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37th PARLIAMENT, 1st SESSION

Special Committee on Non-Medical Use of Drugs

EVIDENCE

CONTENTS

Wednesday, May 22, 2002

0840

The Chair (Ms. Paddy Torsney (Burlington, Lib.))

0845

Ms. Julie-Ann Miller (PARTY Coordinator, St. Albert Association for People with Disabilities)

0850

0855

0900

0905

The Chair

Mr. Howard Faulkner (Executive Director, Prevention/Treatment Services, Alberta Alcohol and Drug Abuse Commission)

0910

0915

The Chair

Ms. Kathy Landry (Manager, Northern Addiction Centre, Alberta Alcohol and Drug Abuse Commission)

0920

0925

The Chair

Ms. Cathy Wood (Manager, Aventa)

0930

0935

0940

The Chair

Ms. Debra Williams (Chair, DARE Evaluation Committee of Alberta)

The Chair

0945

Ms. Debra Williams

The Chair

Mr. Dominic LeBlanc (Beauséjour—Petitcodiac, Lib.)

The Chair

Ms. Cathy Wood

0950

Mr. Dominic LeBlanc

Ms. Cathy Wood

Mr. Dominic LeBlanc

The Chair

Mr. Howard Faulkner

The Chair

Ms. Kathy Landry

The Chair

Ms. Julie-Ann Miller

0955

The Chair

Mr. Dominic LeBlanc

The Chair

Mr. Howard Faulkner

Ms. Kathy Landry

1000

Ms. Cathy Wood

The Chair

Ms. Julie-Ann Miller

The Chair

Mr. Dominic LeBlanc

1005

Ms. Kathy Landry

1010

Mr. Dominic LeBlanc

Ms. Cathy Wood

Mr. Dominic LeBlanc

Ms. Cathy Wood

Mr. Dominic LeBlanc

Ms. Cathy Wood

1015

The Chair

Ms. Julie-Ann Miller

The Chair

Mr. Howard Faulkner

1020

The Chair

Mr. Howard Faulkner

The Chair

Mr. Howard Faulkner

The Chair

Mr. Howard Faulkner

The Chair

Mr. Howard Faulkner

1025

The Chair

Ms. Kathy Landry

The Chair

Ms. Kathy Landry

Mr. Howard Faulkner

The Chair

Mr. Howard Faulkner

The Chair

Mr. Howard Faulkner

1030

The Chair

Ms. Debra Williams

The Chair

Ms. Debra Williams

The Chair

Ms. Debra Williams

The Chair

Ms. Debra Williams

Mr. Howard Faulkner

1035

The Chair

Mr. Howard Faulkner

The Chair

Ms. Julie-Ann Miller

The Chair

Mr. Howard Faulkner

Ms. Cathy Wood

1040

Mr. Howard Faulkner

The Chair

Mr. Howard Faulkner

Ms. Kathy Landry

The Chair

Mr. Howard Faulkner

The Chair

1055

Ms. Marliss Taylor (Manager, Streetworks)

1100

1105

The Chair

Ms. Kate Gunn (Interim Director, HIV Edmonton)

1110

1115

Ms. Deborah Foster (Program Manager, HIV Edmonton)

1120

The Chair

Ms. Deborah Foster

The Chair

Ms. Faye Dewar (Street Reach Worker, Boyle Street Co-op)

1125

The Chair

Ms. Beth Lipsett (Manager, Adult Counselling and Prevention Services, Alberta Alcohol and Drug Abuse Commission)

1130

1135

The Chair

Ms. Beth Lipsett

The Chair

Ms. Beth Lipsett

The Chair

Ms. Beth Lipsett

The Chair

Ms. Beth Lipsett

The Chair

Mr. Dominic LeBlanc

1140

Ms. Marliss Taylor

Mr. Dominic LeBlanc

Ms. Marliss Taylor

1145

Ms. Faye Dewar

The Chair

Ms. Beth Lipsett

Ms. Deborah Foster

1150

The Chair

Ms. Kate Gunn

Mr. Dominic LeBlanc

Ms. Marliss Taylor

1155

Mr. Dominic LeBlanc

Ms. Marliss Taylor

Ms. Faye Dewar

1200

The Chair

Ms. Beth Lipsett

The Chair

1205

Ms. Deborah Foster

1210

The Chair

Ms. Kate Gunn

The Chair

Ms. Marliss Taylor

1215

The Chair

Ms. Faye Dewar

The Chair

Ms. Faye Dewar

The Chair

Ms. Beth Lipsett

1220

Ms. Deborah Foster

Ms. Beth Lipsett

Ms. Deborah Foster

The Chair

Ms. Marliss Taylor

1225

The Chair

Ms. Deborah Foster

The Chair

Ms. Faye Dewar

The Chair

Ms. Marliss Taylor

The Chair

1230

Ms. Marliss Taylor

The Chair

Ms. Marliss Taylor

Ms. Faye Dewar

1235

Ms. Beth Lipsett

The Chair

Ms. Beth Lipsett

The Chair

Ms. Beth Lipsett

1240

The Chair

Ms. Beth Lipsett

The Chair

Ms. Beth Lipsett

The Chair

Ms. Beth Lipsett

Ms. Deborah Foster

The Chair

Ms. Kate Gunn

The Chair

CANADA

Special Committee on Non-Medical Use of Drugs

NUMBER 044

1st SESSION

37th PARLIAMENT

EVIDENCE

Wednesday, May 22, 2002

[Recorded by Electronic Apparatus]

¾ (0840)

[English]

The Chair (Ms. Paddy Torsney (Burlington, Lib.)): I call this committee to order. This is the Special Committee on Non-medical Use of Drugs, and we're very pleased to be here in Edmonton, Alberta.

This committee was struck pursuant to an order of reference adopted by the House of Commons on May 17, 2001, to consider the factors underlying or relating to the non-medical use of drugs. We were also given on April 17 of this year the subject matter of Bill C-344, an act to amend the Contraventions Act and the Controlled Drugs and Substances Act, in relation to marijuana. The committee has been travelling to different parts of the country and hearing about what's going on. There are generally representatives from all political parties here, but for a bizarre combination of reasons, we just have Dominic LeBlanc and me. We're both representatives of the Liberal Party, but we'll play with different hats and try to tease out the information nonetheless.

We're very pleased to have with us today on our panel on education, prevention, and treatment, from the St. Albert Association for People with Disabilities, Julie-Ann Miller, who's PARTY coordinator and, I hope, will spell out what PARTY actually means. From the Alberta Alcohol and Drug Abuse Commission we have Howard Faulkner, who's the executive director of prevention and treatment services, and Kathy Landry, who's the manager of the Northern Addiction Centre. From Aventa we have Cathy Wood, and from the DARE evaluation committee of Alberta Debra Williams, who is the chair of that organization.

I'll have you speak in the order I introduced you. Julie-Ann, you have a PowerPoint presentation for us.

¾ (0845)

Ms. Julie-Ann Miller (PARTY Coordinator, St. Albert Association for People with Disabilities): Yes, I do.

Good morning. It's a wonderful opportunity for me today to share with you our program, which is a health education program. It's called PARTY--to prevent alcohol and risk-related trauma in youth. I've been a social worker for five years, and previously I worked 25 years in health care. You might be wondering what connection this program has with what we're talking about today. Our agency works with people who suffer the consequences of injury or of poor choices, people such as drug- and alcohol-affected babies. We have a strong interest in prevention as a result of this. We took a lead role in bringing this program to our city, and I now coordinate it.

The objective of the program is to use experiential and multi-sensory reality education. In doing that we enable students to make important choices about activities and behaviours. Our intent is to reinforce messages all day long about rating the risks they're taking. We want to reduce the incidence of risk-related trauma in youth. We want them to make informed choices about sports or social activities they're taking part in, activities that may involve drinking alcohol or using drugs. We want to increase the awareness of personal responsibility for their actions.

I want to tell you a little bit about the history of PARTY. You're probably wondering where it came from. In about 1986 both Calgary Hospital and Sunnybrook Hospital were looking at programs that could help to provide an educational program for teens. In 1986 Sunnybrook Hospital started the idea with PARTY. Now there are 45 programs across the country, 31 of them in Alberta. Calgary started in 1988. In 1992 the four of us, Edmonton, St. Albert, Red Deer, and Lethbridge, came on board. We're celebrating ten years this year. Each year we reach about 800 to 1,000 students.

We are certainly looking at the educational focus. The reason this started in the hospitals was that emergency room staff saw too many teens injured and dying. They were wondering what they could do about changing the statistics. The reason teens are involved, as you are probably aware, is that they are often inexperienced and lack judgment. They have the desire to experience life and take some risks. As a result of some of the injuries that happened, we focus on brain and spinal cord injuries primarily. Trauma injuries, like traffic-related, sports-related, or activity-related brain injuries and spinal cord injuries, are the highest category of injuries we see. We talk about brain injury and drug ingestion injuries. It sometimes is a surprise to kids. They don't realize you can harm your brain with what you take. We focus on responsibility to themselves and to others. We try to empower smart choices.

To give you a flavour of some of the things we do at the program, one of the slides we show is actually on SPECT, which is Single Photon Emission Computed Tomography. It shows blood flow and brain activity. Of course, the yellow and pink one in the middle is a healthy brain. There are other brains around it. One is from marijuana use, one is from cocaine use, one is from alcohol use, and one is from heroin use. You can imagine how much difficulty people would have functioning as a result of having their brains work in that way.

As I said, we focus on trauma as well. Once again, they should wear helmets. We show a healthy brain, as well as brains that are the result of a bicycle injury, a football injury, a motorcycle injury, and a roller blade injury.

During the program one of the things we do is very experiential. We examine a calf brain, talk to the kids about parts of the brain, and tell them how very similar it is to a human brain. One of the first things I do is tell people to put two fists together and look at them. It's the size of a human brain. For some reason, people think a brain is huge. I don't know why, but they always think it's huge. The calf brain is very close to the size of a human brain. It really leaves an impact on the kids.

One of our demonstrations is on what paramedics do when they extricate someone from a vehicle. They put him on a backboard and tape him down so he is immobilized. We use a student to do this. It's a very popular part of the day as well.

¾ (0850)

During the day we have them eat lunch with a disability. We put collars on them, we tape up their hands, and we have them wear different glasses. As a result of this, they're experiencing how their life can be affected by an injury that could have been prevented.

One of the more popular activities we do during the day is have them use prism glasses, which are called blurry-vision goggles. The RCMP come and help us do this. These goggles simulate impairment from the legal limit of alcohol, as well as twice that legal limit. We're basically playing with their minds a bit to get them to understand how their reflexes and perceptions, including something as simple as walking, can be affected, and then telling them all the other factors that might relate to being impaired.

This program is really popular. It feels really good to present it to the teens. I'd love to give you my horse-and-pony show, which is motivational, but I think you're more interested in what we're focusing on and how we're attaining that. So I have gone to that mode today.

We use an injury-control model, where we talk about education and evaluation being part of injury control and enforcement, policing and engineering, which is everything from the way roads are built to the way cars are designed. We look at reducing harm, promoting change in behaviour, and because of that, reducing the societal burden of loss.

Then we look at outcomes that can be effective. We constantly look at our programming to make sure we're sticking to our outcomes and focuses. We're hoping to have some of the teens commit themselves to five smart choices, and I'll talk to you about that in a few minutes. We want the students to value the experience and be aware of their future. Many teens think they are indestructible. Little do they know how one bad choice and a few seconds can make a difference in their life. The last part of our focus is that the benefit of the program will outweigh the cost of providing it.

We use a behaviour-change model, which looks at a broad base of awareness and builds on self-assessment and ownership for what's going on and gradual behaviour and attitude change. We want the students to understand what the concern is, and we achieve this through social marketing. We have multimedia. We use varied communication styles during the day, such as live presentations, hands-on presentations, demonstrations, and injury survivor testimonials. We look at audience appeal. We're talking to teens. We know they do not relate to things the same way I do, so we have to look at what appeals to them.

We target teens because they have the highest incidence of the injuries we're dealing with and we want to reduce that. As well, we want to talk to them before they start forming habits that are going to affect the rest of their lives. We want them to examine their own beliefs and attitudes regarding the problems we're looking at. We achieve that through empowering them to look at smart choices, and we reinforce these throughout our program: buckling up, seatbelts save lives, and driving sober. Everybody thinks “don't drink and drive” is a given, but we talk to them about the idea that sleep deprivation is a big problem and you are impaired if you are deprived of sleep.

¾ (0855)

We talked about the use of prescription drugs and the non-medical use of drugs and the effect it can have on your ability to drive or walk or ride a bike or anything. We really focused on that.

The third message was that wearing the gear is protective against trauma, helmets, pads, goggles, those kinds of things. We were really delighted to see a helmet law here in Alberta for under-eighteens.

Looking first is reading the risk of choice for a situation. This relates to the drug education part of it. Often teens will be affected by their peers and will go along with whatever is happening or whatever seems like a really good idea from their experience, from the media, and from their life experience.

The getting trained part of it is activity-specific and involves first aid and knowing what the safe choices are in a situation as well.

With taking ownership, taking personal responsibility for their actions and social responsibility for solving the problem, we're hopefully having them build some good behaviours. We have them look at the societal costs, the future quality of life they might have if they are disabled, or the potential years of life lost and the effect on both their families and the community.

As for behaviour change, that's something we're hoping for, and it only works through awareness and positive strategies that encourage an attitude change. Altruism is a developmental maturity trait; we try to build on the idea that once they have the confidence, they can make those judgments. And of course, attitude change is an overall effect that can happen after you have behaviour change over time. A good example of that is our environmental awareness issue.

In our program, as I said, we look at the cost of the program's being effective. The cost is reduced because it's provided by community agencies--ours is a not-for-profit agency--and by the volunteers. The positive benefit has to be greater than one, and in actual fact--your researchers might be able to correct me on this--$1 of prevention saves about $7 in intervention; it may even be more than that. We're looking at this as being a way of saving the cost to society.

The cause and effect of what we're doing is revolving. You can see that individual change is something we're looking at, along with the smart choices that are involved with that individual change. We want transfer of learning, so that not only do individuals change their own learning, but they will promote it among friends and other people they know and will espouse it. Through the social marketing we're doing, as I said, our appeal to our target audience and our communication styles have been very effective. Then there is community involvement. I heard a prevention speaker who came from CDC speak on looking at prevention programs from around the world, and he really supported the idea that the community has to be behind it to make it effective.

Last of all, looking at what's needed overall, we really feel that accepting the value of investment is a necessary thing on a larger scale, that prevention costs, compared with the burden of societal costs, really are something a lot of people aren't aware of. Also, there is a need for increased social marketing and more awareness of the fact that there are problems and what the expected behavioural changes are as a result.

¿ (0900)

Our community in St. Albert, through the PARTY program, through DARE, through AADAC, and through many other things, has been involved with all kinds of awareness. We've recently looked at a community-wide program for drug awareness. It's always amazing, with so many people being aware, to still have a lot of people saying, we don't have any drug problems in St. Albert. They're everywhere. It's just the fact that there are not only dollar costs, but societal costs and effects on the community.

I know community access to federal funding is not usually a route that's available, but I think there needs to be somewhere to support effective front-line programs. As I said, the funnel-down effect makes a big difference. There's certainly a lot that can happen at a grassroots level. We're always scrambling for another dollar and trying to make it work the best way we can, and we can't do it all. The last part of it that I think is support in evaluating the efficacy of existing programs. It sounds as if it's part of what the drug commission is looking at. I think it is very important to be able to compare apples to apples, oranges to oranges, and to be able to understand the logic behind what's happening out there.

That's it.

¿ (0905)

The Chair: Thank you.

I'll now turn to Howard Faulkner and Kathy Landry.

Mr. Howard Faulkner (Executive Director, Prevention/Treatment Services, Alberta Alcohol and Drug Abuse Commission): Thank you very much.

I'd like to thank the parliamentary Special Committee on Non-Medical Use of Drugs for this opportunity to provide an overview of our treatment, prevention, and information services.

AADAC is mandated by the Alcohol and Drug Abuse Act to operate and fund services addressing alcohol, other drugs, and gambling problems and to conduct related research. AADAC's services are dispersed throughout the province, and they are currently available in over 40 communities.

AADAC is a crown agency of the Government of Alberta, governed by a board of up to 12 commissioners appointed by the Lieutenant-Governor in Council. The chair is a member of the Legislative Assembly of Alberta. Our commission board provides policy direction and reports to Alberta's Minister of Health and Wellness, the Honourable Gary Mar. We have an operating budget of approximately $58 million annually, and that's broken down into 62% for treatment-related services, 17% for prevention-related services, and 21% for information services.

Approximately 77% of Albertans aged 15 years-plus drink alcohol, 23% use tobacco, and 8.4% report using cannabis within a 12-month period, while less than 2% report using other illicit drugs, such as cocaine, LSD, or heroin. Alcohol is clearly the drug of choice for most Albertans, and annual consumption amounts to the equivalent of 512 bottles of beer for every Albertan aged 15 and over.

In an average year AADAC will have more than 35,000 admissions for treatment services, 133,000 admissions for crisis services, and 180,000 contacts for our prevention and education services. Our vision is making a difference in people's lives by leading them to an addiction-free future.

