International - Canada

Basic Data

(Prevalence of Marijuana Use) "The prevalence of past-year cannabis use among Canadians 15 years of age and older was 9.1% in 2011, a statistically significant decrease from 2010 (10.7%) that continues the decline in prevalence observed since 2004 (14.1%). Although there was no change in prevalence among subgroups of the population compared to 2010, the prevalence of past-year cannabis use was statistically significantly lower than in 2004 among males (12.2% versus 18.2%), females (6.2% versus 10.2%), youth aged 15 to 24 years (21.6% versus 37.0%) and adults aged 25 years and older (6.7% versus 10.0%).
"In 2011, the prevalence of past-year cannabis use by youth was 21.6%, three times higher than that of adults (6.7%). Despite the decrease in prevalence of past-year cannabis use among both males and females compared to 2004, prevalence among males remained twice as high as that of females (12.2% vs. 6.2%)."

(Prevalence of Other Illicit Drug Use) "In 2011, past-year use of the most commonly reported illicit drugs after cannabis was estimated to be less than 1% for each (hallucinogens including salvia (0.6%); ecstasy (0.7%), cocaine or crack (0.9%) and speed (0.5%)). Past-year use of methamphetamine is not reportable. The only statistically significant change noted among these substances over time was a decrease in cocaine or crack to 0.9% in 2011 from 1.9% in 2004.
"In 2011, the prevalence of use of at least one of six drugs [cannabis, cocaine or crack, speed, ecstasy, hallucinogens (excluding salvia) or heroin] in the past year was 9.4%, a statistically significant decrease from 11.0% in 2010. While past-year use among males also showed a statistically significant decline (12.4% in 2011 versus 15.0% in 2010), the rate of use by males was almost double that of females (6.5%), which is unchanged from 2010. Prevalence of use was three times higher among youth (21.9%) than adults (6.9%).
"Use of at least one of five illicit drugs excluding cannabis [cocaine or crack, speed, ecstasy, hallucinogens (excluding salvia) or heroin] was reported by 1.7% of Canadians. The reported rate of such use by males (2.4%) was statistically significantly higher than that reported by females (1.0%), while the rate of use by youth at 4.8% was almost five times higher than that reported by adults at 1.1%. Past-year use of at least one of five drugs excluding cannabis in 2011 (1.7%), was a statistically significant decrease from 2004 (3.0%), but not significantly different from 2010 (1.8%). Use of at least one of these drugs also decreased since 2004 among males (2.4% in 2011 versus 4.3%) and youth (4.8% in 2011 versus 11.3%)."

(Prevalence of Cannabis Use, by Province) "Provincial prevalence of past-year cannabis use ranged from 7.9% in Ontario to 12.4% in Nova Scotia. The only province with a statistically significant year-to-year change was Ontario, with a decrease in cannabis use to 7.9% from 11.2% in 2010. Each province's past-year cannabis prevalence was compared with the average prevalence for the remaining 9 provinces. Of these, Nova Scotia (12.4%) and British Columbia (12.1%) both experienced higher than average prevalence."

(Prevalence Among Youth) "Some key findings from the report are as follows. Among students in grades 7, 9, 10, and 12 (i.e., those approximately 12–18 years old):
"• Alcohol use is almost twice as prevalent as cannabis use (46–62% of students report alcohol use and 17–32% report cannabis use in the past year, depending on the province);
"• 19–30% report consuming five or more drinks on a single occasion in the past month;
"• 12–20% of Grade 12 students report driving within an hour of drinking alcohol in the past year;
"• 26–38% of all students report that in the past year they have been a passenger with someone that had been
drinking, and 17–20% report that in the past year they have been a passenger with someone who had had ‘too much’ to drink;
"• 2–5% report using cannabis daily or almost daily;
"• 14–21% of students in Grade 12 report driving within an hour of using cannabis, and more than 33% of Grade students report having been a passenger with someone who had used cannabis; and
"• Among the drugs assessed by the surveys, aside from alcohol and cannabis, ecstasy is the most prevalent drug (4–7% report lifetime use) followed by inhalants (2–4% report lifetime use)."

