Proceedings of the Standing Senate Committee on
Legal and Constitutional Affairs
Issue 20 - Evidence, November 26, 2009
OTTAWA, Thursday, November 26, 2009
The Standing Senate Committee on Legal and Constitutional Affairs, to which was referred Bill C-15, An Act to amend the Controlled Drugs and Substances Act and to make related and consequential amendments to other acts, met this day at 10:52 a.m. to give consideration to the bill.
Senator Joan Fraser (Chair) in the chair.
[English]
The Chair: Good morning, colleagues, I see a quorum. This meeting of the Standing Senate Committee on Legal and Constitutional Affairs is continuing our study of Bill C-15.
Our first witness this morning, who is joining us by video conference, is Mr. Glenn Greenwald of the Cato Institute. Good morning, Mr. Greenwald. Thank you very much for being with us.
My name is Joan Fraser. I am the chair of this committee. I understand that you have an opening statement that you would like to make before we ask you questions. The floor is yours.
Glenn Greenwald, Cato Institute: Thank you for inviting me to speak with you this morning. I am always excited about the prospect of being able to discuss drug decriminalization in Portugal because any discussions of drug policy typically, by necessity, often includes a great deal of speculation. It is often difficult to know what results will occur through changes in the law. That is especially true when more significant or even radical changes are discussed.
In Portugal, we have a country which, back in 2001, enacted a fairly fundamental change to their drug policy law — decriminalization of all drugs. One need not speculate about what the results would be from that type of change because there is abundant empirical evidence that enables one to see which fears were justified, which were not and what benefits a country is able to receive when they enact that type of change.
I want to briefly describe what the law is, how it came into being and what the results were in a summary way. I am then happy to listen to comments, take any questions and talk about whatever you think is most important.
The law in Portugal took effect July 1, 2001. It was the first law in any western country to explicitly decriminalize drugs. It used the word ``decriminalization.'' It applies to all drugs, hard and soft drugs, including cocaine, heroin, methamphetamines and synthetic drugs. It expressly declares that it is no longer a criminal offence to acquire, use or possess any drugs for quantities of personal usage, which is defined as the quantity that the average individual would use over the course of 10 days.
For any substances that fall into that category of personal usage, it is no longer a criminal offence; it is purely an administrative offence if one uses, possesses or acquires drugs. Trafficking in drugs, possessing large quantities of drugs remains criminal, but personal usage is no longer a crime. The citizen cannot be convicted or sent to a criminal court or punished criminally in any way.
Instead, if a police officer or other government official sees someone in the possession of or using drugs, they give them a citation. Within 72 hours, that person is required to appear before what the Portuguese call a ``dissuasion commission.'' The only purpose of this dissuasion commission is to encourage the individual to seek counseling or other services if the commission and the individual both believe that doing so is necessary.
The way that this law came about, as one can imagine, was a controversial proposition at first, especially in a country such as Portugal that is quite conservative and had a severe drug problem. Instead of having the legislature debate, enact and adopt this change, they created a commission of purely apolitical experts. They charged this commission with only one mandate, namely, to identify the policy that would be most effective in getting Portugal's extremely serious and worsening drug problem under control.
The commission concluded that decriminalization would be that policy, and did so for several reasons, which we can discuss. Once that commission issued its report, it made it much easier for the Portuguese congress to enact and adopt those recommendations; and for the Portuguese president, in 2000, to then sign this law decriminalizing all drug usage, which took effect in 2001.
The only thing I will say about the results at the moment — and we can look at them more specifically; there is a great deal of detailed analysis in the report that I prepared — is that the Portuguese had probably one of the worst problems with drug abuse and all drug-related pathologies, including crime, deaths and sexually transmitted diseases relating to drugs, of any country in the EU throughout the 1990s. The more they criminalized, the worse the problem became.
Since decriminalization, in virtually every category, Portugal is now near the top of states managing their drug problems when compared to other EU states. While the proposition at first was controversial in Portugal, the political consensus in Portugal now is that drug decriminalization has worked. Virtually no political parties, politicians or factions within the citizenry are advocating a return to the criminalization scheme. To me, that is quite a compelling testament to the efficacy of this law.
That is a bit of background that frames what has happened in Portugal. I am happy to talk about anything specific that might interest you.
The Chair: Thank you very much indeed. Colleagues, I neglected to tell you that our witness, Mr. Greenwald, is joining us this morning from Rio de Janeiro, so we are doubly grateful. Somehow it seems even more impressive to do this over such a long distance.
Senator Nolin: Thank you, sir, for being with us this morning from far away. We are studying a bill that is not exactly contemplating decriminalization or even softening the prohibition of controlled drugs. I do not know if you have read the bill that we are studying, but the government is proposing a structured and quite vast implementation of mandatory minimum sentences.
I would like to hear from you about the state of the phenomenon of user traffickers in Portugal. I know that the scheme that was adopted by the Portuguese government in July 2001 looked after users, and you keep quite tough sentences for traffickers. What about users who are trafficking to make money from their trafficking?
Mr. Greenwald: One of the issues that the commission that I described confronted when they considered all the options available to them, was the fact that Portugal was a signatory to numerous treaties that required there to be an ongoing prohibition under the law for drug usage in general, and specifically that there be criminal penalties for drug trafficking.
The only option that the commission took off the table in deciding what was the best approach was full legalization as opposed to decriminalization and also decriminalization for traffickers. You do still have this anomaly in Portugal, as you pointed out, where it is perfectly legal or at least not criminal to purchase drugs; yet some drugs remain a criminal offence.
Drug policy-makers will say that one of the best approaches for stemming the problem associated with drug trafficking is to reduce the demand for drugs. Obviously the more drug addicts there are the bigger the market there is for drugs and the more drug traffickers thrive. Therefore, the Portuguese feel that they have been able to really make a dent in their drug traffickers; not so much through the criminalization scheme that continues but instead by slowly, although rather inexorably, reducing the market and the demand on which drug traffickers thrive.
You are correct that drug trafficking is still a criminal offence; it is still punished, and fairly harshly, but the number of prosecutions has declined rather steadily since 2001 as drug-usage rates have stabilized and then declined as well.
Senator Nolin: Another aspect of the Canadian reality — and it is probably the same in Portugal — is medical use or self-medicating use of cannabis. It is a growing phenomenon in Canada. We will hear witnesses later this morning who will talk about more about the magnitude of that phenomenon in Canada. Of course, it deals with a few aspects of the controlling of drugs. First, there is the production of cannabis, which is really prohibited, but when it is done for medical reasons, the approach is different. Of course, the Canadian population sees that from a different angle.
What is the state of that reality in Portugal?
Mr. Greenwald: Drug usage for medical purposes, meaning drug treatments that are prescribed by a medical doctor, by a physician, are legal. It is regulated by the state to ensure that it is not abused. However, Portugal has state- regulated dispensaries to enable patients — cancer patients, people dealing with HIV-related symptoms and other serious diseases — whose physicians have decreed that narcotics will be able to address either the underlying condition or the symptoms to access the drug treatments in a healthy, safe and clean environment.
That is not so much unique to Portugal. I believe there is a broad consensus in the EU generally toward a trend of treating drugs generally much more as a health issue than a criminal issue. Certainly Portugal adheres to and is in line with that consensus in allowing and legalizing drugs for medical usage, with fairly active regulatory involvement by the state.
Senator Nolin: As you know, cannabis, at least in Canada — I do not know about Portugal — cannot be regulated itself. It is not a medicine. However, it is widely use for medical purposes; people self-medicate. Of course, we have a regulated approach for roughly fewer than 5,000 Canadians who register into the process. However, the vast majority of Canadians who use cannabis for medical reasons do it outside of the regulated scheme. Therefore, the production of that cannabis is done outside that scheme, and the purchase and use of that illegal medical marijuana is definitely not the black market as we refer to structured organized crime, but it is definitely outside the purview of the law.
Do you have the same reality in Portugal, and how do you deal with that?
Mr. Greenwald: I am not certain whether there is active regulation of the growing of marijuana itself as opposed to its distribution. I do not know the answer to that question. I know that in the United States, in those states that have legalized medical marijuana, dispensaries that receive permits from the departments of health not only distribute marijuana but grow it as well exclusively for the purpose of providing it to patients who have prescriptions. However, I do not know whether that same process is used in Portugal.
Senator Milne: Mr. Greenwald, in Portugal, the model of legalization of drugs for users is probably based — and I am asking you if it is — on a fairly urban population and not a rural or remote population. Is that one of the reasons that it has worked well there?
One of our big problems in Canada is that the use or abuse of drugs in Canada's remote areas — that is, in the Far North, amongst our Aboriginal people of both the Far North and the northern parts of the provinces — is where I believe the drug problem is the greatest in Canada. How can the Portuguese model possibly address Canada's problems, particularly in very remote communities?
Mr. Greenwald: I would not accept the premise that the impetus for decriminalization was rooted in an urban setting, nor would I necessarily accept the premise that the success has been confined to the urban setting.
Portugal is a country that has long been plagued by some of the worst poverty in the entire EU. The only real cosmopolitan or urban area in Portugal is Lisbon, which is a fairly traditional and standard Western European capital. Serious drug abuse problems have been dispersed fairly equally throughout the country. Portugal has 18 provinces or districts, and resources have been distributed fairly equally, recognizing that the problem has not just existed in Lisbon.
Let me highlight for you what the rationale behind decriminalization was on the part of this commission because it translates fairly well, both for urban and rural settings.
