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UNREVISED (Note: These are the unrevised transcripts of the hearings in floor language (language spoken) ONLY. The final text will be available on the Parliamentary Internet site once editing and translation are completed.) -->18April96-Legal-32030-DM THE STANDING SENATE COMMITTEE ON CONSTITUTIONAL AND LEGAL AFFAIRS Upon resuming at 2:00 p.m. The Chairman: Senators, we start this afternoon with two very interesting witnesses from the City of Toronto: Wade Hillier, who is the co-ordinator of the Mayor's Task Force on Drugs, and Dayle Mosely, Assistant to the Executive Director of the Downtown/Eastside Residents Association from Vancouver. If we could begin perhaps with you, Mr. Hillier, and you could talk to us about this bill from the perspective of the City of Toronto, then we will hear a little bit about it from the perspective of the City of Vancouver. Mr. Wade Hillier, Co-ordinator, Mayor's Task Force on Drugs: Thank you very much. I bring apologies from the Mayor of Toronto that she was unable to make it today. She is particularly interested in this issue. I coordinate her Task Force on Drugs. She spoke yesterday at an international cities exchange with the City of Frankfurt in Toronto on the issue of substance abuse in the City of Toronto and backs my remarks 100 per cent hear today. I do not think I am hear today to speak to you about the intricacies of this bill. I am sure others have come before you and spoken about the details of the bill. I am certainly not in a position to discuss scheduling of drugs, but I do hope to bring to you a practical perspective on this issue from a city. Toronto is Canada's largest city, and because of that it enjoys the privileges of a world-class city. It also has to deal with world-class problems. Substance abuse and the problems created by it for neighbourhoods, police, and individuals is one of those major problems. Over the past few years, we have seen local neighbourhoods in Toronto become plagued by open drug dealing and the criminal activity that goes along with this trade. Individuals feel under siege in their own communities and fear for their safety and that of their children. The response to these fears has taken many forms, from resident group protests to community groups applying for grants to police crackdowns. The result is often that the issue disappears or moves to another street. We have seen over the past few years the efforts to move drug dealers out of neighbourhoods results in the trade moving street by street as people are pushed out from one street to the next. Why am I telling you this, you might ask, and what does this have to do with Bill C-8? I am telling you this because I think today we are at a crossroads where we are probably able to make some changes to these situations. In order to do this, though, we need a multi-faceted approach that includes law enforcement, education, prevention, and harm reduction. Bill C-8 is an opportunity for you to initiate a balanced approach to dealing with drug use in this country. We have for too long focused our efforts solely on criminalizing and the incarceration of drug dealers and on the American approach of interdiction and a war on drugs. Canada has its own drug strategy, which states that it sees the value of harm reduction and prevention as key to making long-term gains in reducing substance abuse. It does not appear that Bill C-8 reflects that strategy. The bill appears to rely heavily on continued prohibition and increasing legal sanctions on users. This approach does not acknowledge that a "war on drugs" approach has failed. It is no longer acceptable to just approach the drug use issue as a legal one. In cities such as Toronto, we experience all forms of substance abuse, and we now see that we must also be willing to work with all those involved in the issue of substance abuse, including drug users. We can no longer relegate them to prisons, as we can no longer afford imprisonment as the only option. This is no longer a fiscally responsibility approach. Too many Canadians are tied up in the legal system on minor drug offences costing the Canadian public millions when we could all be better served by taking an approach that sees drug use as public health and social policy issue. We at the city of Toronto have begun to broaden our perspective. Recently, at the City of Toronto Board of Health, a paper was brought forward entitled Innovative Strategies in Substance Abuse Prevention and Treatment. I should like to highlight for you a few examples of what has been tried in other major cities in other countries that have come to acknowledge that traditional approaches to substance abuse are not working. It is at the city level where drug use is felt most, and it is also where drug policy and legislation has its biggest impact. We deal with it in neighbourhoods and communities. 18April96-Legal-32030-DM THE STANDING SENATE COMMITTEE ON CONSTITUTIONAL AND LEGAL AFFAIRS Upon resuming at 2:00 p.m. The Chairman: Senators, we start this afternoon with two very interesting witnesses from the City of Toronto: Wade Hillier, who is the co-ordinator of the Mayor's Task Force on Drugs, and Dayle Mosely, Assistant to the Executive Director of the Downtown/Eastside Residents Association from Vancouver. If we could begin perhaps with you, Mr. Hillier, and you could talk to us about this bill from the perspective of the City of Toronto, then we will hear a little bit about it from the perspective of the City of Vancouver. Mr. Wade Hillier, Co-ordinator, Mayor's Task Force on Drugs: Thank you very much. I bring apologies from the Mayor of Toronto that she was unable to make it today. She is particularly interested in this issue. I coordinate her Task Force on Drugs. She spoke yesterday at an international cities exchange with the City of Frankfurt in Toronto on the issue of substance abuse in the City of Toronto and backs my remarks 100 per cent hear today. I do not think I am hear today to speak to you about the intricacies of this bill. I am sure others have come before you and spoken about the details of the bill. I am certainly not in a position to discuss scheduling of drugs, but I do hope to bring to you a practical perspective on this issue from a city. Toronto is Canada's largest city, and because of that it enjoys the privileges of a world-class city. It also has to deal with world-class problems. Substance abuse and the problems created by it for neighbourhoods, police, and individuals is one of those major problems. Over the past few years, we have seen local neighbourhoods in Toronto become plagued by open drug dealing and the criminal activity that goes along with this trade. Individuals feel under siege in their own communities and fear for their safety and that of their children. The response to these fears has taken many forms, from resident group protests to community groups applying for grants to police crackdowns. The result is often that the issue disappears or moves to another street. We have seen over the past few years the efforts to move drug dealers out of neighbourhoods results in the trade moving street by street as people are pushed out from one street to the next. Why am I telling you this, you might ask, and what does this have to do with Bill C-8? I am telling you this because I think today we are at a crossroads where we are