(Prevalence of Daily Cannabis Use Among Youth) "Eight of the nine provinces with student drug use surveys ask about daily or almost daily use of cannabis in the past month. Overall, 2.2–5.3% of students report smoking cannabis every day or almost every day in the past 30 days (Table 31 and Figure 31). In four of the eight provinces, the prevalence of daily or almost daily cannabis use was significantly greater among males than females (Table 32 and Figure 32). When examined by grade, the same pattern as noted in all previous indicators emerges. In Grade 7, very few students report daily use - so few that most estimates for Grade 7 students are suppressed. In Grade 12, however, 3.3–10.0% of students report using cannabis daily or almost every day (Table 33 and Figure 33)."

(Prevalence Among Youth of Drugs Other Than Cannabis) "The reported prevalence of drugs (other than alcohol and cannabis) such as cocaine or heroin among students is relatively rare. That said, provinces routinely measure use of these substances. British Columbia, Alberta, Manitoba, and Ontario estimates are for lifetime use. Atlantic provinces, Québec and the YSS [Youth Smoking Survey] ask about use in the past 12 months. Therefore, the two sets of prevalence estimates are presented separately in different tables. In addition to the different time frames used in the survey questions, there is also considerable variation in the terminology used in referring to these drugs as noted where appropriate in the tables below.
"All the surveys ask about ecstasy. Estimates for ecstasy use range from 3.4–7.2% reporting past-12-month use
and 4.4–7.1% reporting lifetime use (Tables 43 and 44). Following ecstasy, inhalants are second overall in reported
use with estimates ranging from 2.6–4.4% for past-year use and 2.2–3.8% for lifetime use. However, not all surveys ask about use of inhalants; some ask about ‘solvents’ or ‘glue’. These differences in terminology result in different prevalence estimates (Tables 45 and 46). Estimates for steroid use range from 1.4–1.7% for past-12-month use and 1.2–1.4% for lifetime use (Tables 47 and 48). Estimates for lifetime heroin use in British Columbia, Alberta, Manitoba and Ontario range from 0.8–1.3% (Table 49). Atlantic Canada does not ask students about heroin use. The YSS asks about past-12-month use of heroin [1.3% (1.0, 1.6)]."

(Age of First Use of Cannabis) "The average age of initiation for cannabis use among youth 15 to 24 years of age has remained unchanged over the past 7 years at approximately 15.6 years of age."

(Number of Medical Marijuana Users) "Among those who used cannabis, 17.7% (representing about 420,000 Canadians or 1.6% of the Canadian population aged 15 years and older) reported doing so for medical purposes. Prevalence of use for medical purposes was similar between male and female cannabis users (17.3% versus 18.4%, respectively), while more than one in five (21.8%) cannabis users aged 25 years and older reported using it for medical purposes, representing 1.5% of all adults in this age group. The percentage of youth who used cannabis for medical purposes is not reportable.

Half (49.7%) of those who used cannabis for medical purposes did so mainly for chronic pain caused by conditions such as arthritis, back pain and migraines, while the remaining 50.3% used cannabis primarily for one of a variety of conditions that included insomnia, depression and anxiety. These numbers do not in any way measure or reflect enrolment in the federal Medical Marijuana Access Program.

(Prevalence of Alcohol) "In 2011, 78.0% of Canadians reported drinking in the past year, a rate not statistically different from that reported in 2010 (77.0%). Since 2004 there has been a statistically significant decrease in past-year alcohol use among youth 15 to 24 years of age, to 70.8% in 2011 from 82.9%. A significantly higher proportion of males than females reported past-year alcohol use (81.9% versus 74.3%, respectively) in 2011, while the prevalence of past-year drinking among adults (79.3%) was significantly higher than among youth (70.8%).
"Provincial rates of current drinking ranged from 72.7% in Prince Edward Island to 81.7% in Quebec. The only statistically significant change in past-year alcohol use was in Alberta, where the percentage increased to 80.0% from 73.8% in 2010. Each province's past-year alcohol prevalence was compared with the average for the remaining nine provinces. Three provinces had lower than average prevalence (Prince Edward Island (72.7%), New Brunswick (73.3%) and Nova Scotia (73.8%)), while the prevalence of past-year alcohol use in Quebec (81.7%) was higher."

