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|Major Studies of Drugs and Drug Policy|
|Canadian Senate Special Committee on Illegal Drugs|
|Volume 2 - Policies and Practices In Canada|
With the exception of the treatment given to offenders
imprisoned in federal institutions and Aboriginals, the care available to
individuals who are substance-dependent is essentially the responsibility of
the provinces and territories. This chapter will therefore be brief since we
received only a few submissions and heard few witnesses on this question.
order to place the discussion in context, we should begin by noting certain
data concerning dependency induced by cannabis and its derivatives. We shall
then examine the various forms of treatment that are available. Finally, we
shall take a brief look at the state of knowledge concerning the effectiveness
of these treatments.
Let us first clarify the terminology. We saw in
Chapter 7 that, while the word addiction is used most often to refer to those
who have a problem of dependency on psychoactive substances, the WHO
recommended as long ago as 1963 that this expression not be used because of its
vagueness. We prefer to use the term dependency for at least two reasons.
First, it is more encompassing and may include different types of addictive
behaviour: substance-related (food, alcohol, illicit drugs) and
activity-related (gambling, sex, extreme sports, etc.). In the cases of
substances, it is also more specific, referring to both the physical and psychological
components of dependency. We share the distinction made by the WHO between
physical and psychological dependency:
[Translation] … psychic dependency is a ‘state in
which a drug produces a feeling of satisfaction and a psychic urge that
requires period or ongoing administration of the drug in order to cause
pleasure or to avoid discomfort’.
Physical dependency is an ‘adaptive state marked by the appearance of intense physical problems when the administration of the drug is delayed or its action is counteracted by a specific antagonist. These problems, that is the symptoms of withdrawal or abstinence, consist of symptoms and signs of a physical or mental nature that are characteristic of each drug. <![if !supportFootnotes]><![endif]>
And third, it is a more neutral term. While dependency is described as a state induced by the prolonged and abusive consumption of a substance, addiction has a connotation of mental illness, indeed a moral connotation. Some authorities such as NIDA, for example, do not hesitate to classify addiction as a true illness that has certain genetic components. Seen in this way, drug use triggers biophysiological mechanisms that lead to addiction. Hence the focus on abstinence. Treatment programs in Canada tend to regard dependency as a bio-psychosocial phenomenon; “[h]owever, support for the various modifications of the disease model continues in some service sectors”.<![if !supportFootnotes]><![endif]> It is interesting to note that more rehabilitation programs for alcoholism (51%) than programs for ‘addiction’ (47%) accept a harm-reduction strategy and thus objectives other than abstinence.<![if !supportFootnotes]><![endif]>
precisions made, the Committee noted the ambivalence in the terminology,
depending on the language. The English name of the Centre canadien de lutte contre l’alcoolisme et la toxicomanie
[Canadian centre for the battle against alcoholism and addiction] is the
Canadian Centre on Substance Abuse (centre canadien sur l’abus des substances).
The French title of the brochure published by the Department of the Solicitor
General describing the Department’s activities is La lutte contre la toxicomanie [the battle against addiction] while
the English title is Countering Substance
Abuse (combattre l’abus de substances). The name of a government
organization in Quebec is the Comité
permanent de lutte à la toxicomanie [standing committee on the battle
against addiction]. In addition to projecting a strong moral thrust, the French
word “toxicomanie” evokes a
vocabulary of struggle and combat, whereas the term substance abuse is more
neutral and we might even go so far as to say more measured. However, the
difference between the two languages cannot be explained by the lack of an
appropriate noun in French: dépendance
is the equivalent of drug addiction, and some in French even use the term
addiction. A little rigour and clarity would be beneficial in light of the
emotion surrounding the debate about drugs.
distinguished between use, at-risk use and excessive use, we feel that we
should logically avoid the term drug addiction to refer to dependency induced
by excessive use. Moreover, federal government departments and agencies should
modify their terminology and ensure that both language versions are in
common is cannabis dependency? In Chapter 7 we determined that physical dependency
on cannabis was definitely rare and insignificant. Some symptoms of addiction
and tolerance can be identified in habitual users but most of them have no
problem in quitting and do not generally require a period of withdrawal.