probably able to make some changes to these situations. In order to do this, though, we need a multi-faceted approach that includes law enforcement, education, prevention, and harm reduction. Bill C-8 is an opportunity for you to initiate a balanced approach to dealing with drug use in this country. We have for too long focused our efforts solely on criminalizing and the incarceration of drug dealers and on the American approach of interdiction and a war on drugs. Canada has its own drug strategy, which states that it sees the value of harm reduction and prevention as key to making long-term gains in reducing substance abuse. It does not appear that Bill C-8 reflects that strategy. The bill appears to rely heavily on continued prohibition and increasing legal sanctions on users. This approach does not acknowledge that a "war on drugs" approach has failed. It is no longer acceptable to just approach the drug use issue as a legal one. In cities such as Toronto, we experience all forms of substance abuse, and we now see that we must also be willing to work with all those involved in the issue of substance abuse, including drug users. We can no longer relegate them to prisons, as we can no longer afford imprisonment as the only option. This is no longer a fiscally responsibility approach. Too many Canadians are tied up in the legal system on minor drug offences costing the Canadian public millions when we could all be better served by taking an approach that sees drug use as public health and social policy issue. We at the city of Toronto have begun to broaden our perspective. Recently, at the City of Toronto Board of Health, a paper was brought forward entitled Innovative Strategies in Substance Abuse Prevention and Treatment. I should like to highlight for you a few examples of what has been tried in other major cities in other countries that have come to acknowledge that traditional approaches to substance abuse are not working. It is at the city level where drug use is felt most, and it is also where drug policy and legislation has its biggest impact. We deal with it in neighbourhoods and communities. Needle exchange programs. These have played a major role in the prevention of HIV in major cities. Toronto and Vancouver were leaders in North America in developing these programs. While needle exchange programs rely heavily on syringe exchange, the provision of condoms, education and prevention are all important pieces as well. Perhaps the most controversial issue surrounding the concept of needle exchange is whether or not these services encourage drug use. Initial studies indicate that there is no evidence that needle exchange programs increase the amount of drug use by needle exchange clients or change the overall levels of drug use in communities. The cost effectiveness appears to be well documented in that the incidence, for example, in Toronto of HIV infection in the intravenous drug use population is approximately 7 per cent, compared to 30 to 50 per cent of infection rates in Chicago and New York. If we looked at the cost of treating AIDS patients at $119,000 U.S. versus the costs of a needle exchange programs such as at the City of Toronto at $450,000 a year, the cost benefits analysis is clear. Methadone programs. These programs used to suppress the symptoms of withdrawal from drugs. Methadone's long-lasting or long-acting affects allow a person to achieve improved social stability and functioning. Methadone maintenance is happening in many countries, including Canada. Numerous studies have shown that the use of methadone has seen significant reductions in the morbidity and mortality of users, as well as decreases in levels of both criminal involvement and the spread of HIV. Regulations have been very restrictive in this country and the availability of space limited. In the U.K., Europe and Australia, methadone is available from clinics as well as practitioners. In Amsterdam, Barcelona and Frankfurt, methadone is distributed by mobile vans. The provision of methadone allows people to be productive, functioning, and contributing members of society. (1410 follows - Prescribing of illicit drugs. Comprehensive approaches that include needle exchange programs) April 19, 1996\Legal\32030\lp ( Mr. Hillier: continuing.) With regard to prescribing illicit drugs, comprehensive approaches that include needle exchange programs, counselling, employment and housing, in conjunction with drug treatment, have been tried in places like Merseyside. They have also prescribed several types of drugs in an effort to meet the needs of some users for whom methadone does not work. The use of prescribing drugs is difficult to accept but appears to be working. For example, the Swiss government has undertaken a study to look at the prescription drug approach. It started in 1994 with 700 participants and expanded the program to 1000 participants in 1995 as the preliminary results of this study are very positive. With regard to law enforcement initiatives, the complexities on both sides of this issue remain officially unresolved. In fact, legalization of so-called hard drugs has not occurred anywhere in the world. The Merseyside experiment, however, has become an example of how all sides of the issue can work together. The Merseyside police have become national leaders in the activities aimed at improving the handling of drug problems. Their police and other officials act in partnership with the regional health authority in coordinating the prevention and treatment of drug-related problems. One of the key elements of this police support is the use of cautioning. Under this policy, an individual found using illicit drugs is taken to a police station where the drug is confiscated and the incident is recorded. The person is referred to support agencies. The intent of these policies is to avoid the prosecution and potential incarceration of drug users rather than dealing with the issue of drug use directly. In the Netherlands, while drug use has not been legalized, there are some legal distinction between drugs. Dealing or possessing small quantities of cannabis is decriminalized. Users are not in prison but rather are monitored and helped by a network of organizations which provide financial, social and medical assistance. Dutch officials counter that this approach helps in the elimination of the underground users. There is no hidden disenfranchised population of addicts because they are not the target of law enforcement agencies. Only big traffickers must hide. Moreover, the Dutch proudly point to national statistics which highlight extremely low levels of homicide and drug overdose deaths. Other cities such as Frankfurt have played a central role in the introduction of measures designed to reduce the harms implicit in drug use. These undertakings eventually led to the abolishment of national paraphernalia laws in 1992 which had restricted government-sponsored needle exchange programs. As well, changes in policies regarding substance abuse are occurring in several other countries including Spain, Italy, France, Switzerland and Australia. With regard to correction strategies, a number of programs offering substance abuse treatment as an alternative to prison operate internationally. The idea is more recently growing in popularity as a number of well-designed studies suggest that individuals coerced into treatment, usually