(Cannabis Arrests) "In Canada, drug offences such as possession, trafficking, importation/exportation and production fall under the purview of the Controlled Drugs and Substances Act. In 2011, police reported more than 113,100 drug crimes, of which more than half (54%) were for the possession of cannabis (Table 4).
"The rate of police-reported drug crime increased slightly in 2011, continuing an upward trend which began in the early 1990’s (Chart 14). The increase in 2011 was driven by a 7% rise in the rate of cannabis possession offences. However, the rate of trafficking, production and distribution of cannabis declined 11%.
"Similar to previous years, British Columbia reported the highest rate of drug offences among the provinces. While British Columbia was highest for cannabis offences, Saskatchewan reported the highest rate of cocaine offences, with a 73% increase in 2011 (Table 5)."

(Cannabis Seizures) "In 2009, Canadian law enforcement seized a total of 34,391 kilograms (kg) of marihuana and 1,845,734 marihuana plants. These figures, which have remained relatively unchanged from 2008 and coupled with steady street prices in 2009, indicated an apparently stable marihuana market. As in 2008, the majority of marihuana seized was domestically produced, yet the drug continued to be imported from Jamaica, the United States, the Netherlands, and Thailand."

(Sources of Marijuana) "The amount of marihuana produced in Canada exceeded domestic demand. Reportedly, there were OC [Organized Crime] groups producing this drug specifically for export to foreign markets, the largest of which is the United States. According to the U.S. National Drug Intelligence Center (NDIC), while seizures of Canadian marihuana have declined13 at the Canada-U.S. border, Canada continued to be a source country for high-grade marihuana destined for U.S. illicit drug markets.v The reported decline was believed to be due, in part, to Canadian-based Asian OC groups using their expertise to establish cannabis cultivation sites within the United States, thereby avoiding the cost of transporting drugs across the border and the risk of detection.
"Shipments of marihuana destined for Canada were smuggled through air cargo or passenger flights, and arrived primarily at Toronto Pearson International Airport. Canada Border Services Agency (CBSA) reported the seizure of approximately 1.15 tonnes of marihuana in 2009, with 60 percent of the total originating from Jamaica. Jamaican marihuana was primarily supplying a small market in Ontario and Quebec."

(Ecstasy Production) "In 2009, an abundant supply of Canadian-produced MDMA continued to meet domestic consumption requirements, as well as provide significant quantities for international markets.⁴⁰ Domestic prices for MDMA remained at the record low levels from 2008, while purity levels of the drug remained high, or even may have increased. The nature or extent of MDMA production in Canada appeared to be unaffected by the significant shortage in the supply of MDP2P, that reportedly impacted European markets. In Europe, the shortage resulted in a decline in Ecstasy seizures and in the number of seizures of laboratories, storage, and dump sites related to large-scale MDMA production.
"Cross-border MDMA smuggling from Canada to the United States, the primary foreign market for Canadian-produced MDMA, significantly increased from 2008. As in previous years, smuggling activity at or between ports of entry (POEs) was reported in the provinces of British Columbia, Ontario, and Quebec.⁴¹ For example, a record amount of 2.6 million dosage unit equivalents confirmed as MDMA were seized in the Pacific region in 2009. However, there was also smuggling activity across the Canada-U.S. border in other provinces, such as Manitoba.⁴²"

(Injection Drug Use) "The number of Canadians reporting use of an injectable drug at some point in their life increased from 1.7 million in 1994 (7.4% overall: 10% of males, 4.9% of females) to a little more than 4.1 million in 2004 (16.1% overall: 20.8% males, 11.7% females). Of those who used an injectable drug at least once in their life-time, 7.7% (132,000) reported past-year use by injection in 1994 compared with 6.5% (269,000) in 2004. The numbers of individuals having used drugs by injection in the past year are too small to allow any analysis."