far as forms of psychological dependency are concerned, the studies are still
incomplete but the international data tend to suggest that between 5% and 10%
of regular users (at least during the last month) are at risk of becoming
dependent on cannabis. If we recall that approximately we estimated that
approximately 3% or 600,000 adult Canadians have consumed cannabis in the last
month and that approximately 100,000 or 0.5% use it on a daily basis; this
indicates that somewhere between 30,000 and 40,000 might be at-risk and 5,000
to 10,000 might make excessive use. For 16 and 17 years old, the numbers were
between 50,000 and 70,000 at-risk and 8,000 to 17,000 potentially excessive
users. The data also indicated that the peak period for intensive use is
between 17 and 25 years. These broad parameters indicate where to look to
prevent dependency and offer treatment services for those in need.
form does cannabis dependency take? Most of the authors agree that
psychological dependency on cannabis is also relatively minor. In fact, it
cannot be compared in any way with tobacco or alcohol dependency and is even
less common than dependency on certain psychotropic medications. Ceasing to
consume the substance for two to four weeks, which can be accompanied by
certain symptoms similar to those involved in nicotine withdrawal (insomnia,
irritability, perspiration, etc.), is usually sufficient to cause the symptoms
to disappear. When treatment is necessary, in the case of some people, it does
not take as long as and is less difficult than the corresponding treatment for
dependency on alcohol or “hard” drugs. It is also worthy of note that those
seeking treatment for cannabis dependency are younger than those who receive
treatment for dependency on other drugs. A number of factors may explain this
situation: consumption of cannabis is more a phenomenon of youth than that of
other substances, reaching its peak when young people are in their early
twenties and declining significantly when they reach their thirties. Young
people who need treatment also display problems of multiple addiction since
cannabis is not the only drug they consume.
dependency or consumption that the user regards as abusive is often a matter of
personal choice and does not necessarily require therapeutic intervention.
There is the phenomenon called spontaneous
remission. Many people, when they get into their thirties either stop using
drugs altogether or tone down their habit. There is an obvious phenomenon of
maturity in terms of drug use.
Among long-term users, we also see the retirement phenomenon, that is these individuals become fed up of their drug-using lifestyle. These individuals lose interest in the ongoing quest for drugs and for the pleasure that these drugs can provide them. In fact, it can be equated with a type of cost benefit analysis, whereby as the individual gets older, he/she decides that the habit is no longer worth it. The individual considers that the negative impact of his/her habit is no longer worth it. <![if !supportFootnotes]><![endif]>
While most people who experience substance abuse problems do not receive help, there is good evidence that people exposed to some types of treatment subsequently reduce their use of psychoactive substances and show improvement in other life areas. In general, treatment outcomes are improved when appropriate treatments are also provided for significant life problems (communications problems, lack of assertiveness, unemployment). <![if !supportFootnotes]><![endif]>
There is every reason to believe that, as far as cannabis is concerned, most problem users do not make use of the various forms of treatment and probably do not need any, firstly because the effects of cannabis are not as marked as those of other drugs and secondly, because cannabis users are more likely to be integrated into society than hard-drug users, which enables them to make use of their natural support groups. The third reason, in our view, why most cannabis users can avoid the trajectory of dependency is the fact that its use is not associated with “degenerate addiction” in the view of society or in the popular imagination, unlike the use of heroin, for example. Furthermore, a Canadian study has indicated that “few (3%) users of illicit drugs, identified in a population survey, reported seeking any kind of help for drug problems.” <![if !supportFootnotes]><![endif]>
Nevertheless, as in the case of any psychoactive
substance, some people opt for or need treatment.
