substance Abuse on smoking policies in alcohol and drug rehabilitation. When we reviewed the literature, I learned that the improvements are greater if smoking cessation programs are included. If you have ever gone to an AA meeting, you know the smoke is usually heavy. There is a tendency for people breaking a dependency to compensate by depending more on another substance. Improved outcomes are seen when rehabilitation is combined with voluntary smoking cessation programs.

The Chairman: I think that Australia has moved to copy the Americans on mandatory sentencing for the Aboriginal youth population. Did you evaluate that area at all?

Dr. Single: That would be an evaluation of the policy itself. We did not really address that.

The Chairman: What were the first steps in Australia toward a national strategy? What was the level of involvement of the population per se? I am not saying that an MP or a senator or an elected representative is not a proper representative of his population, but I want to go beyond that to the general population. Did they have any involvement in the process?

Dr. Single: Initially, they had virtually none. The strategy started off very much as a top-down program. It started because the prime minister at the time had a daughter who had a heroin problem. He was shocked by that. He called a national drug summit with all the state premiers. They created a national drug strategy with the ministerial council - the highest level ministers of Justice and Health from each state in the territory. They dedicated funding for five years and that was later renewed for five more years. It started from the top down.

It started because of a personal problem in the Prime Minister's own family. It could have easily turned into a war on drugs. This could have happened but it did not happen largely because of the Health minister at the time, who was intrigued with what was starting in Europe at the time: harm reduction strategies. He went to the experts - what local expertise they had in Australia - and the people at the program level, people dealing with drug addicts in emergency rooms. They decided that it should be a strategy based on harm reduction.

Even though it started from the top, they did work it down with much greater involvement - at least of the states. Some NGOs are involved in an advisory way. They farmed out the clearinghouse to a major NGO. They have done a better job of creating a partnership among the different levels of government and non-governmental organizations and different ministries within government.

The Chairman: What is the level of understanding or sharing between the population and the learned community and facts and figures and knowledge on the issues and getting rid of myth and really focussing on the problem? What is the level of understanding by the general population in Australia on those subjects? Is it like in Canada, where everyone has an opinion? Is it an opinion based on facts, or do they have a more "educated" opinion?

Dr. Single: I have an impression they have distinctly better educated opinion, but then mine could be biased, because I had public hearings in all the state and territorial capitals as part of the evaluation process. The people who have come forward have educated themselves on these issues and so forth.

The other evidence is not just that. I see more sophisticated reactions to problems that have emerged. For example, when a child dies from a drug overdose in Canada, the reaction to the horrible event is that everyone feels sad, perhaps a politician will call for stiffer penalties for drug dealers. In Australia, the parents will often criticize the government for having turned their child into a criminal and forced them away from treatment by these policies. The reaction is very different and a much more sophisticated response to a terrible situation. The parents of victims of drug addiction are a real political force in Australia. You see this somewhat in Vancouver, but otherwise not at all in Canada.

Senator Kenny: Is there any comparable sense of outrage when young children become addicted to tobacco or when adults die prematurely from tobacco use in Australia?

Dr. Single: I cannot say I really know the answer. My impression, as someone who has visited the country fairly often, is that you do not get the same sense of outrage. I do not think smoking is any more accepted there than here.

Senator Kenny: The mortality rates are comparable and vastly higher for smoking-related diseases than they are for drugs. However, there is this ambivalence that exists that does not translate into political action. It is difficult to make the connection in Canada.

I am intrigued to hear that, at least in terms of drugs, there is a political connection that has been made by the electorate where politicians are getting pushed back as a result of inaction on drugs. That is why I was concerned to see if there were similarities with tobacco.

Dr. Single: I am not aware of any similarities.

The Chairman: Dr. Single, you recommend that more attention should be put on the evaluation of all the projects. If we go further in that recommendation, do you think we should put an obligation on every project that a part of the funding should go toward evaluation of the program?

Dr. Single: In principle, yes, I would agree that a portion of the funding for a project should go towards evaluation. As a practical matter, there are not enough trained researchers around to be able to do that. You might be able to do a portion or have selected ones. Certainly there should be a requirement that at least X per cent of the programming should be subject to systematic evaluation.

The other important element is that you have the same evidentiary standard for all interventions. We have a huge amount of research about treatment outcomes and effectiveness of different treatment modalities, and that is fine, we should. However, in other areas such as prevention programming, there is some evidence on a few things, but very little. When you get down to supply side interventions, there is virtually zero evidence.