There were three main rationales as to why decriminalization would work. The first was that the government drug- policy officials responsible for education services, providing clinics and so on, to the drug-using population found that the greatest obstacle they faced was that when the state harshly criminalizes drug usage and the government is seen as a threat to arrest people and to put them in prison, a wall is erected between the government and the citizenry. This wall makes it difficult for the government and for government officials to be able to communicate with and provide services and education to the citizenry because the government reflects the threat of imprisonment rather than the promise of help and assistance. They thought that that impediment, as long as it existed, would prevent effective drug-treatment policies from reaching the vulnerable population.
Second, when drugs are harshly criminalized under the law, it creates a stigma that affects the drug user so that the drug user is fearful of being identified as a drug user rather than being willing to cooperate with those trying to get help for that person. It makes the person want to hide, deceive and lie, rather than seek out and be receptive to messaging and servicing.
A third aspect was simply a resource aspect; namely, so much money is being spent on prostitution efforts, interdiction and police efforts to arrest, prosecute and imprison traffickers and users. That money would be better spent on drug-counselling professionals and on clinics throughout the country rather than just in Lisbon. Interestingly enough, it was the last factor that really enabled a nation-wide improvement because governments will often allocate resources to urban settings as that is where the most drug usage occurs. They will neglect more distant and rural settings. Freeing up so much money through decriminalization has enabled them to provide a much more nation-wide infrastructure that has helped drug addicts become non-users.
Senator Milne: You are saying that this is working in Portugal because of the distribution of resources throughout rural and remote areas of the country; is that right?
Mr. Greenwald: That is one reason. It is hard to quantify. However, if you talk to Portuguese drug officials, they would say that mere distribution of resources is insufficient if you are not also finding a way to make the citizenry more willing to avail themselves of those resources through more effective education campaigns and offering assurances that identifying themselves as having a problem will not result in stigma and possibly arrest.
However, I would certainly say that their ability to distribute their resources more effectively, more equally and with a wider scheme has enhanced the efficacy of their programs.
Senator Milne: How many clinics are there scattered throughout Portugal?
Mr. Greenwald: I am not sure of the exact number. It is in my report. It has increased substantially since 2001, partly because the demand is greater and partly because the resources are greater. I cannot tell you offhand even a range of how many, but those numbers are in my report.
Senator Campbell: At one point in Canada, we were looking at decriminalization of marijuana. The issues were, first, whether it sends a mixed message; and, second, whether it helps those people involved in organized crime and supplying marijuana, in this case. I would be interested to know how that was looked at in Portugal, and how they were able to come to grips with it.
Mr. Greenwald: That was one of the principal arguments, as one would expect it to be. It is certainly a rational objection that if a state goes from a scheme of criminalization to decriminalization, it will transmit a message, particularly to the more questionable factions in the citizenry — the youth and adolescents — that the government now considers drug usage to be permissible.
However, if you look at what has happened in Portugal, I think it is a very hard case to make that that has taken place. It has not happened, in part, because there are demographic groups, such as the 15 to 19 age group, which has not only seen a relative decrease in drug usage since 2001 but a decrease in absolute numbers. By relative, I mean relative to other EU states, although that has happened. Therefore, the percentage of individuals in these crucial demographic age groups of 15 to 19 and 11 to 15 has actually decreased in absolute numbers in terms of those who use drugs in general, those who use marijuana and cocaine.
It may be counterintuitive, but, first, it is empirically true. Second, the government is not sending a message that if you do X you will be arrested, prosecuted and imprisoned. Instead, it is able to communicate that doing X can be dangerous, whether it is using marijuana or experimenting with drugs, and if you do it, it is important that it be done responsibly. If there are concerns about addiction, the government provides clinics and counselling services. If someone is found taking drugs, instead of sending them before a criminal judge who might sentence them to a harsh criminal penalty — or the threat of that — they are put instead before health professionals whose goal is not to punish the person but to encourage them to seek out counselling.
That is a much more effective way of preventing and deterring the population from using drugs irresponsibly, and from using them in the first place, than a criminalization scheme might be. Ultimately, the proof is in the pudding when you look at what has happened.
Senator Campbell: Are you familiar with the Swedish model?
Mr. Greenwald: No, I am not. I vaguely know about other EU states but nothing that would be worthwhile observing.
Senator Joyal: I would like to come back to page 2 of your brief where I read that the minimum possession for which the act provides is ``defined as the average individual quantity sufficient for 10 days' usage for one person.''
Could you tell me what that is? Is it one, two or three plants of marijuana? Is it five plants? I assume that it was the administrative tribunal that defined that minimum quantity because that quantity is the barometer for an administrative offence versus a criminal offence. Therefore, I assume that a much clearer definition exists than the general text in your brief.
Mr. Greenwald: The law itself does not provide any greater clarity on the distinction between a criminal offence versus an administrative offence. The law simply defines a criminal offence as being what you just referred to, which is an amount greater than the average individual usage for a period of 10 days.
Courts have developed definitions, criminal courts in Portugal. Cases for each substance assess, based on an expert analysis, how much marijuana an average user would be likely to consume over the course of 10 days. I cannot tell you what the amounts are that are considered criminal for each substance. However, the intent is to encompass addicts as well as people who are addicted to marijuana and use it every day.
The issue is not how much the individual citizen uses every day; the issue is the amount an addict — someone who is using a substance every day — would likely use. The intent is simply to distinguish those people who are actually acquiring it for personal usage versus people who intend to sell and distribute it.
The precise definitions of how the law should be applied are developed by courts and judicial opinions using expert testimony. However, that is the intent of the law, and that is why the law is not any clearer.
Senator Joyal: Marijuana is the most common drug, so let us use that as an example. According to the jurisprudence, could you tell us what the minimum quantity is that the court has defined as being a criminal offence? Do you have that answer?
Mr. Greenwald: I do not know the answer to that. For a long time, the substance most cited was not marijuana but heroin, which is the substance with which Portugal had the greatest problem. It is now cocaine, and marijuana is second. However, I do not know what the courts have said exactly about how much marijuana brings you above the 10-day point. Those are judicial cases that I looked at, but I do not recall the exact quantities.
Senator Joyal: Since decriminalization, have you noticed an increase in drug use since addicted people no longer have to hide themselves away? Have you any studies that show that Portugal has become — I will use an expression that our American friends like to use — a ``safe haven'' for drug use? Have you noticed in Portugal either an increase among the Portuguese or a flow of other Europeans into the country to consume drugs?
Mr. Greenwald: The evidence definitively proves that neither of those situations has happened. One argument made by opponents of decriminalization in 2000 was that Lisbon would become a drug haven for tourists — European youth would travel to Lisbon to use drugs. The evidence is clear that this has not happened. You will find a breakdown by nationality on page 8 of my report of individuals cited for drug use, possession and acquisition under the law. Roughly 98.5 per cent of the individuals cited are citizens of Portugal; very few are citizens from any other EU countries. That fear has simply never materialized.
The other aspect of whether individuals have taken to using drugs more readily because they can now be more open is also quite clear. As I indicated earlier, usage rates for almost every narcotic substance through the 1990s showed that Portugal was one of the worst when compared to other EU states. They are now one of the best in virtually every category. The graph on page 21 of my report shows that Portugal has the lowest prevalence rate for cannabis use of any European Union state from the years 2001 to 2005. Page 23 indicates that they have one of the lowest usage rates for school-aged citizens of any country in Europe. Page 24 shows that there are countries with six or seven times greater usage of cocaine than Portugal. This includes some of the states that have the harshest criminalization schemes in all of Europe, including Estonia, the U.K. and Ireland.
We see a reverse correlation to what your question suggests. Decriminalization has allowed Portugal to bring their addict population out of the crevasses, out of the darkness and out of the fear to be able to offer more effective services, counselling and harm reduction programs. The problems that were among the most severe in Europe throughout the 1990s have become among the most manageable.
Senator Joyal: Let us talk about the suppliers of drugs — organized crime. Have you seen any changes in the way organized crime now operates their business compared to before 2001, and whether the government has been more efficient in fighting organized crime to limit the increase of suppliers?
Mr. Greenwald: We touched on this earlier. The view of Portuguese drug and police officials is that there are two ways to deal effectively with drug traffickers. The first is through law enforcement and interdiction efforts; the second is through reducing demand for their product. Drug policy-makers, police and federal drug officials in Portugal feel strongly that by reducing the level of addiction and by making counselling services more readily available and more effective, they have been able to stem the tide of drug trafficking and organized crime in a way that other EU states have failed to do.
Having said that, it is a fairly subjective assessment and difficult to quantify. Page 15 of my report shows the number of individuals convicted and sentenced for dealing, distributing drugs or using drugs. The number of sentences for people trafficking drugs has declined somewhat steadily since 2001. It has remained relatively steady through 2006, 2007 and 2008 as drug trafficking problems and organized crime steadily worsened throughout other EU states.
I do not want to overstate this case. I do not think that Portugal has had great successes in undermining the influence and power of organized crime syndicates and drug traffickers. However, by managing and reducing the demand, they have been able to undermine somewhat the effect of organized crime and drug traffickers.
[Translation]
Senator Carignan: Personal usage has been decriminalized, but there is still an administrative sanction, which can be a fine, for possessing drugs. Is that right?