It has in fact been observed in groups undergoing treatment - and this is a theory - that there are two groups of people trying to stop using. First, there are people who have mainly used opiates on a regular basis for six or more years. Second, there is the group of users who have been using for two years or less and no longer want to deal with the secondary effects of drugs. <![if !supportFootnotes]><![endif]>
decision to seek treatment is determined in particular by the increase in
social and personal problems that use of a substance may cause and by the fact
that it is often combined with problems of a psychiatric nature.<![if !supportFootnotes]><![endif]> Women systematically make fewer requests for specialized
drug and alcohol treatment services; this situation can be explained by the
fact that fewer services are available and women are otherwise looked after by
traditional psychiatric services.
people do not always choose or at least not totally. Family pressures or pressure in the work place and, in some
cases, orders made by judges are only some of the factors that lead people to
seek treatment. Furthermore, little is known about the trajectories of people
who abuse drugs and especially those who seek treatment for the problem. For
example, we do not know to what extent the search for treatment is more the
result of other earlier problems–family or psychiatric problems–than of the
actual use of the substance itself. In
the case of drug users who also have problems with the law and a career of
delinquency, deviant and delinquent behaviour often precedes the start of a
trajectory of drug dependency, as we saw in Chapter 6. Demand for treatment in
these cases will result at least as much from a desire – or indeed obligation –
to put an end to a criminal career as from the detrimental effects of using the
people be forced to seek treatment? That was one of the questions raised by the
introduction in France of a requirement to seek care in the 1970 Law respecting
narcotics, which has now taken the form of a therapeutic injunction,<![if !supportFootnotes]><![endif]> and of drug courts in Canada, as we saw in Chapter
Certain sections of the Criminal Code deal with the issue of
requiring offenders to seek treatment for problems related to alcohol and
drugs. For example, where a court is making a probation order, it has the
discretion to require, as a condition to the probation order that:
In addition, when a court imposes a conditional sentence, one of the optional conditions of the probation order may be that the offender participate in a treatment program approved by the province.<![if !supportFootnotes]><![endif]>
If a person has not been convicted of a criminal offence, it is unlikely that a court will order treatment for alcohol or drug problems, with some exceptions. For example, persons falling under the authority of provincial mental health legislation may be detained because of mental health problems. Such legislation regulates and limits when a person may be confined against their will.
The reluctance of courts to detain a person for substance abuse problems is illustrated in the Supreme Court of Canada decision in Winnipeg Child and Family Services (Northwest Area) v. G. (D.F.).<![if !supportFootnotes]><![endif]> In this case, a young Aboriginal was five months pregnant with her fourth child and was addicted to glue sniffing, a practice which may damage the nervous system of the developing foetus. The Winnipeg Child and Family Services requested assistance from the courts to involuntarily secure the mother in treatment. The case revolved around the issue of the rights of the unborn child, and the Supreme Court of Canada found that neither tort law nor the court’s parens patriae jurisdiction supported an order for the detention and treatment of a pregnant woman for the purpose of preventing harm to the unborn child.
In France, the therapeutic injunction has been harshly criticized, especially because it involves enforced treatment. The question is still open despite the guarded assessments that have been made of the results of this practice.<![if !supportFootnotes]><![endif]>
The therapeutic injunction system has been in place in France since 1970. A study by a colleague at the Institut national de santé et de recherche médicale, in France, showed that many people fell through the cracks because of the therapeutic injunction forcing them to follow a treatment program. These people were never treated, because there were not enough places or follow-up. If we want to set up drug courts in Canada, we shall have to plan effectively and organize consultation mechanisms with the treatment systems to ensure that the required treatment services are available. If we fail to do this, setting up drug courts will be nothing more than a sham, if the people requiring treatment fall through the cracks of the system. <![if !supportFootnotes]><![endif]>
It is estimated that approximately 10% of the offenders imprisoned in federal institutions are there for offences under the Controlled Drugs and Substances Act. Moreover and more importantly, it is estimated that at least 50% of all inmates, whether in provincial prisons or federal detention centres, have dependency problems (drugs and alcohol).<![if !supportFootnotes]><![endif]> Generally, few of these inmates receive any kind of treatment. In the United States, studies indicate that fewer than 10% of inmates receive treatment for dependency problems while they are in prison.<![if !supportFootnotes]><![endif]>
the case of provincial institutions, this situation can be explained by the
short duration of the sentences and by the budget cuts made in correction
institutions in the early 1990s. In the case of federal institutions, treatment
programs are available but they are still very far from meeting the needs.
