Health Committee on May 6th, 2024

[The Chair, Liberal, Sean Casey]

Mr. Johns, please contain yourself. He said that your comments were wacko. That may be unpleasant to hear, but it wasn't an attack on you. Your interruptions do not constitute points of order. I would ask that you wait your turn. You are on the speaking list; you're third.

Dr. Ellis, go ahead.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that, Mr. Chair.

I don't mean to disparage the member. As I said, his comments are wacko. I think it is important to understand that the citizens of this country no longer want to tolerate ongoing difficulties with the experiment. It has been termed by my friend and colleague Dr. Hanley from the Liberals as an experiment from the outset. It was part of the motion of this study here at the health committee.

I'll end my comments there. Thank you, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Madam Brière, please go ahead.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Mr. Chair.

First, Dr. Ellis is clearly conflating decriminalization with drug use in public spaces.

Second, the government of British Columbia didn't request an end to decriminalization. Rather, it asked that its request be reviewed.

Regarding the motion, since the minister has already appeared before the committee and there will be a four‑hour committee of the whole in the House before the end of the month, and given our upcoming trip next week during which we'll have the opportunity to meet people on the ground and ask all our questions, I suggest amending the motion to read as follows: “that the study of the opioid epidemic and the toxic drug crisis in Canada be extended by two meetings to invite further witnesses.”

[The Chair, Liberal, Sean Casey]

All right, we have an amendment. The amendment is in order. The effect of the amendment is to replace identifying the minister and the number of meetings, simply bringing it down to two additional meetings to hear from witnesses.

The debate is now on the amendment, and Mr. Vis has the floor.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Thank you, Mr. Chair.

I won't take too much time. I am a British Columbian, and it's nice to see you again. It's been a few years.

The Leader of the Opposition mentioned the Abbotsford Soccer Association in question period today. My son was playing on the weekend, and I asked Coach Gill, the youth coordinator for the first kicks program, about what was taking place and the letter that was featured widely in our local regional media.

Decriminalization in British Columbia has led to widespread chaos. There were kids who saw a woman get raped at our soccer field last year, and she was on drugs when it happened. The stuff is devastating. My office is adjacent to Haven in the Hollow, which was a homeless shelter that became a safe injection site. During the pandemic, it became a place where people could openly do any drugs they wanted and consume alcohol. It brought chaos to the neighbourhood where my office is. The Legion came to me a few weeks ago. It's less than a block away from the site, and every day they have to ask people not to consume meth, crack and other hard drugs on site.

The decriminalization order put forward by the government was very clear that it wouldn't apply to those types of places, but since it has been unleashed, the consequences have been grave for the residents of the Fraser Valley. I'll note as well, in the context of decriminalization, that in the health region where I reside, the Fraser Health region, we had, I believe, last year—and don't quote me on this—one of the highest per capita death tolls after Northern Health in British Columbia. At the same time as we had a record number of deaths proportionate to the rest of the population in British Columbia—the second- or third-highest number—there was no increase in funding to help people get clean and help people access a detox bed and a site that would give them the treatment they needed.

Decriminalization is killing a lot of British Columbians, and I would encourage everyone to vote for this motion. I think it's a good one.

Thank you for your time.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Vis.

Next we have Mr. Johns, and then it's Dr. Powlowski and Monsieur Thériault.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Thank you.

First, in terms of extending the number of meetings, there are lots of reasons why we should have more meetings.

I look at Fort McMurray. They had an all-time high drug poisoning death rate in the last year. Alberta's death rate from toxic drugs has gone up 17% over the last year. They're on a trajectory to pass British Columbia by June. There are 43.3 deaths per 100,000. British Columbia is at 46.6 deaths per 100,000. Lethbridge has triple the toxic drug death rate of British Columbia. That's all without decriminalization and without safer supply. Regina has a 43% greater death rate per 100,000 than British Columbia.

It is absolutely a tragedy what is happening in the provinces without safe supply and without decriminalization. We are seeing a literal disaster happening. It's a health emergency. In fact, up in Alaska, which neighbours those provinces, there was a 45% increase in toxic drug deaths last year. It's a Republican state without safe supply and without decriminalization.

We're constantly hearing about the need to.... We heard from the police chiefs association that the diversion of safer supply is not what's killing people; it's deadly fentanyl. We heard from Dr. Pauly today that 85% of deaths are from fentanyl, and only 3% of people who died had traces of hydromorphone.