under the threat of criminal sanctions, do just as well as those voluntarily entering treatment. The Delancy Street foundation in the United States is considered one of the most successful centres offering drug treatment alternatives to prisons. Currently about 1000 residents are housed in five facilities in the U.S. The average resident has been a seriously dependent drug user for ten years and has been in prison four times. About 30 per cent have been homeless. During their stay at Delancy House, which is generally about four years in duration, residents receive a high school equivalency degree as well as training in a number of marketable skills. Along with drug treatment, educational and vocational training, social and interpersonal skills are stressed. Another strategy for coping with growing case loads of drug-related offenders is the creation of drug courts. By selectively processing drug-related cases, these courts link defendants to community-based treatment programs in an effort to reduce drug use and drug-related harm. I have taken the time to review some of the above examples of innovation to help illustrate that we in Canada and elsewhere have been doing some very innovative things, and we should continue to do so. Other countries show us what is possible if we are willing to take some risks and explore other avenues for dealing with substance abuse. While Toronto has done some innovative work with things such as needle exchange programs and methadone, we have not taken further steps at this point to implement things such as those happening at Merseyside. Bill C-8 needs to provide opportunities to further some of the innovative things we are currently doing and to be able to explore new ideas. We need a piece of legislation that is able to deal with the hard enforcement issues of drug trafficking, but we also need to be able to work with users and provide them with the health and social supports as mentioned above without fear of prosecution and persecution. We at the city of Toronto have made the necessary link between substance abuse and health and social issues. The legislation in this country now needs to allow the flexibility to pursue innovative strategies, keeping in mind that any approach taken is a balanced one involving communities, law enforcement and users. I am glad to see that you at the Senate are taking the opportunity to hear from all of these stakeholders. I think we can all agree that criminalizing a user does not help in treatment, that public health-based alternatives are the way to go, that the high cost of current laws to individuals, community and society in general are too much, and that we need to look at other models. Thank you very much. The Chairman: Thank you very much, Mr. Hillier. Mr. Mosely, will you please make your presentation based on your experience in the City of Vancouver. Mr. Dayle Mosely, Assistant to the Executive Director, Downtown/Eastside Residents Association, Vancouver: I have been working in Canada's poorest community for eight years. The Residents Association is an association of the people who live in that community. We have probably the highest per capita drug use rate in Canada right now. In the last two years, I have been on the board of directors of the B.C. Coalition for Safer Communities. I am on the Interim Advisory Committee for the City of Vancouver on Safer City Initiatives. I have also been an advisor to the Attorney General on community-based policing. I sit on our local police community liaison. I am also on the steering committee of the Downtown/Eastside Strathcona Coalition which is made up of various people who are interested in the betterment of that community. I am deeply steeped in what is going on in that area of Vancouver, and in Vancouver in general. I heard Senator Carstairs interviewed on the radio. Her perception seemed to be that although there is a drug problem, and that for the people involved in it it is serious, it is not an overwhelming problem. That is really not true in the city of Vancouver. I cannot speak for other Canadian cities, but it is an enormous and pervasive problem in our city, especially in the neighbourhood in which I work. The harm caused by injection drug use has been increasing worldwide with the advent of HIV. B.C. has experienced an increase in the number of HIV positive injection drug users as well as an increase in the number of drug-related deaths. There was also a ten-fold increase in the number of cocaine-related charges in Vancouver between 1985 and 1991. The effects of this problem are nowhere more prevalent or more devastating than in the downtown east side. We who work and live in this neighbourhood are tired of attending funerals and memorials. We want the carnage to stop. I will give you a few statistics on the situation as well as some examples of what is going on. We have an estimated 750 HIV infections in the intravenous drug user (IDU) community, as well as hepatitis A, B and C, skin and blood infections, endocarditis, tuberculosis, et cetera. Tuberculosis is running rampant through the general population in the neighbourhood as well as the drug user community. Our current estimate of the cost of treatment for each of these people is about $150,000 per person per year, and this is increasing dramatically. In addition to the more than 300 deaths investigated by Vince Cain in his famous report, we had another recent shipment of concentrated heroin and watched as, once again, our community was decimated and friends and acquaintances disappeared off the streets. (Take 1420 follows) (We have fetal exposures to various...) MA Take 1410 Legal 32030 (Take 1410 -- Mosely continuing...friends and acquaintances disappeared off the streets.) We have fetal exposures to various substances with both short- and long-term consequences. It is estimated that 30 per cent of the babies born in the downtown eastside are so affected. We have increasing pressure on all community level outreach -- nursing, medical services, advocacy, programs and social services. Addiction is also sweeping through the mentally ill community as more and more are forced on to the streets by hospital downsizing and discrimination in housing. As an organization, DERA operates a 70-room rooming house for the mentally ill. I would say at least 70 per cent of them are also intravenous drug users as well as being HIV-positive. The mentally ill are just coming out in droves, getting involved in drugs and contracting HIV and dying. The combination of drug use and HIV is also sweeping through our aboriginal population who make up 25 to 30 per cent of the community. Not since the early nineteenth century have we seen such devastation of the native population by disease. Young native kids, as well as some non-natives, are turning up on our streets. The products of various types of abuse and neglect, they are quickly exposed to drugs, develop addictions and are forced to choose between selling their bodies or stealing to maintain their habits. In 1995, the Vancouver Police Department identified more than 450 children under the age of 16 working the streets of the downtown eastside. The majority of them are drug users. We have also had more than 40 violent deaths of women who work the streets in the last 10 years. Current estimates are that we have as many as 15,000 intravenous drug users in Vancouver. Nobody knows the exact