[English]
Mr. Greenwald: If the commission finds a problem of addiction and a repeated pattern of offences exists, then, theoretically, administrative sanctions are available, such as imposing fines, suspending licences for certain professions such as pilots or medical doctors and prohibiting the individual from frequenting night clubs, for example, where drug use is notorious.
It almost never happens that those sanctions are imposed. The commissions do not have the ability to punish people for non-compliance with the sanctions. However, the law allows administrative sanctions to be imposed by the commission only if they find a pattern of repeated offences and a problem with addiction.
[Translation]
Senator Carignan: You said that drug trafficking offences were punished harshly. Could you tell us what kinds of sanctions are imposed in terms of production, importing and exporting?
[English]
Mr. Greenwald: When I say ``quite harshly,'' I mean that prison sentences are imposed. I do not mean to imply that Portugal has a particularly harsh prison sentence relative to the rest of the Europe generally. Traffickers may be sentenced to 10 or 15 years, or even more, in prison if they are part of organized crime units. I believe sentences for traffickers in the middle range can range from six months to five years. It is common for traffickers found guilty of moving large quantities of drugs, especially hard drugs such as heroin and cocaine, to be sentenced to prison terms ranging from a couple of years to a decade or more in prison.
The harsh prison terms I referenced are in line with what other European countries impose.
[Translation]
Senator Carignan: In the past few years, in Portugal, have crime rates gone up for other types of crime, such as murder?
[English]
Mr. Greenwald: Yes, the overall crime rate has increased somewhat, but not extraordinarily; I should confine my answer to Lisbon, where most of the crime occurs.
One of the difficulties in trying to figure out if drug-related crimes have decreased is trying to classify a particular crime as drug related. With a mugging or a burglary, knowing whether that is drug-motivated is very difficult.
Law enforcement officers believe that if you reduce demand and the amount of addictions, you reduce the amount of drug-related crime by definition. However, Portugal, and especially Lisbon, has seen a modest but steady increase in overall crime over the last five years.
Senator Baker: I am particularly interested in how the decriminalization law came into being in Portugal.
As you are aware, when you look at governments in Canada, the United States or in many other nations, the politicians are the ones who create the policy. They run in elections and, based on their policies, they stand.
It is difficult for change to take place in a political system in which we continually must respond to voters' wishes. Sometimes, when desired changes are needed, an exterior body will make a recommendation and the politicians will accept the recommendation.
I do not think the Portuguese system of government, when this was brought in, in 2000, was dissimilar to our government here or in the United States. After reading your report, it appears to be a council of ministers who responded to a commission of experts, who then went to Parliament with the blessing of the president. I am interested in the process of how such a radical change could take place in Portugal, but not take place in other nations.
Mr. Greenwald: That is an important question and an interesting process to look at. You are absolutely right that, in general, it is difficult for a political body that stands for election to effect radical change, certainly with drug policy.
Portugal, in particular, happens to be an extremely conservative country when it comes to questions of social policy. The Catholic Church plays a significant role not just in religious matters but in political ones as well. They had very conservative approaches to matters such as abortion and homosexuality. It is not the type of European Union country where one would expect to find experimentation with drug policy.
The impetus behind it and what enabled it was, first, the fact that there was a serious crisis in Portugal throughout the 1990s. With their poverty, they had an out-of-control drug problem that was worsening by the year. I included some statistics that show how precipitous, for example, drug-related mortality was. Addicts were laying in the streets, not just in Lisbon but even in mid-sized cities that were more suburban and even rural.
There was a real desperation because the more criminalization schemes were pursued, the worse the problem became. That climate of desperation enabled options that would otherwise be off the table. The population was more open to them.
The most important aspect of it was what you alluded to; namely, that a commission was created that was entirely made up of apolitical professionals — psychologists, psychiatrists, health professionals, lawyers, professors — people who were there to put together a purely empirical report without any regard to ideology or morality. The question was simply from an empirical perspective: How can we arrest the worsening problems with drug abuse and their related pathologies as a government?
It was only once this commission went off and did its work for 18 months and then issued a report that laid out all of the rationale, which I alluded to earlier, as to why decriminalization would uniquely enable these problems to be managed that the ministers, for example, were able to get behind that proposal. That then enabled momentum in parliament for the law to pass and for the president to sign it. I think without that, it is inconceivable that it ever would have occurred.
To underscore that point, in the United States, some modest debate is taking place over drug policy for the first time in a very long time, based on the recognition that harsh criminalization schemes are clearly failing. There is a senator from the very conservative state of Virginia — Jim Webb, a Democrat — who is in his first term. He is a fairly vulnerable incumbent because he is a Democrat and has only been in office for three years.
He has stood up and said that they have a major and fundamental problem with the way they are treating drug offences — the number of people that they are imprisoning and the vast sums of money that they are wasting in futility on prosecution and criminalization approaches. Rather than introduce a bill to change the law or to decriminalize certain substances, he instead introduced a law to create a commission of the type that Portugal used that would study these problems and make recommendations after a period of 12 to 18 months.
There is significant momentum now, even in the very conservative United States Senate, for that type of study. I think depoliticizing the question and turning it into an empirical matter is an absolute prerequisite to debating and discussing rational changes. That is what Portugal was able to do.
Senator Baker: That answers my question and puts the matter into perspective as far as potential changes are concerned that are as radical as those in Portugal. Thank you very much.
The Chair: In terms of cost, when Portugal freed up those resources by decriminalizing and was be able to put the resources into counselling, et cetera, has it spent more, less or about the same money in total as far as you know?
Mr. Greenwald: You mean ``total'' in terms of treatment, counselling and prevention?
The Chair: Yes. Does the treatment end up costing more, less or the same as the previous efforts put into law enforcement?
Mr. Greenwald: I know that roughly 80 per cent of the savings that Portugal experienced has been redirected directly into counselling, harm reduction and the like. I know they have spent other monies as well, as they have seen it work.
If you are asking if it is simply a dollar to dollar trade-off between the savings from law enforcement and the programs relating to counselling and harm reduction, the answer is no. They have spent some amount of money more as they have seen it work. Portugal has severe budgetary constraints, so the amount of money that went into counselling that was not directly money saved on decriminalization is not substantial, but it does exist. They have spent more as the years have gone by.
The Chair: My second question relates to the fact that, in Canada, we love to sit around and talk about the constitution. In this particular federation, criminal law is a federal matter and health care and social services are largely provincial matters, although the feds do send money.
Portugal is a unitary state, so I am assuming that both criminal law and the health and social services systems are under the authority of the national parliament or the national government; no municipal element kicks in there.
Mr. Greenwald: That is correct. The policies are set by the federal agency. Of course, they have administrative provinces that assist administratively, and they have some degree of autonomy in where the resources go and how the commissions are established.
However, a centralized body determines both drug and legal issues, as well as health and resource issues. That enables them to coordinate those two aspects very well.
The Chair: Mr. Greenwald, thank you very much indeed. It has been extremely interesting and very helpful. You have given us a perspective that we have not previously heard. We are very grateful to you.
Mr. Greenwald: I appreciate the opportunity.
(The committee suspended.)
[Translation]
(The sitting was resumed.)
The Chair: I would like to call the meeting to order on the study of Bill C-15, An Act to amend the Controlled Drugs and Substances Act and to make related and consequential amendments to other Acts.
We now have with us, from the Canadian Centre on Substance Abuse, Michel Perron, Chief Executive Officer; Rita Notarandrea, Deputy Chief Executive Officer; Amy Porath-Waller, Senior Research and Policy Advisor; and Rebecca Jesseman, Research and Policy Advisor.
[English]
Thank you all very much for being with us today, and we are glad to have you. I assume Mr. Perron leads off.
Michel Perron, Chief Executive Officer, Canadian Centre on Substance Abuse: Thank you. It is a wonderful opportunity to be here. I appreciate the indulgence of the committee to having my colleagues here. I guarantee my presentation will be exponentially better with them here. I have prepared text that I will go through. It has been circulated to you as well.
The Canadian Centre on Substance Abuse, CCSA, welcomes the opportunity to appear before this committee on Bill C-15. As you may know, we are an arm's-length organization, governed by a volunteer board of directors and established by an act of Parliament in 1988 to provide national leadership and evidence-informed analysis and advice.
We would like to provide a brief overview of the evidence based on three areas: the prevalence of illicit drug use in Canada; drug treatment courts; and use of mandatory or coerced treatments.
Recent data on the prevalence of drug use among Canadians is available through the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) 2008. This survey, conducted by Health Canada, provides information on alcohol and illicit drug use among Canadians aged 15 and over. Figure 1 in the document provides a graphic illustration of the rates of past-year drug use reported by survey respondents.
According to the survey, cannabis is the most widely used illicit drug in Canada with approximately 11 per cent of Canadians aged 15 years and older reporting use of the drug in the past year. Hallucinogens are the next most commonly reported at 2.1 per cent, followed by cocaine at 1.6 per cent, ecstasy at 1.4 per cent, amphetamines at 1.1 per cent and methamphetamine at 0.2 per cent. Table 1 provides a more detailed statistical breakdown, as well as a comparison with rates obtained in 2004 through the Canadian Addiction Survey, CAS.
It should be noted that although CADUMS was modeled on the CAS, due to some differences in survey methodology, comparisons between the two should only provide rough indicators of trends, and strict comparisons should be used with caution.
Two key observations can also be made when considering prevalence data. First, there is a great deal of variance of prevalence of use according to a range of factors such as geographic location, age and gender. For example, the table clearly illustrates that youth, or those between the ages of 15 and 24, are significantly more likely to report past-year use of illicit substances than people over the age of 24.