It is not enough to see the guns, the drugs and the money on the table at a press conference. That plays well on the six o'clock news, but it does not show what the impact was of what may have been a multi-million dollar major allocation of police resources over a year or two. That does not show the impact on the community on factors such as drug use and drug related problems. That is what I would like to see. No one knows the impact.

The argument can be made that the only impact would be that of increasing temporarily the price of drugs, therefore, leading to an increase in crime as drug users must pay more for their drugs or go further afield to get their drugs. Then another supplier comes in and takes the place of the person who was arrested and taken away.

My point is not that we should not be doing that necessarily, but it is funny that we spend $400 million on drug enforcement each year, but we do not study what its impact is on drug-related problems. We spend much less on prevention and treatment, yet that is where all the research and evaluation goes. The funding must be spread out to cover all the interventions and there should be same evidentiary standards for the interventions.

The Chairman: I understand your concern about the level of funding. However, even if we are investing 10 per cent of what we are spending on police enforcement toward research and other areas, evaluation, according to what I read in your brief, should be there - at least to achieve the objective based on our investment.

Dr. Single: Earlier this morning Dr. Rehm was asked about cost studies as part of the monitoring evaluation process. It was very interesting that the research unit that took the lead in conducting that cost study was disbanded three weeks after the results were reported.

That was not personal. I do not think they were disbanded because of the results. That was just part of the government cutbacks at the time, albeit somewhat short-sighted. We do not even know how many people are using drugs in Canada today. That is not news to you by now. There has not been a national survey specifically focussing on alcohol and drugs issues since 1984 and I am not aware of any plans for such a survey at present.

Our lack of data is embarrassing. I edit and produce, with the Canadian Centre of Substance Abuse, a national statistical compilation of all the information that is available on alcohol, tobacco and drugs called "Canadian Profile." We have not produced anything for three years and have no plans to publish because there is no new information. We would be ripping off the consumers to sell such a profile where we are just updating one or two tables. We do not have any new information. The government has not been investing in research, so we do not know the answers to many questions.

Senator Banks: I believe you said that the aggressive stance of the United States in its war on drugs has not had much of an effect. Does it have any chance of succeeding in stamping out or substantially reducing the use of illicit drugs?

Dr. Single: I believe that it has had virtually no impact, that it has been a black hole that sucked up a huge amount of resources. It has probably exacerbated problems more than it has helped. I am, like probably the majority of people in my field, a critic of the "war on drugs" mentality.

It could be more effective, but it would come at such a cost. There have been historical examples of even more repressive approaches to drugs. Shortly after the civil war in the Soviet Union in the 1920s they lined up and shot people who were caught using or trafficking in drugs. Repression works, but the goal of a drug policy is not simply to minimize drug-related harm. There is always an implicit second goal, which is within the limits of what is acceptable within the limits of available resources. There would be no recidivism if we had capital punishment for cannabis use, but that would go beyond what is acceptable.

I cannot think of any measure that would be within the realm of what is politically acceptable that would not violate that. With writs of assistance years ago they tried to assist enforcement by basically giving a lifetime search warrant to a police officer. That effectively threw out 1,000 years of development of rights privacy dating back to the Magna Carta and it did not seem to have any impact. They have gotten rid of those writs since. It would take draconian measures - which I do not think most people in Canada would find acceptable - to make a war on drugs effective. It is far better to look to other means such as harm reduction. We do not have overwhelming evidence that those measures will work, but they certainly will not make the situation worse.

Senator Kenny: It sounded like you were saying that the war on drugs was a political solution to a health problem.

Dr. Single: That is not a bad way of putting it, I suppose.

Senator Kenny: Further to the chairman's comment about evaluators, you said that there are not enough trained evaluators now. That made me think of Field of Dreams: If you build it, they will come. Would you agree that if you provide the funds for it, you will get the evaluators?

Dr. Single: Yes, although it may take five or ten years to get quality work.

Senator Kenny: How much have we accomplished in the last five or ten years?

Dr. Single: Very little because we have not had the funds.

Senator Kenny: Then perhaps we should take the five or ten years and get the evaluations.

My second observation is that red serge gets money. I do not mean that totally cynically but, frankly, the police in this country are the authorities whom we consult for information. They are the evaluators of the programs they run; and they are the recipients of the funding, which makes it very difficult for us to determine whether dollars going to the police to interdict drugs or to deal with drug-related problems are dollars best spent.