figure. The numbers are climbing. The needle exchange last year exchanged 1,800,000 needles in the city of Vancouver. That is the equivalent of the entire exchange in the United States. We did that amount just in the City of Vancouver. The Vancouver Police Department has basically given up. There is really nothing they can do about the situation. If their entire manpower were put on this problem, there is no way that they could catch up with what is going on. We as a community have not sat idly by and watched passively as this devastation unfolds. We formed the Downtown Eastside Strathcona Coalition which brought together community agencies, government representatives, bureaucrats from three levels of government, the police department and interested residents to try to find solutions to the problems of the neighbourhood. The coalition also included intravenous drug users. We developed an alcohol and drug working group which evolved into an advisory committee to the provincial alcohol and drug programs and later into the Vancouver Eastside Alcohol and Drug Association. In addition, various combinations of residents, government and health care professionals are involved in -- here is a short list -- the maternity care for substance-abusing women and children program; the multiple access model and in-patient working groups; the multi-diagnosis working group; the detox working group; the Safe Ride program; the Vancouver HIV-AIDS strategic plan; the decriminalization discussion group; the task force on the Coroner's recommendations; the needle exchange working group; the Point project; the intravenous drug-user working group with St. Paul's Hospital. The list just goes on and on. I had personally been involved in four or five of these groups. I reached burn-out last year and found somebody else to take over because I could not take it any more; there was just so much going on in this area. The entire community is focused on this problem because it permeates the entire community and it permeates the rest of the city because this problem is not isolated to our community. This is causing break-and-enters all through Vancouver and multiple other problems. Besides this group participation, a vast number of studies and reports have been produced on various aspects of this situation. In preparing to come today to appear before you, I spoke with many different people in the community. I explained what was being proposed by the federal government with Bill C-8, at least as well as I could understand from reading the material. Many of us are very worried. We worry over the implications for the needle exchange programs and any other such services which we might want to put in place. We are worried about the future ability to develop and implement drug replacement or provision programs on which we have been working with the medical profession, with government representatives, with community people and with drug users themselves. We are in essence working towards the Merseyside model that my colleague here was mentioning before. We worry that this bill will ensure the maintenance of the horrendous status quo. This bill is not going anywhere new. It is just entrenching what already exists. We fear that, if this bill is passed, no matter how it is amended, that no one will look at this problem again for 20 years. We need some really creative solutions right now. We need to the room to move in whatever direction we can to keep people from dying from this plague which is sweeping our community. Let me tell you about the irony of this situation. DERA opened up a neighbourhood safety office where we are working on all kinds of programs to increase the safety levels in our community. The Vancouver Police Department constable who is assigned to work with us full time has told me that he was informed by Crown counsel last week, as was the entire department, that they would no longer accept charges for simple possession of any drug in the city of Vancouver. Basically they do not have the time to prosecute these cases anymore. This is just nuts. We are putting into place a law which increases penalties for some of these drugs when the system cannot even get to the charges. The problem is that both the current and the proposed legislation are themselves part of the problem. Women in our community will not access alcohol and drug services because what they are doing is illegal and they fear having their children apprehended. We would like to set up safe shooting sites similar to the ones in Europe to minimize harm to users and to involve medical staff. We would like to try pilot projects with the medically-supervised provision of heroin and cocaine to registered addicts. This is one point I want to make. Easier access to methadone will not solve all the problems. First of all, a number of the heroin users for whom the program was designed will not get involved in it. Second, our biggest problem with serial conversion for HIV is with the cocaine-using population. There is nothing in this legislation or in the current health care system which will take care of that problem. People are dying from this. It almost seems like the problems are out-stripping our ability to come up with solutions. It is just not right to encase another law which may possibly hinder us in solving these problems. This bill says an awful lot about what people cannot do. We need to start from scratch. We need to consult and draft a made-in-Canada drug policy. Then we can draft legislation which makes sense. Some of the worry seems to stem from the fear of being ahead of public opinion. In Vancouver, the harm reduction approach is supported by just about anybody I have ever run into including health care professionals, the schools, parents, police, social service workers, lawyers, community agencies. I cannot think of anyone, other than a few people out in the valley who go to church a lot, who are not really worried about doing something to help people from dying from drugs. The perception of great resistance in Canada is probably false. I was reading some of the transcripts from the Addiction Research Foundation witnesses. They said that we need a large education process. We have been doing that in Vancouver. We do not push our drug users from neighbourhood to neighbourhood in that city. We are trying to deal with what is happening within our own neighbourhood. We have undertaken that educational process and gone beyond that. I do not see that problem in Vancouver. Maybe there are other parts of Canada which have not experienced the same problems and have not bothered to look into the situation and who still need that education. Laws are being drafted for the general population in Canada. The people at the very low end of the stick lose out because they are a special-case scenario. Perhaps Vancouver is different from the rest of Canada; I do not know. I am worried that this law will make it harder for us to do our jobs. Thank you. Senator Gigantès: Both of you listed a whole number of things which could be part of a better solution. Both of you said that this bill, like the existing legislation, would only make your jobs harder. Mr. Mosely said that, in Vancouver, the police will not even bother any more because they just cannot cope. (Take 1430 begins--Mosely: They will not and neither will Crown counsel.Gigantès:Let me hypothesize...) df\96\04\18 Legal #32030