(Sharing of Injection Equipment in Prisons) "Seventeen percent (17%) of inmates reported recently injecting drugs. A substantial proportion of these inmates increased their risk of acquiring a blood-borne infection (BBI) by using someone else’s used injecting equipment (see Table 4 for gender-specific estimates). Of those who recently injected drugs, 37% of inmates reported sharing a needle with a person with a positive or unknown BBI status and 42% reported using someone else’s works after they had used them. Additionally, men were more likely than women to report using someone else’s used needle, 55% vs. 41%, χ2 (1, n=438) = 6.22, p < 0.05 and sharing works with a person with a positive or unknown BBI status, 33% vs. 23%, χ2 (1, n=397) = 4.40, p < 0.05."

(Injection Drug Use in Prisons) "Infectious disease management can be a challenge in correctional settings due to the high rates of BBIs, and risky behaviours such as injection drug use (IDU), tattooing and piercing among people entering the correctional system (PHAC, 2008b). While jurisdictions prohibit IDU, tattooing and piercing within their facilities some inmates continue to engage in these activities with escalated risk of infection due to the need to share equipment. For example, among Canadian studies, the reported level of IDU ranges from 5% to 28% in federal institutions and 1% to 8% in provincial correctional centres (Alary, Godin & Lambert, 2005; Calzavara & Burchell, 1999; Calzavara et al., 2003; Calzavara, Myers, Millson, Schlossbert, & Burchell, 1997; Dufour et al., 1996; Ford, 1999; Ford et al., 2000; Martin, Gold & Murphy, 2005; PASAN, 2003; Poulin et al., 2007; Price Waterhouse, 1996; Rehman, 2004; Small et al., 2005). These rates are higher when capturing ever injecting in prison (8% to 28%) compared to shorter periods of time such as the past 12 months (1% to 11%)."

(Injection Drug Use In Prison by Drug Type) "Overall, 87% of inmates who recently injected drugs in a penitentiary reported opiates as one of their three most used drugs. Although the number of inmates who reported injecting only non-opiate drugs was small, comparisons between this group and opiate users suggests that injecting opiates may be associated with the use of someone else’s used equipment (see Table 9). Inmates who recently injected opiates were more likely, than those who recently injected non-opiates, to use someone else’s used needle, 81% vs. 48%, χ2 (1, n=251) = 13.92, p < 0.05, and works, 59% vs. 36%, χ2 (1, n=236) = 3.98, p < 0.05."

(Number of People Living with HIV, by Transmission Method) "HIV/AIDS remains an issue of concern for Canada. The number of people living with HIV (including AIDS) continues to rise, from an estimated 64,000 in 2008 to 71,300 in 2011 (an 11.4% increase) (Table 1, Figure 1). The increase in the number of people living with HIV is due to the fact that new infections continue at a not insignificant rate which is greater than HIV-related deaths, as new treatments have improved survival. The estimated prevalence rate in Canada in 2011 was 208.0 per 100,000 population (range: 171.0–245.1 per 100,000 population). Nearly half (46.7%) of those living with HIV were men who have sex with men (MSM). Those who acquired their infection through heterosexual contact and were not from an HIV-endemic region comprised the next largest group (17.6%), followed by those who acquired their infection through injection drug use (IDU) (16.9%) and those exposed through heterosexual contact and were also from an HIV-endemic region (14.9%)."

(Estimated Number of New HIV Infections, by Transmission Method) "Although estimates of the number of new HIV infections are uncertain, the number of new infections in 2011 was estimated at 3,175 (range between 2,250 and 4,100) which was about the same as or slightly fewer than the estimate in 2008 (3,335; range of 2,370 to 4,300) (Table 2, Figure 2). In terms of exposure category, MSM continued to comprise the greatest proportion (46.6%) of new infections in 2011, which was slightly higher than the proportion they comprised in 2008 (44.1%). In 2011, the proportion of new infections among IDU was lower than in 2008 (13.7% compared to 16.9%). The proportion of new infections attributed to the heterosexual/non-endemic and heterosexual/endemic exposure categories were about the same in 2011 compared to 2008 (20.3% vs 20.1% and 16.9% vs 16.2%, respectively) (Figure 3)."

