[Recorded by Electronic Apparatus]
Tuesday, March 18, 1997
.0908 
[English]
The Chairman (Mr. Roger Simmons (Burin - St. George's, Lib.): Good morning, everyone.
We do have a quorum, barely. The rules provide that for the purpose of hearing witnesses, we can proceed with three members, but I am surprised we don't see other members, or haven't heard from them. I'm sure they'll be showing up shortly.
I say to our witnesses, don't be particularly psyched out by the presence of only three. This is all being recorded, and whatever you say will be taken into consideration in the completion of our report on this important issue.
We welcome now Mr. Eric Shirt from the Society of Aboriginal Addictions Recovery. He is the executive director, and I think he's come from Calgary to be with us. Welcome, Eric. We hope you might have a brief opening statement, and then give us an opportunity to put some questions to you, if you would.
Mr. Eric Shirt (Executive Director, Society of Aboriginal Addictions Recovery): Thank you for inviting me here today and giving me the opportunity to speak on behalf of SAAR and my native brothers and sisters.
I have been working in the field of aboriginal alcohol and drug problems for almost 27 years, dating back from the start of my own recovery from alcoholism on June 6, 1970. With the help of other Indian alcoholics, I founded Poundmaker's Lodge, the premier native alcohol and drug treatment centre, in 1973, and later established Neechi Institute to train native alcohol and drug counsellors and other personnel.
.0910
Over the past five years my personal journey of recovery, as well as my professional work, has taken me into new territory: the study of nutrition-linked biochemical factors in the development of alcoholism and the highly effective use of nutritional treatment methods to repair alcohol-induced damage to the body and brain chemistry. I firmly believe that a comprehensive nutrition-based approached will revolutionize the treatment of alcoholism and other forms of addiction. I am here today to advocate for policies that will support the further development and widespread implementation of this approach.
I began to observe that although more and more native people were being treated for alcohol and other drug problems than ever before, the overall health status of aboriginal people and the conditions of community life were not getting any better. In fact, virtually all basic indicators of aboriginal health and social welfare were declining. These indicators include: a high mortality rate with an exceptionally high incidence of suicide; a high level of incarceration; high levels of family and community violence; rising levels of sexual abuse; an exceptionally high incidence of diabetes, 40% to 50% in hypoglycemia; high levels of obesity; widespread depression and other mental and emotional disorders; exceptionally high levels of prescription drug abuse, three to four times higher than the general population; and high levels of uninsured health care costs.
On balance, it seemed that something was missing in our traditional approach to the treatment of native addictions. While conventional alcohol and drug programs that employ psycho-social methods of treatment can produce short-term improvements in overall life functioning, the majority of treated alcoholics relapse within the first few months following treatment. I am convinced that the basic reason our conventional treatment programs are not very effective is they provide only partial treatment of a very complex sickness of the body, mind, and spirit. What is not being addressed is the underlying physical dimension of the addiction sickness, namely, the pervasive damage that alcohol and other drugs cause to the body and brain chemistry, which in turn gives rise to a broad spectrum of physical health problems as well as mental and emotional dysfunctions.
I've given you a chart that looks at this. The disease itself starts from the physical and moves on up, but when you go about treating the disease of alcoholism we move downwards. We never get past the psycho-social counselling, and that's the extent of it. We know what damage and what disorders alcohol abuse causes, but we never address any of those things and we don't treat them. The symptoms of these particular disorders caused by alcoholism are themselves debilitating in their own right and usually cause a relapse. The point is you need a comprehensive treatment approach that looks at getting people well physically.
The biochemical damage is not repaired simply by stopping or using drugs. When someone leaves treatment with the same underlying alcohol-induced conditions they had when they entered treatment - such as hypoglycemia and diabetes, which is found in 75% to 90% of the alcoholics; hypothyroidism; neurotransmitter depletion, which gives rise to depression; food and chemical allergies; vitamin and mineral deficiencies, etc. - they will soon experience renewed cravings for a substance that afforded temporary relief from the debilitating conditions of alcoholism and drug abuse. They will continue to wreak havoc in the lives of others, with all the health problems and aberrant behaviour associated with addictions.
The good news is that we now know how to repair the underlying biochemical damage caused by alcohol and drugs through a comprehensive program of nutritional treatment called nutritional recovery. The program was first developed about 15 years ago by Dr. Joan Larson in Minnesota and has produced remarkable results, not only in terms of abstinence rates - 74% remained abstinent three and a half years after treatment compared to 11% for conventional treatment approaches where we just used the psycho-social counselling method - but it has also helped eliminate overall health problems such as cravings, depression, anxiety, insomnia, etc.
The basic treatment and strategy of nutritional recovery consists of, one, eliminating substances known to be damaging to the body and brain chemistry, including alcohol and other drugs such as nicotine, caffeine, and refined sugar; two, repairing the damage by restoring the nutrients depleted and destroyed by the use of alcohol and other drugs; three, traditional psycho-social methods such as counselling, education, and participation in AA.
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It is important to note that nutritional recovery provides a comprehensive approach to the treatment of addictions by incorporating nutritionally based methods in conjunction with traditional psycho-social methods of counselling, therapy, and education. Our conventional treatment is not wrong; it is merely incomplete.
We are currently conducting a series of workshops across Canada to introduce aboriginal health workers and alcohol treatment personnel to the nutritional recovery approach as a comprehensive approach to addiction and optimum health. This summer we will offer an intensive three-week training course to develop in-depth knowledge and skills that will enable participants to implement a nutritional recovery program in treatment centres at a community level.