There are a number of opportunities and challenges. Addiction problems occur at all levels of society and within communities throughout the province. At some point in their lives many Albertans will experience personal problems related to alcohol, other drugs, and gambling, and many more will face difficulties because of someone else's addiction. Effective prevention and intervention require close collaboration between specialized addiction services and other community stakeholders, for example, health, education, and justice, and comprehensive strategies that are aimed at the individual and his or her environment.

In providing Albertans with addiction programs and services, AADAC is attentive to both the challenges and opportunities that exist. AADAC must be able to adapt to meet changing client needs, priorities, and circumstances, including responding to addictions as a key factor in population health by identifying and understanding the many factors that contribute to addiction and the numerous consequences that result and by working with others to coordinate services that enhance health and well-being.

We must balance investment in prevention and treatment by continuing to provide immediate and compassionate care to those persons experiencing problems with substance use or gambling. We must focus over the long term on prevention strategies that target youth and other sub-populations at risk for developing these problems.

We must sustain capacity through strategic planning and partnerships to meet the increasing service demands. We must demonstrate effectiveness through consistent delivery of programming based on research and best practices in the addiction field and report on outcomes and achievements through public accountability mechanisms.

We must remain innovative in our delivery of services, to reach those clients groups that may not readily have access to programs, for example, youth at risk, seniors, and the homeless. We need to foster community solutions through consultation and collaboration with citizens and stakeholders, to ensure the formation of a strategic and comprehensive approach to substance use and problem gambling. We also need to capitalize on the increased use of information technology.

I'd like to speak a little bit about AADAC's service framework. Our core businesses encompass all actions taken to address the impacts and influences related to the use, misuse, and abuse of alcohol, other drugs, and problem gambling. All our work is linked to three goals: delay the onset; decrease the prevalence; and reduce the harms associated with alcohol, other drug abuse, and problem gambling. Our service model is a schematic representation of how the commission's services range from a broad base of information delivery, to more targeted prevention services, and eventually to treatment aimed at a very specific population. Each of our core businesses is affected by external factors, such as the economy, employment, physical environment, government policy, culture, demographics, and client needs. All these external environmental factors affect AADAC's business planning process, and ultimately how and to whom we deliver addiction services.

Although there is overlap in the service activities carried out within each of the core businesses, the intent of each core business is different. Our first core business is information services, whose goal is to provide evidence-based information about alcohol, other drugs, and gambling problems and inform Albertans about AADAC's programs and services. We believe an informed public is knowledgeable about where it can find AADAC's services and has the information needed to make decisions about alcohol, other drugs, or gambling use. Accordingly, Albertans and other stakeholders are provided with current evidence-based information on issues, emerging trends, research, and performance measurement regarding addictions. AADAC's information goal supports all the work we do in prevention and treatment. We strive to establish and maintain information services that position AADAC as a credible and valued source of addictions expertise. Examples of information activities concerning public awareness relate to the national addictions awareness week and AADAC's resiliency media campaign. We also produce a number of publications, videos, and posters on AADAC's programs and services, and we have a website at www.aadac.com.

Our second core business is prevention services, whose goal is to prevent the development of alcohol, other drugs, and gambling problems through planned actions that affect targeted populations and their immediate support systems. We provide programs and services that increase the capacity of individuals, families, and communities to effectively address potential problems relating to alcohol, other drugs, and gambling. Prevention aims to increase protective factors and reduce risk factors clearly associated with the development of addiction. Prevention services include early intervention, community-based education, and training. Services are delivered through a network of 26 area offices across the province, as well as 25 community-based and funded agencies located throughout the province.

¿ (0910)

We define three categories for prevention. Universal prevention targets a broad or universal population, with the aim of promoting the health of the population or delaying the onset of substance use or gambling. These prevention activities can create greater awareness of addiction-related issues and foster acceptance of the need for more targeted prevention. The focus of universal prevention is on building protective factors, including asset and skill development. Examples include health education, school-based programming, and informal mentoring. Universal prevention efforts will also affect the target groups on the prevention model, with enhancement of the same protective factors.

Targeted prevention looks at those who have risk factors related to the development of alcohol, other drugs, and gambling problems. The aim is reducing the influence of these risk factors, and preventing or delaying the onset of the problem. The aim of targeted prevention is to reduce the influence of risk factors and to enhance protective factors in a population not currently using alcohol, other drugs, or gambling. Examples include prevention programming with allies such as schools, children's services, health, and justice.

Indicated prevention targets people who are already experiencing a problem, but may not be ready or able to engage in formal treatment. It may involve an outreach component to identify, engage, and work with people to minimize the harms associated with their lifestyles. Goals of indicated prevention include helping people move along the stages of change, providing information, and reducing problems and harm associated with the behaviour. Examples of these strategies include the methadone maintenance program, the protection of children involved in prostitution, probation referrals, or students suspended for using substances at school.

Our core business of treatment relates to and has a primary goal of providing treatment services assisting Albertans to improve or recover from the harmful effects of alcohol, other drugs, and gambling problems. We provide programs and services that help people improve or recover from the harmful effects of alcohol, other drugs, or gambling. These services include community-based outpatient counselling, day programs, and residential treatment services, which provide a structured environment to assist clients in their recovery from addiction. We operate approximately 750 beds across the province. We also operate a gambling helpline and an AADAC helpline. Specialized programs are available for youth, aboriginal people, business and industry referrals, and those with opiate dependency.

In conclusion, I would like to add that the challenge of addiction clearly continues. The good news is that addiction can be treated and prevented, but the bad news is that it is a very serious and complex problem. Our services provide an opportunity to return to a healthier life. I think we are making a difference, but we need to work together to continue to make a difference if we want to effectively reduce the many costs associated with addictions in our society.

¿ (0915)

The Chair: Thank you very much, Mr. Faulkner.

Ms. Landry.

Ms. Kathy Landry (Manager, Northern Addiction Centre, Alberta Alcohol and Drug Abuse Commission): I wish to thank the chairperson and this committee for the opportunity to present to you information about the Northern Addiction Centre.

The Northern Addiction Centre is a multi-purpose addiction facility located in the city of Grande Prairie. Grande Prairie is about 500 kilometres northwest of Edmonton. We boast a population of about 37,000 people. We have a catchment area, I think, of about 168,000, but I wasn't able to get the last census statistics for you. The centre was opened in June of 1991 by the Alberta Alcohol and Drug Abuse Commission. While the facility was built specifically for northern Albertans, we often find our reputation draws referrals from all over the province and beyond.

AADAC Northern Addiction Centre--which we call the NAC--offers a broad range of addiction services. We have an outpatient treatment and prevention service. It is in our Grande Prairie area office, serving the needs of Albertans living in the Grand Prairie community and surrounding areas. This office provides adult and adolescent outpatient counselling. It's usually done on an individual basis, but we often also offer group counselling for the treatment of problems related to alcohol, drugs, and gambling. This unit also provides outreach addiction services for youth at risk, as well as prevention and information services.

Our detox unit is a 20-bed unit. It offers a safe and supportive environment for withdrawal from alcohol and other drugs. The detox is open 24 hours a day, and it's staffed by nurses. We also have a contract physician who provides for the medical needs of the clients. Clients can be admitted on a walk-in basis.

We also have 43 beds that are the basis for our residential treatment programs. We have three residential treatment programs. The NAC program is a 20-day program designed to help clients develop strategies in overcoming problems associated with alcohol and other drugs. We have the AADAC business and industry clinic alcohol and drug program, which is a 30-day in-patient program using the 12-step recovery model approach to treatment. We also offer a five-month follow-up outpatient program in support of the clinic's alcohol and drug program. We also have a third residentially based program specific to the needs of cocaine-addicted clients, and that's a 50-day in-patient program and a seven-month follow-up program.

I want to speak a little bit more specifically about the business and industry clinic because of its uniqueness. We opened that clinic in 1994. At the time there were individuals within the Alberta workplace advocating for a specialized residential program geared to meeting the needs of the workplace. Employee assistance, occupational health, and human resource professionals representing the Alberta workplace were consulted with regard to establishing a residentially based addictions treatment program. These professionals were consulted because they were most acquainted with the workplace problems and the costs associated with alcohol and drug problems specifically. They were surveyed to determine specifically what features they were looking for in a program. The process also gave us an indication that the workplace was willing and able to pay for programs and services that met their needs.

Our consultations revealed that the workplace valued immediate admission, on-site detoxification, and an abstinence-based approach, access to information and progress and participation for the clients they referred, and longer programs to assist in dealing with resistance. As a result, the clinic initially opened a 30-day alcohol and drug program. The workplace responded positively and, in turn, advocated that the program be expanded to meet the specific needs related to cocaine addiction. The services were subsequently expanded in 1998 to include the 50-day program.

Both programs within the business and industry clinic charge a fee for service. This offsets in part the cost of delivery. A customer service approach and philosophy has proven to be an essential ingredient for the subsequent growth and success of the clinic, and significant effort is given to ensuring that the programs remain responsive to the specific criteria valued by the workplace.

A snapshot view of the clients who attended the business and industry clinic in the last year shows that 43% voluntarily sought help, 27% were advised by their employer to attend treatment, and 30% were required by their employer to attend treatment.

¿ (0920)

Through involvement with Alberta's workplaces, we have learned that the workplace has a vested interest in the health of its workforce and their ability to function safely. Employees understand this, and so the workplace is seen, even by the clients with problems, as having a legitimate role in accommodating access to assessment and treatment and expecting individuals to participate in a recovery program. The workplace values timely access to treatment. The workplace can provide motivation and leverage that is useful in facilitating change in the addicted client. Timely access links the client quickly to the needed resources, and it means individuals can recover more quickly and are able to return their duties, thus reducing costs for the employer. The workplace values an addictions treatment approach that stresses abstinence. Workplaces want the message to be clear, so that difficulties, risks, and hazards can be removed or prevented from occurring. There is no safe level of drug use when it comes to the workplace.

There is an increased concern regarding the heath and safety of staff in their respective workplaces. There is a growing awareness of liability employers have with respect to their employees' misuse of alcohol and other drugs. Alberta's businesses and industry engage a broad range of addictions treatment and prevention strategies within their workplaces. The size of the business and the resources available frequently dictate what strategies are implemented.

The northern Alberta experience is not unique when compared with the experience of other Canadians living in northern or more rural regions of the country. Proximity to services in northern and rural communities is always an issue. However, with our network of area offices, institutions, and funded agencies, AADAC ensures that a range of addiction services across Alberta is reasonably available to the population.

Alcohol is still the primary substance of abuse. We are also seeing the poly-substance user who is using alcohol with other drugs. Greater numbers of our clients at our detox at the NAC are reporting the use of cocaine. There is an increase in the use of methamphetamine by youths as their primary substance of abuse. Clients coming into treatment are presenting with more complex physical and mental health problems in combination with their substance abuse. There is a steady stream of people using THC or cannabis-based products as part of their poly-drug use who consider its use less harmful than other substances.

The Northern Addictions Centre is unique in Alberta, if not in western Canada. It was designed to deliver a range and a continuum of addiction services under one roof. Individuals are detoxed and referred directly into residentially based treatment, and then reconnected with outpatient addictions treatment services within their home community. The model demonstrates a multidisciplinary approach to the delivery of information, prevention, and treatment services. Over the years we've experienced a number of benefits from working together in such an environment, where we are able to draw on the experience and expertise of others within the facility and within the various communities we serve.

Thank you.

¿ (0925)

The Chair: Thank you, Ms. Landry.

Now, from Aventa, Ms. Wood.

Ms. Cathy Wood (Manager, Aventa): Thank you.

It's a pleasure to be here this morning. I want to make a special note of the clerk of the committee, Carol, as she was quite persistent in me getting here today. I received numerous e-mails from her getting me to attend here this morning.

Let me just describe Aventa to you and give a little overview of what we do. As with my partners here, we are a funded service of AADAC and have been providing specialized services to women for more than 31 years. We are the only exclusive women's program in the province of Alberta. Our primary mandate is to provide residential and outpatient services to adult women. We have been providing a broad continuum of services to women. More than 1,700 women and their family members had contacts at Aventa this year. That gives you an idea of the numbers that are coming into Calgary. And 70% of those who approach our service are coming from the southern part of Alberta. The rest are from throughout the province, and other provinces as well.

Because of the uniqueness of our problem gambling service, we will get referrals from across Canada for our residential services for that. It's good to be able to talk about alcohol and drugs this morning, but problem gambling is often a topic that requires a little more attention. I'm going to focus my comments this morning specifically on alcohol and drugs with women.

I want to talk a little about our core program. It's a four-week program we require women to attend. They can secure this service on an outpatient or residential basis. We only have 16 residential beds, and at this point we're up to a three- to four-month waiting list for residential services specifically for women. We're in the process of expanding next year and are going to be providing 36 residential beds as we look to the vision of providing more services to women. Still, at this point we have 16 beds. Women can stay in the residential program up to 90 days, with a minimum requirement of 30 days. We also offer a continuum of outpatient services from aftercare to collateral family support, education programming, and individual crisis programming. We will admit women with a pre-treatment status, and we do 24-hour admission for pregnant women--we take them as priority admissions, considering the severe risk to pregnant women. That is an ongoing issue for us as well.

Let's talk a little about the types of substances we're seeing. I pulled the current data from our database yesterday, so it was current this morning. Of over 1,300 visits to Aventa on our database 75% are alcohol contacts for women, 34% are marijuana or cannabis; cocaine is fairly equal with cannabis at this point. I did not go into the data on prescription meds. Prescription meds are a big issue for women, but I decided not to focus on that this morning. Those are the three primary reasons women are coming in for treatment services.

Services to women and reasons women use substances are what we base our four-week program on. Over 75% of the women using our services have histories of trauma. They come from family violence, they come from sexual abuse, and they have experienced significant levels of trauma throughout their lives. We can't treat women without talking about concurrent disorder issues. Many women come in with a psychiatric diagnosis, that is, with mental health issues. We are also seeing an earlier onset of use for women.

The other key issue on the health side of women when we're treating addictions is to look at the primary age of women with their more severe use. What we're seeing is that women are using substances earlier on, say between the ages of 13 and 14, all the way through the reproductive years into the early-to-late thirties. This also poses significant physical and health issues for women, as those are the core years for women in regard to reproductive health issues.

We are also finding that women are coming in with more complicated health issues. Research supports the view that women are affected differently by alcohol and drug use from men, and we are certainly seeing that in our office on a daily basis.

Other issues that are certainly affecting women in substance use are family of origin, unresolved loss and grief, and also self-medicating through prescription meds for trauma and psychiatric disorders. We find our women have poor coping skills, limited resources, lower educational levels, limited access to educational opportunities, and poor employment histories. We also see a delayed developmental process for these women. We find that when they began abusing substances earlier, their developmental process has stagnated. As a result, their whole training process is held in abeyance until they can get off the substances and move into a recovery base.

FAS and FAE are a huge problem for women. We are very much involved in enhanced services to women in the province of Alberta. AADAC is very much spearheading that project, and Aventa has been involved as well. We have received support through Health Canada to ensure that we begin to offer enhanced services to women and identify the specialized, unique services women need for the prevention of FAS and FAE issues. The loss of children is a big issue for women who are coming into treatment. They are less likely to use services when they are pregnant or parenting, for fear of losing the children. It's a huge barrier for women that is ongoing and has been there for quite some time.

When we look at what works for women on the treatment side, I want to talk a little about the continuum of services. Howard talked about the harm reduction issues, and certainly, in treating women, we find harm reduction is the way we're moving. Aventa is an abstinence-based program, but we certainly look at the continuum of services women need to make their movement towards abstinence a success. We look at providing earlier admission to residential treatment to reduce the potential early harm to pregnant women. We look at providing outpatient services to women until they're ready to seek residential support. We also accept women on methadone as another harm reduction approach to treating the addiction issue.

¿ (0930)

We believe in that long-term, supportive, therapeutic relationship to see successful outcomes of recovery for women. That, to me, is a primary issue. After 22 years of working, in both the U.S. and Canada, on the mental health and addiction side, we have gone through looking at what works and what doesn't work with outcomes. What we are seeing at Aventa and what the literature is supporting is that we need long-term supportive services to see successful outcomes for women.

I mentioned a little bit about barriers. We can't talk about women without talking about the multicultural and minority issues with first nations women. Certainly, these issues are very much a part of what we do every day in looking at providing services.

We are definitely needing to look at child care support for parenting women. Over 57% of women coming into Aventa have children under the age of 18. They are continually dealing with difficulties in lack of financial support for child care and lack of supportive services in that area. Aventa does not do residential support with women and children. There are many successful programs in North America that do provide residential support for women to come into treatment with their children to get the support they need while they're abstaining from substances. This is a road I think would lead to successful outcomes for women later on. It is a resource issue today. We don't have the financial resources to look at this now, but we are not taking it off the burner and certainly see it as a priority in services to women.