(Reported Drug Harms) "The most commonly reported drug-related harm involves physical health, reported by 30.3% of lifetime and 23.9% of past-year users of illicit drugs excluding cannabis, and 15.1% of lifetime and 10% of past-year users of any illicit drug . Following physical health, a cluster of harms, represented somewhat equally, includes harms to one’s friendships and social life (22.3% and 16.4% of users excluding cannabis, 10.7% and 6.0% of any illicit users), home and marriage (18.9% and 14.1% excluding cannabis, 8.7% and 5.1% of any illicit users), work (18.9% and 14.2% excluding cannabis, 9.2% and 5.1% of any illicit users) and financial position (19.6% and 18.9% excluding cannabis, 8.4% and 6.5% of any illicit users)."

(Participation in Methadone Maintenance in Prisons) "At the time of the survey, 7% of all inmates reported being on MMTP. An additional 9% of all inmates reported not being on the program but previously trying to get on it at CSC. The remaining 84% of inmates reported never trying to join the program (63%), never using drugs (20%), and no longer needing the program (<1%).
"Participation in MMTP was associated with drug use in penitentiaries. Of inmates who were on MMTP, 60% reported not using opiates recently in a penitentiary; however, 40% did (see Table 10). Similarly, of those who were not on CSC’s MMTP but had tried to get on the program, almost equal proportions reported no drug use in a penitentiary (45%) and recent opiate use a penitentiary (44%). Conversely, the majority of inmates who never tried to get on MMTP at CSC reported no recent opiate use in a penitentiary (87%) and a minority (12%) reported recent opiate use in a penitentiary."

(Annual Cost of Substance Use) "Measured in terms of the burden on services such as health care and law enforcement, and the loss of productivity in the workplace or at home resulting from premature death and disability, the overall social cost of substance abuse in Canada in 2002 was estimated to be $39.8 billion. This estimate is broken down into four major categories in Figure 1. This overall estimate represents a cost of $1,267 to every man, woman and child in Canada, as indicated according to substance in Figure 2.
"Tobacco accounted for about $17 billion or 42.7% of that total estimate, alcohol accounted for about $14.6 billion (36.6%) and illegal drugs for about $8.2 billion (20.7%) (see Table 2).
"Productivity losses amounted to $24.3 billion or 61% of the total, while health care costs were $8.8 billion (22.1%). The third highest contributor to total substance-related costs was law enforcement with a cost of $5.4 billion or 13.6% of the total."

(Cost of Substance Abuse in Canada) "In 2006 a team of researchers published estimates of the social costs of substance abuse in Canada across several domains based on 2002 data (Rehm et al., 2006). Total costs of substance abuse for all substances (including tobacco) were estimated to be $39.8 billion in 2002, which translates into $1,267 per capita. Of this, approximately 39% are direct costs to the economy associated with health care, enforcement, prevention/research and 'other costs'⁶, and 61% are indirect costs associated mainly with productivity losses resulting from premature death and disability. Figure 2 depicts the estimated direct social costs associated with alcohol, illicit drugs and cannabis in 2002.
"Important findings from Figure 2 include the fact that (1) total direct social costs associated with alcohol ($7,427.5 million) are more than double those for all illicit drugs combined ($3,565.5 million); (2) direct alcohol-related health care costs ($3,306.2 million) are nearly three times as high as for all illicit drugs, excluding cannabis ($1,061.6 million), and over 45 times higher than the direct health care costs of cannabis ($73 million); and (3) annual direct costs for health care ($4,440.7 million) are 31 times higher, and annual direct costs for enforcement ($5,407.7 million) are 36 times higher than annual costs for prevention and research ($147.6 million)."