Is it your position that you cannot have an effective system without one authority, one evaluator and one recipient all in the same person and expect to come out with answers that are not badly skewed?

Dr. Single: Yes. The people doing the research should be at arm's length from the people spending the money.

Senator Kenny: Can you assist the committee by suggesting ways that would provide that arm's-length relationship on the supply side vis-à-vis the police? How do we evaluate police performance? How do we determine whether money spent on police programs is as effective as money spent on prevention?

Dr. Single: In Australia they have created a special pool of research funds. A police research unit has also been created, which does studies. It actually did the one study of which I am aware on what happens to the drug problems in a community where a big drug bust is carried out. They found that it had only short-term impacts that were largely negative with increasing drug prices and leading to increases in crime.

Senator Kenny: So the Australian police wrapped up their drug squads?

Dr. Single: Their political masters did not tell them to do that. I do not blame the police in any of this. They are caught between a rock and hard place. They are doing their job.

Senator Kenny: I did not intend to blame the police either, but they do end up performing all three functions for lack of another body being created.

Dr. Single: Yes, and they are naturally guarded about giving up any of those functions, but I think they should be persuaded. However, it is not entirely monolithic. The chiefs of police have come out in favour of removal of jail penalties as a sentencing option for cannabis possession. They have come out in favour of decriminalization of cannabis.

Senator Kenny: What do street cops think about that?

Dr. Single: It is my understanding that they do not like that. The head of the drug committee of the chiefs of police says that he has received complaints from the rank and file. I suspect that the rank and file makes a lot money on overtime from court work on drug cases. Perhaps there is a problem with police compensation, which is contributing to the problem with drug policy. However, the solution would be to deal with that problem so that they are not dependent on overtime court work on drug cases, which will skew their priorities in what they do.

The Chairman: I have many questions on the financing side in Australia. Whose jurisdiction is it, federal or state? I am also interested in the fact that they have emulated the European practice of rotating the chair of the committee. That is smart. Imagine that in Canada.

In Australia, you are recommending the creation of an information bureau to centralize results. Did you have in mind what already exists in Europe, a repository of knowledge?

Dr. Single: I was thinking more of the Canadian Centre on Substance Abuse national clearinghouse model, which is an electronic linking of resource centres. There are resource centres and treatment centres in Quebec that are purely in French. At the Nechi Institute in Alberta, they have the best collection of material on native substance abuse problems. The Canadian Centre on Substance Abuse has created a bilingual database using the same software and electronically linked them so that everyone can access them. Those outside the resource centres get ordering information rather than direct access, but people can find out about the material and order it. That is the kind of model I had in mind - not a national archive or library - but electronic linking.

The Chairman: I thought that what you had in mind already existed in Europe. There is an arm's-length organization that watches what happens.

Dr. Single: I have seen the European monitoring centre in Lisbon. That is a nice model. It is one of which I am jealous because they have $100 million per year in funding.

The Chairman: Are you jealous because of the funding, or are you jealous of the mandate?

Dr. Single: The weather, too. Lisbon is very nice. I am jealous of both the funding and mandate. They have made tremendous progress in many areas. They have promoted more effective programming in Europe as a result, and they have only been in existence for six or seven years.

The Chairman: Should we have such an independent organization in Canada?

Dr. Single: We do have a national organization created by a special act of Parliament in 1988, the Canadian Centre on Substance Abuse, but it nearly had to close its doors a few years ago because the funding level was so incredibly low, and it remains so. I would look at that first as one of options. I am no longer an employee of that centre, so this is not as self-serving as it sounds. I would look at that option and increase funding for something that exists rather than reinvent the wheel.

The Chairman: Dr. Single, thank you for appearing before our committee today. We will be sending you more questions, and we look forward to your responses.

[Translation]

Before adjourning this meeting, I would like to remind all those who take an interest in our proceedings, that they can access information on this topic by visiting our web site at the following address: www.parl.gc.ca.

They will find the presentations made by our various witnesses, biographical information, the background documents that they thought it useful to give us, as well as 150 pertinent links. You can also use this address to send us e-mails.

On behalf of my colleagues, I wish to thank you for the interest you have taken in our proceedings. The Special Senate Committee on Illicit Drugs is now adjourned until 1:30 p.m.

The committee is adjourned.