I want to talk a little about what we've been seeing in the research in relation to women who are less likely to abstain from substance abuse being a decreasing proportion of the population. I think this is a concern across the continuum of service provision. There are certain groups of women of particular ages who are having more difficulty with alcohol and drug use. As we look at the research, we need to make sure we're assessing what those specific ages are, to provide a comprehensive epidemiological review of the continuing research on women and discover what those issues are. There's a high risk of suicide and lethality for women. Certainly, as women misuse substances in the community, we do a lot of crisis intervention with lethality and suicide issues on a daily basis.

When I spoke with Carol, she talked about providing two recommendations to the committee. I did give quite a bit of thought to that. She was very organized. Continued resources for the treatment and prevention of addictions is primary and in the forefront of my recommendations today.

A multidisciplinary approach is necessary in providing comprehensive services to women. When I talk about a multidisciplinary approach, I'm talking about both the mental health and addiction sides of providing treatment. We've had the wonderful luxury these last two years at Aventa of having a psychiatrist on consultation with us to look at women with concurrent disorder issues. These cases are extremely complicated, not simple to assess. The psychiatrist can provide tremendous support in interventions. These types of nursing, addiction counselling, and psychiatric consultations are crucial for the broad issues of treatment outcome. So providing necessary resources for treatment and prevention is my first recommendation.

The other issue I wish to raise concerns the whole research piece I mentioned briefly. It's about the importance of being able to provide ongoing research on women, on substance misuse and its progression and onset, on the types of effective interventions, and on co-morbid disorder issues and their impact on substance misuse. The treatment professionals I've worked with within AADAC and in Canada since I've been here are very much committed to assessing how we're doing business and how successful our outcomes are. At Aventa we're continuing to look at ways we can provide better services to women. The harm reduction model has really forced us to look at making sure we are taking the best possible approach with the limited resources we have, and that is an ongoing issue.

¿ (0935)

The third issue on a national level would be a preferably--if I can say this--non-government clearing house in a national organization for treatment and research, with the ability to have a broader networking opportunity for treatment professionals on national issues that are working effectively in both rural and urban areas of Canada. When I talk to other professionals in other provinces, certainly on the women's side, we talk about the benefits of telecommunications and being able to collaborate better on our treatment resources, sharing and pooling our resources together, and being able to support each other in areas of the country where there are more limited resources and greater need of more support.

So those three areas would be my recommendations to the committee today as you begin to move ahead in your collaboration. I thank you for being here today.

¿ (0940)

The Chair: Thank you, Ms. Wood, and thank you, Carol, for being persistent.

Our final presenter this morning is Debra Williams, who has done some work in evaluating DARE.

Ms. Debra Williams (Chair, DARE Evaluation Committee of Alberta): Thanks.

I'll just mention that I'm with Alberta Learning, and we're leading the DARE evaluation in Alberta. To put that in context, substance use education in Alberta is covered in our health curriculum from kindergarten up to grade nine, then in our current life management curriculum at the high school level. That focuses on helping students develop the skills to support informed personal choices. Of course, as Howard mentioned, AADAC is also involved in delivering school-based prevention programming. Then schools, at their own choice, can deliver other privately developed programs such as DARE.

DARE, of course, was developed in the United States in the early eighties, came to Alberta in the early nineties, and is currently provided by law enforcement agencies in Edmonton, Camrose, Medicine Hat, Lethbridge, and St. Albert and by the RCMP in various rural jurisdictions around the province. So delivery of DARE is again at the option of the local school authority staff, the municipality, and the law enforcement agency in a jurisdiction.

The current focus of the Alberta government on DARE is on conducting proper research to evaluate its effectiveness. To this end, the Alberta Solicitor General actually completed a literature review on effectiveness research with DARE, and I've left a copy of that for you. Alberta Learning and school system stakeholders were also given an opportunity to provide input to that document. In addition, Alberta also wanted to do an actual program evaluation of DARE. To accomplish that, we're basically participating in a Canadian study along with British Columbia and New Brunswick, so we're not actually leading the formal evaluation study any longer. That will be done by the federal government, led by the Department of Justice.

One thing that's complicating the evaluation of DARE is that on February 15 of last year DARE officials in the United States publicly stated that the program does not have significant long-term impact on preventing substance use and abuse by youth, so they're again revising the curriculum. That curriculum, targeted at grades five to eight, is scheduled for release in 2003. The tentative schedule at the federal level--and I'm sure you'll hear more in Ottawa when talking to Department of Justice employees--is now to look at doing a more extensive literature review until the new curriculum is implemented, hopefully in the fall of 2003, and then doing the actual study again with those three provinces.

Obviously, prevention research is crucial for finding out what works to keep people from abusing substances in the first place, so I think this project will, with the more extensive literature review and the actual evaluation of DARE, offer some insights in that area.

The Chair: Great. Everyone has a copy of the executive summary. The opening paragraph is shocking, given that some parts of the country think it's the best thing since sliced bread.

¿ (0945)

Ms. Debra Williams: It's interesting, because some research, as well as what we've heard from some of our own school stakeholders, suggests... You spoke about addiction professionals wanting that research, wanting to know what works, but that's not necessarily... Especially when you enter the political sphere, there are so many other aspects to consider in decision-making.

The Chair: Don't we know that.

Mr. Leblanc, ask some questions.

Mr. Dominic LeBlanc (Beauséjour—Petitcodiac, Lib.): Thank you.

Again, thank you very much. It was an interesting panel. I learned a lot from each of your presentations. You obviously took considerable time to think about what you were going to say to the committee. I know our colleagues who aren't here, but who will see the transcript of your presentations, will go into our discussions with respect to an eventual report. Thank you for the time you took and thank you for having displaced yourselves to come here this morning.

I have a few questions I wanted to address. I know Paddy will have some as well. Maybe we can have an informal discussion, since there are so few of us. It was an interesting afternoon yesterday.

Inevitably, one of the things the media will focus on with this committee is the question of decriminalizing marijuana, an option some people advocate. We hear contradictory things. Some people say marijuana is addictive, others say it isn't, some say it's a gateway drug. With the experience all of you have in treatment, education, and research, I'm wondering what your views are about whether or not marijuana is addictive. It's interesting. The people we've met in various treatment centres, almost without exception, began their drug abuse with marijuana. They ended up on much harder and much more destructive drugs. I'm wondering what your views are on the addictive nature of marijuana, and whether or not you think it would be appropriate to decriminalize possession of cannabis.

I would be interested to hear from all of you. I recognize that in some cases it may be your own personal views, not the views of the organization you represent.

The Chair: Ms. Wood.

Ms. Cathy Wood: We had a harm reduction conference in Red Deer recently. The subject of decriminalizing marijuana came up. There were some good speakers on the topic. From a treatment perspective and from my experience, I think, in general, people self-medicate on a number of substances. Women are coming in addicted to marijuana. They're smoking marijuana every hour before they come in for treatment. So to assume that it's not addictive would not be the stance we would take at Aventa.

In regard to pregnant women, the effect of marijuana on fetuses is quite substantiated through research and through the health field. We certainly know that cannabis, like tobacco and alcohol, affects unborn children. From that perspective, we would say that using substances like marijuana is detrimental to the health of women and their babies.

On the decriminalizing question, I do have some feelings--and I'm speaking here not necessarily as a representative of my organization, but from my own observation--that there are some things we're doing that aren't working, with the war on drugs and so on. I think there are some valid points in taking the economic gains of drugs out of the picture and considering what would happen to the effects of drugs and alcohol on individuals in that case. I think there's a tremendous economic issue that needs to be looked at in respect of why we're not winning the war. There are some issues that pose questions to policy-makers on both the criminal justice and treatment sides about what we can be doing differently.

These are my initial thoughts on this.

¿ (0950)

Mr. Dominic LeBlanc: Your personal view is that it would not be a mistake to decriminalize?

Ms. Cathy Wood: I'm not saying that. I'm saying there are certainly going to be continued medicinal uses of marijuana, whether we criminalize it or not. This is not going to stop. When I talk to health care professionals who are dealing with spinal chord injury patients, the doctors know their patients are using THC every day to medicate the pain. So I think that's going to happen. I probably wouldn't recommend decriminalizing marijuana, because of the health and prevention and treatment aspects for women of doing this. I wouldn't say I'd take that stance 100%.

Mr. Dominic LeBlanc: Thank you.

The Chair: Mr. Faulkner.

Mr. Howard Faulkner: Our physician board has addressed and studied the issue quite thoroughly, because it is a controversial issue. The board arrived at their decision from the perspective that we are a service delivery organization. The fact is that a number of our clients show up addicted to cannabis or marijuana. From this perspective, we don't support the decriminalization of marijuana.

When talking about the continuum or balance of service, I think we have to look at cannabis in this realm. From our perspective, if it were ever decriminalized--and there are lot of reasons to decriminalize it, such as the cost to the justice system--it would lead to increased use of marijuana, because it is an addictive substance. It may become normal in some people's minds. I think this is one of the issues with harm reduction too. By using the very term harm reduction and not taking an abstinence approach, many people feel you're actually endorsing the use of a drug. Of course, this is not what's recommended at all.

So we don't support the decriminalization of marijuana. However, if you were to decriminalize it, it would be very important to put resources behind the prevention, treatment, and enforcement issues, so they're still there and it's stated very clearly that it is not acceptable to use marijuana.

The Chair: Ms. Landry.

Ms. Kathy Landry: Obviously, working in the field, we see clients coming into our programs addicted to marijuana. A withdrawal process occurs. Clients themselves don't see it as a really serious harm, but as professionals, we have to look at history. I very much associate marijuana with tobacco use. Hopefully, we've learned something from the broad use of tobacco and the harms it produces. Why would we go down that path again? We're just getting around to dealing with the harms associated with tobacco. Why would we go there?

The Chair: When we listen to presenters, there are days when we wonder why we ever legalized alcohol, but clearly that's not going to change.

Ms. Miller.

Ms. Julie-Ann Miller: From my perspective, from a health perspective, I would say it wouldn't be a good idea to decriminalize. The addictive effects and all the things everybody's been talking about, such as the effect on families and the personal effects, are just incredible. But from a medical point of view, I'm torn between supporting the idea of a pain reliever for spinal chord injury or work with the MS Society. It's another group that's very supportive of the idea of using it as a medication. So I think there needs to be some thought as to the value of the drug. I'm not sure tobacco and alcohol were ever thought of as being medicinal. Certainly, some of our other substance abuse drugs have medicinal uses. They're not legal, but they are legal for medicinal use. I would support that.

I can't see any value in legalizing marijuana. Nowadays we all have choices as to whether we drink alcohol, smoke, or drink coffee. They are things we know. The caffeine in coffee, for instance, has a lifestyle effect on us, and yet many people can't control it. I think there's a responsibility to provide some kind of legislation for the good of the society.

¿ (0955)

The Chair: Mr. Leblanc.

Mr. Dominic LeBlanc: Another issue we hear a lot about is the whole question of harm reduction. We're going to hear a group later this morning. I appreciate that many of you are involved in programs that are abstinence-based. Abstinence is the ultimate goal for many treatment programs, I appreciate that. I think Ms. Wood said sometimes on the road to abstinence, on the road to successful treatment, or whatever it is in the individual person's case, some harm reduction approaches are warranted and helpful. I recognize that individual communities across the country have different needs. In many cases, in rural and urban areas, substance abuse manifests itself differently in different communities. There's an appetite in different communities for different approaches to harm reduction. I recognize it. It's a big country.

One of the more controversial issues we hear about is the question of safe injection sites and heroin maintenance programs. What are your views as to the effectiveness of that kind of approach? I've learned that many communities have needle exchange programs that operate quite successfully. We were in Halifax. You wouldn't think Halifax or smaller communities on the east coast have the need for needle exchanges. It was an eye-opener for us, or for me anyway. There are colleagues on the committee who will advocate safe injection sites and heroin maintenance programs. What are your views with respect to the effectiveness of harm reduction options? What message would it send if the government were to recommend that some communities should have access to those kinds of options?

The Chair: Mr. Faulkner.

Mr. Howard Faulkner: Clearly, harm reduction has its place in the addiction field. I think it's very important that we endorse harm reduction along the whole continuum of service in addiction, relative to injection-drug use specifically and injection sites. The research has not yet proven that they will make a difference. I think we do need to support the pilot projects relative to injection sites and evaluate them.

When we look at it, we need to consider what the addiction piece of the business is, if you will. If you look at the models of change and moving a person through the change process, it might be the only time we come into contact with the individual. It is very difficult to get these individuals into treatment. They don't respond to some of the more common forms of treatment. It protects the wider population, especially when you look at injection-drug use. It might be an opportunity to get them into further addiction services. On the other hand, for many it won't work, but it will still offer some control of the situation. I think research needs to be done on it.

Ms. Kathy Landry: I echo Howard's thoughts, and not just because he's my boss. I think government has a very specific role in moderating what we consider to be the social norm. We need to be sure decisions that are made at a policy level are indeed well founded in research and we're not making decisions that will move society in a direction that may actually be harmful to people. You can look at harm reduction very specific to needle exchange programs, safe injection sites, and things like that, but in the process of getting there, it's essential that harm reduction be looked at from a broader perspective, one that isn't limited to people's use of drugs or substances to get them through. Some of the broader determinants of health need to be considered in that view of harm reduction. If government at both the federal and the provincial level--or even the researchers--looked at some of the broader determinants of health, employment, and simple physical health, that would go much further in reducing harm both at the individual and the community level. In dealing with harm reduction strategies and harm reduction policy, you must not isolate it to addictions, you need to look at other things.

À (1000)

Ms. Cathy Wood: I'll add something on the health issue. When we look at harm reduction, we're also looking at the reduction of communicable disease and HIV. With safe injection sites, that's a huge issue. For pregnant women, exposure to HIV and hepatitis is certainly a very big issue.

The other piece on harm reduction, whether it be safe injection sites, methadone maintenance, or whatever, is that addiction medicine has come a long way. The abstinence-based approach is certainly driven by the grassroots movement of the 12-step AA process, and for years there has been tremendous anxiety about challenging what has been working for a very long time. Now we have addiction medicine, broader educational programs specializing in addiction, professionals providing services on specific addictions, and provincial agencies providing comprehensive services. This has allowed us to move away from some of the intensity of the 12-step movement and say that there are other ways of treating addictions, ones that work.

For me, abstinence is not about 12 steps. For me, abstinence is about wellness and health, and that's really what we're moving toward, creating an opportunity for a woman to have greater health and wellness in her life. That's what the abstinence-based issue is for Aventa. We're finally at a point now where we can be more public and open about it throughout North America, moving away from that historical addiction treatment modality and saying there are other ways we can successfully treat the problem.

The Chair: Ms. Miller.

Ms. Julie-Ann Miller: I would like to add that from a social perspective, you have to take a more holistic approach to things for sure. I don't have experience in addiction treatment, but I know from the other things I have been involved in that sometimes one thing does not solve the problem enough. There are so many other things to consider that have equal or more effect that it's hard to say it would be an effective thing. I'm sure our AADAC people can support their view a little more strongly, but I think you have to look at a more holistic approach, an overall approach that weighs those factors as well.

The Chair: Mr. LeBlanc.

Mr. Dominic LeBlanc: There are two issues I'd be interested in hearing your views on. Some witnesses have advocated coercive treatment, for instance, for a hard-core addict who's involved in a series of criminal behaviours as a result of addiction. We've heard that in some communities the court would give the person who was convicted of some kind of criminal activity a choice between incarceration in a correctional facility and participation in a treatment program. With the waiting lists to get into a treatment program and so on, I recognize that's a complicated problem. Based on your experience, can that be effective? Is there any evidence or research to conclude that a coercive treatment approach in some cases--I recognize that the variety of persons who end up requiring treatment is probably as vast as that of the facilities that offer treatment--is a valuable tool for the court system? Do you think that's something that has value?

The second issue, which some of you touched on, is the rural-urban dichotomy. I said earlier it's a big country, and there are different problems in different parts of the country. In a rural community 50 kilometres away there can be a different set of dynamics from that in a large urban centre. From the education and treatment perspective--and all of you have vast experience in those fields--what are the particular challenges of reaching small rural communities? Am I correct in thinking the problems there are different from those experienced in a large urban centre? I have the sense that in many cases people with substance abuse problems who live in small rural centres are not easily reached or don't have easy access. Many of them aren't wealthy enough to take a plane or even a bus to a large urban centre, stay in a hotel, and meet with a professional treatment counsellor, for instance, if you live in a small fishing village in northern Newfoundland. I'm wondering what your views are on how we can also have an impact in small rural communities.

À (1005)

Ms. Kathy Landry: I'd like to speak to the coercive treatment issue. We do get what we call mandated clients, and I have to say, on the treatment side of things, they are the toughest to deal with. The business and industry clinic programs are somewhat coercive, but those clients are not mandated clients so much as they are coming to us because the employer has said, you need to go and your job is contingent on it. We find that little bit of leverage we can use with the client does do some good. I believe the clinic has a success rate of just over 70% in maintaining abstinence for a year. We're just undertaking a 3-year evaluative study as to the outcomes of the clinic's programs and its success, but early indicators are that this little bit of leverage, which we use with our clients to moderate change and recovery, seems to be working.

