The first drug treatment court in Canada began operation in Toronto in December of 1998. This paper describes some aspects of the evolution, structure, and operation of this court. In addition, the federally-funded evaluation of the new program has produced data from the first 18 months of its full operation when 198 drug-dependent individuals were admitted. These preliminary results are described and compared to the findings of an Australian study and to select American studies. Important differences in sentencing practices and options for drug offenses between Canada and the United States are highlighted. Even at this early stage of development, it is suggested that the types of clients retained and more successful in this Canadian experiment may be quite different from the more typical American drug treatment court clientele. The need for careful monitoring and more complete, long-term information is emphasized before the viability of this approach is established for Canada.
Despite a juvenile justice system that, since its inception in 1908, has been predicated on meeting the rehabilitative needs of youth, Canada has few specialized programs for substance misusing young offenders, preferring more holistic approaches. This is in keeping with an addictions treatment system that has evolved recently in the direction of more integrated services within the general health care and social services delivery systems. In addition, Canada has tended to emphasize community-based over institutional treatment programs. Nevertheless, for youth in conflict with the law, "substance abuse" is recognized as a significant risk factor for recidivism. The approximately 9000 young persons held in custodial facilities on any given day across the country are exposed to a variety of programs aimed at reducing antisocial behavior and hence, re-offending. Some of these have a substance use component. Programs for Aboriginal youth offer some of the most innovative approaches for particular drug use problems. This article provides an overview of the Canadian response and elaborates features of some programs, particularly Multisystemic Therapy, mainly in the province of Ontario. Few programs have received adequate evaluation, however, and the need for systematic assessment is crucial for the development of future effective interventions for youth with multiple drug and other problems.
Relatively little is known about how youth obtain marijuana and other drugs. The Drugs, Alcohol and Violence International (DAVI) study explored youthful drug markets among samples of school students, detained youth, and school dropouts (ages 14-17 years) in the greater metropolitan areas of Philadelphia, Toronto, Montreal, and Amsterdam. Students frequently reported sharing drugs, either getting them from others or giving them to others for free. Sharing was less common among the more drug-involved detainees and dropouts. Marijuana was typically obtained either outdoors or in a house or apartment. Few youth reported getting marijuana at school. In Amsterdam, where marijuana can be purchased in small quantities in coffeeshops, this was the most common place to get marijuana, even though 18 is the legal age for purchase. Alcohol was also most likely to be obtained in stores or restaurants across all the sites, even though none were of legal age except those in Amsterdam age 16 or older. Youth most often reported purchasing marijuana in nickel, dime or other small bags, which are not standardized units. The exception again was Amsterdam, where youth most often reported quantities in grams or joints, which is how it is sold in coffeeshops. The lack of standardization of units makes economic cost estimates suspect. Even standardized units such as alcohol present problems since youth report a wide range of 'typical purchases.' Survey data can, however, more aptly describe drug market characteristics such as general location of purchase, and relationship with the seller.
Canada is an egalitarian society committed to accessible and comprehensive health care. Although there has been a tendency to assume that its various social welfare programs have improved health conditions for lower income citizens, Canada's record in ensuring health equality remains poorer than expected (Humphries and van Doorslaer, 2000; Wasylenki, 2001). The Canadian Health Act stipulates that all residents of Canada are to have access to medically necessary hospital and physician services based on need and not the ability to pay. However, for marginalized groups such as drug users and the homeless, structural barriers to better health remain. This paper examines the health care needs and experiences of 30 women who were heavily involved in the street life of crack and prostitution in Toronto. Through their ready access to local drop-in clinics and nearby hospitals, the women reported generally positive experiences with the health care system. The study concludes that the women experienced many of the health problems that typify homeless, poorly housed and economically marginalized groups. Both positive and negative experiences with the health care system, and structural barriers that hamper its full utilization, are identified.
In Ontario, those dependent on substances are no longer eligible for welfare payments based on an addiction disability. While the impact of this program has not been assessed, evidence from a similar policy shift in the USA suggests deleterious effects on the health and social functioning of about half of those who lose this form of social support. A review of the research on the chronic-illness view of addiction, the fostering of stigma by exclusionary social policies, and the negative effects on mental health and homeless status associated with the loss of welfare benefits leads to the conclusion that this is an ill-advised policy for Ontario. Its continuation there, and its extension to other provinces, is not recommended.