CADUMS also asked respondents about harms associated with illicit drug use. Overall, 2.7 per cent of respondents reported experiencing at least one harm associated with illicit drug use in the past year. Among those who used illicit drugs themselves, this rate increased to 21.7 per cent, which increased to 37.5 per cent if cannabis was excluded.
To provide you with a brief international context, Figure 2 compares past-year prevalence of illicit substance use in Canada, the United States, Australia, England and Wales. Unfortunately, Canada ranks highest in terms of past-year use of cannabis. However, Canada is comparable to or lower than other countries in past-year use of cocaine, heroin, ecstasy and amphetamines.
The Chair: Mr. Perron, could I interrupt you? The written text before me says ``lifetime'' and you said ``past-year use.''
Mr. Perron: ``Past-year use'' is correct. I am sorry; I thought that text had been amended. To be clear for the record, the final paragraph, where it says, ``As you can see, Canada ranks highest in terms of past-year use,'' is correct, and further on it would also be past-year use.
The Chair: Thank you.
[Translation]
As for mandatory and coercive treatment, in its invitation to appear, the committee expressed an interest in evidence on mandatory treatment. There has been a great deal of research on the efficacy of coercive treatment, both for offender rehabilitation and for substance use. The evidence generally indicates that program structure — for example, evidence-based programming — and qualified staff predict outcome better than client motivation. For example, research has demonstrated that remedial programs for convicted impaired drivers have a beneficial effect on recidivism rates.
In terms of drug treatment courts (DTCs), CCSA encourages increased access to services and supports for substance use.
Evidence clearly indicates that individuals involved in the criminal justice system are significantly more likely to have a history of problems with substance abuse. The remainder of our testimony will therefore focus on Bill C-15's proposed addition of clauses 10(4) and 10(5).
The committee has heard a great deal of evidence and debate on the overall role and efficacy of DTCs. Rather than revisit that debate, I would like to highlight a number of considerations within the context of best practices in treatment, which may inform the committee's deliberations.
First, DTCs have not been able to meet the challenges posed by Canada's diversity. In terms of geography, accused persons outside the six urban areas in which DTCs are currently located will not have access to DTCs at all.
The committee heard last week from James Bonta, who spoke about the principles of risk, need and responsivity in effective offender treatment. DTCs have demonstrated particularly poor levels of responsivity to clients with diverse backgrounds including women, first nations, Inuit and youth.
Second, DTC policies and the policies of community partners need to be revisited in order to suit client profiles. Because street-level dealers are fairly accessible to enforcement, they often have lengthy criminal histories, sometimes involving violence, which may exclude them from program eligibility.
Ensuring that program eligibility reflects the reality of potential clients will be essential in meeting client needs.
Finally, CCSA joins with previous witnesses in calling for the implementation of comprehensive, methodologically rigorous program evaluation. Given the infrastructure and significant operational costs associated with DTCs, this model of service provision needs to clearly demonstrate efficacy, value for money and superiority over other models and approaches for responding to individuals with substance problems who engage in criminal behaviour.
Inherent to the challenge of evaluation is the question of what defines success. Clause 10(5) exempts an offender from mandatory minimums if a program is successfully completed.
DTCs typically consider successful completion to be approximately three months of abstinence. Current research, however, indicates that substance use is best approached as a long-term challenge. There is increasing movement away from seeing relapse as treatment failure, and instead seeing engagement or re-engagement with services following relapse as evidence of both personal and system-level success. Should the proposed legislation be enacted, CCSA proposes that success be defined according to progress within a period of time determined by the court, along with individualized case plans developed through evidence-based assessment and screening.
[English]
With respect to provincial treatment options, the proposed new section 10(4) of the act also includes a provision for attending treatment. CCSA believes this option is necessary given the lack of national coverage offered by drug treatment courts. It comes as no surprise that there are currently significant gaps in treatment capacity across Canada that will pose barriers to any increase in clients referred from the criminal justice system.
Many community-level programs exclude clients for whom treatment participation is a condition under the criminal justice system. As discussed by Dr. Bonta and Dr. Bourgon in their testimonies, many community service providers that work with criminal-justice-system clients may not have the expertise needed to deal with their complex needs in an evidence-based fashion. Complex substance use requires a continuum of services and supports in areas such as housing and mental health.
The services that are available in Canada vary considerably from one location to another. The inconsistency in access to programs that meet offender needs is, therefore, not limited to drug treatment courts. For example, the North is an area of particular interest to Senator Watt. He may be aware that currently Nunavut has no treatment facilities. Inuit clients must travel to Ottawa to reach culturally appropriate programs. They will have limited, if any, follow-up options when returning to their communities.
Unfortunately, we do not have a clear picture of what services are available or how many people are currently accessing them across Canada. As I mentioned, there is tremendous variability in accessibility, quality and nature. These challenges, as well as recommendations for addressing them, are included in the report A Systems Approach to Substance Use in Canada: Recommendations for a National Treatment Strategy, which is included in the kit provided to you. The strategy is based on the concept of client-centred care provided through system-level coordination and collaboration.
Finally, we need to be cognizant of the fact that treatment is primarily under provincial and territorial jurisdiction. The National Treatment Strategy is based on an integrated approach developed to reflect a broad range of jurisdictional considerations. It is important to acknowledge the funding that has been provided for treatment under the National Anti-Drug Strategy, particularly through Health Canada's Drug Treatment Funding Program. The systems funding provided to the provinces and territories by Health Canada directly supports the capacity development recommended in the National Treatment Strategy.
In other words, there is a plan, and we are trying to mobilize it. However, we must recognize there is considerable work to be done. We, therefore, encourage the government to work closely with the provinces and territories to ensure that the treatment capacity needed to support Bill C-15 is in place.
Although the intention of the proposed new section 10(4) is to ensure that offenders requiring treatment can do so outside of the prison system, we also need to recognize, for those not eligible for that, that treatment options for those within the prison system are particularly limited at the provincial and territorial levels. These services need to be considered as an integral component to develop an overall system capacity.
In conclusion, Bill C-15 can be interpreted as a means of promoting access to treatment for those who need it. CCSA would like to emphasize that substance use is primarily a health and social issue. However, we recognize that the criminal justice system is a common access point for substance use assessment and intervention and welcome opportunities to divert criminal-justice-system clients with treatment needs into services that can better meet their needs. As a result of that, CCSA recommends that we develop a real-time monitoring of treatment capacity to evaluate the efficacy and impact of Bill C-15 if it is enacted. That is something I would like to unbundle in the question-and- answer session if we could.
Thank you for this committee's ongoing dedication to investigating this matter thoroughly. I know that you have received much testimony giving polarizing views. You have a difficult task ahead of you.
Tremendous progress has been made in Canada in many areas, including the development of the National Treatment Strategy, harmonization of different orders of government and the not-for-profit and private sector working together. That is something that we can leverage as we move ahead. There is massive work to complete, but it is a far better situation than the one we were in five years ago. That is something for the committee to consider and that we would be happy to unpack for you at an appropriate time at a later date.
[Translation]
Senator Nolin: I want to start with one or two questions on treatment.
[English]
You or your colleagues may answer. I want to focus on that famous word ``success.'' I have a problem with that word because it is very subjective. I would prefer not to see that word as long as the individual is completing a treatment program offered by federal or provincial law. Of course, the judge would be the ultimate referee of treatment completion.
What is your opinion if we were to suppress the phrase ``avec succès'' in the proposed new section 10(5)?
Mr. Perron: My colleagues can answer about the variability of what this word ``success'' means. It is highly subjective and interpreted in different ways.
Senator Nolin: As you know, subjective words such as that in law are a problem.
Mr. Perron: Exactly. You have already noted from your witnesses that there is a vast difference of opinion among the witnesses themselves.
Senator Nolin: Exactly.
Mr. Perron: It is important to know that treatment works. If the premise of this bill is to help those in need of treatment and provide a pathway to credible, evidence-based services, it can work for them. That is the first point I want to make to ensure that committee members have a level of confidence that it can work if we are referring people to the system.
We know that it is a chronic relapsing condition that prohibits the neat definition of ``success'' as to how we operationlize it. For those who need it, having the adequate systems and pathways to it and the capacity to meet those is primordial in how we define success.
Senator Nolin: I will say more about why I am afraid of the word ``success.'' You referred to total abstinence in your testimony. I know you know much more than us on that, but I am afraid that someone could read that as total abstinence over six months or a year. We know that in some areas with some individuals it would be a problem. I do not think we really want that. We want someone who accepts first to go through a process to find a solution to his or her problems.
That is why I have a problem with the word ``success.''
Rebecca Jesseman, Research and Policy Advisor, Canadian Centre on Substance Abuse: I can speak to that a bit especially using the Drug Treatment Court of Vancouver, DTCV, as an example. I know that the DTCV has both program completers and program graduates. A program graduate is someone who has achieved four months of abstinence as well as a series of other health and social achievements, such as housing stability and lifestyle improvements. You are considered a graduate, but you can be a program completer without necessarily having all the criteria required to graduate.
In this legislation, whether both program completers and graduates would be defined as successful is open to interpretation. Therefore, that is one area that we would like to respectfully recommend that the Senate look at putting in some additional guidelines because we also know from best practice in treatment that treatment pathways need to be catered to individual needs. If we try to impose universal criteria on all offenders with a very complex diversity of needs, evidence-based practice will not be respected.