Last year we developed a proposal for a pilot research project designed to demonstrate the feasibility and effectiveness of a nutritionally based approach in the treatment of addictions, which we submitted to NHRDP. Unfortunately, we were not able to carry out this research because NHRDP felt our project was too clinical. That may be the first time that a native proposal was considered too clinical.
The Chairman: Thanks very much, Eric.
On the last point you were making, did you submit anything to the Medical Research Council?
Mr. Shirt: We submitted the proposal and they referred us to the Medical Research Council. That kind of reminds me of the old shell game, because the Medical Research Council is not known for funding native projects. You know, the pea is not in this pot; go see this pot. I think that approach is very commonly used in the submission of research projects.
Our health is getting worse. The Medical Research Council is receiving higher funding. It was $269 million last year, and our health is getting worse. Something has to be wrong there. In terms of funding this one, from what we understand with the Medical Research Council, their money goes through universities. We're not a university.
So where do we get the money to do the research? We've provided a copy of the research proposal to the members here. It's very straightforward. We want to do a pre- and post-.... We want to retool one of the treatment centres. We want to track people before treatment and after treatment so we can do a comparison in terms of this approach. We know it works because we've seen it work in other treatment centres in Minnesota, California, Alaska, and also Australia.
The Chairman: We'll hear from Pierre and then Grant, please.
[Translation]
Mr. Pierre de Savoye (Portneuf, BQ): Mr. Shirt, before the meeting began, I had the opportunity to take a quick look at the notes you gave us.
.0920
One of the things I noticed is that you maintain that alcoholism is not, at the outset, the symptom of a failure to adapt to one's environment but rather a primary disease, in other words a physiological disease. There are people who, genetically, would have a predisposition to alcoholism in the sense that their liver metabolizes alcohol differently from the liver of most individuals.
I understood that this metabolizing happens in two stages and that in the first stage metabolizing occurs twice as quickly and, in the second stage, metabolizing happens twice as slowly, and this apparently creates major physiological problems.
I believe you also said that native populations are genetically predisposed to have this physiological problem associated with alcoholism and that if we are to be successful in treating alcoholism, then we also have to intervene in the physiological area. That's what you were saying a few moments ago.
Earlier, in conversing with our Chairman, you came to the conclusion that to be able to demonstrate all this, money would be needed because there's research to be done. You have a research project.
I have a two-pronged question. First of all, do I have a correct understanding of the nature of the problem you are raising, and second, would there perhaps not be an opportunity here, in terms of scientific research, to look at the situation of native people? That was the case for the Tremblays in the Lac-Saint-Jean area. It was found that the concentration of certain genetic traits was attributable to the closed community lifestyle that this population experienced for many years. This would allow for a more convincing clinical experience because there's more of a common genetic baggage.
Don't we have the opportunity here to determine whether alcoholism, in the ranks of our native population, is physiological in nature? Based on your hypotheses, this could lead to a specific study. Did I understand you correctly?
[English]
Mr. Shirt: Yes. You covered it very nicely.
We know that in any country there are basically three biotypes that develop the disease of alcoholism. One has an extra liver enzyme that turns alcohol into acetaldehyde very quickly but very slowly into acetic acids, which get rid of the alcohol. The acetaldehyde escapes into the system and gets lodged in the endorphins and causes havoc as far as mental functioning is concerned.
The other one is what we call the allergic/addicted people, who have a genetic make-up where they may be allergic to the underlying component of alcohol, whether it's the alcohol itself, the wheat, the sugar, or the grape. They develop an allergic/addicted reaction. We know these people because the first time they drink they go on a mean drunk and are very sick. They say well, I'll learn how to drink, and as a result of that it develops into an allergic/addicted reaction.
When they quit drinking, they find they weren't really allergic to the alcohol; they may be allergic to the wheat. From the surveys we've been doing at the training site where we do the biotypes, we're finding out that the one that seems to be coming up a lot is the allergic/addicted. In terms of allergy, what is it that the allergic/addicted is triggering? Is it wheat, sugar, or what? We know there's a high rate of hypoglycemia also.
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Then there's the other one, which is what we call the essential fatty acid deficiency. They are missing a metabolite called PGE-1 in the brain. As a result, when they drink alcohol it triggers their meagre supplies of PGE-1 and they're the happy drunks. You remember these people. You say, listen, I wish you'd go back to drinking because you're a lot better when you are drinking than you are sober - that particular biotype. You can track them in terms of how they behave.
But the ones who get the PGE-1 are usually Irish, Welsh, northern Europeans, and some native groups - native groups that are around a lot of fish. Back in our country it's Saddle Lake, Goodfish Lake, Beaver Lake, or Heart Lake. We were always around lakes and our diet was very heavy in fish, but now it isn't any more. In terms of PGE-1, are we getting it? It's a nutritional kind of situation.
With regard to research in that area, one of the things we'd like to know is what biotype are our people. Once you know the biotype, it's easy to treat from a nutritional perspective, and it's easy to correct the physical damage that's been caused by that particular alcohol, because the biochemical and brain chemical reaction to alcohol is very severe and very devastating.
If you look at Indian country, back when I first started, one of the figures that kept coming up was that 80% of our population was alcoholic. This has interesting kinds of implications. That's why this research is so important to us. Our approach as far as research in Indian country in the past has been what we call the WAG system. We used the method called ``wild-ass guess''. This is because we don't have the resources the Medical Research Council or NHRDP have and we can't access them to do this kind of work - and we want to do that.