Mandated clients are a different kettle of fish, in that any client being offered a residentially based treatment program as an alternative to incarceration is obviously going to say, let me go to treatment. That's because we're much nicer there, I've heard. There's some value in providing treatment to mandated clients. I think it needs further research to give us a sense of what works for those clients.

We deal with clients pretty much where they're at, so when we do get clients from the justice system, we're able to set aside that kind of stuff and say, okay, how can we make it work for you, how can this be of benefit to you? Some clients are receptive to that, some aren't. We're always dealing with the behaviours around that.

On your second question, I think Alberta has about 80% of its population in larger or urban centres, and the remaining 20% are geographically spread all over the place. It makes it tough to deliver services to them. I think the advent of technology is assisting in at least getting information out to the rural areas, but it's still a challenge. The network system we have in place with AADAC, where we have institutions strategically located in larger and smaller centres, and the area office network are extremely efficient in getting services out, particularly to the smaller and rural communities. It is a challenge. We're limited by the resources we have, obviously, but I think the number of folks we see in our services, both from the treatment and prevention side, is a good indicator of the success we are having.

On the mandated client side, we've had contact with Justice for many years to provide residential beds for women coming out of the prison system. So we've been dealing with mandated clients for a very long time. We get mandated clients from the child welfare system also, where children are removed for temporary guardianship.You will seek treatment in order to get your children back. Many of them go for permanent guardianship as well. And we get people through probation and through a range of areas. I think it's very important to collaborate with Justice on the issues they're facing, space and overcrowding and the numbers who are being incarcerated for drug and alcohol offences. The reality is, when you look at the pathology of the types of people who are incarcerated, addiction is a primary issue. In that sense, mandated clients can be successful in treatment, and we certainly have seen that.

I've also been involved in a pilot project in the U.S., where we provided a six-week, in-custody treatment program and did a one-year follow-up on it. We saw no greater success in recovery outcomes for in-custody than for mandated clients in the community. We did some comparative research on that back in the mid-eighties. I'm reminded on a regular basis that they are successful, but they also often require more resources on the treatment side, because they bring a whole host of issues.

À (1010)

Mr. Dominic LeBlanc: I remember from media reports some years ago, it might have been in Manitoba, that some women were incarcerated and mandated into a treatment program because they were pregnant and there was fear of potential harm to the unborn child. I recognize that the whole issue of legal rights of an unborn child is a much more complicated problem, but leaving the legal rights of an unborn child out, is there a role, from your experience seeing women who are pregnant and abusing substances, for the judicial system or for some form of mandated treatment, at least during the time of the pregnancy?

Ms. Cathy Wood: In a perfect world I'd like to leave the justice system out of dealing with treatment, in that we need to look at the reasons women are involved in the justice system and why they're using substances in a general sense. My feeling is that to be penalized or punished for that is unfortunate, really, in the big picture.

To deal with the whole issue of pregnancy, we certainly are not supportive of incarcerating pregnant women across the board.

Mr. Dominic LeBlanc: No, we wouldn't incarcerate all pregnant women, just those abusing substances.

Ms. Cathy Wood: Right, those using substances.

Mr. Dominic LeBlanc: I wasn't advocating incarcerating pregnant women across the board.

Ms. Cathy Wood: I'm making the assumption we're talking about addicted pregnant women. My feeling is that we should look at earlier intervention, so as not to get to that point. Many women will talk about the fact that if they're pregnant, it's a major motivator for them to stop using substances. As soon as the baby's born, they'll go back to using substances again. So it's an interesting process that goes on. They're not going to hurt their unborn child, but they will hurt themselves. The majority of women are non-violent offenders. I'd certainly like to see the alternatives, to look at ways of dealing with their addictions other than through the justice system.

On the rural and urban issue, I didn't mention in my speech that we do have, on average, about 15 women a year who come to Aventa from the Northwest Territories. The reason is that we're the only specialized service for women available to them, so the government sends them to Calgary. It's not ideal, because two issues come up. They have difficulty leaving the reserves, primarily because of children, so they can't come down to Calgary. That is a long way for them to come. And second, they go back to the very same environment. So we're really doing a band-aid job in dealing with the addiction problem, because there's no way to have a long-term relationship with them and continue to support them. They go back to having no resources and no support.

There are very few opportunities for women to continue to move away from the violence they're experiencing on the reserve, to get the kinds of support services they need, to be working with other women, because they're extremely isolated. So the rural issue, from a woman's perspective, is a big one. We certainly will try to keep them for at least 90 days when they come in for treatment, but that's the maximum time the government will subsidize them to come to Calgary.

À (1015)

The Chair: Thank you.

Ms. Miller.

Ms. Julie-Ann Miller: I'd like to make a comment on mandated treatment versus incarceration. As a behaviouralist, I always back positive support for a situation, but I recognize that sometimes people with addiction problems have mental health issues that prevent them from really being able to assess what their positions are, what their options are. So sometimes it's really difficult to know what the best situation is. If an advocate is available to assess that kind of thing, I think it would be very valuable to tell which avenue to go with.

On urban and rural differences, I think there's a different cultural attitude in those areas. I have lived in both, grown up in both, and certainly in respect of drug use, I know there's a different attitude in both areas. And I support the observation that technology is a very good tool to support education and prevention, and certainly early intervention is the key in that area. So I think that's a good way to go.

The Chair: Mr. Faulkner, do you want to comment?

Mr. Howard Faulkner: I'd like to add in respect of court-mandated treatment that treatment is really about the individual. People get through the door by many different ways. Some clients will show up, they're self-referred, but they really don't want to be there and they're scared silly. Other clients are referred through the justice system, and it is, go to jail or go to treatment. That may be the motivator to get the person into treatment. The issue is that all our services are voluntary, so the client needs to start working with that. They do tend to be more disruptive, they're harder to deal with, but if they can get over that initial barrier and work with the program, they can be very successful. The focus is really on the individual; they have to be willing to change. Of course, relapse is part of that as well. It takes more than one time for many clients to go through treatment.

On the urban-rural issue, I'd like to add that we have tried to strategically place our officers across the province so that no Albertan has to drive more than about an hour to get to an outpatient clinic. I refer to 26 area offices, and those offices generally consist of two counsellors and an administrative support person. They provide outpatient counselling and community education and prevention services as well. We have 17 regional health authorities in the province, and we now have at least one area office in every regional health authority. But clearly, I do agree with the comments made earlier that there are different issues in urban and rural areas.

À (1020)

The Chair: Thank you. Thank you, Mr. LeBlanc.

I have a couple of questions for you, Mr. Faulkner, about AADAC. I see in your business plan on the first page that you're really starting to spend much more money, as a percentage, on prevention and treatment. It looks as if your numbers are going to switch quite dramatically. Is that because there's more of a recognition that you have to turn off the tap before you ever solve the problem?

Mr. Howard Faulkner: Certainly, prevention is the top priority for us, particularly focused on youth. At the same time, as I'm sure you've heard over and over again, we have the client standing in the doorway saying, I need help. So in times of budget reductions and when we've had to make decisions, we've still had the client standing in our door. As a result, we've had to draw back on some of our prevention and information services. However, we definitely see that as a key priority. The increases you see before you really are related to the tobacco initiative we undertook this year, the Alberta tobacco reduction strategy. We had roughly $9 million added to our budget this year, but that is all related to tobacco. So those are the changes of numbers, and prevention is a key component of that.

The Chair: Would we see that there has been a huge increase in prevention and information--perhaps even treatment, actually--that's funded specifically out of the gambling initiative? There's been a huge increase in revenue for this province out of gambling.

Mr. Howard Faulkner: Our programs are all integrated. I believe there's about $4.2 million dedicated to gambling, if you take all the services across the province. We accepted the mandate for problem gambling in 1994, and at that time we used an approach of training a key number of staff in that area. Then we sent them out and we trained all the staff, so all of our counsellors are familiar with problem gambling and what needs to be done in that area. The way history played itself out in some areas was that problem gamblers didn't show up in the same numbers as they did in, say, the urban areas, the higher population areas.

The Chair: You have a target of 95% of people being able to secure treatment facilities. Is that accurate? Is that what is happening? You have 35,000 admissions for treatment services in a year. How many beds are there?

Mr. Howard Faulkner: There are about 750 across the province. Those are for all services, though, so they don't break down to residential versus outpatient. Those are the targets we've set for ourselves on client satisfaction, client access to service, and effectiveness. We follow up with clients after they've left the program, and those are the numbers that are reported. We are achieving those targets, though.

The Chair: Okay, but Ms. Wood has identified that there is a three- to four-month waiting list. Again, maybe it's because it's a women-only program, but is this an issue across the province, that things are backed up where people are seeking treatment and it's not there?

Mr. Howard Faulkner: Certainly, the demand for our service is significant. The waiting lists do vary, depending on the location, also the time of year, as well as the service. What I'm referring to there is the case of shelters in the winter. In Calgary and Edmonton there's a significant problem with the waiting list simply to get into shelters. So that's one end of the spectrum. The numbers we report in our business plan are for all the services, so they're an average.

À (1025)

The Chair: Ms. Landry, how long are people waiting to get into your residential programs?

Ms. Kathy Landry: With any of our residential programs--the clinic is an exception--we get people in very quickly. From the point of referral, they're in within two days, I would say. For the residential treatment program, there's about a three- or four-week waiting period, specific to our centre. There's a demand for the women-only program because it's specialized. But treatment isn't limited to residentially-based services. Clients who have addiction issues can gain treatment on an outpatient basis.

The Chair: So they're getting some intervention.

Ms. Kathy Landry: Absolutely. Treatment isn't limited to the residential beds. Some clients think that's the only kind of treatment there is, but clients who use outpatient services do equally well with individual counselling.

Mr. Howard Faulkner: We also try to get clients into self-help groups immediately. They may not get into residential treatment for a month, but we try to connect them to AA or NA immediately, or, as Kathy mentioned, to outpatient counselling.

The Chair: It's been mentioned to some extent by all of you that most of the people who end up in treatment facilities said their first problems were with alcohol, not cannabis. Alcohol plays a much bigger role, but prescription drug use, self-medication, and over-the-counter drug use are pretty phenomenal right across the country. You mentioned specifically that you have new amounts of funding for prevention of tobacco use, but does there need to be an effort to stop the siloing of these different programs and instead have more of an approach like Ms. Miller's, to make better choices and understand all of their activities? This province is much like most of the provinces, where a lot of people are using a lot of substances without even understanding them. In this province there's certainly a lot more alcohol consumption than in others. It's getting close to two beers a day for everybody over 15. That's high, and those are legal substances. The beer story doesn't even include things they might be taking at the same time, like Robaxacet, Tylenol, and all kinds of other stuff.

Mr. Howard Faulkner: Our services are integrated. I mentioned the Alberta tobacco reduction strategy, which was created through a cross-ministry committee involving Justice, Human Resources and Employment, and Health. AADAC chaired that committee and took a plan forward to government. Once the plan was approved, it was given back to AADAC to take the lead role. But our role is one of coordination, so all those other departments are involved, because addictions cross so many different fields.

The Chair: But will the message be just be about tobacco, or will it be about making more informed choices?

Mr. Howard Faulkner: It will definitely be about making more informed choices. With tobacco, we increased our youth initiatives last year, so we'll be going into the schools, but we won't be talking just about tobacco. We'll be talking about addictions and empowering youth to make better decisions, providing them with some of those protective factors and skill development.

On a broader level, we also have a cross-government initiative in Alberta called the health sustainability initiative. We're looking at all the different prevention and promotion programs of all the different departments. We're determining what pieces of them we can share, so when we go forward with a message, if it's a health message, we'll all be part of that, to break down those silos. I think we've made some good strides in the last couple of years in breaking down the silos, but we have a way to go on that too. It's important.

À (1030)

The Chair: Ms. Williams, does Alberta Learning consist of curriculum development people for the education system?

Ms. Debra Williams: The education ministry, yes. We do develop the curriculum.

The Chair: You mentioned that right through K to 9 there is some education component about substance abuse and choices, but when we talk to young people, they tell us they never got anything. So how up-front is it? Can we get a copy of some of the stuff that is being taught to young people? That would be helpful.

Ms. Debra Williams: Yes, you can. I have a copy here. I can leave that with you, and it's also on our website.

Again, it's the making healthy choices approach. So for instance, outcomes in the curriculum include analysing possible negative consequences of substance use and abuse, for example, fetal alcohol syndrome, and drinking and driving. Those are outcomes in the curriculum, and it is mandated by law that this must be taught in Alberta schools, so the kids should be getting that. When you ask a student what they did or didn't get, I don't know how great their recall would be. I suppose it depends what age they are.

The Chair: Is there some evaluation process going on to see if those programs from K to 9 are working?

Ms. Debra Williams: We do have a provincial achievement testing program. It covers our core subjects, and so it wouldn't include the health curriculum.

The Chair: But even with the evaluation the PARTY program has, it's great that the kids are saying they're going to make better decisions, but I would think the evaluation would be seeing that they actually do.

I think the challenge we face is in a couple of places. I hear from young people that they don't drink and drive because they might get caught. In my province it's called a RIDE program--I forget what it's called here--where a police officer can give you a blow test on the street corner as you're driving by. So you don't want to get tested, be positive, and get charged. Really, it's about, as you mention, Ms. Miller, understanding that you could cause an accident, that you could be wearing the fuzzy glasses and not be in full control. That's why you don't want to drink and drive, or that's why you don't want to get high. It seems some kids are reporting, especially 20-year-olds, that they're using marijuana because the police officer can't test them, so they'll get away with that behaviour. They go to the party, have a good time, and forget about the consequences.

Is there any evaluation of the program on that level?

Ms. Debra Williams: As Howard mentioned, AADAC also has a role in school programming. I know, Howard, you're piloting a new program in schools right now, and that has an evaluation component that goes along with it.

Mr. Howard Faulkner: The program's worth mentioning. We're developing materials with Alberta Learning actually. Our counsellors will go in and deliver some of the programs to the schools, but the material will also be packaged in a way that teachers will be able to deliver as well. We also will use the Internet as a means of delivering service.

I'd also like to speak to your comment about kids saying they don't want to drive and drink because they might get caught. They're starting to recognize that there are consequences to making those decisions, and legal consequences are just one type. There are also health consequences. I think that's a learning experience, certainly for youth. They're going through their development and there are transition points for them, so it's important to provide them with the opportunity to learn those skills. I think that's what the programs are doing.

The evaluation you mentioned is a key component in all this. When we're talking about indicators, though, and outcomes, some of the outcomes are going to be much longer than one to two years. The other part of this health sustainability initiative I was mentioning is that we're starting to look at what ten-year indicators we should be examining. The issue there is so complex because addiction is just one component. We'll never claim all the credit, there are always other partners involved, but the key thing is that you need to look long-term at the 10-year indicators to really know you're making that difference.

À (1035)

The Chair: Would part of that be that you would be looking to see that annual consumption of 512 bottles of beer for every Albertan reduced?

Mr. Howard Faulkner: That would be wonderful, wouldn't it?

The Chair: Except if you're a beer maker, in which case you're pretty happy with the way things are.

Ms. Williams, you've identified the cost of the DARE program as $237 per student. Are there comparable figures for the PARTY program? What would those be?

Ms. Julie-Ann Miller: It varies. For our program, we're looking at volunteer time. I'm funded through a not-for-profit agency, and my position is provided for the program. As well, there are several other professionals whose time is volunteered, and then other community volunteers. So the actual costs are down to about $35 per student to provide the program. The difference between DARE and PARTY is that DARE is over a series of weeks and ours is a one-day program. So that's a limitation there.

I wanted to address the matter of the information that's provided in the school program, because it is provided and it supports what we do. But the value in what we're doing is that it's generally more experiential. It's in the hospitals; there are people with uniforms on. It's the social marketing aspect of it that leaves the impact with the kids. They're getting those messages in a curriculum, they're getting their messages all sorts of other ways, but we're in their face with it. We have people who have survived injuries who tell them about what their life is like now, what effect it has on their family. It's the testimonial type of effect that really makes a difference. When our police officers talk about having to go to a scene where somebody's injured or having to go to somebody's home to say, your child has died of an overdose, or things like that, it really has impact, and it's a little different from a school situation. I talked about different communication styles. A lot of our teaching is based on people hearing what's happening. We try to vary that a whole lot and we know it's effective in that sense.

The Chair: Are there any programs that specifically address, or is there an emerging concern about, the number of people displaying addictive behaviours who come from a background of addictive behaviours--obviously, that's one of the components--but are FAS or FAE people, and so may need a completely separate or different type of program, given the way they learn or the way they might be affected? Is there something going on in this province on that level?

Mr. Howard Faulkner: There's a whole initiative on FAS and FAE in concert with Children's Services, and yes, absolutely, people with FAS do have those problems and are more difficult to deal with.

Cathy, do you have anything to add?

Ms. Cathy Wood: We are seeing more women in treatment as adults from an FAS or FAE background themselves, and so we are looking at ways we can present the material more effectively to them, so that they can understand it. They are certainly coming in with some disabilities, cognitively and behaviourally, participating in traditional psychotherapy and group therapy. They don't necessarily do well in that sort of traditional model, and so we are continuing to assess it. We don't do comprehensive testing there on site, but we can look at the cognitive deficits and say, maybe we need to be doing some things differently on the treatment side to get better outcomes for specific women.