Senator Nolin: We heard many witnesses — and you — refer to the variety of options. They all said that there was no one-size-fits-all portrait of a treatment, and the treatment must be tailored for whoever is presenting in the system. Do you agree with that?
Ms. Jesseman: I agree.
Senator Nolin: That is why, Mr. Perron, in your opinion, we are moving in the right direction in the treatment area of substance abuse.
Mr. Perron: Absolutely. We often speak in these ephemeral terms, so to give a real life example, we had a speaker at our conference last week in Halifax Mr. Christopher Kennedy Lawford. You might have heard of his family — the Kennedys. He had a heroin addiction for many years. He has been 22-years clean, but it took him 9 years to get there. He speaks very eloquently about recovery. He said that he failed repeatedly within those 9 years, but it got him to where he could be sober.
The point is that even someone with the wealth and access to resources, as a Kennedy in the United States has, with all the reams of services, it takes time. It takes a great deal of work. In addition, a caring support system is necessary based on evidence and key principles of engagement as they are in the National Treatment Strategy to reach out to that individual. Absolutely, we need a tailored process that is patient yet forward-looking and allows a person to make his or her own journey but understands that abstinence, at the end of the day, is the goal. Someone such as Mr. Lawford gives a perspective as to how that can play out.
The Chair: One cannot rationally expect the law to say that success will come after nine years or ten years or whatever, so if we were to write in guidelines, they might be useful. They might indeed be very useful and contribute to justice. However, they would also, in a sense, have to be artificial in that we would suggest that the judge would set some realistic, in terms of the law, deadline that might not be realistic in terms of patterns of addiction. It is a bit of a conundrum.
Mr. Perron: I would agree entirely. Speaking to the types of relationship with the treatment program that you can describe as opposed to the timeline, the only reason I mentioned Mr. Lawford is to give a real-life example. Some people after one intervention can be changed people and go on to abstinence. There is an entire scale. The challenge before you as parliamentarians is to try to find language that accommodates access to a system and to a treatment process that is responsive, and some measure or marker for the judge to allow for this success to continue. We could probably come up with language at some point if that is helpful when you are looking at guidelines; we would turn to the National Treatment Strategy that has been pulled together by the provinces and territories and ourselves as to where to go in that regard.
Senator Nolin: Drug treatment courts have experience dealing with the social analysis of individuals where they are sentencing. The way it is written, if we get rid of the word ``success,'' they will have ample latitude because they decide if the sentence will be given, if the treatment is completed. They will, from that, I think, deduct that they are in charge and will decide what fits. One individual needs to make the decision that he or she is convinced that the client went through the treatment, completed it and is on a good path. It needs to be the judge.
Mr. Perron: This is not just any program. Obviously the act is specific. It is drug treatment courts and those programs accredited by provinces. It is not willy-nilly.
Senator Nolin: We have access to both now.
Mr. Perron: By the same token, many of the aggravating circumstances listed in the bill are primary means of exclusion for the drug treatment courts. That is an issue in and of itself.
Senator Nolin: I want to move into the medical use of marijuana in terms of prevalence.
The Chair: That is a new topic.
Senator Nolin: I can wait.
The Chair: You will be on the second round.
Senator Wallace: Mr. Perron, I notice on page 4 of your presentation, under the heading ``Prevalence and Harms,'' some statistical analysis with respect to the harms of drug use. Are there any other studies or other evidence-informed cost analysis that your organization has undertaken that has attempted to quantify the harms of illicit drug use in Canadian society, say in regards to health care costs or work productivity costs?
Mr. Perron: We have, senator, and we actually came out in 2002 with the second report, The Costs of Substance Abuse in Canada 2002. I am not sure if a copy was included in your kits. If not, one will be. You have my apologies for that as well.
To give you a sense of perspective, in 2006, our study based on 2002 data estimated the cost of substance abuse, including alcohol, tobacco and illegal drugs, to be $39.9 billion per year of which illicit drugs alone account for $8.2 billion.
Just to make the first point, it is in the minority as it relates to legal drugs, and that is always a conundrum that I know you have been brought to — legal versus illegal. However, the costs are real in terms of illegal drugs.
If you unbundle that $8.2 billion per year, you have direct health care costs of $1.1 billion; direct law enforcement costs of $2.3 billion; and indirect cost, productivity losses are $4.6 billion — those are massive costs through suicide, overdose deaths and therefore not being able to contribute to society on a long-term basis. Therefore, $8.2 billion, and these are conservative estimates of direct and indirect health care and social costs.
Senator Wallace: That was a result of analysis done in 2006?
Mr. Perron: Based on 2002 data. This is our second study. The previous study done in 1996 came up with a total cost of $20 billion. One might ask what we are doing for the number to keep going up like that. That is where the strategies that I spoke to at the end of my presentation have now been put in place to try and mitigate this. It is a real and significant cost to society and, in many respects, a preventable one; hence, prevention is an important point of what we do.
Senator Wallace: On page 8 of your presentation, you referred to the funding provided for treatment under the National Anti-Drug Strategy from the federal program through to the provinces and territories and support for the recommendations in the National Treatment Strategy.
Do you have any analysis or summaries of those drug treatment prevention programs that have been funded through the National Anti-Drug Strategy?
Ms. Jesseman: The Drug Treatment Funding Program, DTFP, was recently introduced, so most of the programs are still in development with Health Canada. Many of the agreements with the provinces and territories have not been finalized. I would guess no summary is available yet, but you could probably contact Health Canada for a summary of what has been disseminated to date.
Mr. Perron: If you look at the role of the federal government as it relates to largely provincial and territorial services and treatment, there is a direct fund that is funding programs that are in their infancy.
The second tranche is going to the provinces to increase system-level performance. There is a lot of money going to the provinces in terms of transfer payments that ostensibly goes to treatment programs. I could surmise that the federal government wanted to, as part of the National Anti-Drug Strategy, create a system where we can raise the benchmark.
Can we measure outcome? Can we tell if it is making a difference? We have a paucity of data as it relates to treatment in terms of availability, efficacy, outcome and matching of need. That is part and parcel of what the federal government is trying to put in that treatment pillar as part of the National Anti-Drug Strategy.
Senator Wallace: In funding those provincial efforts and dealing with treatment, do you have any sense of how broadly that is being dealt with across the country? Is it focused only in one province, for example, or does it have a broad-based application throughout the country?
Mr. Perron: I think Health Canada could probably provide a definitive answer. However, my understanding anecdotally, in speaking with colleagues from the provinces, is that it is fairly widespread. The provinces are taking full advantage of it.
As importantly, this National Treatment Strategy that my colleagues here develop with the provinces and territories to say if we will deal with treatment in this country, how best to do it, this was the result of that product. We now have to put that into place.
Interestingly, the federal government modelled its terms and conditions for its funding for the provinces along the lines of the treatment strategy here. You have a harmonization of what federal dollars are available with what the provinces and territories and not-for-profit organizations are saying that we need to do in treatment. Ideally, it will help make that system operational.
Senator Wallace: There is a consistency in objectives at the federal-provincial-territorial levels to try to get to some common end results, as opposed to each of them going off in their own direction.
Mr. Perron: I would agree with that, but I cannot say definitively that that is the federal government's position as I am not the federal government.
Senator Watt: I will try to cover the area that deals with the substance abuse. This is an area that concerns me the most, especially coming from the North.
I appreciate that you point out in your presentation one of the areas on which I have been focusing. For your information, I am not only concerned with the Nunavik aspects of it; it is Nunavut, including Labrador and the Inuvialuit on the western side.
No facilities are available in the North, regardless whether it is Nunavut, Nunavik, Labrador or the Inuvialuit side. However, we do have medical services' studies being provided for general purposes, for Medicare purposes. You mentioned in your presentation that housing also is one of the factors that needs to be looked at seriously. I am trying to address what you call the rehabilitation aspects of it and the criminalities.
In terms of accessing the facilities in both areas, that does not exist. For that reason, our young people have to leave their homes and be brought to the South, where they become part of the bigger picture in the penitentiaries. I have been hearing from the witnesses before you, from people who have responsibilities determining what is happening in the correctional institutes, and they have all indicated that numbers are increasing. My point is how we keep those people away from those institutions — the federal penitentiaries or even the provincial penitentiaries.
I know the people who were making the presentations were trying their best to stay away from the word ``discrimination.'' Personally, it is hard for me to believe that discrimination still exists in this country, but nevertheless it does. If that is a big factor for why that the Aboriginal people, especially the Inuit, are not being properly treated, what is the better way from your point of view? It is easy to say that we should keep them away from those institutions; but, on the other hand, we do not have any facilities at this point.
With Aboriginal people living in the North, where do we put our emphasis to concentrate and realize that we have a special need? Our special need cannot be answered by the South. Our special need can only be answered by the North.
I am talking about even, if necessary, a private sector might have to get involved to provide the facilities that are needed in the communities. Down the road, government might have to come up with a different solution.
Should we become more alarmed now as Aboriginal leaders in this country? Otherwise, we are losing our people very quickly, and the numbers are increasing in the penitentiaries. If we do not do something, I do not know what the future holds. Can you respond to that?
Mr. Perron: The brevity of my answer will not reflect the seriousness of the situation.
First, many of your people who appear to give testimony of this nature for drug policy often present things in binary issues; either you do this or you do that. Frankly, it is having to do many different things at once. That means to have prevention and education programs in place, to have access to treatment, to harm reduction and enforcement programs, but in a coherent whole.