UNREVISED

(Note: These are the unrevised transcripts of the hearings in floor language (language spoken) ONLY. The final text will be available on the Parliamentary Internet site once editing and translation are completed.)

-->18April96-Legal-32030-DM

THE STANDING SENATE COMMITTEE ON CONSTITUTIONAL AND LEGAL AFFAIRS

Upon resuming at 2:00 p.m.

The Chairman: Senators, we start this afternoon with two very interesting witnesses from the City of Toronto: Wade Hillier, who is the co-ordinator of the Mayor's Task Force on Drugs, and Dayle Mosely, Assistant to the Executive Director of the Downtown/Eastside Residents Association from Vancouver.

If we could begin perhaps with you, Mr. Hillier, and you could talk to us about this bill from the perspective of the City of Toronto, then we will hear a little bit about it from the perspective of the City of Vancouver.

Mr. Wade Hillier, Co-ordinator, Mayor's Task Force on Drugs: Thank you very much. I bring apologies from the Mayor of Toronto that she was unable to make it today. She is particularly interested in this issue. I coordinate her Task Force on Drugs. She spoke yesterday at an international cities exchange with the City of Frankfurt in Toronto on the issue of substance abuse in the City of Toronto and backs my remarks 100 per cent hear today.

I do not think I am hear today to speak to you about the intricacies of this bill. I am sure others have come before you and spoken about the details of the bill. I am certainly not in a position to discuss scheduling of drugs, but I do hope to bring to you a practical perspective on this issue from a city.

Toronto is Canada's largest city, and because of that it enjoys the privileges of a world-class city. It also has to deal with world-class problems. Substance abuse and the problems created by it for neighbourhoods, police, and individuals is one of those major problems. Over the past few years, we have seen local neighbourhoods in Toronto become plagued by open drug dealing and the criminal activity that goes along with this trade. Individuals feel under siege in their own communities and fear for their safety and that of their children.

The response to these fears has taken many forms, from resident group protests to community groups applying for grants to police crackdowns. The result is often that the issue disappears or moves to another street. We have seen over the past few years the efforts to move

drug dealers out of neighbourhoods results in the trade moving street by

street as people are pushed out from one street to the next.

Why am I telling you this, you might ask, and what does this have to do with Bill C-8? I am telling you this because I think today we are at a crossroads where we are probably able to make some changes to these situations. In order to do this, though, we need a multi-faceted approach that includes law enforcement, education, prevention, and harm reduction. Bill C-8

is an opportunity for you to initiate a balanced approach to dealing with drug use in this country.

We have for too long focused our efforts solely on criminalizing and the incarceration of drug dealers and on the American approach of interdiction and a war on drugs. Canada has its own drug strategy, which states that it sees the value of harm reduction and prevention as key to making long-term gains in reducing substance abuse.

It does not appear that Bill C-8 reflects that strategy. The bill appears to rely heavily on continued prohibition and increasing legal sanctions on users. This approach does not acknowledge that a "war on drugs" approach has failed. It is no longer acceptable to just approach the drug use issue as a legal one. In cities such as Toronto, we experience all forms of substance abuse, and we now see that we must also be willing to work with all those involved in the issue of substance abuse, including drug users. We can no longer relegate them to prisons, as we can no longer afford imprisonment as the only option. This is no longer a fiscally responsibility approach. Too many Canadians are tied up in the legal system on minor drug offences costing the Canadian public millions when we could all be better served by taking an approach that sees drug use as public health and social policy issue.