I'm not aware of a specific program targeting adults of FAS and FAE in respect of treatment. Are you, Howard?

À (1040)

Mr. Howard Faulkner: There is the early childhood development initiative that's just under way, through federal funding, actually.

The Chair: The person who is an adult and has a substance abuse problem may not work at Aventa, because of the whole learning thing, it's too hard to adapt the program. There may need to be a specific place or a specific program delivered for people who have FAS or FAE. Is there discussion about that yet?

Mr. Howard Faulkner: There isn't a specialized program specifically for adults with FAS.

Ms. Kathy Landry: Our programs are assessment-driven, so the client is assessed individually with regard to their addiction issues, their level of function, let's say. It's not an in-depth assessment like some of the psychiatric assessments in respect of mental function and that sort of thing. Then the client is matched to what kind of treatment approach would work best for them. Clients who are fetally affected are less likely to do well in a therapeutic group setting. However, high structure, individualized focus of attention, life skills training, and those kinds of things would be coordinated with that client in an individualized program. We don't have residentially based programs for adult clients who have been assessed as fetally affected.

It's the same issue we have with our concurrent disordered clients. We see a significant number of folks who are mentally ill as well as addicted. Because we're assessment-driven, we're able to pick up on some of the subtleties of some mental illnesses and provide a treatment approach that's appropriate for that individual. Because of our network and our connectedness with the communities we work within, we're able to connect quite nicely with other agencies and departments.

One of the significant issues is our ability to get that client the other kind of help they need. As much as we are under pressure because of limited resources, other agencies are equally, if not more, so. In our community in Grande Prairie, for us to be able to get a client in for a mental health assessment, a psychiatric assessment, unless they're in crisis, psychotic or highly suicidal, it's about an eight-week wait, which is huge.

The Chair: And with every day, you run the likelihood that they'll walk away.

Ms. Wood, you mentioned that your clients can come in on a methadone maintenance program. I guess they're coming from Edmonton, because there are no methadone maintenance programs in Calgary. Is there some discussion at AADAC about setting up more methadone maintenance programs?

Mr. Howard Faulkner: Absolutely. A report was produced a couple of years ago on non-prescription needle use by that consortium. It recommended expansion of the methadone program to various areas of the province. We only have the one in Edmonton now. People from different points in the province can gain access to it, but it does mean they need to relocate, and the caseload is growing. I know Beth Lipsett is going to be speaking about that in the next session. We do recognize the need to expand it. Our first priority would be Calgary, again because of the population base, but also Red Deer, Lethbridge, Grande Prairie. The issue there is one of resources, and it is something we're working on. Expansion is needed.

The Chair: This committee is going to continue to hear witnesses for a couple more weeks, and then meet to make recommendations to the House of Commons in November 2002. So if something comes up, if there's a magic wand that suddenly appears that can solve the problem, we'd love to hear about it. Carol Chafe would be the best point of contact, so she can distribute it in both official languages to anybody. If there's a person you think we need to hear from or a program we need to hear about, let us know. You've heard some of the questions we're trying to probe. Also, the full testimony of hearings is available on the website, if you're interested and want to check into it. And if you see something in there and think, that person's crazy, don't listen to him, here is something else you need to look for, we'd love to hear about that too.

We really do appreciate the effort and the time you've taken to come here and to prepare a presentation, as well as the work you're doing and the dedication you bring to it. We wish you lots of luck, for the people of Alberta and for all Canadians. Thank you very much for coming to us today.

We'll suspend for a couple of minutes.

À (1041)

À (1050)

The Chair: Perhaps I can call the meeting back to order.

Our next panel is focused on harm reduction, which is great, since we have been hearing lots about that.

For those of you who weren't in the room when I said this earlier, we are the Special Committee on Non-medical Use of Drugs, struck last year in May, trying to look at the underlying factors. We also were referred in April of this year to the subject matter of Bill C-344, which was an act focused on decriminalizing small amounts of marijuana.

From Streetworks we have Marliss Taylor, who is the manager. From HIV Edmonton we have Kate Gunn, who is an interim director, and Deborah Foster who is the program manager. From Boyle Street Co-op we have Faye Dewar. From AADAC--and we've had an AADAC person on every panel--we have Beth Lipsett, who is the manager of adult counselling and prevention services.

And just so you know who's here, Chantal Collin and Marilyn Pilon are our researchers, Eugene is our clerk on an interim basis, and Dominic LeBlanc is a fellow member of Parliament from New Brunswick. I'm Paddy Torsney, and I'm from just outside Toronto. This committee has five parties represented, although not all in the room at this time. We are very happy that our opposition colleagues have allowed us to go ahead without a full complement, which, as a bare minimum, needs to be three, because we have, I think, rescheduled all of you to today from a previous attempt. We had a little scheduling problem again yesterday, but we were able to keep going.

So, from Streetworks, Marliss Taylor, we'll have you start.

À (1055)

Ms. Marliss Taylor (Manager, Streetworks): My plan was to give you an overview of what we do in Streetworks, of who we're working with, and to touch on some of the issues we're coming across.

Streetworks is the harm reduction program here in the city that is involved in needle exchange. It has been around since about 1989. It is operated from a group of agencies that are called the council. We don't belong, really, to anybody. We're a non-profit program. Our funding comes from the Alberta Community Council on HIV. That is a provincial body, and all the needle exchange programs in the province are funded through this. There is a pie, we decide how to slice it up. That is basically what happens.

We have a staffing complement in this program of five nurses and five outreach workers. We also are lucky to have a half-time administration support person, a researcher position, and a physician who is attached to our program, Dr. Trish Murphy. I think that is a little different from most other places. Unfortunately, it's a pilot project, so we may or may not have her past June. Our staffing complement, actually, was doubled a year and a half ago. That funding is running out at the end of this year, and so we may go back down to 4.8 positions.

We have six daytime fixed sites where people can go and receive support, help, needle exchange, nursing services--although nursing services aren't at every place. As well, we have a van that goes out in the evening. We're working with street-involved injection-drug users and sex trade workers, so that's where we're focussed. We basically work in a 20-by-30 block area, because we're working with the most vulnerable populations.

Our program itself has a number of different components. There are nursing services. There is health education. There is a business program, working, say, with area gas stations and pharmacies and places where people may inject in their bathrooms, for example. We're trying to help those staff stay safer and healthier.

We have a ride-along program. There are specific agency people who come out on our van at night, and it provides them with the opportunity to do some outreach services outside their normal business hours.

We do a large number of referrals. We do the needle exchange parts--needles, condoms, lubrication, tourniquets, water, all the things you need for safer injecting and for safer sex work. We have a card entitlement program; there are some agencies that will take in used needles and write out a card. People can then bring the card to us, and we'll give them that many clean needles.

We do a lot of advocacy for individuals, helping them work their way through some of the systems, because our folks are not sophisticated in the mainstream. They have many skills, but not so much in weaving their way through the systems.

As well, we do a lot of group education and work on a number of committees, trying to help improve the situation for people who are injecting drugs in this city and in the province. We have a prison program where we do some outreach, and then we do research and evaluation.

The issues we're seeing on a regular basis are to do with life. For us, it's about poverty, it's about discrimination, and it's about poor housing situations. Mental health is a concurrent disorder, and it's huge in our population. We have a lot of people with multiple drug use patterns. What's different here from some of the bigger cities is in the amount of our drug use that is prescription-based. We have a lot of prescription opiates, for example, rather than heroin. We do have heroin in this city, but not in the same quantity as in other places.

As to this program itself, in our 20-by-30 block area last year we exchanged about 836,000 needles, and we saw about 7,500 people. Of our clients 55.4% are of aboriginal descent. That is a bit different, I think, from what you find in some of the other centres, but then we're also focusing on the downtown core in Edmonton. People of aboriginal descent are the most marginalized, so that's where we tend to find people. Forty-two per cent are Caucasian, and the male to female ratio is about 60:40.

Morphine and cocaine are the highest use drugs. For a snapshot, for a week last February we asked everyone who came to the exchange, what's your main drug of choice? Coke and morphine were about the same, at 28%. Talwin and Ritalin use, which tends to be more of a prairie phenomenon, has gone down, interestingly enough, to about 18%. With the health issues attached to Talwin and Ritalin, called a set on the prairies, a number of our people are dying or have died, so that's part of the reason, I think, cocaine tends to be more attractive to the young population. There's a shift in drug use. Heroin is at 13%, others at 11%, and speed or methamphetamines are just around 2% or 3%, although that shifts. We find that at different times of the year and for different reasons things will shift like that.

One of the things we've been involved in is the NPNU project, which I heard mentioned earlier. I'm not sure if you're familiar with that, the non-prescription needle use project that's gone on in the province. In a snapshot, here's what happened. About seven years ago I was on the original committee, and what Alberta Health and Wellness did was get together the needle exchange programs in Calgary, Edmonton, Grande Prairie, and Red Deer. We met for three years. They brought us together, which was fabulous. It meant networking, and then we could track the trends. It meant all kinds of great things, such as being able to see others face to face and referring people personally, rather than impersonally, to other places. Over the three-year time period we were able to note that we were all having the same issues, or in speaking for our client groups, we found there were all the same kinds of issues. We knew we needed a broader, systemic response.

Á (1100)

Alberta Health and Wellness, to their credit, got together and started this project. The second three-year project involved about 35 to 40 different agencies from around the province, and we were all focused on injection-drug use, harm reduction being the major part of that. There were government agencies, the Alberta Medical Association, the Alberta Pharmaceutical Association, non-profit organizations, and all that, the help agencies. We split into eight different task groups, which then became nine groups, looking at specific issues. We worked towards some changes that could benefit everyone we were seeing.

There were successes. It was tough slogging. I've always said we don't have good poster children in our group. We have injection-drug users and sex trade users. Not a lot of people really want to help. There certainly tends to be a blaming attitude in general. Anyway, there were some successes and some challenges. They felt it was good enough for us to redo it. NPNU III is under way right now. It is another three-year project, again involving the broad government non-profit agency response.

I think the harm reduction programs, that is, the needle exchange programs, in the province still have a really big role. It's very good. We can bring the perspective of the street into some of the meetings. Perhaps the language isn't always the best, but we do bring the street to these things.

Maybe I'll stop there. Did I get under nine minutes?

Á (1105)

The Chair: You did, it was eight minutes and 37 seconds. You get the prize.

From HIV Edmonton we have Kate Gunn.

Ms. Kate Gunn (Interim Director, HIV Edmonton): Good morning, members. I'd like to thank you, on behalf of HIV Edmonton, for letting us have this opportunity to tell you a bit about the work we do as it relates to harm reduction.

HIV Edmonton supports, educates, and advocates for those living with and affected by HIV and related conditions in the greater Edmonton area. Our agency marked its 15th anniversary in 2001. We have a staff of over 12 full-time support and outreach workers located in an office building in downtown Edmonton, off the city centre core. Our work is informed, in all aspects really, by harm reduction.

In Alberta in 2001 there were 159 new cases of HIV reported. There were three groups that really stood out as new and high-risk categories. They were three groups that hadn't been prominent earlier in the years since this epidemic. One group was youth, one was women, and one was injection-drug users. In this past year injection-drug use was indeed the highest risk category, accounting for 42% of the new cases of HIV in Alberta. I think the statistics are confirmed across the country as well.

At HIV Edmonton every day we see many inner-city residents. Over 60% of our clients are of aboriginal descent, with many youth and women, many of whom are injection-drug users. Meeting the needs of the clients is our job. We do it quite well. We also know what works for us and for our clients. In the experience of this agency, the harm reduction approach is a critical part of our services. It's really a cornerstone of how we operate.

I'm quite new to HIV Edmonton and, in fact, to the entire field. In the past few months I've been with this agency, I've come to understand a little bit about harm reduction. I really have a respect for it and what it attempts to do. I've learned two main things. One is that it helps reduce the risks and the harm of risky behaviour for people who, in a real world, exist along a continuum of change. In other words, having a harm reduction approach in our agency helps us help people, in small ways, to take steps to make decisions and healthier choices in their own lives. Second, it provides a framework for us to help people recognize the value of individuals. They may not all be ready at one time to make different decisions. It directs us, essentially, to be inclusive, not exclusive, and to accept people as they are. At HIV Edmonton, of course, we do not turn away clients who are seeking help and happen to be under the influence of drugs or alcohol. For example, we make services available, on their terms, for those who need them. I think it really provides a client-centred approach for us as an agency. We focus on the needs of the clients we're there to serve and, in our case, on people living with HIV or affected by HIV and related conditions.

I'd like to take the next couple of minutes to give you a thumbnail sketch of what harm reduction means in our agency and how it manifests itself on a day-to-day basis. There are about six or seven points here.

One is that about two years ago HIV Edmonton began developing a harm reduction policy for our agency. We have a copy of it in this harm reduction kit that I'll be mentioning. I've left copies for the entire committee ,and it is in there on page 14 of the booklet in that kit. Our first step was to develop that policy.

Second, in keeping with the harm reduction approach, we provide immediate, responsive, and non-judgmental access to our services. I think non-judgmental is the key term here. When dealing with our clients who are involved in risky behaviour, a harm reduction approach means we promote safer sex practices and safer needle use.

If you were to walk into our reception area today, you would find pamphlets and literature on harm reduction and on safer needle use. Our staff have them as well. So that's another way the work we do is manifested. Our staff are informed about addiction treatment services and how our clients can gain them. One of our staff people is in charge of two of our portfolios, called corrections and addictions, and has extensive experience in those areas.

Marliss was talking about the Streetworks needle exchange, and we're pleased at HIV Edmonton to be one of those six sites in the city where there is a needle exchange. We have that in our office. Essential to this service for us is that it provides a critical point of contact for clients who come in, the point of contact from which those relationships that are so important can be developed, or not developed, but the clients who come in to exchange needles have that opportunity to make a connection with a counsellor if they're ready to do so. That's a really essential outcome of having a needle exchange in our office.

Our staff do a large number of education and outreach programs. I know you were talking about education earlier today. We have six portfolio areas that our staff work in. All of them are out leading seminars, workshops, working with agencies, responding to requests from groups and community organizations, attending trade shows, and simply sharing information based on a harm reduction approach.

Finally, and perhaps most importantly, having a harm reduction approach really means we have to realize that we cannot do all this work ourselves, we can't do it alone, although we sometimes think we'd like to try. So much of our important work is done with community partners, who are all sitting at this table, as a matter of fact--not all of them, but a good number of them--from around the province. It's very important, because many of us work from a harm reduction approach, that we work together.

In the past six months that I've been at HIV Edmonton I've been able to work with a couple of real success stories, I think, that are focused on harm reduction. I'd just like to mention them.

One is called Edmonton Safe Streets. This was launched in March this year. It's a community-based project that was set up--it took a couple of years to pull things together--to begin a program of installing needle drop-boxes to prevent needle injury in the city to children and the general public. It was just launched in March, and we're hoping it will encourage safe disposal of used needles. It has been a very interesting experience, with a variety of people from emergency services, police services, most of the people you see around this table, sitting around that table, and we're hoping this will bring to the public an awareness of the need for concern about needle use and harm reduction.

Finally, these past few months I have also chaired one of the task forces Marliss mentioned of the non-prescription needle use consortium. That task force is the public awareness task force. The consortium is a very exciting project. As Marliss mentioned, she was one of the founding members. Today there are about 35 or 40 groups that sit around the table from across the province. I really think our job is quite an interesting one. This year we produced two pieces of material and two projects that really are designed to try to build public awareness about what harm reduction is.

Á (1110)

The harm reduction kit was really the first project of this task group, about two years ago. It was produced, I believe, in 2000. It was designed to provide people working in the field of harm reduction with information about how to make a policy in harm reduction, how to set it up. It was really for professionals working in this area, but it was a very important first step. Then we turned from the print media to video and film, and we have a 30-second public service announcement that's just coming out this summer looking at harm reduction. We have a half-hour documentary looking at harm reduction, how it can help save lives, how it can help improve people's conditions, and how it's manifested in different organizations throughout the province. I think some of the people sitting here were interviewed in the film.

So having been involved in it, I think the work of that task group is very important, because I don't think harm reduction is understood by Canadians. I think the words don't mean very much to most people. They doesn't really speak to the lay person. For example, in our 30-second PSA the words harm reduction are not there. They're seeing a picture of a young girl, someone having an encounter with someone in a needle exchange van or program, and a picture of her father. It's not a 30-second PSA that has a lot of words, it doesn't have any jargon, it doesn't refer to those words. What it's designed to do is try to begin the process of opening people's minds to the fact that harm reduction can help, that it is one important alternative people have to begin to be aware of and understand. And as Marliss said, that blame thing is often there.

I think that's really the focus of our task group, to try to combat that by opening people's minds. In fact, I think the words harm reduction themselves, being new to this field, are very limiting. It's a very technical term. What I've seen in harm reduction in our agency is that it is really an attitude and approach to people, and I think that's a much more inspiring concept. The idea of reducing harm is what is being used there, and it is the goal, but we're really hoping our PSA and our film will reach out with the message and the spirit of what harm reduction is, not trying to tell people the details, the technical terms to use, just trying to open their minds a bit in that area.

