International - Canada

(Canada - perception of seriousness of substance abuse) "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."

(ecstasy - manufacturing) "With these changes in demand, the location of manufacturing operations has changed. In the past, most of the pills sold as ‘ecstasy’ were manufactured in Europe, but this does not seem to be the case any longer. Manufacture of ‘ecstasy’ has increased in North America (notably in Canada) and in several parts of Asia. In line with the increases in manufacture in Canada, there are now also early signs that the strong downward trend in ecstasy use in North America after the year 2000 could be reversed."

(interdiction - Canada/United States border) "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."

Canada - Data

(2009 - Canada - cost of illicit drug use) "Addiction costs Canadian taxpayers hundreds of millions of dollars per year. Illicit drug use costs approximately 0.2 percent of the GNP. A recent “cost of illness” analysis estimated over $45,000 per year in societal costs per person who has an addiction."

(2009 - Canada - THC level of seized cannabis) "Cannabis remains the main illicit drug produced in Canada. In 2009, Canadian law enforcement officers seized more than 34 tons of cannabis herb, a slight decrease over the figure for 2008. The majority of the illicitly produced cannabis in Canada has been cultivated indoors, which means that its potency is high. In 2008, the average THC level of cannabis seized in Canada was 11 per cent."

(2009 - Canada - arrest rates) "Rates of cannabis-related arrests in Canada have risen from approximately 39,000 in 1990 to 65,000 in 2009."

(2007 - Canada - marijuana) "Marihuana remains widely popular among drug users across Canada. Marihuana produced in Canada primarily supplies the domestic market; marihuana produced outside Canada, in countries such as Jamaica, represents a minimal portion (less than 1%) of the marihuana seized in Canada."

(2007 - Canada - cocaine) "The market for cocaine in Canada has remained relatively stable in 2007."

"According to Health Canada, 2,630 kilograms of cocaine and 23.946 kilograms of crack were seized by various law enforcement agencies across Canada in 2007."

"In spite of the increased smuggling activity originating in Mexico in 2007, the United States remained the primary transit country for cocaine destined for Canada. According to CBSA, approximately 1.4 tonnes of cocaine were intercepted in the United States en route to Canada over the two-year period from January 2006 to December 2007."

(2007 - Canada - ecstasy) "Demand for MDMA (Ecstasy) across the country is stable and continues to be driven by expanding domestic manufacture that has resulted in a widely available supply"

"Decreased prices over the last two years, with an average range of $10 to $25 per tablet compared to previous averages of $30 to $45, also reflect increased production and supply."

"Canada’s status as a prominent MDMA producer and exporter remained undisputed in 2007. Canadian-based crime networks ensured plentiful supplies for the worldwide consumer base with continued peak levels of production. ... Many of these labs, particularly those located in Ontario and B.C., are capable of industrial-scale manufacture of mass quantities for the international market. These labs are often multi-site enterprises, equipped with synthesis and tableting operations and storage facilities."

(2007 - Canada - heroin) "Heroin consumption remains one of the least common forms of drug use in Canada, with the exception of British Columbia."

"Seizure data from Canada Border Services Agency (CBSA) indicates an increase in heroin seizures between 2006 and 2007 of approximately 19 kilograms for a total of 112 kilograms."

(2006 - Canada - drug threats) "MDMA (Ecstasy) is increasingly being produced in Canada affording wide availability for both the Canadian and U.S. markets. Seizures of MDMA en route to the United States from Canada have risen fivefold, with U.S. Customs and Border Protection (CBP) reporting an increase from 1.1 million dosage units in 2004 to 5.2 million dosage units in 2006.

"Cocaine also remains a drug threat to our two countries. The United States has become the primary transit country for cocaine entering Canada. About 40 percent of the seized cocaine intended for Canadian markets either transited or was intended to transit the United States. Cocaine enters both countries by a variety of routes originating in South America. The amount of cocaine destined for Canada seized by Canadian authorities at the U.S.-Canada border from 2004 to 2006 (1.6 tons) more than tripled the amount seized between 2001 and 2003 (496 kilograms).

"Marijuana is the illicit drug most widely produced, trafficked, and consumed in both the United States and Canada. Seizures of marijuana destined for the United States from Canada have declined considerably with CBP reporting approximately 6 tons confiscated in 2006 compared to about twice that amount in 2004. However, Asian drug trafficking organizations (DTOs) in the United States, some with ties to Canadian DTOs, are among the diverse criminal groups producing increasingly potent marijuana at indoor sites.

"Of continued concern in both the United States and Canada is the prevalence of methamphetamine. Strengthened Canadian Precursor Regulations governing the import and export of precursor chemicals, greatly reduced the cross-border trafficking of chemicals that can be used in the production of methamphetamine. However, methamphetamine production in Canada is on the rise. Thus far, cross-border smuggling of methamphetamine is limited."

