Health Committee on May 29th, 2008

[The Chair, Conservative, Joy Smith]

Thank you, Madame Gagnon. Your time is up.

Ms. Davies, go ahead, please.

[Libby Davies, NDP, Vancouver East, BC]

Thank you, Minister Clement, for appearing here today. I've listened to your presentation carefully, and in fact I've followed every public utterance I could find that you've made. This issue of what's going on in the downtown eastside is very dear to my heart.

There are a number of comments I'd like to make. I think what's really at the heart of this debate, what is disturbing to me and a growing number of people in Canada, is how the Minister of Health makes a decision based on public policy. You have said that it's a difficult decision to make. But what's at the heart of this debate is how you as the Minister of Health make a decision about whether or not Insite continues and how you respond to the recent court case.

I find this very disturbing. On the one hand, you have continually said that you are seeking more information, that you want more studies. Even today in your presentation you have said that you'll be looking for new evidence or new assessments. On the other hand, you are asking the Minister of Justice to appeal the important decision that was made on Monday in the B.C. Supreme Court. Moreover, the so-called anti-drug strategy that your government brought in has clearly dropped harm reduction. Now you're trying to say that harm reduction is part of the other three pillars, but it was clear what the continuum was. I don't think anybody doubts that the government consciously dropped harm reduction. That's being cut out of your program. When we look at Bill C-26, which brings in mandatory minimum sentencing for drug crimes, we can that see the direction you are going in is enforcement. That's where the priority is.

I think we face a very serious situation. As the Minister of Health, you are in effect denying all of the research that has been done. I don't think it's acceptable that a minister should be able to cherry-pick one police officer or one study that wasn't even peer-reviewed.

Yes, there are diverse opinions, but your job as the minister is to weigh up all of the evidence, just as Justice Pitfield did, who is actually a conservative judge. I find this very disturbing. It raises questions about how the government is making public policy decisions.

Second, I think it is problematic when things are presented as either/or. Somehow if you're for harm reduction, you're against treatment. No one is saying that treatment is not a critical part of the solution. We need more treatment. But as we heard earlier today, to have low-threshold programs that draw in chronic and hard-to-reach users is a critical public health policy. I don't understand why you don't get that. I really don't.

The only conclusion I'm left with is that it has to do with an ideological agenda that you cannot deviate from. The research would show us that engagement at the street level leading to other interventions—treatment, detox long term—is part of the continuum. So I can't understand why you don't intellectually understand this.

The four-pillar approach that was begun in Vancouver was a bottom-up approach. It's quite concerning that a government would refute all of the work that's gone on at both the local and provincial levels. We now have everybody on board with this in B.C. and across the country. You're now the last remaining barrier to Insite's continuation.

I have two questions for you. Even if treatment were available to everybody who needed it, the most extensive programs, we'd still probably be capturing only 10% to 20% of the people who need it. What is the obligation for the remaining 80%?

The World Health Organization has guidelines that make it clear that, as public health policy, we have a responsibility to keep people free of disease and to keep them healthy. That's what Insite and harm reduction programs are partly about.

Are you not abandoning your responsibility under the WHO guidelines as the Minister of Health? Even if you're putting everything you can into treatment, you're still leaving a lot of people outside the loop, particularly those people who are very difficult to reach.

My second question is this. What is your understanding of low-threshold services? I'll stay away from the term “harm reduction” because it's like a big, red flag at this point. But what is your understanding, as the Minister of Health, of low-threshold services, and what is your government doing to provide those kinds of important low-threshold services to this drug-user population?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you for your comments. I appreciate them.

First of all, let me state for the record and make it crystal clear that this was never about closing Insite. I don't have the power to close Insite. I didn't want Insite to be closed. It was about whether there would continue to be an exemption under the Controlled Drugs and Substances Act.

Insite does other things. They do some referral, not as much as I'd like, but they do it. They do treatment now. They didn't at the beginning, but now they do. They do needle exchange. I have nothing against needle exchange. They distribute condoms. I have nothing against the distribution of condoms. These are all aspects of harm reduction that our government has no complaint about.

I want to put that on the record, because sometimes I read statements like “Clement is going to close Insite” or “Clement wants to...”. I don't have the power to do that, and second, I don't want to do that. So I want to put that very clearly on the record.

My understanding of low-threshold services includes needle exchange, condom distribution, and a number of other facets of activities that occur at Insite or around Insite. We have no difficulty with that. Indeed, we want to support that as best we can. That's why I announced $10 million directly for the downtown eastside, to get the teams out there on the street to identify people who can be helped, and to specifically....

When I visited the downtown eastside, I was appalled by the lack of beds available for sex workers, most of them women. It was appalling, and quite frankly almost criminal. One of the things I want to do with that $10 million is make sure the women of the downtown eastside, the sex workers of the downtown eastside, have beds specifically available to them. And I'm very proud of that announcement of two weeks ago.

Second, you asked about the treatment impacting on 10% to 20%. The injection site only impacts a certain number of people in the downtown eastside, and those who use it only use it 10% of the time. So when we talk about the panacea, the fact of the matter is that the injection site has been tried and the evidence is now in that very few people use it—97% don't use it, and those who do use it only use it for 10% of their injections. So if I want to do something for Canada, if I want to do something for the downtown eastside, I will put my eggs in the basket of treatment and prevention.

[Libby Davies, NDP, Vancouver East, BC]

Minister, with all due respect, you cannot blame Insite for the fact that it only serves 5% of injections.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

It's not a question of blame.