Á (1115)

I'd now like to introduce our program manager Deb Foster, who I'm really pleased to have here today. She's worked with us at HIV Edmonton for six years and is responsible for our programming. She can really give you some insights into our clients, and I know she'd be pleased to answer questions afterwards.

Ms. Deborah Foster (Program Manager, HIV Edmonton): Thanks.

As well as being involved in the NPNU projects Kate has just mentioned, we also sit on the aboriginal task force, the social support task force, the addictions task force, the corrections task force, and the youth task force. So we have been quite involved in the whole NPNU project for phase II and phase III. In addition, HIV Edmonton holds the chair of the Streetworks council Marliss was speaking of. We also sit on the blood-borne pathogens committee, which is a committee in Edmonton where individuals who are involved in blood-borne pathogens in general get together. It's a table where we see people we don't see anywhere else. The Liver Foundation, in the area of hepatitis, sits at that table, as well as occupational health and safety for the police department, the fire department, and ambulances. So it gives us an opportunity, from a harm reduction standpoint, to work with many players who don't otherwise come to the tables many of us sit at.

Another project we've recently been involved with is an activity the gay and lesbian community centre has started in Edmonton with funding through the Alberta community HIV fund. Two-spirited individuals in Edmonton are made up of gay, lesbian, bisexual, and transgender aboriginal people. Clearly, the majority of our clientele are aboriginal, and as Marliss mentioned, a large portion of hers are as well. So this is an initiative to reach a further marginalized group, those who are two-spirited within the aboriginal community, where there's also a high level of addiction.

Although we are HIV Edmonton, we deal quite extensively in the area of hepatitis. About 55% of our clientele are co-infected with hepatitis C and HIV. About 45% are HIV infected alone, and about 5% have hepatitis C alone. The individuals with hepatitis C tend only to be the partners or family members of those who are co-infected. So in many ways they are very close to being infected with HIV themselves, because of high-risk behaviour, for the most part sharing needles.

I'll just take another moment to describe a typical client who used to walk through our door, as opposed to those who walk through it now, and to describe what harm reduction meant eight years ago compared to what it means today.

Eight years ago the majority of staff and clientele at HIV Edmonton were what I refer to as middle-class, gay men. When we spoke of harm reduction, we spoke of a group we called GMOC, the gay men's outreach crew. They had a harm reduction philosophy. They worked in Edmonton with gay and bisexual men, as well as men who have sex with men, to reduce the harm by discussing condoms and other safer sex activities. In Edmonton we find that many of the men we deal with have sex with men. They have wives at home and they have sex with men out in bars or other public sex environments. So they don't see themselves as gay or bisexual. They have missed many of our earlier messages, so we are trying to aim more at dealing with men who have sex with men. Harm reduction back then meant talking about condoms and what kind of lube to use.

The typical client who walks through our door today is an aboriginal man between the ages of 30 and 35, with a history of corrections, injection-drug use, and homelessness. Those who spend the most time in our office are mainly those who are still using and are homeless. They use our facility in the winter to warm up, to have a coffee, and maybe to sleep for 20 minutes, because they've been sleeping under a bridge all night. The second most typical person to walk through our door is a female aboriginal aged 30 to 35 who also has a history of corrections, addictions, and homelessness. So harm reduction in this sense is very different. We've really had to move into the whole area of non-prescription needle use and harm reduction generally. We're very happy to have a needle-exchange site in our office, which gets used by our clientele.

I think I will leave it at that and talk more later.

Á (1120)

The Chair: Both the first and second most typical person is actually quite a bit older than I would have thought. Is there a corresponding group of young people too?

Ms. Deborah Foster: We don't see as many young people in our office as you might otherwise expect. Some of the other speakers can possibly comment on where these individuals might be. We do have an outreach worker who goes to Old Strathcona Youth Co-op, which is on the south side. It tends to be a place where many of the young, homeless individuals congregate.

The Chair: Okay, thank you.

The next person is Faye Dewar of the Boyle Street Co-op.

Ms. Faye Dewar (Street Reach Worker, Boyle Street Co-op): Hi. My name is Faye Dewar, and I work at the Boyle Street Co-op. I'm a mental-health outreach worker. I'm also doing a project called Street Reach, where I'm out walking the streets and talking to the people on the streets.

I'm not going to be talking about the IV drug users, because Marliss just talked about them. As outreach workers, we work on meeting basic needs, trying to listen, and giving people referrals and information they need on the street. I want to talk about three different areas, mental health, marginal, low-income people, and youth, because they haven't been talked about very much.

As a mental health outreach worker, I have two types of clients. I have people, usually aboriginal, who self-medicate. They usually never get diagnosed until after they're in the justice system, because this is where they get picked up. They get into doing petty crimes to severe crimes, for whatever reason. If they haven't been diagnosed or they do not take the opportunity to be diagnosed, they use drugs to self-medicate, because they know there's something wrong, but they don't know what. The other person is a mental health person who has been diagnosed, but does not like the side effects of the medication, so they self-medicate to help with their delusions or voices and to calm things down.

I want to talk about the marginal people, the low-income aboriginal women who have had their children taken from them, the homeless, etc. The economic situation in the community is very upsetting. They end up having to use all the money they get from social services to pay the rent and the damage deposit. Then they have no money for food etc., so they do petty crimes. They might do prostitution. They need to use drugs and alcohol to continue this lifestyle. Sometimes it's by choice, and that may be the only choice they do have. The other thing is that they use certain types of drugs. They may smoke pot, use crack, sniff solvents or hair spray, use prescription drugs, such Tylenol no. 3 and valium, or take acetaminophen, which is available over the counter. I've heard of clients using over-the-counter sleeping pills. They use whatever they can to dull their pain and their problems. When you have no money, you have to do crime. They feel like failures, they don't feel they are succeeding, they think nobody is listening to them.

The youth grow up in this type of family and see this situation. They see the hardship their parents are going through. They may be apprehended by the child welfare system. They don't feel they belong there. They inherited the problems of their parents, so they may even inherit the addiction. They do crimes. When they do the B and Es, they may even look in the medicine cabinet to see what's there, and that may be the start of their using prescription drugs. They use the gangs, because that may be their only family, their only way of being recognized as belonging to something or fitting into something. They do not stay in school. They are usually kicked out by about grade 6 or 7.

FAS and FAE children who are coming up will be a big problem in the justice system. There isn't a lot out there for these marginalized people. We need to have a clear understanding of where we're going to go with them. I hope that when they do hit the justice system, there will be a better case plan than just releasing them to the streets.

I think we need to have better linkages between Justice, Mental Health, the Capital Health Authority, the provincial Department of Human Resources and Employment, treatment centres, etc. I think there is a big gap between all those places. We need to have better linkages so that they can have people listening to them and can make a better transition and a better life for themselves.

Now that was fast.

Á (1125)

The Chair: You get the prize today. Thank you. You've given us lots of things to ask questions about.

Next is Beth Lipsett from AADAC.

Ms. Beth Lipsett (Manager, Adult Counselling and Prevention Services, Alberta Alcohol and Drug Abuse Commission): Thank you.

I'll give just a quick overview. I'm sure you've already heard it. The Alberta Alcohol and Drug Abuse Commission has been providing addiction services to Albertans for over 50 years as an agency of the Government of Alberta. The work of addiction treatment, prevention, and information services is mandated through the Alcohol and Drug Abuse Act. Harm-reduction strategies have become an integral part of the way AADAC delivers addiction services. It has become an expansion of the treatment and prevention services we have offered in the past. We provide a continuum of addiction interventions that aim at reducing the risks and consequences of addiction or harmful involvement with alcohol, drugs, and gambling.

AADAC defines harm reduction as a policy or program directed towards reducing or containing the adverse health, social, and economic consequences of alcohol, drug use, and gambling, without necessarily requiring a reduction in the consumption of substances or abstinence from substance use or gambling. We view the first priority of harm reduction as actively engaging individuals, target groups, and communities in addressing their most pressing health and safety needs. From this perspective, persons with alcohol, drug, or gambling problems are treated respectfully as legitimate members of the community who need help and who share in the responsibility to find solutions to the problems associated with substance use and gambling.

While we believe harm reduction emphasizes a change to safer practices or patterns of use, we don't believe it rules out a longer-term goal of abstinence, should an individual decide to pursue it. The emphasis is on change that is relevant, beneficial, and realistic for the client. AADAC views harm reduction as part of a multi-dimensional response to substance misuse and problem gambling that includes addiction, prevention and treatment, supportive public health and social policies, research and evaluation. Harm reduction does not offer a simple solution to the complex problems that can arise for individuals and communities because of substance use or gambling.

In the delivery of prevention, treatment, and information services for alcohol, drug misuse, and problem gambling, harm reduction strategies are consistent with AADAC's mandate and responsibility to support population health. AADAC's harm reduction strategies can be considered secondary prevention with high-risk groups. They are designed to engage and educate those who are current users, rather than preventing initial use.

As was mentioned by the previous group, the only methadone maintenance program is here in Edmonton at this point in time. We call it the opiate dependency program, or ODP. About 25% of our clients report injection-drug use. That doesn't necessarily mean opiate use, though. The opiate dependency program has used methadone maintenance to safely and effectively treat opiate addiction in Alberta since 1971. The program provides assessment, stabilization, maintenance, and counselling services to clients dependent on opiates. We currently provide treatment to approximately 400 clients across Alberta in partnership with over 200 pharmacies spread throughout the province.

Although methadone maintenance in itself is considered an effective harm reduction strategy, AADAC continues to develop and broaden its program in a manner that will meet the needs of clients, respectfully considering the impact of treatment on an individual's life. Methadone treatment within Edmonton is closely linked to the needle exchange program Marliss represents and primary health care. As well, ODP is able to provide support to current clients who find themselves within the criminal justice system.

Our experience in Edmonton has been positive in addressing a broad range of need in collaboration with other care providers. We all have a role to play. In discovering what each of us can offer, I believe we move closer to a comprehensive continuum of care for the injection-drug user. We all aim, through the non-prescription needle use consortium, to streamline the continuum of care for injection-drug users, regardless of where they live in the province.

There are challenges. Harm reduction is commonly misunderstood and can be misperceived as encouraging drug use. Community members may have strong values that see the use of substances and gambling as contrary to their beliefs. Often harm reduction strategies involve working with highly marginalized populations, some of which have been mentioned, the socially and economically disadvantaged, the homeless, and injection-drug users. Within Alberta we are challenged with providing methadone treatment and maintenance from a centralized location, rather than from multiple sites across the province.

Á (1130)

For individuals, to admit a problem is not easy, to seek help is even more difficult. People are often ambivalent and fearful about being judged by their own support groups, who continue to use, as well as by the community, who stigmatize them. Harm reduction offers an opportunity for inclusive and non-coercive involvement within that process of change.

Á (1135)

The Chair: Thank you, Ms. Lipsett.

Before I turn to Mr. Leblanc, why is the program only provided from one location?

Ms. Beth Lipsett: At this point in time, as Howard mentioned earlier, it's primarily a resource issue. Historically, it might have also had something to do with the communities within which we explored expansion. We are very active right now in looking at expansion into Calgary.

The Chair: How many of your clients from 1971 would still be with you?

Ms. Beth Lipsett: I'm not sure we have any currently from that period of time. There is a group of clients who will get to a certain point, a very low dosage, and stay there for many years, then come to a place where they feel they can give it up and move on, and do so successfully, but it may take them 10 years to get to that place.

The Chair: The 400 people across Alberta, are those the people who have been here at one point, gone through the program, and then moved off?

Ms. Beth Lipsett: A client will come from their home community, which is part of the issue: they need to move up here for stabilization. Depending on the individual and what they're using, that stabilization process can take as little as three days, more typically three months, and if they are poly-drug users, up to five months before stabilization occurs. Once it does, a link is made with a pharmacy, hopefully in their community, that agrees to dose them daily. So they move back into their home community and get dosed from their pharmacy.

The Chair: Then would they come back here for checkups with the doctor, or would they work with their own doctor?

Ms. Beth Lipsett: That is what we would aim for, having physicians in the province look at methadone maintenance as part of overall primary health care. Right now that is not the rule of thumb.

The Chair: Okay.

Mr. Leblanc.

Mr. Dominic LeBlanc: Thank you, Paddy.

Thank you for your interesting presentations. It's been a discovery for me and for some colleagues who aren't here today to see different parts of the country and some of the challenges you have. There are many similar problems, from Halifax to Edmonton to Vancouver, which is the most dramatic, perhaps, because there's a great deal of media attention. It's been a learning process, and your presentations this morning have been very informative. I thank you.

I wanted to look at two questions. One involves the role of the federal government as you would see it. Before we address that, this is just a sense I have, and it's based on a great deal of ignorance, no doubt, and anecdotal media reports. I found it interesting, as you talked about the profile of your clients, that more than half of them are aboriginal and more than half of them are male. The age group, as Paddy noted, was higher than I might have expected. I'm wondering if you can tell us more about the types of clients, whether it's at the co-op or in some of the work you're doing, Marliss, or at HIV Edmonton. I think there's a misconception about the kinds of people who end up in injection-drug addiction. There's a knee-jerk reaction from a lot of people: that's not in my community, I don't know those people, I've never met somebody who has that problem. It's an easy way for people to close their eyes or look the other way.

I appreciate the confidentiality of your clients, but I'm curious to know if you have anecdotal evidence of who these people are. I'm curious about how the van works. You go out at night with a van. What do you have in the van? How do people come up to the van? Where does the van go? I'm curious about the mechanics of how this works, the outreach stuff. It's not a world I've been exposed to a lot, but I think a lot of the ignorance with people like me and others is that we don't know who these people are, the kinds of people, the factors that lead to their substance abuse. Everybody has his or her story, and I'm learning about a lot of the social and economic factors that lead people to these types of addiction and into a world that often includes crime and so on. You know better than anybody. Tell me a bit about the kinds of people who end up as your clients.

Á (1140)

Ms. Marliss Taylor: I've been a nurse for a number of years, and this is the most fun I've had and the most challenging work I've ever done. I love it. The group we work with is fascinating. Unfortunately, I think most media focus on the negative. We tend to focus on the strengths of the people we work with, because they are absolutely incredible folks and have skills I will never have in my lifetime. We're very lucky in that everyone on our team, except one, has had some sort of drug use history, some much more involved than others. We also look for a certain personality type in who we hire, which is interesting. If we want to go down to the York Hotel, for example, and sit in the bar and do immunizations with a nurse and an outreach worker, it's great, because sometimes they already know, sometimes it's their family that's sitting in there.

With the outreach piece, a lot of it is word of mouth and trust. Harm reduction makes it so that people don't have to lie to us. I think that's absolutely crucial. So you do drugs, what else is going on with you? That's what we can say, and start working with those other issues. Often drugs are not the biggest issue in these folks' lives. That's what gets you through the day. The problem is that your kids were taken away and you don't have a place and your old man is beating you up and on and on. So outreach and nurses work together and understand that, and I think that's critical. The trust piece, through harm reduction, is absolutely paramount. We can't work without that.

We did a study a couple of years ago and found that most of our clientele who started to inject, more than 50%, started before the age of 19. The most common ages they said were 12 and 15. Our youngest was 9.

Mr. Dominic LeBlanc: This is injection-drug use?

Ms. Marliss Taylor: Yes, first injection. A lot of times they were with someone older, a sibling, for example: come on, let's go to the bedroom and do this. But when you really look at it...

I'll just take a typical individual I can think of right now. She's a young woman of 22, of aboriginal descent. Her mother injected, her father injected. When she was eight, her mom sent her out onto the streets to buy her drugs for her. The dealers wouldn't sell to her. Actually, there was a code at that time and they thought that was too young too. Her stepfather was her first sexual encounter--often both her and her sisters. Her mom turned her out to work the streets when she was 12. She got hooked up with this guy. He was pretty nasty--he chased me down the street one day. But anyway, he was very violent, so she never knew anything any different from hitting. She said to me one time, how many times do you get hit? It was a question I had to answer fairly carefully. She now has just had her first child, which is interesting; she's 22. We were there for the delivery and have been supporting her through, trying to get on with child welfare, but that child will likely be taken. She had been taken from her family at one point. Her child will be taken at some point. So we're looking at intergenerational issues.

Most of our clients are in their thirties when they come to us. But remember that cocaine in itself brings about a paranoia, so you're paranoid anyway. You're 12 years old and you don't want anyone to know, so you hide, hide, hide. Unfortunately, I think that's the most dangerous time for transmitting diseases, for example. Pharmacists won't sell you drugs and you're scared to go to this guy, even though you heard it's okay. As people get more secure in their own drug use and settle down and have been there, done that, they're more likely to start coming to us over time.

The van goes around. It has a number of supplies, health supplies, medical supplies, harm reduction supplies. We often have a nurse or a physician--not every night, but most nights--out there, so we can do, for example, prenatal checks. We let moms hear their baby's heart beat, which is always a wonderful moment. We have a cell phone so people can call us. We have a sort of route, and we stay in a couple of spots for half an hour at a time.