With regard to the native institute that was recommended by the health forum, I think it's a good idea, but I don't think it should be political in the sense that you say we want political appointments as far as Indian organizations are concerned. I think it should, in large extent, be non-political in the sense that the Medical Research Council is a non-political kind of body. Health should also be on that basis as far as the research institute, the Indian institute, is concerned.
We're not talking about new moneys as far as this research is concerned, nor are we talking about new moneys as far as the native institute is concerned, I would think, especially if you were to develop a research component. It's just a matter of reallocating some of the resources that are presently being made available to the Medical Research Council, NHRDP, and all the other research departments within the government.
Mr. Pierre de Savoye: If I understand you well, a lot of money is effected for the treatment of alcoholism for all the bands but with virtually no bang for the buck. You suggest that some of that money be diverted toward your project because you have a sense that this leads to a definite productive solution. Am I understanding you well?
Mr. Shirt: Yes. One of the things is that you have NNADAP workers out there. You have a lot of NNADAP workers. You have a lot of native moneys.
When I started the Neechi Institute we had ten weeks of a training program. Now they have, what, 14, 15, somewhere in that range.
You're a dentist in Alberta. You're required by their association and I don't know what else to take almost three weeks of training per year just to keep up to date with the stuff.
We don't have that kind of resourcing within the alcoholism programs to be able to do this. You have some alcoholism workers who are funded, but you have workers who are never trained. You create situations such as when I was starting up the Hay River treatment centre back in the late 1980s. There was one program up north that was funded. They said, oh, NNADAP; so they were funded, and they hired a worker who'd been sober for x number of months. That's who they relied on, because he was their best resource as far as that was concerned.
He wanted to address the people who were drowning, coming back with their booze from Fort Simpson. He bootlegged so that people wouldn't have to travel down by boat to get the booze. That was his idea of an alcoholism program. But he never received any kind of training. He was solving what he saw as a problem.
.0930
It's understandable. We saw the same kinds of situations when I was working in Australia, where the prevention programs of the police entailed getting the plastic bottles, filling them up with gasoline, and leaving them out, because that would save the kids from breaking into cars and getting the gas to sniff. That was a prevention program, but it was insane. Yet because of a lack of training and education you use methods you think might work and are not very effective.
What we'd like to do is run training programs for this. But in order for our people who are working in these communities to attend, they need to be resourced to attend these courses. I think that's a big problem as far as NNADAP workers in Canada are concerned.
The other thing is that alcoholism in the last 40 years hasn't changed. When you look at the treatment of cancer and heart disease, there have been major changes, but with alcoholism we still get 11% after three years and 24% after one year. We're still going along with this thing and trying to make it work.
What we've learned is an old expression: you can't make chicken salad out of chicken shit. If something doesn't work, let's look at it and see what needs to be done to get those rates up. We know that this stuff works. There are no ``ifs'' or ``buts'' about it. We'd like to implement it. Let's take a look at it.
Take a look at the nutritional deficits from which all alcoholics coming into treatment suffer. Let's take a look at zinc or vitamin D, or some of the other stuff. Some of those things trigger diabetes. It is very easy to treat at the treatment centre level, but it's a high-cost item down the road, and you see it in terms of the diabetic rates. Of alcoholics coming into treatment, 85% to 95% are hypoglycemic. What does that mean down the road if you don't treat it at that level? It's easier to treat at that level and it's cheap to treat at that level. With vitamin deficiency, mineral deficiency, heart disease, and boom, what does it cost down the road? In this sense, it makes economic sense to treat it at that level.
If you have a zinc deficiency, you're going to be depressed. No amount of talk therapy is going to correct it. But if you have that zinc deficiency you will try to find an answer. You'll go to the inner child, the outer child, sexual abuse counselling, and all of these other things, to try to feel better. That's what we see happening. We keep sending them to talk therapy. We're not saying it's wrong; it's just incomplete.
We need to look at the physical side of it and really correct the damage that's been done by alcohol. There's been a lot of damage. We know what the disorders are that alcoholism causes, and it's not that hard to correct; it's very easy to correct. It's just a matter of getting the training and the resources to be able to implement that. But in terms of saving a lot of money and saving a lot of lives down the road it's a big plus. I think in this sense you have a major opportunity to effect change that's going to improve Indian health right across the board, and it's not going to be a high-cost item. But to leave it untreated means it's going to be a high-cost item.
The Chairman: Grant.
Mr. Grant Hill (Macleod, Ref.): Thank you, Mr. Chairman, and you, Eric. In your preamble you talked briefly about uninsured health benefits. Could you be specific as to what you're referring to?
Mr. Shirt: Let's take a look at Alberta. I don't have the figures on me, but I can easily get them. Alberta has 13 Indian treatment centres. We used to have 15, but we lost a couple, such as Napi Lodge in Lethbridge, which went into sunset and sunrise.
Anyway, we've always been in the forefront as far as alcoholism is concerned. Because you leave these kinds of things untreated, the symptoms, as we outlined, of these conditions are right here: depression, memory loss, anxiety, irritability, confusion, and sudden anger. What people do is try to find something to provide relief from those particular psychological symptoms.
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The thing we're finding is that people are going to doctors and getting uppers or downers. In Alberta one of the guys I was driving with to a powwow told me he'd been sober for 18 years, but he didn't mind taking those little things that put out the fire - astawikonsa in Cree - and he didn't mind taking halcyon when he got home. He found he could live with that.