A number of years ago, why those numbers kept going up is because we had no plan for Canada writ large. The provinces did one thing, the territories did another and the feds did another, so we created the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada for how we should organize who should do what where: What is the role of the territories versus the private sector versus the not-for- profit sector?
We came to agreement on how we should do that, and two key priorities emanated from that: reaching out to the North; and First Nations, Inuit and Metis, understanding exactly, for the eloquence that you provided, the disproportionate impact on those communities.
On your questions as to what to do, my personal commitment as head of CCSA is that I have gone to the North and said that I will not knowingly perpetuate what my predecessors have done, which is tell you how to fix your problems. We are waiting to take our direction from the North.
We created an elders committee a number of years ago that is guiding us to work with the key entities, such as Inuit Tapiriit Kanatami and the mental health program that ITK works with to bring in the key protagonists of the North, in particular, Nunavut and Labrador, in terms of how to deal with this issue.
It has to start with prevention in many respects. It speaks of prevention with hope. You have to give hope to the people that there is an opportunity; you have to give them options. It is more than just telling them to say no to drugs; it is say yes to what. We have to give them options in that regard, real treatment options.
They leave the North and come to the Mamisarvik Healing Centre in Ottawa, which offers a fantastic, culturally appropriate program; they have to return to a community that does not necessarily have the wraparound services that you discuss from housing — which we know is a massive problem in the North — to job employment and job offers and the rest; we know there are many problems in the North.
I do not mean to paint an even bleaker picture. It is important that we have the right people at the right table, all agreeing on how best to deal with the issue based on evidence and investment, based on that we must stop doing what we know does not work and agree on a way forward.
At some level, we are getting there with having the discussion and eliciting the solutions. However, the long term will require an investment. It will require transparency and accountability as to who should be doing what where.
That is part of the role that CCSA is trying to play. However, we are doing so with tremendous respect to ITK, all First Nations groups and their governance responsibilities, and to the elders, who are the ones who guide us in this area. I am not sure if this answers the question.
Senator Watt: That partially answered my questions. I assume it means that we have many things to think about in where to go from here.
You mentioned that various instruments already exist through an organization such as ITK. We know that. Some of those instruments are only beginning to go in that direction and to try to find the solutions to the problems with which they are confronted.
At the same time, they are totally disconnected from the lawmakers because they were not even asked to appear in front of the House of Commons standing committee that dealt with this subject matter. They are kept at a distance while the changes are taking place, and they are not following the changes, so they cannot make an adjustment. A sort of double standard exists. I would like to address that.
Mr. Perron: For many of those reasons you point out, ITK is a co-chair of the National Treatment Strategy Leadership Team. We have reached out to them to work in a very concerted fashion with the provinces and among everyone who is trying to create this coherent National Treatment Strategy for Canada in ensuring that there is the voice of the North, and Nunavut in particular, through ITK.
In terms of their relationship with parliamentarians, I leave that to you. The need for political leadership, engagement and bringing these voices to the table here is definitely required.
You also spoke of the issue of discrimination and stigma. When we use that language in our world, the world of addictions, it transcends all cultures. The fact that someone is a drug user is a stigmatizing factor that might diminish his or her ability to access the services required. You often hear the example of if you are diabetic, you can go to hospital, but if you are a drug user, there is a problem.
The stigma of discrimination applies to all users and not one culture within it. It is an important area to address.
Senator Watt: The word ``discrimination'' is not necessarily coming from me directly but from the witnesses that we have heard. Apparently, in those institutions, when the person is being put away, that person is being exploited and discriminated against, knowing that that person is disadvantaged.
The Chair: There are two kinds of discrimination: direct personal discrimination and systemic discrimination. Systemic discrimination is harder to tackle, in some ways.
Mr. Perron: We would welcome the opportunity at any time to speak on this more specifically and give you a full briefing on what we are doing with the North.
Senator Watt: I would appreciate that.
[Translation]
Senator Carignan: You talked a little bit about impaired driving. That is an interesting example because the problem exists here. You can consider examples from elsewhere, but you always have to be careful because it is not necessarily the same type of population with the same culture.
Alcohol is an addiction problem just like drugs. There have been amendments to the Criminal code that impose minimum sentences. There were a whole slew of measures, similar to the drug strategy, for impaired driving. The fact that there were known minimum sentences allowed us to publicize those sentences, which had a deterrent effect. Without a firm minimum sentence, it is hard to publicize the sentence. We were able to do it here. We have access to treatment. We know there was a significant decline in impaired driving.
Are there studies on impaired driving that give the figures before the minimum sentence was introduced? Is there data on the people who were forced to complete a treatment program and the success rates — using the somewhat vague idea of success, as Senator Nolin pointed out earlier? Have you really examined these aspects of impaired driving?
Mr. Perron: I will ask my colleagues to answer. But I can tell you that the success we saw on a national level with respect to impaired driving reflects not only an alignment of federal, provincial and territorial government partners, among others, but also an alignment of repression, prevention and education measures. It was a societal change. Impaired driving is not acceptable in our society. Everyone was moving in the same direction to try to solve the problem.
When all those elements are aligned — prevention, education, treatment, rehabilitation and repression — that is when you see a significant change. To some extent, that is what we are trying to do with the national framework on substance abuse, which brings together all of those aspects for drugs. It is a successful model that we should look to.
As for the specific data you asked about, I will ask my colleague Amy to respond. She is more familiar with that aspect than I am.
[English]
Amy Porath-Waller, Senior Research and Policy Advisor, Canadian Centre on Substance Abuse: I am not familiar with any specific studies. However, one of my colleagues at CCSA was involved in a report that looked at the mandatory programs for impaired driving. I would be happy to follow up and provide that document.
The one addition I would like to make to my colleague's comment is that one reason we have been so successful in reducing rates of drinking and driving is because significant investment has been made into the prevention of this issue. Over the past two decades, there have been many prevention campaigns and a significant investment. Therefore, we are starting to see strides in that with respect to drug-impaired driving. Studies document that the prevention efforts in which we have been investing have had effects on reducing rates of drug-impaired driving.
[Translation]
Mr. Perron: Treatment program success is not necessarily tied to how the person came to receive treatment. So coercive treatment — if we can call it that — is just as successful as a treatment program offered to someone who enters voluntarily.
When a person is arrested or incarcerated, if you have a problem, you should be directed to the appropriate treatment program. By ``appropriate'' treatment, we mean a program that is based on convincing data for your condition on the best way to treat the problem.
Someone could be denied treatment because they have those characteristics. If the bill goes forward as is, we need to make sure that the treatment and rehabilitation programs in place can be offered to this specific group of individuals. That is key because it is in the spirit of the legislation. The system has to be in place to provide assistance to an individual who needs it.
Senator Carignan: That is part of the data I would like. Popular thinking — mine, at least — is that the person should seek treatment on their own and that as long as they do not think they have a problem and need treatment, the chances of success are lower.
I see from your testimony that that is not necessarily the case.
Other witnesses have said that, in some cases, the fact that a person was in custody was the reason they decided to undertake treatment and that it was somewhat successful. So the fact remains, and there must be some statistics.
Mr. Perron: We will endeavour to find those numbers. If the threat of imprisonment is a motivator, so be it. But that does not mean that we should put people in prison. It is enough to provide them with the necessary services.
The Chair: Before we move on to the second issue, I want to ask you to send us all of the documentation that pertains to Senator Carignan's questions. You can send it to the clerk of the committee.
But we already have the March 2006 study on costs that you referred to. We could pass it around to the committee members. So you do not need to provide that.
Senator Carignan: My question is precisely about that study. We will review it, of course, but I am not sure that it will answer my next question. Have the indirect costs related to productivity loss, for instance, been calculated? An individual who develops schizophrenia or who suffers from a mental illness as a result of significant substance abuse will face a loss of income and productivity for the rest of their life. Was that consideration factored into the calculations?
Mr. Perron: The costs associated with the loss of productivity were calculated based on the number of years lost in the case of death. They are not necessarily based on conditions similar to those you are suggesting.
Senator Carignan: Disabling conditions?
Mr. Perron: Exactly. The current data is somewhat limited.
Senator Carignan: So you are talking about premature deaths, before reaching normal life expectancy.
Mr. Perron: A young person who drinks and then crashes their car into a tree and dies represents a cost to society in the amount of X or Y in lost contribution. Those calculations are difficult. In the case of illicit drugs, the cost is estimated at $8.2 billion annually. Alcohol represents an overall amount of $14.5 billion annually.
Senator Carignan: Have you studied the situation in Portugal? Those who use illicit drugs are said to be more likely to commit crime. In your presentation, you talked about 21.7 per cent, and when cannabis was excluded, it was 37.5 per cent. So the number of users seems to be proportional to the crime rate. I am surprised to find a country where the statistics show that the number of users is dropping while the crime rate is going up. Have you studied the situation in Portugal, specifically?
Mr. Perron: Personally, I have not. I will ask my colleagues if they have any clarification as far as interpreting the data you just referred to.
[English]
Ms. Jesseman: There may be a misunderstanding. That paragraph speaks to harms experienced, not to crime.
[Translation]
Senator Carignan: So it is talking about harms?
Mr. Perron: It talks about harms inflicted on the individuals themselves.
Senator Carignan: So those acts did not necessarily translate into criminal charges?
Mr. Perron: No.
Senator Carignan: So we cannot make any connections.