We know a lot of these folks by name. A lot of them are doing exchanges for many people, maybe up to 20. It might be one person coming from a drug house. If I have a connection in a drug house, I'm always a bit saddened when the drug house gets busted, because that's my connection with those people. We've called those folks natural helpers. They're the people who take care of the people in the drug houses. If the place gets busted, everyone scatters, we lose them again. There's a part of that, and I have concerns about drugs laws myself.

I'll pass it over to others.

Á (1145)

Ms. Faye Dewar: The people who usually don't get diagnosed are the aboriginal people with mental illness, and they start self-medicating. They know they're different, even as a child. Maybe at seven or eight they are sad, there is some depression. They start drinking because their parents are drinking. The parents may pass out and there is a bottle of wine there, or because of the poverty on reserves and in the community, they may go to sniffing paint thinner, etc. Because there is not enough income for alcohol, they go to other substances. As they grow up, this addiction continues, because they feel good and it gets them out of their space of poverty, starvation, abuse--physical and sexual--and the stresses and peer pressures they have in school. Then they continue doing some self-medication.

The ones who are diagnosed are mostly Caucasians. The family is stable enough to get their child to a psychiatrist or a doctor, then they are given medication. It's the side effects, where they get the stiff neck or something. It's sort of a high when they have mental ill health, and if they self-medicate, it dulls their ability, because usually they have quite high IQs.

What else do I need to say? There are different varieties, and they usually end up on the streets or in the inner city, because they are safer there. People don't judge them. They have access to support and stuff they need, and this is the source where they get the drugs and so on.

The Chair: Ms. Lipsett.

Ms. Beth Lipsett: The only comment I really have is that the client Marliss describes is the same person who will come to us after they've felt a sense of safety, that maybe the system can be trusted. So there's a continuum of care that occurs within the city.

We're a formal organization and there's a lot more anxiety about walking through our front doors than there is about going to a van, but we still see the older client. We don't have an awful lot, especially in our methadone program, of youngsters. So I think it may be a mythical perception to think you're looking at the 20-something client, when you actually may be looking at the 30-something client. At least, we're experiencing that.

Ms. Deborah Foster: I would have to concur with what's been said already. Many of our clients have the mental health issues and have started using as adolescents, but it takes them quite a long time to get to our door. When we're talking especially about HIV, there's a whole period of denial people often go into, and they use, and they use really hard, and they use for a long time. Usually, it's not until they come out of that or they die that we hear about them. We hear they've passed away, or we see them because they've come out of that denial phase. The typical client Marliss describes is our client, but often we don't see them for another 5 to 10 years after they first approached the van. Sometimes it's that van connection. HIV Edmonton is one of the ride-alongs; it goes on the van with Streetworks. Often that's the place we make the connection with people for the first time. Or we might make the first connection with them in a correctional facility, and then the next time we see them, we see them while we're on the van. And then it's maybe after 5, 10, 15, 30 times that they actually get the nerve up to come to our building.

We've moved into a building where there are other services, such as Edmonton Housing and the welfare office, which we thought would be a real bonus in bringing people in. I think in some ways it's been a bit of a detriment, because that building connotes other things for people, and they're afraid to come through the door. Since we're the only thing on the sixth floor, if anyone hits six, there's an automatic, oh, you're going to HIV Edmonton. I think that keeps some of the younger people away. It's that macho image of not wanting their friends to know.

Á (1150)

The Chair: Ms. Gunn.

Ms. Kate Gunn: I'd just like to say one thing. When I first came to HIV Edmonton a few months ago, I attended one of our three-day courses called “The Dynamics of HIV”. It's a course we offer, for anyone who's interested, a number of times each year. It's a three-day program where we look at HIV, harm reduction, treatment, options. We look at things like hepatitis C and other related issues.

One part of the three-day program involves always having a few people coming in, as part of a panel, to talk from their own experience about having HIV and having that diagnosis, living with the disease, and what it means to them. In many cases a big part of their story is how they acquired HIV, their early history, and their life. It was certainly a real eye-opener for me to hear several of them say, really, the diagnosis of HIV, as Marliss was saying with regard to injection-drug use too, is just one of many issues they are dealing with in their lives, as they tell stories of abuse and poverty and homelessness. The diagnosis of HIV, which many people, not knowing that kind of scenario, might think would be the most severe blow to them, is really just one of many. Then they're dealing with other more current issues in their life, like where they're going to sleep that night, or their family, or where they're going to get some food, and that kind of thing.

Mr. Dominic LeBlanc: Thank you very much.

The other issue I would be interested to hear your views on--we touched on it a bit yesterday-concerns the federal-provincial dynamic in these health care issues. This province and the Government of Canada haven't always been on the same page. It's perhaps the luxury of being a rich province. In my province of New Brunswick, if the Government of Canada offers you money, you don't often say no. But the federal-provincial dynamic is complicated, and you're at the front line of trying to deal with some of these health issues. What do you think, from your experience, the national government could do to support your work, other than just give you money? Many provinces will say, you give us the money, and then we'll give the groups the money. I don't know the specifics of this province, but in Quebec and other places that's the automatic reaction. What specific things would you like to see the national government do to support the work you're doing in a tangible way, a real way?

Ms. Marliss Taylor: I've actually been quite delighted with the efforts of the federal government in the last little while. The federal-provincial-territorial committees have met on injection-drug use and have decided to be bold and creative. Our program is delighted with that. Certainly, they are looking at different ways of managing drug use. The idea of safe injection rooms, for example, has come up and is being talked about seriously. I think that's fabulous.

I think harm reduction allows you to look at things differently. I don't care what anyone says, there are not enough jail cells and there are not enough treatment beds anywhere, so we have to be creative, because there's no other option, I don't think, other than to keep hiding in back alleys, basements, and bathrooms, and that's not providing any sort of real help. So I think to keep to the course and to keep looking at ways to be creative is incredibly important.

Our clients are not dying of their drug use. We have people who have been using for 40 years, 50 years. It's not the drugs that kill them, it's the trauma of what you have to do to get drugs. It's overdose because you have an unstable shipment coming in. You don't know what's coming from Vancouver, how much it's been cut, or how pure it is, so you can overdose fairly quickly and easily.

I have never been able to make sense in my mind of why people chose a drug. If there's a fight going on downtown and I'm walking past it, I know a whole lot of the reason is that it's alcohol-based. It's not our heroin users, they don't have the energy. I don't know why drugs were chosen the way they were. Even so, we would not be for full-out legalization of everything by any means. I think a reasonable, thoughtful approach to it would make a whole lot more sense. I applaud the efforts of medical marijuana, but I think we need to look even further than that.

I think harm reduction being seen as simply a health initiative is also not the way to go. The issues we're talking about that affect the people we work with do not all fall under one department. This stovepiping splits people into parts, and in truth, you have to lie to most of those different departments along the way, whether it's provincial or some of the federal programs and stuff. I think, the more it can be all enmeshed and entwined.... I worked in the Northwest Territories at the time they changed it territorially from the Department of Health to the Department of Health and Social Services, and I think that philosophical shift made a huge difference in the way people thought. You can't be healthy if you're isolated and poor, period.

So I would like to see a lot more crossover, a lot more departments understanding that they have a role in all substance use. My personal area is concerned with injection-drug use, but Justice has a role, and Housing has a role, and Health has a role. Everyone does have a piece of this pie. No one can point fingers at anyone in particular.

Á (1155)

Mr. Dominic LeBlanc: Marliss, what about the federal initiative in homelessness, for example? We were told in Vancouver by the Portland Hotel Society that it has made a big difference in some cases that the federal government is engaged in trying to help people who are homeless. Has that made a difference in this community?

Ms. Marliss Taylor: At this point Faye would probably have a better understanding of this. I know, though, that one of the other places that was chosen as a model was Urban Manor here in the city. What we still don't have is a place where people can inject safely. If they've been injecting for 40 years, it is really hard to say, no, you can't, to live here. So I would keep pushing the envelope.

I do think it has made a difference. We are in critical shape. We have a client who gets $402 a month in social assistance and pays $395 in rent because you can't get anything else. That's $7 to live on, and I don't think we're surprised that this person is doing crime. I don't know how else they'd survive. It's insanity right now in the housing market in Edmonton. If you want a sink in your room, your one room, it's $300 to $350 a month. It was desperate. Things had to improve.

Ms. Faye Dewar: I belong to the Edmonton Joint Planning Committee on Housing and the Edmonton Aboriginal Committee on Homelessness, so I'm quite involved in the housing, and that's probably why Marliss mentioned me. I find that so far here in Edmonton the federal money is coming through, and we're really happy, but it's still not enough. The focus is on families and people who do not have addictions. They have a few places that are working--Urban Manor is one--but it's more for the alcoholic, it's not for the IV injectors, it's not for the sniffers or the solvent abusers, it's not for the more difficult clients. But as long as the doors are opening to some of the other places, the nicer places, the rooming houses may be more accessible to these people--but then the rents are still very high. There's not a subsidy happening here. Because of the money coming through, we aren't getting the subsidy too, so that makes the rents high. There's no standard of rent control, so there are some problems with that. Even though we are getting new buildings and so on, it's not quite enough.

With the federal government, the provincial, the local government, we need to have better bridging, better linkage. The funding goes to the Department of Justice, and they say, this is our funding and we do not connect with the Capital Region Housing Corporation or the Capital Health Authority or the Alberta Mental Health Board. So there's no bridging between them. One makes the decision, the other one makes the decision, but they don't make it together, because the funding is separate. We need more bridging between the two to help deal with the people, because the people's problems are not just black and white. They may have mental health problems, they may have justice problems, they may need to have welfare. These need to all be worked together to help that individual. When they don't work together, they end up falling through the cracks, and those are the ones we see in the streets having to use drugs and alcohol to deal with their everyday survival.

Â (1200)

The Chair: Ms. Lipsett.

Ms. Beth Lipsett: I'd like to describe a program we're attempting to get off the ground that I would love to see philosophically come from the federal government. Within Edmonton there is what we call the Eastwood project, which is representative of the Capital Health Authority, AADAC, Children's Services, Mental Health Services--I'm probably missing someone in there. We all have the same clients, and what we want to provide is a place where people can feel safe to address all their issues, and that's a huge thing to say. When AADAC looks at going into this facility, we're looking at providing our methadone program out of it.

How do you have a methadone client come in for stabilization and treatment when their Children's Services worker is talking to them about whether they should even have their kids at home? There are huge shifts in the way we, as professionals, think and integrate how we work, as well as how clients can feel sure that it's okay to come here, that everybody is on the same page, that our goals are all the same, we just come at it from different angles. So the object of coming together is to look at how we may come at it with a common focus, which is client-focused. I would really like to see more of that integration, and I think both Faye and Marliss talked about the need. We have lots of silos that all ask for different pots of money. We get this pot of money for this period of time, and then it disappears. What happens to the clients? What happens to the program?

I think there needs to be an ability to share that commitment. The problem is so complex. It didn't start with that first needle. So where do we begin? We begin right at the beginning, and we provide that service similarly, with a common philosophy, all the way through until the client says, you know what, I've got skills, I've got the capacity now to do this without your support. And that's what all of us want to see. We all want to see these clients go out there and not need our services any more. Doing us out of work is the goal of all of us. I don't think we will be successful in doing it if we aren't truly integrated in providing that service. And I would like to see that philosophical base and message come from a national perspective, so that it would be integrated all the way down to the local level.

The Chair: Thank you.

Ms. Foster.

Â (1205)

Ms. Deborah Foster: The federal aid strategy hasn't increased the supply of dollars for 10 years. Clearly, the number of clients has increased dramatically. In addition, 10 years ago it was the gay male we were dealing with. Now we have the gay men, but we also have the injection-drug users and the women who are partners of the injection-drug users or partners of the men who have sex with men. We're having to split the pie even further, and this makes it more difficult.

I spoke about the level we have of co-infection with hepatitis C. We are lucky to have some project money to deal with hepatitis C right now, but it will disappear. What happens to those clients then? Do we stop seeing those clients? I don't want to just focus on money, but the money is an issue for sure.

As well, within the aid strategy there is a general strategy; there's also a corrections strategy and an aboriginal strategy. The corrections strategy goes to Corrections Canada. Now well over 50% of our clients are in and out of jail. We can't have access to that pot of money, it goes directly to Corrections Canada. At the same time, Correctional Services Canada wants us in the correctional facility to be a bridge for the clients when they come out, in hope that they won't go back to the life they were in before, but Correctional Services clearly are not prepared to pay us their amount from the aid strategy to come and do the work.

The same is true of the aboriginal strategy, in that dollars come down, but they come down for the aboriginal organizations. You have to be an aboriginal organization to secure those dollars. In Alberta there's one provincial aboriginal organization, and when you think about it, it clearly can't have an individual client base if it's provincial. It's the other 15 aid service organizations in the province that aren't aboriginal that get the aboriginal clients, but again, we can't secure the dollars.

What about the individuals with Corrections Canada, what about aboriginals, what about hepatitis C, and how far can we split our people? We as an agency have gone from having an education department and a counselling department to organizing everything in portfolios. We have somebody taking care of corrections, someone taking care of addictions. We only have so many staff. As the new populations emerge, for example, in mental health, we don't have a staff for mental health.

That's one piece, and the other piece concerns housing. We too have been quite involved in the homelessness and housing issues in Edmonton. One of the many issues we handle with our clients is damage deposits. Landlords in the city require a damage deposit, and in order to move in, it's generally the cost of the first month's rent. Social services in the province doesn't give you money for a damage deposit, so what do you do? If you put your damage deposit down, you can't live in the place, because you don't have your first month's rent. HIV Edmonton has had a program off and on, again using project dollars, to provide damage deposits. That's a huge issue for individuals getting out of jail. Their drug dealer will meet them at the LRT stop and give them their first drugs for free, their pimp will drive them right back down on the street as well, but nobody's standing there handing them their damage deposit so they can change their life, and I think that's a huge issue.

Our inner city is being revitalized, richer people are moving in, and where is that pushing the clients who used to have that area to use? The cheaper housing places are disappearing.

Finally, when an individual's workers find out that the client is HIV-positive, quite often that's when we receive a phone call from the group home, the school, or wherever, saying, Joe Blow is now HIV-positive, could you please tell me where he can live now, where he can get his food, where his support group is, and the whole thing? It's as if the HIV diagnosis overrules everything else. This person's been an injection-drug user for years and has had mental health issues for years, but they get diagnosed with HIV, and then it's supposed to be HIV Edmonton or the HIV organizations providing housing for these individuals. We're not in the housing business, but landlords don't necessarily want to rent to people who are HIV positive, and it's a huge issue. How do they find out? Joe knows Steve, who knows someone else. Steve really wants the apartment and tells the landlord Joe has HIV. Steve gets the place. It's a real issue for our clients in finding adequate housing.

Â (1210)

The Chair: Ms. Gunn.

Ms. Kate Gunn: I think Deb touched on most of the points I wanted to mention, but I want to stress that it isn't only about money. In the field of HIV this past year an organization has been formed across the country to really try to work for increased federal funding for the federal AIDS strategy. It's something that's important. We really need increased operational, ongoing, and sustainable funding, as everyone has mentioned. It's not only in this particular area that it is a problem. Project funding is available for people, but it causes lots of problems when the project funding comes to an end. We're doing work we want to do and our clients need. It's really important. We want to continue it, but we know the money, at some point, is going to stop, while the expectations are still going to be there.

With HIV and AIDS, we still working on federal funding. I think, and have heard everyone say, the most successful work we do is work that is done together, like our non-prescription needle use consortium or any kind of project that involves a number of people. It's not to say they're always the most successful projects. They may be ones that are difficult to manage when you have lots of people, as it's much easier sometimes to do things on your own, but I think ongoing funding and support of the concept of working together, the bridging Faye was talking about, is really important. When we work with each other, it is really the direction I would hope the federal government would support. I think it's where we can really do our best work.

The Chair: Mr. Leblanc was asking about what the federal government could do to make things different. Clearly, an area where we have a huge role is in aboriginal health and education, yet it seems to be an area where there are some really difficult problems. There's a need to get far better outcomes than we currently have. Is there anything within the envelope that we need to do? Is there leadership within the aboriginal community you're dealing with that is helping to tackle some of the problems? Certainly, the whole residential school issue has damaged a significant number of the people who are supposed to be parenting. It has created a lot of issues with mental health and the need to self-medicate. I would think there are also some really amazing people who've managed to get to the other side and can provide some leadership and some of the healing needed.

We were at Poundmaker's Lodge last night. The few young people we met talked about spirituality stuff that was missing. This province has a significant force of aboriginal people. They talked about being treated as second-class citizens and not really feeling they were part of anything. Is there something going on in the whole area that would give some hope? Is there a need to do more at the federal level where we are funding things?

Ms. Marliss Taylor: From a needle exchange perspective, I would say harm reduction is a lot more along the lines of traditional aboriginal thinking than abstinence models are: kinder, gentler, and understanding people have many strengths. You're not garbage because of one piece of your life. It may or may not hold true, I don't know. It certainly would be one thing to think about.