Laws & Policies

(National Anti-Drug Strategy) "The Government of Canada has a long history in the horizontal management of drug issues, beginning with Canada’s Drug Strategy (CDS), which began in 1987 and which focused on substance use and abuse. The National Anti-Drug Strategy, announced in 2007, represented a change from the former CDS in focusing particularly on illicit drug issues. More specifically, as noted in the Strategy RMAF, it is intended to improve Canada’s response to illicit drug use and its consequences through three action plans to prevent drug use, particularly among youth, where rates of illicit drug use are higher than the general population; address critical treatment gaps in targeted populations and areas of need, including services for young people, First Nations and Inuit populations, and other vulnerable groups and areas such as Vancouver’s Downtown Eastside; and enhance federal enforcement capacity to dismantle and disrupt domestic illicit drug production and distribution.
"In addition to the DOJ, federal partners of the Strategy are:
"— Health Canada (HC);
"— Public Safety Canada (PS);
"— Royal Canadian Mounted Police (RCMP);
"— Correctional Service of Canada (CSC);
"— National Parole Board of Canada (NPB);
"— Office of the Director of Public Prosecutions (ODPP);
"— Canada Border Services Agency (CBSA);
"— Department of Foreign Affairs and International Trade (DFAIT);
"— Canada Revenue Agency (CRA);
"— Public Works and Government Services Canada (PWGSC); and,
"— Financial Transactions and Reports Analysis Centre of Canada (FINTRAC).
"The Strategy is intended “to prevent illicit drug use, particularly among youth, address critical treatment gaps in targeted populations and areas of need, and enhance federal enforcement capacity to dismantle and disrupt illicit drug production and distribution.”³ The Strategy seeks to achieve its goal through three action plans devoted to prevention, treatment, and enforcement."

(Federal vs. Provincial Perspective and Responsibilities) "The federal government’s role in enforcement is defined by the Constitution, domestic legislation such as the Criminal Code and the Controlled Drugs and Substances Act, and by various international conventions Canada has ratified. While prevention and treatment are areas of primarily provincial jurisdiction, there is general agreement among those interviewed that the federal government can and should be active in these areas, since the sheer magnitude of the illicit drug problem demands sizeable resources and because the problem is not contained within local, provincial/territorial, or regional boundaries.
"At the federal level, continued federal commitment to the Strategy has been demonstrated by recent public statements by the Ministers involved in the Strategy and by the reintroduction of the Mandatory Minimum Penalties (MMP) legislation in February 2009. More broadly, the Strategy links to other federal government initiatives, including its Tackling Crime and Safe and Healthy Communities agendas. By comparison, the provinces and territories focus on substance abuse in general rather than abuse of illicit drugs, support harm reduction, and take a more holistic approach to substance use issues."

(Perception of Seriousness of Substance Abuse Problems) "Our analyses suggest that public perceptions of the relative seriousness of substance abuse problems are incongruent with the actual costs they impose on Canadian society. In particular, the total social costs associated with alcohol are more than twice those for all other illicit drugs in 2002, yet the public consistently rated the overall seriousness of illicit drugs as higher at the national, provincial and local levels in the Canadian Addiction Survey (2004). Interpreting these findings it is possible to suggest that perceptions of the seriousness of illicit drugs are relatively amplified while perceptions of the seriousness of problems associated with alcohol are relatively attenuated in Canadian society."

(Medical Marijuana) The Canadian government in 2001 established regulations to expand the use of marijuana as a medicine. According to an editorial in the Canadian Medical Association Journal, "The new regulations promise more transparency in the review of applications to grow or possess medicinal marijuana, a broader definition of medical necessity, and greater latitude for physicians in determining the needs of individual patients."

(Prison-Based Methadone Maintenance Programs) "Ensuring that offenders have access to interventions that address their substance abuse issues allows the Correctional Service of Canada (CSC) to support the safe reintegration of offenders into society. The treatment needs of offenders with opioid dependence are met through CSC’s Methadone Maintenance Treatment (MMT) Program.¹
Some of the objectives of CSC’s MMT program include reducing relapse to opioid drug use and the incidence of drug-related criminal activity; improving the offender’s general health and quality of life; and assisting and motivating offenders to gradually desist from all illicit drug use."

(Seizure of Children from Drug Producing Homes) "In 2006, the province of Alberta passed the Drug Endangered Child Act,¹⁷ which authorized the state (child welfare authorities or the police) to seize children from drugproducing homes, even if based on suspicion alone.¹⁸ Often these children, and even the parents, might not know about the drugs. More troubling is that there may not even be illicit substances present, but rather the chemicals used to create such substances, and this may be deemed sufficient for apprehension of the children. To add to the equation, the Motherisk Laboratory at the Hospital for Sick Children receives hair samples to be analyzed for drugs of abuse from thousands of parents implicated in child-protection matters each year from across the country, and they are analyzed for drugs of abuse. Based on consultations with child protection workers or the respective authorities, children are rarely removed from drug-using parents’ care until substantial evidence of child safety issues is built. Among our cohort of children presented here, however, the majority of the parents were not known to be using illicit substances themselves and, on the basis of our clinical assessments, appear to be able to parent their children adequately. It is not likely that the production of drugs, particularly marijuana, hinders effective parenting much more than actual drug use, yet the differences in the ways these cases are handled suggest that police and child protection agencies perceive the former to be of greater concern with respect to child safety than the latter."