Mr. Grant Hill: You missed my question, Eric.
Mr. Shirt: I'm just talking about the prescription drug use - the non-insured health benefits. The non-insured health benefits are what boost up the cost of medical services - when you take prescription drugs and go to see a doctor. All the things that are not insured by Alberta Health.... Alberta treaty Indians have the highest per capita use of prescription drugs, but we have the longest relationship in terms of treating alcoholism.
One of the things Chief Chris Shade said is that whenever our people en masse on the Blood Reserve fall off the wagon, our prescription drug use falls, but when suddenly our people go on this rage of sobering up, our prescription drug use goes up.
Mr. Grant Hill: You're talking then about prescription drugs that are covered outside the normal health care system.
Mr. Shirt: Yes.
Mr. Grant Hill: They are covered and paid for, for natives.
Mr. Shirt: Yes, and they're covered by the medical services branch.
Mr. Grant Hill: You talked about nutritional depletion in those who are alcoholics. For sure that is the case. You try to treat the nutritional depletion to get them better, not only by going off the alcohol but by treating those things. Which specific things do you find usually are depleted and that you can replace?
Mr. Shirt: The amino acids, the vitamins, and the minerals - all of them - are depleted, mainly because the alcoholic.... A couple of things happen. One is that the alcoholics, when they're drinking, are not eating properly or are not eating at all. They miss meals. The other one is that the alcohol itself irritates the lining of the stomach, so it affects the absorption of the nutrients.
The biggest thing that it does is divert the liver, because the alcohol is so toxic. The liver's job is focused on trying to get the alcohol out rather than taking the nutrients out of the food and distributing them throughout the rest of the system. So it affects the liver, and the liver is diverted from its primary job, which is to get nutrients out of the food and to try to get rid of this toxic substance that's in the body. That's the way -
Mr. Grant Hill: You've mentioned amino acids, vitamins, and minerals.
Mr. Shirt: Yes.
Mr. Grant Hill: I've noticed in your proposal that there is a reference to macronutrients, which are supplements used in larger doses than you would normally use in your diet.
Mr. Shirt: Macronutrients.... What we were talking about are nutrients that are in things we need a lot of, such as water. In terms of the nutrients, let's say, for instance, that a detox formula.... It's also in that binder we supplied.
Section 4 refers to the nutrients that are listed on the second page and to the formula on the last page. For instance, we noticed that it helps a lot to take 12,000 milligrams of vitamin C. The treatment setting costs about $3 per day to make these available to the clients.
Mr. Grant Hill: This page is actually what I was looking for.
As you probably know, the health protection branch is currently developing a process whereby many supplements will be placed on the endangered species list. For instance, it's impossible to get the large doses of vitamin C that you're talking about in some other countries. Do you have any concerns that some of the things the health protection branch is doing would have an impact on your program?
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Mr. Shirt: I don't know what they're doing. One of the things we know is that if you look at the statistics...how many people have died from nutrients over the past year? How many people have died from over-the-counter drugs? How many people have died from prescribed medication? The numbers are significant in terms of looking at the safety of these products. In some ways, nutrients, except for the fat-soluble vitamins...what the body doesn't need is water soluble and it gets rid of them. Why the huge doses during the initial phase is to get the body used to absorbing these nutrients.
Mr. Grant Hill: If I could go at it another way, are there any of these things that you have had difficulty accessing lately?
Mr. Shirt: Yes, the amino acids.
Mr. Grant Hill: Do you know why you're having difficulty getting the amino acids.
Mr. Shirt: No.
Mr. Grant Hill: The reason is that health protection branches required them to have a DIN number, and so they have become less available in Canada. I thought you would know that since you're so intimately involved with the nutritional programs.
Mr. Shirt: No. What I do with regard to my amino acids is I get them from the States by courier.
Mr. Grant Hill: Exactly, and that has changed over the past...how long? You could get them in Canada prior to that.
Mr. Shirt: When I was in Australia I got them from the States and when I came to Canada I just kept the same suppliers because I was satisfied with the product.
Mr. Grant Hill: Okay.
Mr. Shirt: With trytophan I couldn't get it in the States. I had to get it from Canada but I had to get a prescription in order to get it. But I know with trytophan we were able to get it in Alberta but we weren't able to get it in some of the other provinces.
Mr. Grant Hill: All right. Thank you.
The Chairman: This has been very interesting and we could keep you here all day, actually. You've given us a fair amount of material and you've stimulated our interest in a whole new issue - not a whole new issue for many around the table, but for me, certainly - and we'll be back to you, I am sure. We thank you for coming. Our research staff may well be in touch with you again, if you don't mind, to pick your brain a little further. Thanks for bringing all your experience to the table.
Mr. Shirt: Thank you for having me here - and spread the word.
The Chairman: Now we invite to the table Mr. David McKeown from the City of Toronto Public Health Branch. Welcome, Mr. McKeown. We are glad to have you. Perhaps you're prepared to give us a brief opening statement and then follow that with some questions from the committee. Welcome, and proceed.
Dr. David McKeown (Medical Officer of Health, City of Toronto Public Health Department): Thank you, Mr. Chair and members of the standing committee, for inviting the Toronto Public Health Department to take part in these hearings.
Good morning. My role as medical officer of health for the City of Toronto means that I oversee a range of public health programs and services in that city. I am also an adviser on health program and policy matters to our board of health and city council.