Everyone in the needle exchange work around the province struggles with making good contacts in the aboriginal community. I feel I can speak for all of them, because I know them very well. Many street-involved people are of aboriginal descent. There is intergenerational poverty and there are intergenerational addictions. Some people don't want to go to a traditional framework, while others do. Places like Poundmaker's Lodge are nice to have.

I think there is an incredible lack of aboriginal people sitting in positions of power. Sometimes what happens in Alberta, and perhaps happens all over, is that someone says, we need an aboriginal perspective, so let's get one aboriginal person to sit at the table and they'll represent everybody. That shouldn't happen at all. We've been really lucky in our program to have lots of staff that are of aboriginal descent, so there's a lot of that give and take, there's not just one person who has one piece of the pie.

The Chair: Not all aboriginal people have to think the same way.

Ms. Marliss Taylor: Exactly. Deb is right, there is one provincial aboriginal group on drug use. I think it's an issue. Injection-drug use is something people are struggling with on reserves and in Métis communities, and they probably have a better handle on it than in the downtown core area, because it's something that's a little more able to be spoken about. But I am no expert in this.

Â (1215)

The Chair: A big chunk of the challenge seems to be mental health issues. It's not that aboriginal people are self-medicating, it's dealing with all these mental health issues. So is there some leadership in the aboriginal community on mental health as well, sort of preventing the problem?

Ms. Faye Dewar: I don't have the answer to this and I really don't want to speak for the whole of the aboriginal people, because that's not my role here. I think we need to start with the basics of dealing with the community and getting the community involved. If this is the reserve, then you must talk to all the people at the reserve and come up with a strategy. It's when we start from the top down that it doesn't work. If we start from the grassroots and go up, I think we have better success, because then they're buying in as being part of it, they're involved.

The Chair: Are there some examples to point to, though, in this province? You talked about the clearing house. Are there some best practices among aboriginal communities? Are there some success stories you know of? You don't have to speak for everybody, but is there a Joe Smith out there we need to contact?

Ms. Faye Dewar: A good example is the Edmonton Aboriginal Committee on Homelessness. I think they're all working people, but they are all trying to help the homeless people and they identify that they are working for those people.

Again, it's hard, because the aboriginal people are trying to survive their everyday living. Sometimes it's hard to be involved, because they have to find out where they're going to sleep, where they're going to get their food. They have to get in a lineup before such and such a time. So they have a whole bunch of criteria already to just live on the streets and survive. Being involved in a project etc. is sometimes very difficult for them.

The Chair: Does anyone else want to comment?

Ms. Beth Lipsett: We have a couple of things within our site here in Edmonton, at the clinic I am responsible for. One is Poundmaker's, which has a couple of staff who actually live with us in that office. When clients come through the front door, they have an option. They can choose to go and seek help through Poundmaker's, but I think that's another misperception, because there are aboriginal people who aren't interested in being treated through an aboriginal organization. Still, the option is present for them.

As well, in the fall we will be beginning a healing circle for women. We didn't go and seek that. We had a young aboriginal woman who had a strong desire to facilitate that process for some of the people. It was something she experienced within a program she went through with us. So we're saying, by all means. We have an amazing lack of service, I think, that's culturally appropriate.

On a broader spectrum, not from any internal knowledge, my overall perspective is that we talk about aboriginal spirituality quite glibly. As a society, I'm not sure we are serious. If we were serious, we would be integrating all our work with that component in place, particularly in a province like this, where so many of our clients are aboriginal. Generally, what we do is we speak to it. I heard what you've said about the young people out at Poundmaker's saying there is nothing, and they're absolutely right. For most formal organizations, it doesn't exist. No matter hard we try to integrate it, it becomes too formal for the need the individual may find. I think it becomes another piece of that continuum of care that runs an entire length. It isn't a silo unto itself, but how do we integrate it into the whole picture? I don't have the answer. I just think it needs to be there.

Â (1220)

Ms. Deborah Foster: I truly do think it's intergenerational, in that it's about the parenting classes and the prenatal classes and working with the new moms. It's the family where the breakdown happens, and that's why so many of our clients are aboriginal. They don't have that social support or that safety net. Studies will show that if there's one individual in a child's life they've learned resiliency from, often that's the child who does make it out of the dysfunction in which they've been raised. Focusing more on mentorship programs and ways to bring the mentorship to the family, as opposed to pulling the family apart, is one thought I have.

Ms. Beth Lipsett: Even with communities, I would think. I don't know how you would design that, but developing a program that would look at mentoring whole communities would be an amazing boon, I should think, to everybody involved, the mentors and the people receiving it.

Ms. Deborah Foster: I'm also not convinced that creating a parallel stream for aboriginal people really is the way to go. I do truly think it's a sense of integration and non-aboriginal organizations need to make an effort to have the aboriginal staff, to have the aboriginal programming, and to have the option, so that when the individual walks through the door, whether they be black, Asian, aboriginal, or white, they have the choice of who they want to see and how they want to get their services. I can think of too many examples where there are parallel systems, whether that be education or health or whatever. Having worked extensively in aboriginal communities, I know the level of care in the parallel system, as opposed to the mainstream system, often is not as good.

The Chair: It was distressing to hear these young people identify as at least part of their problem, to begin with, not feeling they had any worth. That's a systemic problem. If all of us have somehow communicated that message, all of us have to take responsibility in making some changes. It was sad.

Marliss.

Ms. Marliss Taylor: You've touched on exactly why some people in harm reduction would say that drugs play a useful role in a life. If you're a young aboriginal woman, 19 years old, your kids have been taken away, your old man is beating you up once in a while, and you have to go out and work because you don't have enough money from social assistance, you feel pretty powerless. I think, for those folks, cocaine does that. For a very short time you feel powerful, you feel confident, you feel important, you feel you're on top of it, because when you're not, you're not.

I think it's understanding that while it's not the way we would choose for people to cope, if that's all you've got, the changes need to happen with a very broad perspective. Our opiate users talk about it. When they do a hit, it is like love going through their veins. There are people who are chased by demons and haven't felt the fulfillment many of us are lucky enough to feel because we have homes and jobs and cars and dogs and kids and all the rest of it. I don't want to give the impression that only Edmonton's inner-city people are doing drugs, as they're doing drugs all over this place, believe me; it's just that we are focusing on this front here. We need to deal with the broader issues, to look at what role that drug plays in that person's life. I've told people, because they want to jump off a bridge, if that's your option, then use. If that's the only thing that's going to keep you from jumping into that river, then go and use drugs, because I don't want you to do that. I can't fix your problems, for today. Then we'll try to think of something tomorrow.

It's about looking at what drugs are fulfilling, and the problem is our society, I think. As there's a greater gap between rich and poor, particularly in this province, the people who are at the bottom of the economic feeding frenzy are at the greatest risk and are the most marginalized. It's about life, it's not about the drugs.

Â (1225)

The Chair: Are you looking at safe injection sites as part of the pilot?

Ms. Deborah Foster: We kind of got pulled into it. Originally, they mentioned that Vancouver, Toronto, and Montreal would be the sites, so we never entertained the idea in this city, we didn't think about it. Then our chief of police said publicly last summer, yes, it's doable, which caught us all off guard, and I was delighted to hear it. We have a pretty good relationship with the upper echelon at Edmonton Police Service. Then our mayor went to a municipalities meeting and signed on, and we were all again taken aback and startled. The next thing I knew, I was invited to Ottawa to this meeting of municipalities, and they asked us when we're going to start this thing. We are very lucky on injection-drug use. We have this group of many agencies, including Edmonton Police Service, HIV Edmonton, AADAC, Capital Health, Boyle Street Co-Op, Boyle McCauley Health Centre, Catholic Social Services, Northern Alberta HIV Clinic. This group is in the best position, I think, to look at it and evaluate it. I think it needs to be a group effort.

So we're just dipping our toes in that ocean now. It's not because we don't want to, the worry is that you set something up, and again it goes. If the funding goes in a couple of years, what's going to happen to those folks? You haven't done them a lot of favours. That gets me upset all the time.

The Chair: Is there talk about a drug court? Several of you mentioned the lack of coordination, and when we visited the drug court in Toronto, you saw, maybe not for all the right reasons, people integrating the services, because you had to find accommodation, you had to find a job, you had to get welfare on-side, everybody had to work together, and the physicians were involved. It was perhaps a different way to drive everyone into the same room to work together, but the drug court seemed to work.

Ms. Faye Dewar: Marliss and I both sit on that committee. One of the problems we see is that they have to do it, there's no choice. The individual either has to go to jail or take treatment. It's sort of a forced program. As a community member and as a person who thinks communities should be involved, I believe they should have some choices in picking some of these things, so I have some issues with this. That's why I'm on that committee. I want to make some changes so that it's not forced, because forced treatment, most of the time, doesn't work.

The Chair: Are you trying to set one up for Edmonton?

Ms. Marliss Taylor: Yes, we started that process at the very end of last year. Vancouver had just started theirs. Interestingly enough, we've had warnings from Vancouver that have said, be very careful. Some of the folks are not happy with the way it's worked out there, which I find very interesting.

The Chair: You should talk to the guys in Toronto, because they have actually implemented it now for a while. They're feeling pretty good about getting services to people and about outcomes. We actually had one person who had got into a little trouble and said to the judge, you know, judge, I'd go the other way, and I'd be finished with the program by now. It's a lot harder to stay in here and work through these issues. I'm still here. A number of us approached it with concern, but we were extremely impressed with how they cooperated.

Â (1230)

Ms. Marliss Taylor: I think it depends who the target group is. In Edmonton this drug court has decided to target people of aboriginal descent. So we are picking the most marginalized groups, with the most issues, poverty, discrimination, and the most strikes against them. There are very few safety nets for people. So I'm not sure. We'll see. Instead, I would almost have picked a group that is a little less vulnerable, so if it doesn't go, who is going to be blamed, who is the finger going to be pointed at?

The Chair: Finally, is there much work done in harm reduction with doctors and dentists in this province? For a lot of people who use OTC or prescription drugs, different provinces have different systems in place. It's been a bit shocking to see what systems aren't in place in certain provinces. Is there much work done on bringing doctors, dentists, and pharmacists into the fold?

Ms. Marliss Taylor: This is probably more Beth's area of expertise. As Beth and AADAC are very aware, one of the difficulties was a four to five month wait for methadone. Some people are ready to get their drug use under control, but can't get into the program. So we have a number of physicians who are bridging. They are on very thin ice. The medical association here and the college have been working with us and them in helping with the triplicate program, so they don't lose their licences. But it's a very difficult position for them to be in. I don't blame them for being very concerned about doing this. They are trying to keep their patients safer and healthier, and in some cases, I think they're risking their licences.

With the NPNU youth project, the needle exchange program just did a series of talks around the province on what harm reduction is. It was called “The Essentials of Harm Reduction”. We in-serviced 280 practising pharmacists. It was an accredited program, which was great. We go into the faculty of pharmacy on a routine basis. We take medical, nursing, social work, and pharmacy students in our programs. I'm seeing a real shift, as young people are getting it, for lack of a better term, they are understanding that there are different ways to practise.

We from the old school, nurses and physicians of my age and others, really struggle here. I think it is an easier way to work when you can have someone come in front of you, give you the list of what you're doing wrong, tell you what you need to do, and send you off. If they don't do it, then there's obviously something wrong with them, they are flawed. Physicians are now understanding that harm reduction is being honest, not having to lie, not putting out a list of all the things you're doing wrong. It's looking at what are you doing right. I think these changes in attitudes are coming. Through retirement and attrition, we'll get there.

Ms. Faye Dewar: As a mental health outreach worker, it has been very difficult for me dealing with the medical area, because it separates the two into mental health and addiction. If the client has addiction problems, they aren't touchable by mental health, because the doctors will not treat a person who is addicted. So there has been some lack of connection between the two and in trying to deal with the two.

There are some good programs. There is a good program out of Ponoka that deals with schizophrenia or mental health and addictions. But the person has to volunteer. There are only 18 beds in the program, and there is a long waiting list.

I'm not sure how AADAC deals with some of the situations, but I find that my clients who have mental health are not being treated in the addiction and treatments centres because of their mental health. There have been some connections, but if they go to Henwood or Poundmaker's, they can't take medication for their mental health, because they're dealing with addictions. There have been some problems in the two areas. For the street people who are doing solvents and stuff, there is nothing being done, though.

I think FAS and FAE people are going to be a big problem. I'm not sure how we're doing to do that, because they don't have the cognizant stuff to deal with the end results and those sorts of things. It's here and now and tomorrow, so they get taken in by the shiny lights and don't realize what may happen to them. There are some issues with that, and there needs to be a lot more investment in these people.

Â (1235)

Ms. Beth Lipsett: I chair the addictions task group as part of the NPNU. One of our focuses is looking at physician education, which is sorely lacking. Right now any physician who is interested in, for example, looking at methadone needs to go through an education course and needs to make a very conscious decision, because of the infrastructure that's required to see this population. There are very few province-wide and very few within Edmonton itself. That's one piece of work that's just really beginning from that perspective, one that will probably link closely with the work that is happening with the task group Marliss is sitting on.

The pharmacists we're linked with across the province are very well informed about harm reduction and methadone maintenance. It's a narrow perspective, it's not a broad perspective.

Beyond that, within the Edmonton site we're very lucky. For about 10 years we've had two psychiatrists who come to the clinic three times a week to see AADAC clients. Concurrent disorder is actually being addressed, or there's a capacity for them to address it, right on site in conjunction with the addictions counsellor. In addition, we organize two groups jointly with Alberta Mental Health Services. A group of AADAC clients who have mental health issues meet weekly with an addictions counsellor and a mental health worker, and weekly at Alberta Mental Health Services clients who have been identified as primarily having mental health issues, but have addictions issues are seen by the same two staff people. It's not comprehensive, but there are a few things that exist within our environment.

The Chair: Do you at AADAC help educate physicians? Frankly, we've heard in some places that they are the problem. They're giving prescriptions for 90 Dilaudids to people who are drug addicts.

Ms. Beth Lipsett: If we're aware of it, we will make contact, but we're not often made aware. The client is not going to tell us.

The Chair: No, but in one case we met a very young kid in a methadone maintenance program. He had been in hospital and received pain killers, but they didn't realize these were creating a problem for him. He dropped out of the hospital on a Saturday night, and he has a nasty little addiction because nobody had said, you're liking these painkillers a little too much, maybe they are not just managing your pain.

Ms. Beth Lipsett: I think it starts right with medical education. Addiction is not a big deal in medical school. There isn't extensive education in that area. Personally, I don't understand how physicians can get through school when they are prone to delivering these products to people without having that understanding. It's definitely a gap within the medical program.

Â (1240)

The Chair: You have two medical schools here.

Ms. Beth Lipsett: We have the University of Alberta and--

The Chair: Does Calgary have one?

Ms. Beth Lipsett: Yes.

The Chair: But is there a program, as far as you're aware, for implementing your education?

Ms. Beth Lipsett: There's a course, but it's thin. We go and talk to nursing students, medical students, but it's two hours in a course of how many years? It's nothing. It's a huge problem.

Ms. Deborah Foster: HIV Edmonton's involvement, for the most part, has been taking students, much as Marliss has described, pharmacy students, nursing students. We have not had a program aimed at those already in the field.

The one other piece I'd like to mention is related to the story of the guy with the Dilaudid. What we find with many of our individuals is that they don't seek out medical help because they're given a prescription that should really treat them well, but they're street-involved drug addicts, so it doesn't even touch their pain. I think we need to do education in that area as well and make it safe for our injection-drug users and other drug users to fess up to their physicians and pharmacists and say, look, this is how much I'm using just to get by and to keep the voices down, so for my toothache you have to give me that much more.

The Chair: Yes, they were describing some of the amounts in one of the centres. Of course, it would have killed most of us around the table to have even half of what they were getting. It was a bit frightening.

Ms. Gunn.

Ms. Kate Gunn: I'd like to mention a couple of things in regard to working with pharmacists, for example. I believe we have the pharmacists' association on the NPNU, and we hope the documentary film we're working on will get broad distribution and be used with students, be used in classrooms. Deborah and Beth were saying we go out to talk to students, but you can't get to all of them, and maybe it's not in the depth one would like.

At HIV Edmonton we are also fortunate to often have placements of students who come to work with us on a one-to-one basis, maybe for six months or for three months, social work students. I'm not sure if we've had medical students. It's a wonderful opportunity for young people who are going into a field like social work to actually live day to day for six months and experience the kinds of issues we're dealing with. That kind of thing is certainly good.

We work very closely with physicians on a one-to-one basis in the northern Alberta clinic and various HIV clinics that are here. In fact, we've had people on our board of directors who are working in that field. So we have good one-to-one relationships, but as to an overall initiative, I think there's a lot of work to do in that area.

The Chair: Thank you all very much for the time you put into your presentations and coming here today. Also, thank you very much for the work you do each and every day, your passion and desire to make some really great changes. And your optimism was refreshing too. I don't know how you do it some days. We really appreciate your input, and if there are things you think about in the next couple of months that you want to let us know about, or if you have that silver bullet, we'd be happy to hear about it. Again, we really appreciate your time.

I'll suspend until 1.00 p.m.