We at the city of Toronto have begun to broaden our perspective. Recently, at the City of Toronto Board of Health, a paper was brought forward entitled Innovative Strategies in Substance Abuse Prevention and Treatment. I should like to highlight for you a few examples of what has been tried in other major cities in other countries that have come to acknowledge that traditional approaches to substance abuse are not working. It is at the city level where drug use is felt most, and it is also where drug policy and legislation has its biggest impact. We deal with it in neighbourhoods and communities.

18April96-Legal-32030-DM

THE STANDING SENATE COMMITTEE ON CONSTITUTIONAL AND LEGAL AFFAIRS

Upon resuming at 2:00 p.m.

drug dealers out of neighbourhoods results in the trade moving street by

street as people are pushed out from one street to the next.

is an opportunity for you to initiate a balanced approach to dealing with drug use in this country.

Needle exchange programs. These have played a major role in the prevention of HIV in major cities. Toronto and Vancouver were leaders in North America in developing these programs. While needle exchange programs rely heavily on syringe exchange, the provision of condoms, education and prevention are all important pieces as well. Perhaps the most controversial issue surrounding the concept of needle exchange is whether or not these services encourage drug use. Initial studies indicate that there is no evidence that needle exchange programs increase the amount of drug use by needle exchange clients or change the overall levels of drug use in communities. The cost effectiveness appears to be well documented in that the incidence, for example, in Toronto of HIV infection in the intravenous drug use population is approximately 7 per cent, compared to 30 to 50 per cent of infection rates in Chicago and New York. If we looked at the cost of treating AIDS patients at $119,000 U.S. versus the costs of a needle exchange programs such as at the City of Toronto at $450,000 a year, the cost benefits analysis is clear.

Methadone programs. These programs used to suppress the symptoms of withdrawal from drugs. Methadone's long-lasting or long-acting affects allow a person to achieve improved social stability and functioning. Methadone maintenance is happening in many countries,

including Canada. Numerous studies have shown that the use of methadone has seen significant reductions in the morbidity and mortality of users, as well as decreases in levels of both criminal involvement and the spread of HIV. Regulations have been very restrictive in this country and the availability of space limited. In the U.K., Europe and Australia, methadone is available from clinics as well as practitioners. In Amsterdam, Barcelona and Frankfurt, methadone is distributed by mobile vans. The provision of methadone allows people to be productive, functioning, and contributing members of society.

(1410 follows - Prescribing of illicit drugs. Comprehensive approaches that include needle exchange programs)

April 19, 1996\Legal\32030\lp

( Mr. Hillier: continuing.)

With regard to prescribing illicit drugs, comprehensive approaches that include needle exchange programs, counselling, employment and housing, in conjunction with drug treatment, have been tried in places like Merseyside. They have also prescribed several types of drugs in an effort to meet the needs of some users for whom methadone does not work. The use of prescribing drugs is difficult to accept but appears to be working. For example, the Swiss government has undertaken a study to look at the prescription drug approach. It started in 1994 with 700 participants and expanded the program to 1000 participants in 1995 as the preliminary results of this study are very positive.

With regard to law enforcement initiatives, the complexities on both sides of this issue remain officially unresolved. In fact, legalization of so-called hard drugs has not occurred anywhere in the world. The Merseyside experiment, however, has become an example of how all sides of the issue can work together. The Merseyside police have become national leaders in the activities aimed at improving the handling of drug problems. Their police and other officials act in partnership with the regional health authority in coordinating the prevention and treatment of drug-related problems.

One of the key elements of this police support is the use of cautioning. Under this policy, an individual found using illicit drugs is taken to a police station where the drug is confiscated and the incident is recorded. The person is referred to support agencies. The intent of these policies is to avoid the prosecution and potential incarceration of drug users rather than dealing with the issue of drug use directly.

In the Netherlands, while drug use has not been legalized, there are some legal distinction between drugs. Dealing or possessing small quantities of cannabis is decriminalized. Users are not in prison but rather are monitored and helped by a network of organizations which provide financial, social and medical assistance. Dutch officials counter that this approach helps in the elimination of the underground users. There is no hidden disenfranchised population of addicts

because they are not the target of law enforcement agencies. Only big traffickers must hide. Moreover, the Dutch proudly point to national statistics which highlight extremely low levels of homicide and drug overdose deaths.

Other cities such as Frankfurt have played a central role in the introduction of measures designed to reduce the harms implicit in drug use. These undertakings eventually led to the abolishment of national paraphernalia laws in 1992 which had restricted government-sponsored needle exchange programs. As well, changes in policies regarding substance abuse are occurring in several other countries including Spain, Italy, France, Switzerland and Australia.

With regard to correction strategies, a number of programs offering substance abuse treatment as an alternative to prison operate internationally. The idea is more recently growing in popularity as a number of well-designed studies suggest that individuals coerced into treatment, usually under the threat of criminal sanctions, do just as well as those voluntarily entering treatment.

The Delancy Street foundation in the United States is considered one of the most successful centres offering drug treatment alternatives to prisons. Currently about 1000 residents are housed in five facilities in the U.S. The average resident has been a seriously dependent drug user for ten years and has been in prison four times. About 30 per cent have been homeless. During their stay at Delancy House, which is generally about four years in duration, residents receive a high school equivalency degree as well as training in a number of marketable skills. Along with drug treatment, educational and vocational training, social and interpersonal skills are stressed.