Our work in public health covers the entire spectrum of substances that are under consideration in this committee's review: tobacco, alcohol, over-the-counter and prescription substances, and illicit drugs. We do work with very diverse populations and it's clear to us that there's as much diversity in the people who use substances as there is in the reasons underlying their use.
Our services include a range of direct services, including counselling, group education, and programming in schools, communities, and workplaces. We mount targeted and broadly based health promotion campaigns for our population in Toronto. We also operate a community grants program, which I'll talk a bit more about later. We also see policy at both the federal and provincial levels, which we try to influence to some extent, and policy on the local level as critical instruments.
An example of that is our attempt to make public places smoke free as an inducement for smoking cessation and also as a clear protection from the health harms of second-hand smoke. You may have heard about our recent efforts to do so in bars and restaurants with the most stringent by-law of its type in this country.
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From the perspective of an urban service provider, I'd like to briefly comment on federal policy and strategic directions that are needed to support the health of Canadians and to support our work at the local level. A vital step towards a healthier future has been taken with this committee's consideration of Bill C-71, its passage through the House of Commons and soon, we hope, through the Senate.
The Supreme Court decision to strike down parts of the Tobacco Products Control Act, following on the heels of the 1994 tax roll-back on cigarette prices, did take federal tobacco policy off course. This new legislation does very much, in my view, to put Canada back on track in preventing and reducing tobacco use, particularly among young Canadians, where we have recently started to see it rise again.
Unfortunately, recent federal policy developments relating to alcohol and some other drugs have not served the public health interests so well. In the alcohol arena, the regulatory framework governing broadcast advertising has recently been changed to eliminate, among other things, mandatory pre-clearance review and authorization for radio and TV ads. Also, the proposed health warning label strategy for beverage alcohol containers was sidetracked and it was my assumption that it was rolled into the mandate of this committee.
In terms of drug policy, the Controlled Drugs and Substances Act did maintain a focus on criminalization and penalties. While this is important, it does draw attention away from creative solutions to reduce the harm associated with illicit drug use, such as needle exchange programs - one of which we operate - methadone maintenance clinics, which play a very important role and which we are attempting to establish to a greater extent in Toronto, and prescribing controlled substances to addicts.
The legislation also criminalized kat, the drug used primarily for social, religious, and ceremonial purposes by some groups new to Canada, including a number who have settled in the Toronto area.
This federal policy review, however, is an opportunity to reconsider some of these changes, to examine policy alternatives and to support approaches that would work to prevent and minimize the harms associated with substance use to both individuals and our population as a whole.
I know the committee has heard from numerous witnesses. Tobacco, alcohol, and other drug use, misuse and abuse, do exact a heavy toll, and I'm not going to review that in detail here. In economic terms costs have been conservatively placed at an estimated $18.5 billion in 1992. As you know, tobacco and alcohol are by far the largest contributors not only in economic terms but also in proportion to the population that experiences health impacts.
In the last few years in Metropolitan Toronto we have seen increases in tobacco use among youth, in high-risk drinking activity, again among youth, and in illicit drug use. As a consequence, we can expect in our region of the country to see the post-1992 costs and rates of problems increase.
As a nation we cannot of course afford to continue with such a preventable burden, or, I would point out, primarily at the local level, where people live, go to school, and work and where most health services are provided.
Today, local services like public health face even greater challenges to respond to substance use and abuse-related health needs as the resources for those services and those of our community agency partners are decreasing or disappearing. Using resources effectively and appropriately to prevent and reduce the harms associated with substance abuse and to support improved health are even more important in the face of these restrictions.
To this end I'd like to highlight two key areas that this committee should consider in developing the federal framework. The first is an appropriate balance of approaches and strategies. Secondly, I'd like to stress the importance of supporting small-scale local community action.
First, with respect to an approach to drug strategies, there's a wide range of ways of approaching substance abuse, which I'm sure you have heard about and have had many discussions about, ranging from control policies, through to prevention, knowledge and skill building, education, enforcement, and treatment. The challenge is to strike the appropriate balance for different substances. While enforcement must continue to have a role, there can be greater coordination between health and enforcement, and enforcement, overall, is costly.
I would contend that we would be better to invest in demand reduction and harm reduction strategies, as was the thrust of the now expiring Canadian drug strategy, with attention to the socio-environmental conditions underlying or affecting substance use, such as housing, employment, education, and family stresses.
The way in which demand and harm reduction are operationalized will vary according to substances and whether the authority to act lies at the local, provincial, or federal level, or some partnership of the three. For tobacco, clearly, our efforts have and must centre on prevention and cessation, partnered with health protection strategies such as creating smoke-free public places, which create an environment supportive of wise substance use or non-use.
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For alcohol, our attention must be on promoting low-risk use, preventing binge drinking, or use in circumstances when the safest course would be not to consume, such as before driving or when pregnant.
Alcohol-related, harm-reduction initiatives can be implemented at all levels: municipal alcohol policies such as we've seen in a number of Ontario municipalities, including Toronto; mandatory server-intervention training, which we are pushing for at the provincial level; and, at the federal level, requiring standard drink labelling on containers of alcoholic beverages.
In relation to tobacco and alcohol, it's essential that strategies are set within a coordinated, federal-provincial policy framework to control critical variables that influence consumption, such as price and taxation, access and availability, advertising and promotion.
Now, when it comes to other drugs, harm-reduction strategies need to include services like mobile and fixed-site needle exchanges, methadone maintenance, and testing new initiatives, such as pre- and post-diversion programs. These services need to be coordinated with appropriate drug treatment services and programs so that there is a seamless continuum of services, improved access to quality health and social services, and support for people who use substances.