Mr. Perron: That is correct. You can compare Portugal to Sweden or to Canada, but every country has its own situation. You need to consider the problems as well as the legislative tools and programs used to address them.
Those issues were discussed when we worked on developing the national framework. In Canada, there are a number of factors that need to be taken into account. So the question that needs to be asked is how do we move forward to solve this growing problem. And that is the resulting strategy.
Senator Carignan: I understand that we need to be cautious before we copy any models.
Mr. Perron: Absolutely. Similarly, I would not necessarily tell the Swedes to adopt the Canadian model. You can look to a model when you have data that is convincing and comparable. But every country's situation is different.
Senator Rivest: You mentioned the repression aspect. In your opinion, does the nature of the sentences currently imposed by the courts, in other words, not minimum sentences, have a significant impact on drug use trends?
[English]
Ms. Jesseman: In short, no. A strong correlation has not been demonstrated.
Senator Rivest: Thank you.
Senator Nolin: Wait for the answer.
Ms. Jesseman: I know my colleagues in the Department of Justice Canada and at Statistics Canada can provide you with more figures on this. However, in general, studies indicate that there are not strong correlations between legislated penalties for drug crime and the commission of drug crime.
[Translation]
Senator Rivest: So, in your opinion, imposing minimum sentences does not seem to be necessary in order to improve treatment for drug users?
Mr. Perron: From my understanding of the bill, anyone with a drug abuse problem who is arrested for a crime will be given help. In that regard, CCSA wants to stress how important it is that these treatment programs be accessible to those who need them. Whether it is the courts, DTCs or provincial programs, as soon as you open the door to helping individuals who have been arrested and who have a drug abuse problem, you have to make sure that the treatment system is in place before imposing a minimum sentence that would make that type of treatment mandatory; otherwise, you go against the spirit of the legislation.
The way I see it, the spirit of the legislation says that we should help those with a drug abuse problem. But those who are profiting on a commercial level should be punished.
Senator Joyal: I would like to come back to this aspect of the bill, which seems to come under your area of expertise.
As you quite rightly pointed out, there are two ways for a drug user to be rehabilitated. The individual can appear before a specialized court. There are six of them in five of the provinces. They are all in Ontario and western Canada. There are none in Quebec, the four Atlantic provinces or the three territories. In those cases, you have to go with the other option.
Mr. Perron: Yes.
Senator Joyal: The one set out in section 720(2) of the Criminal Code, which reads as follows:
[English]
It states:
. . . to attend a treatment program approved by the province under the supervision of the court, such as an addiction treatment program or a domestic violence counselling program.
[Translation]
How many programs have been approved by the province or territory?
Mr. Perron: I cannot answer that question, unless my colleagues can help me out. The method for approving these programs varies depending on the province. Some programs are approved because treatment services are subsidized by the government.
In Ontario, for instance, if they cannot treat a person with a drug problem, very often, they send that person to the U.S. or another province for treatment.
Clearly, the lack of capacity is significant for those who are using these services today. In order to increase the number of potential clients using these services through the courts, a major investment is needed. That is why we put forward the following suggestion: as long as the bill includes an evaluation component in two years, you should carry out an immediate evaluation, real-time monitoring to ensure that if there are indeed all kinds of people who would be good candidates for these programs, if there are no programs, you should know that sooner rather than later. If we come back to the spirit of the legislation, in other words, if you need help, we will give it to you, then of course that help has to be in place. We could get you a list of treatment programs in the provinces that are well established, funded and evaluated, but as for a list of qualified programs, we do not have that.
[English]
Rita Notarandrea, Deputy Chief Executive Officer, Canadian Centre on Substance Abuse: I would add that a number of addiction programs in hospitals do have to undergo accreditation, so there are a number of them. There is the Canadian Council on Health Services Accreditation, and standards are associated with addictions. We do have those sorts of programs that have passed the accreditation standards.
Senator Joyal: Therefore, you would have a list of those certified programs, and you would have it by province and territory. Even in the provinces where there are drug courts, such courts are normally located in a large city. However, drug problems exist outside of main cities. Let us take British Columbia, as an example. I am sure our colleague, Senator Campbell, could identify many cities other than Vancouver in which a significant number of drug users should have access to that program.
In other words, even with a drug court system in six cities in Canada, it does not even cover the whole of the territory within one city.
The first option does not cause a problem; drug courts are known. However, the second one seems to be more or less a very far away outreach objective. I have couched that in the most positive terms possible. On page 7 of your brief, under ``Provincial Treatment Option,'' you say, ``there are currently significant gaps in treatment capacity across Canada that will pose barriers to any increase in clients referred from the criminal justice system.'' I understand that waiting lists exist because resources are limited.
You go on to state that ``many community-level programs exclude clients for whom treatment participation is a condition under the criminal justice system.'' In other words, they do not want to have criminals. That is another barrier.
Third, you state, ``The services that are in fact available vary considerably from one location to another.'' You come back to your point. Therefore, in fact, and I quote, ``We do not currently have a clear picture of what services are available or how many people are currently accessing them across Canada.'' In other words, we are moving within unknown territory.
I then read your report, A Systems Approach to Substance Use in Canada: Recommendations for a National Treatment Strategy. The first recommendation is to invest resources and develop infrastructures to ensure that ``the services and supports required within each tier are available in all jurisdictions.''
Therefore, a question of money arises. Otherwise, all that will remain at the good-intentions level. However, in practical terms, nothing will change tomorrow morning if that bill is passed by Parliament.
Mr. Perron: You have summarized the situation quite well.
If the premise of this is to reach those who need help, then that is wonderful. Let me back up, if I might. Hopefully, we have many intervening points with individuals with drug problems far before they come before the criminal justice system. We have to remember that there is a long list of those people at times. For those who do come face to face, if an opportunity exists, we would rather see those people get help than go to jail. It would be the spirit of the act, as I read it, and the intent of the government to also have that and to make two avenues available for it.
The federal government's closest area of control is the drug treatment courts, given that they fund them. They are very new. You have heard testimony on their efficacy and where they should be going. Immediately we know that there are exclusion factors in the drug treatment courts that prohibit people who, by the very nature of getting there because of aggravating circumstances, cannot have admissibility. As a policy decision or recommendation, the federal government should at least open up the opportunity for their drug treatment courts — I say ``their'' because the federal government is funding them — to allow these clients to access their programs because, by nature of the act, they are putting them there.
There is no question that a gap exists in the availability of and need for provincially mandated programs. We have to bridge it. I go back to my response to Senator Watt from the North. It is not ``either/or''; we have to do these things together. If there is a capacity issue, can we increase the capacity? However, there must be a proper hand-off between the federal government and provinces as to how that is done.
Again, the premise stands. We are happy with it as a point of access for treatment, but the treatment system must be there to accommodate them.
The Chair: The longer this goes on, the more fascinating it gets.
Senator Wallace: On a point of clarification, Senator Joyal raised the issue of the provincial treatment programs. Mr. Perron, I think you said — or I took from what you said — that you have a list of provincial treatment programs throughout the country. I thought you said that you were prepared to provide that. I am not sure if we took Mr. Perron up on his offer. If there is any uncertainty, I wanted to be clear about that.
Senator Joyal: Any serious offer is not refused.
Mr. Perron: To be clear on what I offered, we have a listing of treatment services available in provinces. That is not to say that these are accredited, approved services as defined by the section of the act, cited by the code or Bill C-15. However, it is a starting point.
The Chair: We would be pleased to receive any information that you have. You can send it to the clerk, sooner rather than later.
Mr. Perron: You will have it by the end of the day.
Senator Wallace: Good.
Senator Baker: Do you understand what happens in a province where there is no treatment program? I will use the example of Newfoundland and Labrador. A judge in a sentencing hearing will entertain a submission that someone is accepted to a treatment program either funded by the public through social services or funded by that person themselves in the province of New Brunswick. There does not appear to be any consistency in the identification of these programs that are acceptable to the court.
Therefore, in the study that you do to come up with these institutions, would you have a look at the case law to see what provinces recognize the other provinces? Please provide us with any material that deals with elements of justice, fairness or the charter that recognize that certain provinces and the North are subjected to that rationale when there does not appear to be a consistent policy nationally as to which institutions are recognized under section 720(2) of the Criminal Code.
Mr. Perron: We will do our best to do that for you, senator.
Having said that, there might be limitations to what you will receive from us. We will likely go on the basis of what programs provinces deem appropriate to bill against. We will go to our provincial and territorial colleagues for that.
There is some practice, as you know, in Newfoundland. CCSA or the system must do a better job in educating judges, Crown counsel and defence on what drug addictions are and why these people are before them. They need to better understand the follow-through from the criminal justice system. That is an aside that we will take away from this that we should do.
Senator Baker: Also the costs of actually getting accepted.
Senator Joyal: You will provide us with a list of the treatment programs that exist by province. If you have information that qualifies those programs recognized by the court, will you provide that to us also?
Mr. Perron: To be clear, we will get that cue from the provinces. We will interact with the group that we work with on the treatment side and, perhaps, contact Health Canada. We will do our best to pull it together as quickly as we can.
Senator Joyal: A conclusion in your brief on page 8 states: ``Ensuring comprehensive system development to provide those services, without reducing the services available to the public . . .''
Have you any idea of the magnitude of the public investment that should be made to reach the objective of the act?
Not to do it in one year, but within a reasonable period of time, for example, to do it in three to five years, how much money will be needed to reach the level of services that you suggest in your brief?