Another strategy for coping with growing case loads of drug-related offenders is the creation of drug courts. By selectively processing drug-related cases, these courts link defendants to community-based treatment programs in an effort to reduce drug use and drug-related harm.

I have taken the time to review some of the above examples of innovation to help illustrate that we in Canada and elsewhere have been doing some very innovative things, and we should continue to do so. Other countries show us what is possible if we are willing to take some risks and explore other avenues for dealing with substance abuse. While Toronto has done some innovative work with things such as needle exchange programs and methadone, we have not taken further steps at this point to implement things such as those happening at Merseyside.

Bill C-8 needs to provide opportunities to further some of the innovative things we are currently doing and to be able to explore new ideas. We need a piece of legislation that is able to deal with the hard enforcement issues of drug trafficking, but we also need to be able to work with users and provide them with the health and social supports as mentioned above without fear of prosecution and persecution.

We at the city of Toronto have made the necessary link between substance abuse and health and social issues. The legislation in this country now needs to allow the flexibility to pursue innovative strategies, keeping in mind that any approach taken is a balanced one involving communities, law enforcement and users.

I am glad to see that you at the Senate are taking the opportunity to hear from all of these stakeholders. I think we can all agree that criminalizing a user does not help in treatment, that public health-based alternatives are the way to go, that the high cost of current laws to individuals, community and society in general are too much, and that we need to look at other models.

Thank you very much.

The Chairman: Thank you very much, Mr. Hillier.

Mr. Mosely, will you please make your presentation based on your experience in the City of Vancouver.

Mr. Dayle Mosely, Assistant to the Executive Director, Downtown/Eastside Residents Association, Vancouver:

I have been working in Canada's poorest community for eight years. The Residents Association is an association of the people who live in that community. We have probably the highest per capita drug use rate in Canada right now. In the last two years, I have been on the board of directors of the B.C. Coalition for Safer Communities. I am on the Interim Advisory Committee for the City of Vancouver on Safer City Initiatives. I have also been an advisor to the Attorney General on community-based policing. I sit on our local police community liaison. I am also on the steering committee of the Downtown/Eastside Strathcona Coalition which is made up of various people who are interested in the betterment of that community. I am deeply steeped in what is going on in that area of Vancouver, and in Vancouver in general.

I heard Senator Carstairs interviewed on the radio. Her perception seemed to be that although there is a drug problem, and that for the people involved in it it is serious, it is not an overwhelming problem. That is really not true in the city of Vancouver. I cannot speak for other Canadian cities, but it is an enormous and pervasive problem in our city, especially in the neighbourhood in which I work.

The harm caused by injection drug use has been increasing worldwide with the advent of HIV. B.C. has experienced an increase in the number of HIV positive injection drug users as well as an increase in the number of drug-related deaths. There was also a ten-fold increase in the number of cocaine-related charges in Vancouver between 1985 and 1991. The effects of this problem are nowhere more prevalent or more devastating than in the downtown east side. We who work and live in this neighbourhood are tired of attending funerals and memorials. We want the carnage to stop.

I will give you a few statistics on the situation as well as some examples of what is going on. We have an estimated 750 HIV infections in the intravenous drug user (IDU) community, as well as hepatitis A, B and C, skin and blood infections, endocarditis, tuberculosis, et cetera. Tuberculosis is running rampant through the general population in the neighbourhood as well as the drug user community.

Our current estimate of the cost of treatment for each of these people is about $150,000 per person per year, and this is increasing dramatically.

In addition to the more than 300 deaths investigated by Vince Cain in his famous report, we had another recent shipment of concentrated heroin and watched as, once again, our community was decimated and friends and acquaintances disappeared off the streets.

(Take 1420 follows)

(We have fetal exposures to various...)

MA Take 1410 Legal 32030

(Take 1410 -- Mosely continuing...friends and acquaintances disappeared off the streets.)

We have fetal exposures to various substances with both short- and long-term consequences. It is estimated that 30 per cent of the babies born in the downtown eastside are so affected.

We have increasing pressure on all community level outreach -- nursing, medical services, advocacy, programs and social services. Addiction is also sweeping through the mentally ill community as more and more are forced on to the streets by hospital downsizing and discrimination in housing.

As an organization, DERA operates a 70-room rooming house for the mentally ill. I would say at least 70 per cent of them are also intravenous drug users as well as being HIV-positive. The mentally ill are just coming out in droves, getting involved in drugs and contracting HIV and dying.

The combination of drug use and HIV is also sweeping through our aboriginal population who make up 25 to 30 per cent of the community. Not since the early nineteenth century have we seen such devastation of the native population by disease. Young native kids, as well as some non-natives, are turning up on our streets. The products of various types of abuse and neglect, they are quickly exposed to drugs, develop addictions and are forced to choose between selling their bodies or stealing to maintain their habits.

In 1995, the Vancouver Police Department identified more than 450 children under the

age of 16 working the streets of the downtown eastside. The majority of them are drug users.

We have also had more than 40 violent deaths of women who work the streets in the last 10 years. Current estimates are that we have as many as 15,000 intravenous drug users in Vancouver. Nobody knows the exact figure. The numbers are climbing. The needle exchange last year exchanged 1,800,000 needles in the city of Vancouver. That is the equivalent of the entire exchange in the United States. We did that amount just in the City of Vancouver.