"Heroin also poses a threat to the United States and Canada, but levels of cross-border trafficking are proportionately low. Heroin from South America and Mexico dominate U.S. markets, while Canada’s heroin supply comes increasingly from Southwest Asia. Availability of South American and Mexican heroin in Canada has also risen steadily."

"There is relatively little cross-border hashish smuggling."

(2004 - Canada - marijuana use) "... we found that only one in six Canadians has used an illicit drug other than cannabis, and even fewer—one in 33—has used such drugs during the past year. Given that most who have used an illicit drug in their lifetime no longer continue to use suggests that more emphasis should be placed on recent use and current harms and consequences."

(2004 - Canada - injectable drug use) "The data indicate that the number of Canadians who report having used an injectable drug at some point in their life increased from 1.7 million in 1994 to a little over 4.1 million in 2004. Of those, 7.7% (132,000) reported having used a drug by injection in 1994 compared with 6.5% (269,000) in 2004."

(2004 - Canada - 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)."

(2004 - Canada - lifetime drug use) "Excluding cannabis, the most commonly reported drugs used during one’s lifetime are hallucinogens, used by 11.4%, and cocaine (10.6%), and then speed (6.4%) and ecstasy (4.1%). The lifetime use of inhalants, heroin, steroids and drugs by injection is about 1% or less. The percentage reporting the use of any of the five illicit drugs, excluding cannabis (hallucinogens, cocaine, speed, heroin, ecstasy), is 16.5%, and the percentage reporting the use of any of the eight drugs, including cannabis, is 45.2%."

(2004 - Canada - prevalence) "Self-reported rates of drug use are higher in 2004 than they were in 1994. The proportion of Canadians reporting any illicit drug use in their lifetime went from 28.5% in 1994 to 45.0% in 2004 and from 7.6% to 14.4% in the 12 months preceding the survey.

"Across all surveys, cannabis is the most widely used illicit drug followed in order by LSD or hallucinogens, cocaine and crack, speed, and heroin. Rates of lifetime use identified in 2004 are significantly higher in all cases except for heroin. In terms of lifetime use, the rate for cannabis increased from 23.2% in 1989 to 28.2% in 1994 and to 44.5% in 2004. For cocaine, the figures rose from 3.5% in 1989 to 3.8% in 1994 and to 10.6% in 2004. For LSD or hallucinogens the corresponding figures increased from 5.2% in 1994 to 11.4% in the CAS."

"Rates of past year use of cannabis across the surveys rise from 6.5% in 1989 to 7.4% in 1994 and significantly to 14.1% in 2004. For cocaine and crack, rates go from 1.4% in 1989 down to 0.7% in 1994 and back up significantly to 1.9% in 2004. Use of hallucinogens and speed are both at about the 1% level and reportable differences do not emerge in comparisons of 2004 rates with earlier surveys. Rates of past-year use of heroin are unreportable across all surveys. Finally, rates for the aggregate category of LSD/speed/heroin go from 0.4% in 1989 to 1.1% in 1994 and 1.3% in 2004."

(2004 - Canada - alcohol) "Consistent with previous Canadian surveys, the CAS reveals that alcohol is the psychoactive substance most commonly used by Canadians. In the 12 months before the survey, 79.3% of Canadians aged 15 years or older had consumed alcohol, 13.5% were former drinkers, and 7.2% were lifetime abstainers."

"... the rate of past-year drinking is significantly higher among males than females (82.0% vs 76.8%, respectively). Past-year drinking increased according to level of education and income adequacy, with rates of consuming at least one drink in the past year being highest among those with a university degree (84.1%) and those in the highest income adequacy bracket (88.7%)."

"... the rates of pastyear drinking peaked among youth 18 to 24 years of age, with about 90% of persons in that age range having consumed alcohol during the course of the year. Conversely, former drinkers tended to be in the older age groups, with 21.6% of those 65 to 74 years of age reporting that they had not consumed alcohol during the course of the year."

"For many Canadians, drinking is ingrained in everyday life. Of the 79.3% of Canadians who reported having consumed alcohol during the year, 34.1% report they had drunk alcohol one to three times a week, and 9.9% report they had done so four or more times a week."

"In Canada, the age for legal access to alcohol is 19 years in seven provinces, and 18 years in three provinces. The 2004 survey shows that among past-year drinkers, about 17.4% of youth under 18 years of age, and 34.1% of youth 18 or 19 years of age, consumed alcohol at least once a week."

"The survey reveals that most Canadians drink in moderation. About 63.7% of past-year drinkers report their usual consumption was one or two drinks per typical drinking day."