Ms. Notarandrea: We had a number of research experts involved in this report. We contracted out a particular piece of work to arrive at that very figure. In the end, because of all the factors involved, it was not possible.
What you see in the report is that we cannot have everyone with an addiction problem accessing specialized services only. We must ensure that the rest of the system has the tools needed to be able to screen and to intervene so that those most in need and those who are the most complex, who we are talking about here, have access to the top of the tier. Only those people should be accessing those specialized services that deal with mental health and addictions. If we can equip the rest of the system to deal with those clients before they ever hit the judicial system, we would have done our best in terms of the treatment system.
The simple answer to your question is that we attempted to do that, and it was impossible.
Senator Joyal: Have you any ballpark figures? Do we have to multiply existing resources by five, 10 or 20? Have you an idea of the magnitude of the effort that should be made?
Ms. Notarandrea: We do not. However, if we have the three tranches that have been spoken about, if we have more prevention services, rather than looking at how the current system looks today, perhaps we could make a dent in the numbers that would require treatment in the future. There were too many factors to consider in the population itself — the elderly, the youth — to come up with one answer.
We did try to do that for this report.
Mr. Perron: The demonstrable costs associated with illicit drugs alone are approximately $8 billion per year. If we want to address that in an efficient and productive manner, it should be our first clue as to the commensurate investment required.
As to the actual number, if we were to undertake a rolling evaluation of the impact of this bill in access to the system, we could possibly look at scaling that on a real-time basis. That takes work and coordination as to who will do what.
First, we cannot assume that all services are as efficient as they could be; second, ask the question of how best to stream along the different service lines; and, third, determine the gap and who should provide it. Without answers to those three areas, to suggest a specific number to you would be inappropriate given the lack of that data presently. All we know is that a gap exists.
The Chair: We are talking about a large amount of money. However, it may be money that would be invested extremely profitably.
Mr. Perron: The last person who asked me that question in this room was Senator Kirby as part of his report Out Of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. A compelling business case is before you if you apply that lens to the type of investment required.
[Translation]
Senator Nolin: As for the therapeutic use of cannabis, do you have any empirical data on the number of Canadians who use cannabis for therapeutic purposes, whether they obtain it through regulated means or not?
[English]
Mr. Perron: Yes, it all depends on the question. If you extrapolate the numbers and do the calculations from the last question posed by the Canadian Addictions Survey, approximately 1 million Canadians indicated that they had used an illicit substance for ``therapeutic'' benefit in the past year. That is the order of magnitude.
Senator Nolin: I am more interested in the order of magnitude than a specific number.
Mr. Perron: With the caveat, however, if you asked a question where the wording was fairly broad and undistinguishable about how many people consumed alcohol for therapeutic purposes, you would probably get as many people. It does not necessarily mean it is the right use for therapeutic purposes.
Senator Nolin: I am not saying that.
Mr. Perron: Also, it is not appropriate to suggest that that cohort should be under Health Canada guidelines. It simply says that a number of people reported it that way. However, we did not repeat that question in the CADUMS data because we felt it was spurious in its conclusion based on the way it was worded and could possibly be inflating or could give the wrong information.
It is something we should consider looking at, but the data is dodgy at this point.
Senator Nolin: Slightly fewer than 5,000 Canadians are using the regulatory process to access marijuana. There is a multiplier of unknown magnitude — I do not know the number — of Canadians self-medicating with marijuana for therapeutic reasons, and they believe in that. I am sure you can provide us with those numbers.
Mr. Perron: Yes. We will provide that to the committee along with the question posed.
Senator Nolin: I am also interested in the prevalence of people who are both users and traffickers. Do you have such numbers because the bill that we have before us may capture those people?
Ms. Porath-Waller: I have prevalence figures on the percentage of Canadians using cannabis. In the 2004 data, 14.1 per cent reported using at least once in the past year. This corresponds to about 3.6 million Canadians aged 15 and older. In the 2008 CADUMS data, 11.4 per cent of Canadians aged 15 and older reported use at least once.
Senator Nolin: That is the users. If you add the users to the traffickers — those trafficking to fund their use — do you have that information?
Ms. Porath-Waller: I do not have that data with me, but we could provide it.
Senator Nolin: Your earlier answer gave me the impression that you probably had the answer.
Ms. Jesseman: I should qualify that I am pulling it from the same source that the earlier testimony from the Canadian Centre for Justice Statistics would have used, so you should have this data in your packages.
Senator Nolin: They were not dealing with users; you are. I was waiting to ask you that question.
Ms. Jesseman: This is again going back to the police-reported offences. The rate for trafficking is 24.1 per 100,000 people for cannabis, and 206.3 overall for possession of illicit substances; and production, importation and exportation — and again this is illicit substances— overall at 27.8 per 100,000.
The Chair: We do not know how many traffickers are users and vice versa?
Mr. Perron: We do not know precisely. Not all users are traffickers and not all traffickers are users. Where in between they meet, and what that cohort looks like are the questions.
Senator Nolin: The specific section of Bill C-15 will affect those people. At least proposed new sections 10(4) and (5) will apply to those people.
Mr. Perron: The only data we could look to are arrest statistics, which at that point probably underestimates the number given the plea-outs and so forth that happen ahead of time. We can try to extrapolate a figure. It will likely come with a long list of caveats, but it will give you an order of magnitude. It will not necessarily be the definitive point on which a decision is made but will add to the general body of knowledge to help the committee.
[Translation]
Senator Carignan: Ms. Jesseman, Senator Rivest asked about the deterrent effect of sentences. You answered with a firm yes. I would like you to clarify that answer.
In order for a sentence to be a deterrent, in my opinion, it has to be known. Knowledge of the sentence brings about a change in behaviour. If I take the example of drunk driving, which is a crime, the sentences for that crime are quite well publicized. Few people do not know that drunk driving is a crime. That led to a decrease in drunk driving.
When Ms. Joncas, an expert in criminal law, appeared before the committee yesterday, I asked her what percentage of her clients knew what the sentence was that they could receive if convicted. She estimated a maximum of 2 per cent, which suggests that 98 per cent do not know.
Let us look at another example. In California, when the three strikes and you're out law was passed, a law that was also much publicized, crime rates dropped for the same period.
So the studies contradict one another. Are there any studies or surveys that examine the importance of awareness of the sanction in terms of deterring recidivism? When you say yes, does that take into account the level of awareness that people have of the sanction? Is it the low proportion of people who know the sanction who say that it does not have an effect, or is that the overall picture?
[English]
Ms. Jesseman: I would like to clarify: In my earlier response to Senator Rivest, I intended to state that there is not a clearly established relationship between sentence severity and dissuasion of criminal activity. I want to be clear on that.
I agree that in the criminological research, there are three contributing factors to deterrence. Bill C-15 is clearly about the concept of deterrence when it comes to the mandatory minimum sentences and denunciation. However, if we want to effectively deter crime, people have to know about it. There has to be certainty, severity and celerity. Therefore, that means people have to be certain that they will receive punishment; that speaks more to enforcement. Severity speaks to the mandatory minimum sentences, which would be an example of severity. However, severity cannot act alone without that knowledge of increased probability of receiving that punishment. There also has to be celerity, which means the immediacy of punishment. That means essentially a court process that is quick and responsive, and also quick and responsive access to quality treatment. It would have to be very much part of a comprehensive package to be effective.
[Translation]
Senator Carignan: Does that include publicity?
[English]
Ms. Jesseman: Absolutely. That would have to be a major part of it. In terms of studies of awareness of punishments associated with criminality, I admit this is going back to my undergraduate studies, but at the time, any studies that I recall did not indicate that there was a high level of awareness of punishments associated with criminal activity among those engaged in criminal activity.
[Translation]
Senator Nolin: You have been in your position for a long time, Mr. Perron, so you must be able to tell the committee about usage trends in Canada over a fairly long period of time. We have the most recent data in front of us, for 2004. What year does the other equally important study that you conducted go back to?
Mr. Perron: It is a 1994 study.
Senator Nolin: During this ten-year period, there was a major change in the trends regarding the simultaneous use of legal psychoactive substances — tobacco and alcohol — and illegal ones, cannabis being the main one. What do you think could have caused that?
Mr. Perron: The increase in alcohol use is not as pronounced as the others. There are all sorts of suggestions as to what brought about the increase, be it decriminalization or the trivialization of drug use. There was a period of time when a lot of young Canadians thought that it was legal or that it did not have any harmful effects. The confusion in Canada stems from the fact that people were not quite sure what constituted a drug or whether they should take it or not. There was a lack of prevention or education programs aimed at youth before.
There are all sorts of reasons we could give for the increase in use. I cannot really tell you what the reasons are, but I can tell you that not only has use, which is only one side of the coin, increased significantly, but so have the resulting harms, the other side of the coin.
The fact that 80 per cent of Canadians drink alcohol is a statistic, but what are the resulting harms, and it is important to know where we should focus our efforts to reduce those harms, be they health related or economic. That is the data we should examine in the future. Who is in the best position to address them? That is what prompted us to develop the national framework for a real agreement.
All roads do not lead solely to the federal government. We need to ensure that investment is properly coordinated among the various levels of government, NGOs and the private sector. It has to be done in a manner that is transparent, evaluated and based on convincing data.
And that is exactly how we will proceed in the years ahead.
The Chair: Thank you very much.
[English]
This has been extremely interesting and helpful, as will be the information that you will send us. We will circulate the study on costs to committee members.
(The committee adjourned.)