Health Committee on Feb. 1st, 2024

[The Chair, Liberal, Sean Casey]

There's a point of order from Dr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

On a point of order, Mr. Chair, can you provide for this committee the actual ruling, showing us exactly where it says, in the books and in the orders, that this is exactly for committees, please?

[The Chair, Liberal, Sean Casey]

[Inaudible—Editor]

Dr. Ellis, you have two minutes and 18 seconds.

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

Well, thank you, Chair.

Do you know what? It's interesting that during this committee, we know very clearly from the Canada.ca website that a few grains can kill you. We know that's true. That would be simply a small amount of sugar, if there happened to be any on my desk. It's a very tiny amount.

I guess the question is this: Do you think it is appropriate, Minister, that now we're going to prescribe that to children?

[Ya'ara Saks, Liberal, York Centre, ON]

I believe the colleague's question was also asked during the previous committee meeting of one of the officials.

What I'll say is that the decriminalization pilot is, first of all, anchored in reducing the level of stigma for those who use drugs to ensure that they get to treatment and get access and care. We've already—

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

Minister, what we're talking about is giving drugs, very potent opioids, to children. The Canada.ca website says very clearly that a few grains can kill you. Is that appropriate?

[Ya'ara Saks, Liberal, York Centre, ON]

Mr. Chair, my colleague did ask this question before. I believe we've already tabled all the proof on safer supply. I'll be happy to table it again for further reference.

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

That's not the question, Minister. My question is this: Do you think you should be giving an incredibly potent synthetic opioid, of which a few grains can kill you, to children? It's yes or no. It's simple.

[Ya'ara Saks, Liberal, York Centre, ON]

Each physician works with their patient on the treatment protocols that work best for them. That is a very unique and important relationship that every patient should have.

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

Thank you very much, Minister. I appreciate that.

Doctor-prescribed opioids are being sold on the streets. A Global News reporter was able to buy 26 tablets of hydromorphone in east Vancouver from the so-called government taxpayer-funded safe supply. The total price was $30, about a buck a pill.

When you saw that report, what did you do, Minister?

[Ya'ara Saks, Liberal, York Centre, ON]

I'm aware of the concerns about diversion. I've said it in this committee before and I will say it again: Diversion is illegal—

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

Minister, what action did you take? What did you do?

[Ya'ara Saks, Liberal, York Centre, ON]

I'm happy to answer, Chair, if I'm not interrupted.

[The Chair, Liberal, Sean Casey]

Yes. Please go ahead.

[Ya'ara Saks, Liberal, York Centre, ON]

I am aware of the physicians' letter. I've actually met with the expert physicians who submitted the letter to me. We also conducted a round table discussion with them with department officials on January 30. We continue to consult with them on ensuring that we safeguard prescriber interventions that are safe.

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

Minister, what I heard you say is that you had a couple of meetings and actually did nothing about it. Well done.

[The Chair, Liberal, Sean Casey]

That's the last question. Go ahead and answer it, and then we'll move on.

[Ya'ara Saks, Liberal, York Centre, ON]

In addressing the toxic illegal drug supply, I say to my colleague that we need to use every resource and tool we have available to us and continue to consult with experts, including those who have concerns about prescriber models.

Thank you, Chair.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Next we'll go to Ms. Atwin, please, for six minutes.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you, Mr. Chair.

Thank you, Minister, for being with us, and thank you to this incredible panel of department officials as well. This is certainly a critical discussion for Canadians.

I'll just pick up on the last piece, on the question around diversion. I know it's an important topic that we'd like to address. I think nobody would be surprised to know that of course diversion is illegal. It's an issue that applies to all prescription drugs in Canada.

We have many doctors around the table, and I'm sure they make tough clinical decisions in their practices in balancing the benefits and risks of intervention. Can you talk about mitigation measures put in place to diminish the risk of diversion?