The second area I'd like to highlight is the need for increased support by all levels of government for small-scale local action. Local level and locally directed demand-reduction initiatives are important for all substances. In Toronto in recent years we have had a special commitment to community-based drug prevention projects.
Since 1990 we have had a drug abuse prevention program, which has offered a modest amount of annual grants, up to a total of $500,000 per year. Over the past six years, through this program and in partnership with other agencies and levels of government, we have assisted 300 community projects. That's an average of about only $10,000 per project.
By and large, these projects have focused on strengthening community capacity, including strengthening young people at risk and their families, promoting healthy, positive lifestyles, outreach to multicultural communities, and building partnerships, networks and coalitions amongst local agencies and community groups. This empowering, or community capacity-building approach, has allowed Toronto communities to strengthen themselves. I believe this has played a role in helping to stop the downward slide associated with serious drug use in major American urban centres.
One of our projects, the Ambassador School Partnership, was featured in Maclean's last July, and I think I've given you a copy of that article. It has targeted the street youth and youth who've dropped out of school. The Ambassador project has school and work components, so participants can continue to build their education to a recognized credit level and learn skills that will provide them with employment options.
In addition, working as ambassadors, the participants in this program go into Toronto schools to speak out to their peers, particularly their younger peers, about the harsh realities of life on the streets, and their drug and alcohol experiences.
We are now looking at taking the project in new directions to do more work with older peers - organizing, job training, and skill development - and to look at access barriers to food and housing, some of the socio-economic determinants of drug use I spoke of earlier.
In addition to resources from the city grants fund, this Ambassador project has had support under Canada's drug strategy, but this will run out at the end of March. We're seeking corporate support for this project, but the federal government should not allow its support for this and similar initiatives to expire.
Another innovative project we've supported locally through the city drug prevention fund, and in partnership with the Metropolitan Toronto separate school board and the City of York - a neighbouring municipality - is a Portuguese community coalition, Pais e Filhos, which means parents and children.
This coalition was formed out of a concern in the community about the gap between parents and children in the Portuguese community, which is the largest non-English speaking community in the City of Toronto. Struggles of culture assimilation and a lack of appropriate resources to support parents to deal with issues like alcohol and drug use were recognized.
So working through a two-year community process, the coalition has held a series of very successful and well-attended community fora on substance use issues, including sexuality and violence.
Most recently, the coalition has started parenting skill development programs modelled on the Ready or Not parenting program, which is a program developed by Health Canada to improve parenting skills. This program has helped adapt to the needs of the Portuguese community. It has also developed a Portuguese parenting resource booklet as a part of the program.
This coalition is now working with local media to develop the parenting tips to build into popular programming on culturally and linguistically specific television, for example.
There's strong interest in other parts of Canada. We've had inquiries, for example, from the City of Winnipeg with respect to replicating what this coalition is doing for its community. Again, this is where the support of the federal government in disseminating this kind of program and learning would be very helpful.
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Through our city grants fund we have also supported the development of projects to de-escalate youth-gang-related violence and substance abuse by channelling youth energies into community arts, recreation, and local economic development. Theatre has been a popular medium in these grants - for working through issues - and we have funded youth theatre projects, workshops, and an annual showcase for high school students, where an interactive dialogue about substance use and interpersonal issues is supported.
I hope these few examples will give you a sense of the local energy, creativity, and potential to produce action to prevent and reduce the harm associated with substance use.
In a few instances, projects have received some funding under Canada's drug strategy, but for the most part support has come from our city fund and local partnerships. Our ability to maintain this support is severely stressed, and there's clearly a need for federal involvement.
Federal support is also needed for drug-related, harm-reduction services like needle exchange and methadone maintenance. Given that in urban centres like Toronto there is a greater amount of drug use, the level of need is higher, and so is the need for support. A key component of any drug strategy in a community is good information about who is using what and when, which substances, and what the trends are. It's very necessary to have this information both to design programs and evaluate their effectiveness.
With respect to tobacco and alcohol, we have fairly readily available ways of assessing patterns of use and trends in the community. However, with illicit drugs it is much more complicated. Since 1990 the Metro Toronto Research Group on Drug Use has been monitoring trends in illicit drug use by bringing together bits of information from a variety of sources. This is a partnership of public health, the local police, the local coroner's office, the Addiction Research Foundation, and others who have some information to contribute to building up a picture of drug use in Metro Toronto.
We have proposed that similar monitoring efforts be established in other parts of Canada and then linked into a network. The Canadian Centre on Substance Abuse has received this proposal favourably, and they have begun to do some work in this area. In my view, they're ideally suited to provide this assistance and coordination, but with their funding in jeopardy, so too is this important development.
I'd just like to close by emphasizing that for us to achieve meaningful progress towards health goals in the area of substance abuse there must be federal leadership and commitment in several areas: preventing and reducing tobacco and alcohol use; funding, and continuing to fund, community-based local action; supporting innovative harm-reduction services, such as needle exchange and methadone maintenance, and strategies specific to local needs; and investing in research and information dissemination in order to share learning and successes across the country.
Those are my prepared remarks, Mr. Chairman. Thank you very much for your attention.
The Chairman: Thank you, Dr. McKeown.
Before we question the witness, just let me say something about housekeeping here. The House of Commons will be in recess for a couple of weeks. With that in mind, it's important that we get two or three decisions this morning.
