Public Health and Regulatory Policy: CAMH Research Annual Report 2002

The Regulatory Policies and Legal Controls Section assesses the impact of policy and legal control initiatives and conducts research on potential policy options for various levels of government. We have implemented or completed a number of significant projects this year. These projects are largely funded from external sources, totalling about $15 million dollars, and will continue for the next few years.

Antisocial Behaviour, Alcohol and the Automobile

Dr. Reg Smart and Dr. Bob Mann received funding from the Networks of Centres of Excellence program to support their work on drunk driving and road rage. One aspect of this work is a comprehensive analysis of several impaired-driving policy initiatives in Canadian provinces. They have recently assessed the impact of Ontario's Administrative Drivers License Suspension law. They found that, since this law was introduced, there has been a 17 per cent reduction in the proportion of fatally injured drivers with a blood alcohol content over the legal limit.

As well, in a comprehensive review of the literature on road rage, they found that, although scientific literature does not yet support claims of an epidemic of road rage in modern society, some findings suggest that road rage may be an important cause of injuries and deaths on our highways.

Lowering Blood Alcohol Content Limits for Driving

Dr. Mann, Dr. Scott Macdonald and Gina Stoduto have found that every jurisdiction that has introduced or lowered a legal blood alcohol content limit for driving saw a reduction in collisions, injuries and fatalities. Recent studies consistently indicate that a lowered legal limit can be associated with a lasting reduction in collision fatalities. Variations in the impact of reduced legal limits may be due to such factors as levels of awareness and enforcement of the law.

Collaborative World Health Organization Study on Alcohol and Injuries

Drs. Macdonald and Norman Giesbrecht are the Canadian investigators of a world-wide, multi-site comparison study, co-ordinated by the World Health Organization, looking into the relationship between alcohol and injuries in hospital emergency-room departments. The intent of the study is to use a common methodology and to draw comparisons of the relationship across countries.

Driving Records of Clients in Treatment for Alcohol, Cocaine or Cannabis Use

Dr. Macdonald has received funding from the Canadian Institute of Health Research for this study. Using data from client records and traffic violations, the study is looking at the relationship between traffic violations and people in treatment for alcohol, cocaine or cannabis use to determine if this group is more prone to traffic problems. The data collection phase has been completed.

Interdisciplinary Health Research Teams Illicit Opioid Addiction Study

Drs. Benedikt Fischer and Jürgen Rehm and their colleagues have begun three of four of the project components of this national multi-site site study that is funded by the Canadian Institute of Health Research. These include a multi-site cohort study with untreated opioid users, meta-analysis on opioid pharmacotherapy treatments, and an animal studies program. The study is being conducted in a number of cities in Canada, and will use multiple, interrelated disciplines to investigate the appropriateness of a variety of opioid treatment options.

North American Opioid Medications Initiative

The purpose of this study is to determine the extent to which non-conventional forms of opioid-assisted therapy may be more successful than conventional oral methadone therapy in recruiting, retaining, and benefiting chronic, opioid-dependent people who use injection drugs. Drs. Fischer and Rehm are part of a national team that have recently received funds from the CIHR to begin this first study its kind in North America. The study is scheduled to begin this year and to take place in three Canadian cities.

Drug Treatment Courts in Toronto

Dr. Louis Gliksman and Brenda Newton-Taylor have received funding for 4.5 years from the Department of Justice (National Crime Prevention Centre) to evaluate the impact of drug courts in Toronto. The Drug Treatment Court (DTC) offers a new approach to repeat offenders based on the notion of restorative justice. This approach also allows for a unique opportunity for the criminal justice system and treatment agencies to collaborate, and to actively engage in partnerships with community agencies, services and organizations. The study has resulted in a number of sub-projects within the framework of the overall evaluation:

Using both qualitative and quantitative data, we are investigating the unique needs and issues of female DTC clients, involving women from expelled, graduate and comparison groups, as well as key court members (judge, Crown, duty council, court liaison, therapists).

We are conducting a summary of drug court related literature, focusing on international comparisons, and research/evaluation issues.

With DTC judicial collaboration, we will be conducting a qualitative examination of drug related sentencing alternatives distributed to a national sample of justices involved with addicted felons.

Municipal Alcohol Policy and Aboriginal Communities

Dr. Gliksman, Ron Douglas, Margaret Rylett and Claire Narbonne-Fortin have been adapting the Municipal Alcohol Policy approach to be culturally appropriate for First Nations Communities. This adaptation covers three potential environments where alcohol is used and it has been implemented, in part, in a number of communities as a demonstration project. We will use the findings from the demonstration project to develop a research proposal for expanding Community Alcohol Harm Reduction Policy development to other First Nation communities in Ontario and Canada.

Alcohol Policy Developments in the U.S.

Drs. Thomas Greenfield and Norman Giesbrecht have been working on a project, funded by the Robert Wood Johnson Foundation, that focuses on American policy developments with regard to alcohol advertising, pricing and institutional change and the roles of alcohol industry, public opinion, research and political change in their outcome. This study will inform the general public and policy-makers about the factors that contribute to effective, sustainable alcohol policies in the American context.

Canadian Alcohol Policy Project

In this project, funded by the National Health Research and Development Program, Health Canada, Dr. Giesbrecht has examined several Canadian federal and provincial developments in alcohol policy, including privatization trends in alcohol retailing at the provincial level. At the national level, we investigated the effects of changes in trade, smuggling, proposed warning labels on alcohol bottles, intoxication as an excuse for violence and deregulation of alcohol advertising controls as factors that may have aided or hindered the development of these policies.

Canadian-Nordic Alcohol Policy Project

In this ongoing project, funded by a number of Scandinavian agencies, Drs. Giesbrecht and Thor Norstrom are conducting a study that focuses on trends and patterns in access to alcohol and alcohol policy in Canada and the provinces since 1950. By studying changes in access, per capita consumption and drinking-related damage using time series analysis and other methods, they hope to draw out implications for alcohol policies in the Nordic countries.