The police were clear that criminalizing people who use substances causes more harm. That's what we heard from the expert task force and the police chiefs association, and what we continue to hear from chief medical health officers, including every single chief medical health officer on Vancouver Island. They have been unequivocally clear that criminalizing people causes more harm and that safer supply reduces deaths.

We have peer-reviewed data that the very small amount of safe supply that is used to replace toxic street drugs—which are unregulated, and manufactured, marketed and sold by organized crime—reduces the risk of toxic overdose deaths. We have had a multitude of reports. I believe the chief medical health officer for Toronto is also asking for the government to consider decriminalization.

We've heard from the police chiefs association repeatedly about the fact that there is no going back on criminalizing people. “Those days are gone.” That is a quote from the president of the British Columbia Association of Chiefs of Police. They were looking for tools in British Columbia to move people out of public spaces so that they could make sure the public felt safe. At the same time, they were clear that they want to see more safe consumption sites.

I'm disappointed that we won't be in Lethbridge, because Lethbridge is where they closed a safe consumption site, and Lethbridge is ground zero in Alberta. It has the highest death rate in the province of Alberta. It has three times the toxic drug deaths that we're seeing in British Columbia. In Medicine Hat, there are 63 deaths per 100,000. That is almost 40% greater than the death rate we're seeing in British Columbia, and it's almost the highest death toll we've seen in any health authority in British Columbia.

I just wanted to highlight these really important reasons why we need to have more meetings. I support having two more meetings. I hope we can centre one of those meetings on getting a purely indigenous perspective. I think we should invite Ms. Hopkins back, out of respect, since this meeting might be cut short and her testimony might be cut short and minimized. I would hate to see that happen, especially when we know that indigenous people in my home province are seven times more likely to die from a toxic drug overdose. In her community, it was 36 times more.

We also heard from Ms. Petra Schulz from Moms Stop the Harm, when she testified, that the recovery model in Alberta is just a name. We heard that for a nation south of Lethbridge that was promised a therapeutic treatment centre, the only shovel that's gone in the ground was a ceremonial one three years ago. People are waiting. They're waiting up to six months to get help in certain parts of Alberta. That's if they want help.

The goal should be to keep people alive. Harm reduction, treatment and recovery go hand in hand. We don't need to have one without the other. This is a crisis that is ravaging North America. It is skyrocketing in Conservative provinces and Republican states. We need to change direction. We need to work collectively.

In Portugal, politicians were successful when they got out of the way and let the experts lead with evidence-based policy, evidence-generated policy and peer-reviewed research. That's how they moved forward. I can't think of another health issue where politicians are having their say like this and interfering with what is truly a health issue.

I support going to two meetings. I also wanted to make sure that my comments were on record.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Johns.

Dr. Powlowski, please go ahead.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I would like to get back to the expert witnesses we've invited here and not listen to other MPs wax on about their views on this subject. I was certainly tempted to move a motion to adjourn debate, but I won't.

Can we not all decide to vote on this? There seems to be unanimity. Let's vote and let's get back to the witnesses. We are doing a study on this subject. We invited these people here to ask their opinions, and I'd like to get their opinions.

Thanks.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Powlowski.

Mr. Thériault, you have the floor.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I find it quite ironic that a motion is being tabled to hold more meetings and hear from further witnesses, while our witnesses are being sidelined today. We had many questions to ask them.

I'll be brief, so as not to contradict my previous statement. I said I was willing to extend the duration of this study. I believe we can trust ourselves. We want to present recommendations that will matter and not just be shelved. We'll be going to see what's happening on the ground. I would have been very comfortable with extending our study. If, one day, we realize that we need four meetings, we'll hold four meetings.

However, for today, I would like to hear what the witnesses have to say. This isn't the first meeting that has been interrupted by a motion. We should perhaps take a look at how the committee works. I would rather discuss our business in a subcommittee than during a study, where we make a spectacle of ourselves in front of witnesses about our understanding of the issue. I find it disrespectful. I'll stop there.

I'm ready to hear any proposals. However, when we have witnesses with us, let's ask them questions so that they can provide information.

In two and a half minutes, I would like to ask the remaining witnesses what they think of the situation in Vancouver and what they think of criminalization being reinstated in British Columbia.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault.

There are no further speakers on the list. I presume that we are ready for the question.

The question is on the amendment. Just to be specific, the amendment is to delete the following words from the motion: “That the committee invite the Minister of Mental Health and Addictions and Associate Minister of Health before the committee for no less than two hours; and”. It would also change the word “six” to “two”.