The Vancouver Police Department has basically given up. There is really nothing they can do about the situation. If their entire manpower were put on this problem, there is no way that they could catch up with what is going on.

We as a community have not sat idly by and watched passively as this devastation unfolds. We formed the Downtown Eastside Strathcona Coalition which brought together community agencies, government representatives, bureaucrats from three levels of government, the police department and interested residents to try to find solutions to the problems of the neighbourhood. The coalition also included intravenous drug users.

We developed an alcohol and drug working group which evolved into an advisory committee to the provincial alcohol and drug programs and later into the Vancouver Eastside Alcohol and Drug Association.

In addition, various combinations of residents, government and health care professionals are involved in -- here is a short list -- the maternity care for substance-abusing women and children program; the multiple access model and in-patient working groups; the multi-diagnosis working group; the detox working group; the Safe Ride program; the Vancouver HIV-AIDS strategic plan; the decriminalization discussion group; the task force on the Coroner's recommendations; the needle exchange working group; the Point project; the intravenous drug-user working group with St. Paul's Hospital.

The list just goes on and on. I had personally been involved in four or five of these groups. I reached burn-out last year and found somebody else to take over because I could not take it any more; there was just so much going on in this area.

The entire community is focused on this problem because it permeates the entire community and it permeates the rest of the city because this problem is not isolated to our community. This is causing break-and-enters all through Vancouver and multiple other problems.

Besides this group participation, a vast number of studies and reports have been produced on various aspects of this situation. In preparing to come today to appear before you, I spoke with many different people in the community. I explained what was being proposed by the federal government with Bill C-8, at least as well as I could understand from reading the material.

Many of us are very worried. We worry over the implications for the needle exchange programs and any other such services which we might want to put in place. We are worried about the future ability to develop and implement drug replacement or provision programs on which we have been working with the medical profession, with government representatives, with community people and with drug users themselves.

We are in essence working towards the Merseyside model that my colleague here was mentioning before. We worry that this bill will ensure the maintenance of the horrendous status quo. This bill is not going anywhere new. It is just entrenching what already exists. We fear that, if this bill is passed, no matter how it is amended, that no one will look at this problem again for 20 years. We need some really creative solutions right now. We need to the room to move in whatever direction we can to keep people from dying from this plague which is sweeping our community.

Let me tell you about the irony of this situation. DERA opened up a neighbourhood safety office where we are working on all kinds of programs to increase the safety levels in our community. The Vancouver Police Department constable who is assigned to work with us full time has told me that he was informed by Crown counsel last week, as was the entire department, that they would no longer accept charges for simple possession of any drug in the city of Vancouver. Basically they do not have the time to prosecute these cases anymore.

This is just nuts. We are putting into place a law which increases penalties for some of these drugs when the system cannot even get to the charges.

The problem is that both the current and the proposed legislation are themselves part of the problem. Women in our community will not access alcohol and drug services because what they are doing is illegal and they fear having their children apprehended. We would like to set up safe shooting sites similar to the ones in Europe to minimize harm to users and to involve medical staff. We would like to try pilot projects with the medically-supervised provision of heroin and cocaine to registered addicts.

This is one point I want to make. Easier access to methadone will not solve all the problems. First of all, a number of the heroin users for whom the program was designed will not get involved in it. Second, our biggest problem with serial conversion for HIV is with the cocaine-using population. There is nothing in this legislation or in the current health care system which will take care of that problem. People are dying from this.

It almost seems like the problems are out-stripping our ability to come up with solutions. It is just not right to encase another law which may possibly hinder us in solving these problems. This bill says an awful lot about what people cannot do. We need to start from scratch. We need to consult and draft a made-in-Canada drug policy. Then we can draft legislation which makes sense. Some of the worry seems to stem from the fear of being ahead of public opinion.

In Vancouver, the harm reduction approach is supported by just about anybody I have

ever run into including health care professionals, the schools, parents, police, social service workers, lawyers, community agencies. I cannot think of anyone, other than a few people out in the valley who go to church a lot, who are not really worried about doing something to help people from dying from drugs. The perception of great resistance in Canada is probably false.

I was reading some of the transcripts from the Addiction Research Foundation witnesses. They said that we need a large education process. We have been doing that in Vancouver. We do not push our drug users from neighbourhood to neighbourhood in that city. We are trying to deal with what is happening within our own neighbourhood. We have undertaken that educational process and gone beyond that. I do not see that problem in Vancouver. Maybe there are other parts of Canada which have not experienced the same problems and have not bothered to look into the situation and who still need that education.

Laws are being drafted for the general population in Canada. The people at the very low end of the stick lose out because they are a special-case scenario. Perhaps Vancouver is different from the rest of Canada; I do not know. I am worried that this law will make it harder for us to do our jobs. Thank you.

Senator Gigantès: Both of you listed a whole number of things which could be part of a better solution. Both of you said that this bill, like the existing legislation, would only make your jobs harder. Mr. Mosely said that, in Vancouver, the police will not even bother any more because they just cannot cope.

(Take 1430 begins--Mosely: They will not and neither will Crown counsel.Gigantès:Let me hypothesize...)

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