Furthermore, it may be somewhat ironic to offer treatment programs in
institutions where drugs circulate freely and where it is not uncommon for the
inmates to have access to cannabis in particular.
the treatment offered to inmates is an essential component of their
reintegration into society given the magnitude of the problems caused by
dependency on drugs, especially harder drugs, and alcohol.
final comment: some of the people who appeared before us observed that in
certain cases cannabis maintenance could be used in combination with other
forms of withdrawal and treatment for dependency on opiates.<![if !supportFootnotes]><![endif]> To the best of our knowledge, there are no studies
on the subject–for good reason! However, we should note, as we did in Chapter
5, that cannabinoid and opioid systems engage in complex interactions, and we
may be justified in assuming that the consumption of D9-THC could cause a dopaminergic
response that could reduce opiate withdrawal.
<![if !supportEmptyParas]> <![endif]>
<![if !supportFootnotes]><![endif]> WHO (1964), Comité d’experts des drogues engendrant la dépendance, Technical
Reports Series, No. 273, quoted in Caballero and Bisiou, op. cit., pages 5-6.
<![if !supportFootnotes]><![endif]> Roberts, G. and A. Ogborne (1998), Profile: Substance Abuse Treatment and
Rehabilitation in Canada, Ottawa: Canada’s Drug Strategy, Department of
Health, page 20.
<![if !supportFootnotes]><![endif]> Dr. Céline
Mercier, testimony before the Senate Special Committee on Illegal Drugs, Senate
of Canada, Thirty-Seventh Parliament, First Session, December 10, 2001, Issue
12, page 9.
<![if !supportFootnotes]><![endif]> Robert, G.
and A, Ogborne (1999) Best Practices:
Substance Abuse Treatment and Rehabilitation, Ottawa: Canada’s Drug
Strategy, page 9.
<![if !supportFootnotes]><![endif]> Roberts and
Ogborne (1999) op. cit, page 59.
<![if !supportFootnotes]><![endif]> Dr. Céline
<![if !supportFootnotes]><![endif]> Roberts and
Ogborne, op. cit, page 60.
<![if !supportFootnotes]><![endif]> We describe
the French system in greater detail in Chapter 20.
<![if !supportFootnotes]><![endif]> Criminal Code, paragraphs 732.1(3)(g) and (g.1).
<![if !supportFootnotes]><![endif]> Criminal Code, paragraph 742.3(2)(e).
<![if !supportFootnotes]><![endif]>  3 S.C.R. 925.
<![if !supportFootnotes]><![endif]> Simmat-Durand, L. (1999), “Les obligations
de soins en France”, in Faugeron, C., (ed.) Les
drogues en France. Politiques, marchés, usage, Paris: Georg.
<![if !supportFootnotes]><![endif]> Dr Serge
Brochu, Professor in the School of Criminology at the Université de Montréal,
testimony before the Senate Special Committee on Illegal Drugs, Senate of
Canada, Thirty-Seventh Parliament, First Session, December 10, 2001, Issue 12,
<![if !supportFootnotes]><![endif]> Brochu, S. (1995) Drogues et criminalité. Une relation complexe. Montréal : Université de Montréal.
<![if !supportFootnotes]><![endif]> Lipton,
D.S. (1995) The effectiveness of
Treatment for Drug Abusers Under Criminal Justice Supervision. Washington,
DC: National Institute of Justice.
<![if !supportFootnotes]><![endif]> Among others at a private meeting with staff
of the Vancouver Compassion Club.
Schaffer Library of Drug Policy
Major Studies of Drug and Drug Policy
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Licit and Illicit Drugs
Short History of the Marijuana Laws
The Drug Hang-Up
Congressional Transcripts of the Hearings for the Marihuana Tax Act of 1937
Frequently Asked Questions About Drugs
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Guide to Heroin - Frequently Asked Questions About Heroin
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Drugs and Driving
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Drug Abuse Treatment Resource List
American Society for Action on Pain
Let Us Pay Taxes
Marijuana Business News
Reefer Madness Collection
Medical Marijuana Throughout History
Drug Legalization Debate
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Marijuana, the First 12,000 Years
DEA Ruling on Medical Marijuana
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GAO Documents on Drugs
Response to the Drug Enforcement Agency
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