The problem is that, almost without exception this morning, members of our committee are involved in other committees that need them for various reasons. We don't have a quorum now, because Dr. Hill has just left, but we're trying to round up somebody to make a quorum. We need a total of six bodies - warm bodies at that.
So assuming we get a quorum in a minute or two, we're going to interrupt the proceedings to deal with a couple of motions, if you don't mind.
[Translation]
Did you hear me, Mr. de Savoye?
Mr. Pierre de Savoye: Loud and clear, Mr. Chairman.
[English]
The Chairman: Okay, go ahead.
Mr. Pierre de Savoye: Don't worry. I will stay here.
The Chairman: You can put your question, but I may interrupt you.
Mr. Pierre de Savoye: I understand that, and I will flatly accept it.
[Translation]
Mr. McKeown, do you speak French or would you prefer listening to the interpretation?
Mr. McKeown: If you put your questions to me in French, I'll try to answer but I'll probably answer in English because I can be more precise in that language.
Mr. Pierre de Savoye: Great. I really appreciate it. From what you said in your presentation, I understood you're of the opinion that our law enforcement agencies should continue to play their role but that you find it is rather expensive. The cost is high.
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You think the result would probably be better if we were to invest in a decrease in demand and in strategies whose goal would be to reduce damages to health and you mentioned different areas such as social environment, housing, employment and education.
What you're telling us is that we should really be careful where we put our money, because there's a matter of efficiency.
The Chairman: I'm sorry. We must now...
Mr. Pierre de Savoye: Back to you, Mr. Chairman.
[English]
The Chairman: Now then, we've agreed to interrupt things here so we can deal with a couple of motions. I thank Ovid and Geoff for joining us, at least temporarily. We have a couple of motions to deal with, relative to the child report, which should have been, but have not been, presented to the House through various circumstances.
We need three motions. I'll read them for you, and then if there's need for debate, please have one. The first is that pursuant to Standing Order 109 the committee requests the government to table a comprehensive response to the report within 150 days.
This is a pro forma motion, but we neglected to pass it earlier.
Mr. Andy Scott (Fredericton - York-Sunbury, Lib.): I so move.
Motion agreed to
The Chairman: The second motion is that the chairman be authorized to issue a press release and/or hold a press conference immediately upon the tabling of the report in the House.
Mrs. Bonnie Hickey (St. John's East, Lib.): I so move.
Motion agreed to
The Chairman: The third is a motion that the committee print 1,500 copies of the seventh report in tumbled bilingual format with a distinctive cover.
Mr. Andy Scott: I so move.
Motion agreed to
[Translation]
Mr. Pierre de Savoye: Mr. Chairman, about the second motion that was passed, during your press conference will you also invite the representatives from the opposition?
The Chairman: Yes. The party will be invited.
Mr. Pierre de Savoye: Thank you.
[English]
Mr. Andy Scott: It wouldn't be a party without you.
The Chairman: Yes, I thank you, sir, and Ovid.
Dr. McKeown, that's how we do things around here. When you get your megacity it will be the same.
Thank you for your indulgence, sir. Proceed.
[Translation]
Mr. Pierre de Savoye: From what you're telling us, and I'm going back to where I left off, in terms of efficiency, money invested in preventing or reducing health problems would provide greater value than money invested in law enforcement. That's what I understood.
That doesn't mean that one should be totally eliminated, but if there has to be cuts somewhere... Here's what I'm getting at. In the present economic context of which you are aware, year after year, the government is slashing programs and budgets.
What you're telling us is that if something has to be slashed, we shouldn't be slashing where efficiency is the greatest. We should see to it that enough money is granted to those organizations in the area of prevention and rehabilitation to get the best results possible.
I'll touch upon something else here and ask you to take all this into account when you answer. I remember that when we were examining Bill C-7 or C-8, I asked the people from the Department of Health in charge of the anti-drug strategy program if they had any figures or statistics showing how efficient their work was. The answer was that this did not exist.
Now, what you're suggesting here is the creation, based on your own experience, of a national network that could be used to measure what are the effects of the money invested.
Basically, if I understand what you're saying, we should invest our money where it's most profitable and set up a system to monitor the profitability.
Could you share your views on that with us?
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[English]
Dr. McKeown: I think that at the margin, where we are now in terms of investment in strategies in the drug area, it seems there's little evidence that additional investment in enforcement will yield good results. Yet despite the paucity of information referred to by an earlier witness about the effectiveness of some prevention activities, there are clearly areas in which an additional investment would be very effective.
I think methadone maintenance is a good example of that. In the city of Toronto there are long waiting lists of opiate users who would like to go on methadone maintenance. Very good studies have shown that putting someone on maintenance costs the public purse a lot less than having someone out in the community stealing in order to support a habit.
At the margin we're at now there certainly are areas where there's a lack of evidence of effectiveness of further enforcement. At the same time, there is evidence of good effectiveness for at least some prevention and harm-reduction measures. Again, this is the margin at which we are now.
With respect to having accurate information about drug use and abuse, and trends, it is fundamental for us to be able to do a better job of saying what works and what doesn't. As I said, in the areas of alcohol and tobacco, our information is pretty good and quite comprehensive across the country.
In the area of illicit drugs, it is much more difficult. Speaking now with my epidemiologist hat on, I think the kind of collaborative approach I've described, which is in place in the Metropolitan Toronto area, is one of the best ways of acquiring the information we need.