(Canada/United States Border Enforcement Cooperation) "Through successful binational fora such as the Cross-Border Crime Forum (CBCF) and Project North Star, the United States and Canada have increased intelligence-sharing and joint training opportunities for law enforcement officials. Investigative cooperation has also been expanded, through the establishment of new Integrated Border Enforcement Teams and notable enforcement initiatives such as Operation Sweet Tooth/Project O’Skillet and Operation Triple Play/Project O’Slider. The result: greater success in seizing illicit drugs crossing the U.S.-Canada border and apprehending those that traffic them.
"Despite our best efforts, drug trafficking still occurs in significant quantities in both directions across the border. The principal illicit substances smuggled across our shared border are MDMA (Ecstasy), cocaine, and marijuana."

(Public Health and Drug Control Policy) "Public health oriented regulation has much potential to reduce the health, social and fiscal harms associated with all psychoactive substances.
"In addition, public health oriented regulation is supportive of Canadians human rights as established by the pre-eminence of the Charter of Rights and Freedoms 7 i.e. the “right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.” (section 7), “subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society” (section 1)."

North American Opiate Medication Initiative (NAOMI)

"The North American Opiate Medication Initiative (NAOMI) is a carefully controlled (clinical trial) that will test whether medically prescribed heroin can successfully attract and retain street-heroin users who have not benefited from previous repeated attempts at methadone maintenance and abstinence programs.
"The NAOMI study will enroll 470 participants at three sites in Vancouver, Montreal and Toronto. The Toronto and Montreal sites are expected to begin recruitment this spring.
"Each site will enroll about 157 participants. About half of these volunteers will be assigned to receive pharmaceutical-grade heroin (the experimental group) and half will receive methadone (the control group). The prescribed heroin will be self-administered under careful medical supervision within a specially designed clinic. Those in the heroin group will be treated for 12 months then transitioned, over three months, into either methadone-maintenance therapy or another treatment program. The researchers expect a 6-9 month recruitment period, so that the total time to complete the study will be 21 to 24 months."

What is the NAOMI clinical trial?
"The North American Opiate Medication Initiative (NAOMI) was a randomized trial aimed at testing whether medically prescribed diacetylmorphine, the active ingredient in heroin, offered benefits over and above optimized methadone therapy in the treatment of individuals with chronic opioid dependence who were not benefiting from other available treatments. Patients allocated to injectable diacetylmorphine were more likely to stay in treatment and more likely to reduce their use of illegal drugs and other illegal activities than patients allocated to oral methadone.

If the NAOMI trial was a success, why the treatment did not continue?
"The NAOMI investigators requested permission to prescribe diacetylmorphine under compassionate use through Health Canada's Special Access Programme. However, the requests were denied. Also, the funding for both clinics (Vancouver and Montreal) was part of a CIHR grant that ended with the study period. The investigators are working on other options, such as the SALOME study. Canada is the only country where diacetylmorphine has been tested for addiction treatment and has been denied compassionate use."

(Findings) "Our study had two primary findings. First, we found that most study participants were motivated for treatment, despite not accessing it in at least the past 6 months (as per trial entry criteria). This may be the result of a lack of accessible or attractive treatment options available to them. Second, we found that baseline motivation for treatment did not predict retention in either HAT [heroin assisted treatment] or MMT [methadone maintenance treatment], however motivated patients receiving HAT were more likely to achieve response than unmotivated patients. While HAT is likely to retain patients regardless of motivational status, success in treatment, in terms of decreases in illicit drug use and crime, is more likely among motivated patients, as measured in our study. Further, HAT was statistically significantly more effective than MMT on each of the outcomes assessed."

Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME)

"What is the SALOME clinical trial?
"The Study to Assess Longer-term Opioid Medication Effectiveness [SALOME] is a clinical trial that will test whether diacetylmorphine, the active ingredient of heroin, is as good as hydromorphone (Dilaudid®), a licensed medication, in benefiting people suffering from chronic opioid addiction who are not benefiting sufficiently from other treatments. Also, this study will test if those effectively treated with injectable diacetylmorphine or hydromorphone can be successfully switched and retained to the oral formulations of the medications."

"How are SALOME and NAOMI trials related?
"In the NAOMI study, a small group of patients received hydromorphone (Dilaudid®) instead of diacetylmorphine in a double-blind basis (nor the patients or staff knew which drug they were receiving), for the purpose of validation of self-reported use of street heroin in urine toxicological tests. An unexpected finding was that injection patients could not accurately discriminate whether they were receiving diacetylmorphine or hydromorphone."

Insite

(Support for Insite) "Since its inception, Insite has been subject to an independent review by a team of physicians and scientists put in place to provide an 'arm’s length' evaluation of the program. The results of this scientific evaluation have been published in peer-reviewed academic journals and have indicated that Insite has reduced unsafe injection practices, public disorder, overdose deaths and HIV/Hepatitis while increasing uptake of addiction services and detox [8]. To date, there have been over three-dozen peer-reviewed papers evaluating Insite published making it one of the most evaluated healthcare programs in the history of Canada [9-38]. In light of the evidence, the program has garnered widespread support from Canadian physicians, scientists and healthcare professionals."

(Insite's Goals) "Insite opened on 21 September of 2003 under an exemption granting it status as a scientific pilot study until 12 September 2006. The primary goals of the program are: (1) to reach a marginalized group of IDUs with healthcare and supports who would otherwise be forced to use drugs in less safe settings (2) to reduce dangerous injection practices (syringe sharing) thereby reducing the risk of infectious diseases like HIV and HCV; and (3) to reduce fatal overdoses in the population of people that use the facility. The program also aims to provide referrals to treatment and detoxification, reduce public disorder (public injection) and validate the personhood of a deeply stigmatized target population."

(Insite Evaluations) "The British Columbia Centre for Excellence in HIV/AIDS was commissioned to evaluate Insite. A study published in 2006 showed that there was an increase in uptake of detoxification services and addiction treatment.¹³ Another study published that year showed that Insite did not result in increased relapse among former drug users, nor was it a negative influence on those seeking to stop drug use.¹⁴ Results of studies using mathematical modelling showed that about one death from overdose was averted per year by Insite.¹ A subsequent study estimated 2–12 deaths averted per year.¹⁵ Although these studies did not have sufficient power to detect any difference in incidence of blood-borne infections, Kerr and colleagues did find that Insite users were 70% less likely to report needle-sharing than those who did not use the facility.¹⁶ Before the opening of Insite, those same individuals reported needle-sharing that was on par with cohort averages. As for public order, Wood and colleagues found that there was no increase in crime following the opening of the facility.¹⁷ In fact, there had been statistically significant decreases in vehicle break-ins and theft, as well as decreases in injecting in public places and injection-related litter."

(Reduced Overdose Mortality) "In this population-based analysis, we showed that overdose mortality was reduced after the opening of a SIF [supervised injecting facility]. Reductions in overdose rates were most evident within the close vicinity of the facility—a 35% reduction in mortality was noted within 500 m of the facility after its opening. By contrast, overdose deaths in other areas of the city during the same period declined by only 9%. Consistent with earlier evidence showing that SIFs are not associated with increased drug injecting (panel),38,39 these findings indicate that such facilities are safe and e!ective public-health interventions, and should therefore be considered in settings with a high burden of overdose related to injection drug use."

(Other Drug Use) In an evaluation of the Vancouver supervised injection facility Insite, researchers concluded that: "Although there was a substantial increase in the number of participants who started smoking crack cocaine, it is unlikely that the facility, which does not allow smoking in the facility, prompted this change. These findings are relevant to a recent review of supervised injection facilities by the European Monitoring Centre on Drugs and Drug Addiction, which highlighted concerns that these facilities could potentially 'encourage increased levels of drug use' and 'make drug use more acceptable and comfortable, thus delaying initiation into treatment.'"