[Ya'ara Saks, Liberal, York Centre, ON]

I want to thank my colleague for the question.

As I mentioned previously to Dr. Ellis, we take these concerns very seriously, which is why we asked officials to further investigate the anecdotal reports that were made available. We also wanted to ensure we took steps so the pilot projects we are funding have the appropriate and important safeguards, guardrails and measures in place to control diversion.

In terms of actions taken, our officials undertook a detailed assessment of the risk mitigation measures that all federally funded programs providing pharmaceutical alternatives are obliged to have. The outcome of doing that detailed assessment was this: Most programs demonstrated very strong approaches and have a range of protocols in place to mitigate diversion. In the instances where further information or improvements are required, we've instructed officials to reach out to those sites and continue to work with them.

We're committed to saving lives. Some of the steps we've taken on these projects to ensure they implement the practices we want in place to reduce risks of diversion include patient screening, matching drugs to patient tolerance, risk-based protocols for assessing patient eligibility for take-home dosing and patient monitoring.

Actions also include instances related to diversions we were concerned about. We took the option to switch the observed dosing prescriptions, transfer the individuals to a different set of support services or, in some cases, remove them from the program.

We want to ensure that this is as safe as possible. We also understand, as everyone around this table does, that diversion is illegal. We will continue to maintain safety in our programs.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you very much.

Of course, we know there's no one-size-fits-all approach to this. As you mentioned, it's a multi-faceted, pervasive epidemic that we're dealing with in Canada. I am the parliamentary secretary to the Minister of Indigenous Services Canada, so of course I'm going to have a lens on supports for indigenous peoples. With regard to supporting local organizations that conduct this life-saving work, how do we best support the needs of individual indigenous communities, particularly in urban settings?

[Ya'ara Saks, Liberal, York Centre, ON]

I want to thank you for that very important question.

We know that in the overdose crisis, when we look at the numbers and some of the most vulnerable, we see that there are disproportionate numbers within our indigenous communities in terms of risk of death from overdosing. That disproportional impact has to do with decades upon decades of systemic and institutional racism, colonialism and intergenerational trauma. The lack of access to culturally appropriate substance use services and supports has been something our government is committed to addressing.

I'm working with Minister Hajdu, as I mentioned in my opening remarks. We're working hand in hand to ensure mental wellness and substance use supports are in place. We've allocated $650 million in the current cycle to ensure indigenous communities—both on reserve and off reserve in urban settings—are getting the services they need.

[Jenica Atwin, Liberal, Fredericton, NB]

Excellent. This is what I love to hear. Thank you so much.

I'm the member of Parliament for Fredericton. We are one of the first original five sites for the SUAP projects, but we are also struggling with a lot of misinformation. In communities, sometimes there's Nimbyism that happens as well around the safe consumption sites and harm reduction measures.

Can you explain why these interventions provide critical supports to those who use drugs and substances?

[Ya'ara Saks, Liberal, York Centre, ON]

Thank you for the question.

When we look at how we're going to tackle the toxic drug supply that is pervasive throughout the country, persistent and so deadly, we have to look at the full continuum of care in responding to this crisis so that we're meeting people where they're at. Where we meet them is in communities. That's why safe consumption sites are so critical in terms of harm reduction. It's part of the continuum of care and services. Safe consumption sites open the door for those who use substances. Oftentimes, they have their first encounter with health care service providers and outreach providers in order to understand what safety measures they should be considering when using drugs. It provides them with information, resources and options for services towards wellness.

Without that entry door, these people would be home alone, or not even home—somewhere else, in vulnerable situations, and exposed to the illegal toxic drug supply, which is the primary driver of the overdose deaths we're seeing. These safe consumption sites are critical as part of our continuum of care.

Harm reduction—if I may say this very clearly and resolutely in this place—is health care. It is a health care service. I think that once we wrap our heads around that, adopt it and understand it, we can push back the tide of stigmatization and misinformation that we're seeing.