[Translation]
Mr. Pierre de Savoye: In fact, Mr. Chairman, I find that this idea of monitoring the results is a brilliant one in the sense that it would not only allow us to identify the methods that actually work, but also to target any further investments more appropriately. As it is, we're listening to witnesses, but there is virtually no quantitative information. We're putting a lot of stock in qualitative impressions. That's all we have to go by. I think this is a brilliant suggestion.
Thank you, Mr. Chairman.
[English]
Mr. Andy Scott: I just have a brief intervention, and I apologize in advance for the fact that I will have to leave shortly.
I would agree with my colleague with regard to our ability to measure various types of programs, but I want to speak a little about the place of the federal government, specifically in terms of your written submission. I should say, the place of the federal government and where we fit in this strategy.
I'm assuming that the tone of your intervention suggests that you're on the side of this being a harm-reduction approach rather than a criminal approach, and so on. I would ask the question, what role do you see organizations, or even individuals such as yourself, playing in creating a climate that allows us to act more liberally, perhaps on some of these issues?
I don't think the problem is a substantial one, as much as it is, in my case, the climate in my community where a harm-reduction approach to substance abuse is a very difficult one for me to sell.
Consequently, I think that's a political reality we all have to face. And we need non-politicians, who have more credibility on the issue than we do, perhaps to be on the front line, to help us create a climate that would allow us to do that.
The question of the federal government's role is a broader issue than just the drug strategy, or the federal government's involvement. If we decide there's a critical problem in Canada and the federal government is going to take action - generally without the enthusiastic support of my colleague from Portneuf....
The reality is that if the federal government decides there's a critical problem and that we need to attend to it, and we say we're going to give five years to a drug strategy, or we're going to give five years to a strategy regarding disability, and we're going to test new approaches, we're going to do a whole bunch of things, but at the end of five years we're going to redirect our attention towards something else - it's AIDS, it's something else.... If at the end of the five years we say, but these programs are just too good to walk away from, then we've denied ourselves the ability to identify a new crisis.
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So which is it? Should we be sustaining programs? They're good programs. I don't think anyone denies that they're good programs. But what if the role of the federal government is to trigger the attention of the provinces, the communities, and agencies by focusing their attention on something with great intensity, with limited resources? How do you balance those two competing interests?
I'm sure you would share the view that in three years there's going to be something into which the federal government would want to put a great deal of energy. And it may mean that we can't put energy into some of the things we're putting energy into now.
Where do we find the balance between that kind of intervention and sustaining programs that are good programs?
Dr. McKeown: I think there are some federal roles that transcend crises.
In the health field, in which I work, we exist in a very decentralized system. For the most part, at the provincial level across the country, health is decentralized. In my province, Ontario, public health, for example, is decentralized to the local level, so there are 42 public health agencies in the province. So we are coping with this fact of decentralization, which has some clear benefits, but it has some disadvantages.
In this situation there are some transcendent roles for the federal government in linking and providing the kind of across-the-country structures that are necessary. For example, to benefit from work that's being done in Vancouver with respect to injection drug use, my agency.... We have some of those linkages that we can establish on our own, but to a greater extent than less we operate in isolation.
There are professional linkages, and there are national organizational linkages. There can also be linkages supported by the federal government. I think the federal government has a responsibility in that area, independent of the health flavour of the year.
Mr. Andy Scott: I don't disagree at all, but the reference you are making is to a specific program that would be a delivered program.
I think you're right: we do have transcending responsibilities, and some of those are being minimized right now because we are also trying to sustain programs.
That's what I'm trying to find. I don't mean to be.... I'm curious about this myself. How do you reconcile the fact that we should support this program? It's not a linkage thing; it's a direct program delivered.
Dr. McKeown: Well, I think what we're facing at the moment pragmatically is the withdrawal of public resources at all levels of government. So this is a time when I think you have to look....
If you have a real winner, I think you should back it, whatever level of government is involved. Of course, as on-the-ground service providers in my community, we have to try to seek resources wherever we can. In Ontario right now we're seeing a large-scale withdrawal of public resources from health and social services, and, as you know, for the past several years there has been such a withdrawal at the federal level.
So in my presentation today we're trying to identify for you some of the key areas in which the investment should be sustained, since we recognize that it cannot be sustained throughout the funding.
Mr. Andy Scott: Thank you.
The Chairman: Thank you very much, Dr. McKeown. I think we're at the end of the questions.
You've hit us on a very bad morning, in the sense that we very regularly have a full complement of members here. It so happens that just about every member on this committee is attending another committee at this time. It is not just one committee; there are three or four other committees happening right now.
I guess it comes partly from the fact that we're in recess next week and everybody is trying to get their meetings in this week.
But what you've said has been heard and recorded and will be taken into account during the drafting of our report. Thank you very much for coming.
Dr. McKeown: Thank you.
The Chairman: Let me say to the committee - or what's left of the committee - and for the record that there will be a special meeting of the committee at 5 p.m. the day after the House resumes, which is April 8.
You will get a notice, but just to alert you, the reason for that is that we've had a request from some parliamentarians from France, who want to meet with us, and it will basically be their agenda.
I guess it will be a kind of free-for-all, a question-and-answer-type thing. If we can get any more specific information from the French embassy on what they want to talk about, we'll not only alert you, but get you some briefing notes, if that's possible.
It's generally alcohol issues.
So I would ask you - would you mention this to your people, too - if we could have a good showing for that particular afternoon. It's an awkward time of the day, but with that kind of notice maybe you can plan for it. We might get an early notice around, Clerk, to the committee for that same reason. Thank you very much.
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The meeting is adjourned.