[Libby Davies, NDP, Vancouver East, BC]

It was a pilot project. If anything, that would be an argument that it needs to be opened 24 hours a day and that we need to have other facilities in other communities, some in the downtown eastside and some in other neighbourhoods, in order to provide that service, just as we would have with needle distribution.

If you say you don't want to close Insite, why are you saying today that you're going to be appealing or you're going to ask the Minister of Justice to appeal the court decision?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I think I just spent 25 minutes telling you why, so I won't go over that ground again.

[Libby Davies, NDP, Vancouver East, BC]

But the position you hold is completely contradictory.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Insite does a number of things. One of the things they do is facilitate injection drug use. They need an exemption from the Controlled Drugs and Substances Act in order to do so.

The issue before me was whether that exemption would continue. That was the issue before the court, or it should have been. That will certainly be the issue on appeal, if appeal is decided upon.

I just wanted to put it on the record because I hear people saying, “Clement is about to close Insite”, or “Advocate saying Clement wants to close Insite”. It's not true. It simply isn't true. I don't even have the power to do it.

[Libby Davies, NDP, Vancouver East, BC]

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Minister.

Mr. Fletcher, I understand you're sharing your time with Mr. Tilson.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

I'm going to try. How much time do I have, Madam Chair?

[The Chair, Conservative, Joy Smith]

You have 10 minutes.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Great.

Thank you, Minister, for coming to committee. In particular, thank you for adjusting your schedule due to the votes today. I think people should understand that there was an interruption in today's meeting, and it would have been very reasonable for the minister to have cut short his visit to our committee. He chose not to. He chose to be here to answer questions from all parties, and I think that is a refreshing change from perhaps other health ministers in the past who have tried to dodge this issue whenever possible. So I appreciate it.

Minister, let's be very clear here. I know you've said it, but I want to be absolutely crystal clear, black and white. Do you think Insite should be closed down?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

No, I do not. I think there are worthy services that occur there and should continue to occur there. They are funded by the Province of British Columbia through the Vancouver Coastal Health Authority. Indeed, we have added to the budget of the Vancouver Coastal Health Authority with our $10 million announcement for the downtown eastside in terms of the treatment services.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

We've heard about science a lot today. I wonder if you would expand on your comments about public policy and the importance of public policy in making these types of decisions.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I think science is one of the issues that must be taken into account when it comes to a public policy decision. Certainly, as we've discussed, there are many different ways to look at the science; there are many different ways to look at the advocacy surrounding the science. Sometimes the advocates advocate the science and sometimes the scientists advocate their conclusions. We've had a state of that in this particular case.

That's all part of the process. Indeed, I want to state for the record, if I might, that should another exemption application come forward, I have a duty to once again look at all the evidence and once again turn my mind to it in a way that gives due process. So I'm not resigning from that obligation that I have as health minister. But science is part of it.

Then when we get to the public policy, there are other issues. When you start to peel away at crime, for instance--and I've heard some of the advocates say that of course they know crime didn't go up. Okay, well, let's look at what happened when Insite was created and did open stores: 65 more police officers in a five-block area were added to the mix. It is no surprise to me that crime did not go up.

But as you heard through some of my remarks, when you look at what has to be accomplished in order to get the $35,000-a-year cost of the fix, it's $350,000 worth of crime. That's a cost to society. That's more innocent victims being affected by the scourge of this terrible disease. So, to me, the public policy is clear: get people off drugs and ensure that as many people as possible don't get on the drugs in the first place.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

I have two more questions, and then I'll pass to my colleague, Mr. Tilson.

Do you have any concerns about the medicalization of illegal drugs? Secondly, are illegal drugs, like heroin, harmful in themselves, or is it possible to live a normal life with an addiction to a substance like heroin?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

On the latter, I'll leave it to Dr. Butler Jones to answer that one.

Certainly, the trend has been to what is called “medicalize” illicit injection drugs, and perhaps other drugs as well. By that, what we are saying is that somehow this is a health choice. It's not a health choice; it's an addiction. Call it what it is: it's an addiction, not a health choice. It leads to very unhealthy consequences. To call it a “medical choice” or a “health choice” really condemns people to a slow, painful, and terrible death. I don't want to do that, and I don't think any Canadian wants to do that.

In terms of the second question, I don't know if Dr. Butler Jones wants to weigh in on that.

[David Butler Jones]

Obviously, the greatest harms come from the connection with criminality, disease through unsafe needles, or social and other problems. The use of drugs is extremely complex, as are addictions, whether it's to alcohol, nicotine, heroin, or other drugs. They often have similar effects, similar problems. Some people manage them better than others. Designating the implications would make for a long discussion. It's often very individual.

[The Chair, Conservative, Joy Smith]

Mr. Tilson.

[David Tilson, Conservative, Dufferin—Caledon, ON]

I have two areas I'd like to ask the minister to comment on.

The first has to do with safety. I understand and support the principles of needle exchange, the treatment, condom provisions, the counselling. I think we all encourage that, but it's a safety issue. I look at Alcoholics Anonymous, where the whole principal is abstinence.

We're lobbied continually by groups such as Mothers Against Drunk Driving. We even passed a law some time ago about being impaired while driving a motor vehicle.

As I understand this, someone can drive up to this site, park their car, take their drugs in, receive assistance in being injected under the observation of a government official, and then get back in their car and drive away.

Is that an incorrect interpretation? I'm taking an example that is unlikely to happen, but it could happen.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

It could happen. Not many of them have cars, but—

[David Tilson, Conservative, Dufferin—Caledon, ON]

I would suspect that.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

—I understand what you're trying to say.