"... a considerable proportion of past-year drinkers (16.0%) report that their usual consumption pattern when they drank was five or more drinks. This level of drinking has been associated with an increasing risk of alcohol-related problems. This pattern of drinking is found to be more common among males than females (23.2% vs. 8.8%), and is particularly high among persons 15 to 24 years of age, peaking at 42.5% among persons 18 to 19 years of age."

"The CAS reveals that the vast majority of Canadians consumed alcohol in the year prior to the survey, and a considerable proportion did so on a daily basis. Drinking five or more drinks a day, and drinking four or five or more drinks at a sitting, are consumption patterns known to be associated with a high risk of alcohol-related problems. Based on this survey, 77.4% of Canadians who consumed alcohol in the course of the year did so within the low-risk drinking guidelines."

(2004 - Canada - cannabis) "Overall, 44.5% of Canadians report using cannabis at least once in their lifetime, and 14.1% report use during the 12 months before the survey.

"Males are more likely than females to have used cannabis in their lifetime (50.1% vs 39.2%) and during the past year (18.2% vs. 10.2%). Younger people are more likely to have ever used cannabis in their lifetime, with almost 70% of those between 18 and 24 having used it at least once.

"Younger people are also more likely to be past-year users. Almost 30% of 15-17 year olds and just over 47% of 18 and 19 year olds have used cannabis in the past year. Beyond age 45, less than 10% of the population has used cannabis in the past year.

"Those who were never married are more likely to have smoked cannabis. More than half (57.5%) of the never married have used cannabis in their lifetime, compared with 35.2% of those who had been previously married, and 40.9% of those who are currently married or living with a partner. However, after adjusting for age differences between marital status groups, both lifetime and past-year cannabis use is significantly lower among married respondents compared with never-married and previously married respondents."

(1999 - Canada - HIV/AIDS) "An estimated 125,000 people in Canada inject drugs. Injection drug use is a major risk factor in the spread of HIV/AIDS and hepatitis. In 1999 it resulted in an estimated 34 percent of all new HIV infections."

(1999 - Canada - drug offenses) "In 1999 about 50,000 people were charged with offences under the Controlled Drugs and Substances Act in cases where the most serious offence was drug-related.... In that same year, we estimated that Canadian criminal courts heard 34,000 drug cases that involved more than 400,000 court appearances. About 19 percent of offenders in the federal correctional system are serving sentences for serious drug offences.

"For the roughly 50,000 persons charged, 90 percent of the charges related to cannabis and cocaine. Cannabis accounted for over two thirds of the charges, and about half of all charges were for possession."

(2006 - economics - global - Canadian dollar cost of substance abuse) "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.

"Important findings ... 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)."

Canada - Law and Policy

(Canada - 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.... Health Canada's decision to legitimize the medicinal use of marijuana is a step in the right direction. But a bolder stride is needed. The possession of small quantities for personal use should be decriminalized."

"The decriminalization of marijuana possession for personal use does not mean making marijuana “legal” or letting it be sold in every schoolyard. It does mean that possession of small amounts for personal use would become a civil offense, like a traffic violation, not a criminal one. The provisions of Canada’s Contraventions Act make this a relatively simple legislative task. Mr. Justice Minister, let’s decriminalize the possession of small amounts of marijuana for personal 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."

(substance abuse treatment in Canadian prisons) The Auditor General of Canada notes that Correctional Service Canada (CSC), which is responsible for offenders serving criminal sentences of over two years, provides substance abuse and harm reduction services to inmates: "Substance abuse is one of seven criminogenic factors contributing to criminal behaviour. Nearly two thirds of offenders entering the federal corrections system have drug abuse problems. An estimated 5 percent of offenders participate in substance abuse programs while serving their sentences.

"In addition to substance abuse programs, CSC has provided methadone treatment to some opiate-addicted injection drug users. Injection drug users pose a serious problem for institutions as they can contribute to the spread of HIV/AIDS and hepatitis. As a harm reduction measure, CSC also makes bleach available in prisons to sterilize needles shared by inmates."

(Canadian drug strategy) "In 1992 the government approved Canada's Drug Strategy, a co-ordinated effort to reduce the harm caused by alcohol and other drugs. The strategy calls for a balanced approach to reducing both the demand for drugs and their supply through such activities as control and enforcement, prevention, treatment and rehabilitation, and harm reduction."

(Canada - law & policy - public health oriented drug regulation) "... 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)."

Canada - Heroin Maintenance

(heroin maintenance vs. methadone) "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 enrol 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."

(heroin maintenance clinical trials in Canada)
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."

(heroin maintenance clinical trials in Canada)
"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."

(heroin maintenance clinical trials in Canada)
"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."

(NAOMI heroin maintenance clinical trial and motivation) "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."

Canada - Insite

(safe injection - 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."

(safe injection - Insite 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."

(safe injection - Insite - evaluation) "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."

(safe injection - 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."

(safe injection - 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.'"