The amendment would be the following: “That the study of the opioid epidemic and toxic drug crisis in Canada be extended by two meetings to invite further witnesses.”

All those in favour of the amendment?

(Amendment agreed to)

(Motion as amended agreed to)

The motion is adopted unanimously.

Thank you, everyone. That brings us back to the witnesses.

Mrs. Goodridge, you have 47 seconds left in your turn.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you for that, Mr. Chair.

I'll go really quickly to Dr. Pauly.

More people are dying in British Columbia despite both safe supply and decriminalization. Why do you think that is?

[Dr. Bernadette Pauly]

They're dying because 85% of deaths are caused by a toxic, unregulated drug market, and we haven't adequately scaled up interventions like harm reduction and treatment. It's a combination of those things that will reverse the trend.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Do you believe recovery from addiction is possible?

[Dr. Bernadette Pauly]

I believe recovery is absolutely possible, and it is an individual journey. There are many pathways to recovery.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge.

I'll go to Dr. Powlowski, please, for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Dr. Pauly, I'm sorry for putting you on the spot, but help the committee out. In response to Mr. Thériault, who said that the experts seem to have different opinions as to the evidence for safe supply, you said that you did a peer review and it seemed to pretty overwhelmingly show the benefits of safe supply.

Let me just point out what else our committee has heard. We asked Health Canada to appear before the committee. We had the experts who I think were behind approving B.C.'s request, and they seemed to be in favour of safe supply. They themselves admitted that there wasn't very good evidence for the benefits of safe supply. I would note the B.C. health officer, in a review of prescribed safer supply, said:

Most of the limited published peer-reviewed studies lack a control or comparison group and the actual intervention received by study participants is in most cases a combination of broader access to wrap around health services including [safe supply]...and primary care, making it difficult to attribute any benefits to PSS alone.

They suggested that they need to have more studies.

The Stanford-Lancet commission, which looked at the opioid crisis—and I would point out that these aren't a bunch of right-wing fanatics—in their study said, “the evidence clearly shows the folly of assuming that population health inherently improves when healthcare systems provide as many opioids as possible with as few possible regulatory constraints as possible.” They, too, were against safe supply. We talked to the head of that commission, and he said the problem with safe supply is that basically you're replicating what has caused the problem to begin with, which was doctors prescribing too many narcotics, people getting on them and then people having trouble getting off them.

Do you continue, though, to say that no, the evidence is clear that safe supply is good?

[Dr. Bernadette Pauly]

I really appreciate that question about the science, because it has been very confusing and disturbing to see the way that some of the debates have played out.

To begin, many of the citations that you provided preceded 2020 and were from the very early days of the development of the body of evidence on safer supply. Since 2020, it's doubled. In fact, some of the strongest evidence has emerged in about the last six to 12 months. Our team is obviously at the forefront of producing evidence in British Columbia, where we are seeing positive impacts.

Yes, I stand by my statement. After a review of over 40 studies, the findings were overwhelmingly positive. What I really want to urge this committee to do is separate ideology from evidence. I don't think any of my colleagues wouldn't say we need more treatment, yet we know there are still challenges with treatment. People come out of treatment and do relapse. We need to look at what kind of comprehensive system we're creating instead of creating these ongoing tensions.

I'll stop there if you have a follow-up.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

The B.C health officer's report was quite recent, as was Health Canada's, and after looking at the evidence, I certainly wasn't overwhelmed with it. However, let's change the subject.

Your study wasn't a randomized control trial, which is the gold standard, and the validity of your results depends on how well you matched the people getting safe supply with those who weren't getting safe supply.

One of my concerns with your study—and you can correct me if I'm wrong—is the comparison group, the people who weren't in safe supply. You got those names from various places, one of them being the discharge abstract database, which, in my understanding, is from hospital records of people who had been admitted for either a diagnosis or something to do with using opioids. My concern is that in your comparison group, you have a sicker population, because they've been in the hospital recently, either because they overdosed—

[The Chair, Liberal, Sean Casey]

Dr. Powlowski, you're out of time. If you could get to a question, we can get a short answer.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

She's heard my question. I guess I get no response for her answer, but am I wrong?

[Dr. Bernadette Pauly]

Is it possible for me to answer?

[The Chair, Liberal, Sean Casey]

Do so as succinctly as possible, Doctor.