Public Safety Committee on Oct. 27th, 2014

[Hilary Geller]

Information that's already available would presumably be relatively easy to put into a report and submit.

I'd note that almost half of the criteria say “information, if any”. So it is recognized that in certain circumstances the information may not be available. Then all the applicants would need to do is show they had addressed that and that the information is not available and why it's not available.

I'd also mention that a number of these criteria are very typically ones that we ask for in various circumstances, including with InSite in the past, around criminal record checks, security of a facility, plans for disposing of controlled substances, etc. Many of these are I think widely understood, at least with InSite.

[Marjolaine Boutin-Sweet, NDP, Hochelaga, QC]

Your reply involves one aspect that scares me a bit. It concerns the discretionary powers of the minister.

If several of these criteria have not been met, can this mean that the minister will for that reason not approve the request?

[Diane Labelle]

As we already mentioned, the minister has to use the criteria with public health and safety in mind. Everything will be assessed on a case-by-case basis. We will determine if the health and public safety criteria are being met.

Finally, the minister understands very well that her decisions have to align with those of the Supreme Court of Canada, as well as with the Canadian Charter of Rights and Freedoms.

[Marjolaine Boutin-Sweet, NDP, Hochelaga, QC]

Could you summarize the discretionary powers of the minister and tell us at what level they apply?

[Diane Labelle]

There is a certain assessment of evidence and information at all levels. In some cases, if evidence or information is not available, it is difficult to see how the minister can arrive at a conclusion. In this case there is a certain amount of information, and I think that this one is quite reasonable.

The Supreme Court does not require that the minister arrive at a certain conclusion, or not. The court demands that the minister take into account public health and safety considerations, and that everything be in accordance with the charter. Whether the information is there or not, she is going to have to make a decision in light of those factors.

[The Chair, Conservative, Daryl Kramp]

Fine, thank you very much. The time is up now.

We will move to Mr. Richards, please, for five minutes.

[Blake Richards, Conservative, Wild Rose, AB]

Near the conclusion of your exchange with Ms. Ablonczy, she asked about the national anti-drug strategy, and you talked about the three pillars of that: enforcement, treatment, and prevention. I would like to just give you a bit of a chance to elaborate more on the national anti-drug strategy, particularly in terms of the treatment action plan and the prevention action plan. Could you give me and the committee more detail on some of the activities that the department is undertaking to help people with drug dependency and to help prevent drug abuse? Could you give me some details on some of the programs that are being undertaken there and some of the initiatives the department is currently working on?

[Suzy McDonald, Associate Director General, Controlled Substances and Tobacco Directorate, Healthy Environments and Consumer Safety Branch, Department of Health]

As Hilary mentioned earlier, the national anti-drug strategy is really built on three pillars. Those pillars are all designed to reduce or eliminate the negative impacts of illicit drug use and contribute to healthier and safer communities.

The health portfolio invests approximately $126 million a year to address addictions and illicit drug use in Canada. Since 2007 Health Canada has funded 139 projects to discourage illicit drug use among youth through the drug strategy community initiatives fund. Health Canada also provides $13.2 million annually to provincial and territorial governments and other key stakeholders to strengthen substance abuse treatment across Canada through the drug treatment funding program. As our minister noted, prescription drug abuse is now also being addressed through these funding programs.

Specifically with regard to prevention, the program provides approximately $9.6 million in contribution funding, and this supports a variety of recipients in delivering health promotion and prevention projects that facilitate the development of national, provincial, territorial, and local community-based solutions to drug use among youth aged 10 to 24, and promote public awareness of substance abuse issues.

More than 139,000 youth, 11,000 parents, and 2,000 work or schools have been reached through these programs. Projects have focused on capacity building: they've resulted in more than 13,000 youth and almost 5,000 teachers being trained on various topics, including peer leadership, facilitation, and life skills.

I'd note that an evaluation of that prevention program did note that the program increased awareness of healthy choices, increased perceived overall awareness of illicit drugs, increased awareness of potential problems that can affect people who use illicit drugs, decreased the likelihood of trying or regularly using marijuana, decreased the likelihood of trying or regularly using other illicit substances, and improved overall community engagement and capacity.

With regard to treatment, the program provided funding to 29 projects across Canada. I'd say that, for example, the introduction and increased reporting against national treatment indicators has provided consistent measures for treatment systems across the country for the first time. The production of evidence-based standards and guidelines has led to consistency and quality of treatment of care. Prior to the program, many PTs reported working in silos where collaboration with other sectors or regions was not a priority. Evidence shows that the program has helped to establish conditions necessary to support collaboration, including the development of a national knowledge exchange platform for all of these projects.

I can go on a little bit further in terms of first nations and Inuit health. We've invested $12.1 million to improve quality access to addiction services for first nations and Inuit. This funding has contributed to the reorienting of 36 treatment centres to more effectively meet community needs: services for women, youth, people with co-occurring mental health issues, and prescription drug abuse. It has contributed toward an increase in the number of treatment centres receiving accreditation: 82% of treatment centres were accredited in 2013, which was up from 68% in 2010. It has contributed toward an increase in addiction workers receiving training and becoming certified: 434 community-based addictions workers and treatment centre counsellors were certified in 2013, and this was up from 358 in 2010. Now 78% of all treatment centre counsellors are certified, up from 66% in 2011.

You can see the enormous impact these are having on prevention and treatment, both in first nations and other vulnerable communities, and particularly among our youth, parents of youth, schools, and teachers.

[Blake Richards, Conservative, Wild Rose, AB]

That is great. Thank you. You provided a very good overview in that regard.

Actually, the next question I wanted to ask you was about first nations communities, so it's almost as if you anticipated that. I appreciate that.

How much time do I have? I have about a minute.

Maybe what I would do then is just ask, on the prevention side and on the treatment side, if you could give me one example, very briefly, of a specific program, if you have that available to you.

[Suzy McDonald]

The Centre for Addiction and Mental Health received over $930,000 from 2010 to 2014 for the national youth screening project. This has led to piloting of standard screening and assessment tools in 10 communities across Canada, which quickly and reliably identify youth who may have one or more mental health or addiction problems. It improved pathways to care for youth, with screening tools implemented by front-line workers, working with youth in other sectors including mental health, youth justice, child welfare, education, and housing. It increased early identification and intervention, with more than 500 front-line workers trained and more than 1,300 youth screened using the common screening and assessment tool created under this funding. That's with regard to treatment.

Then with the drug strategy community initiative fund, one example under there would be that the Council on Drug Abuse is presently receiving close to $1.4 million for a three-year drug abuse prevention program for aboriginal and vulnerable youth in northern and prairie school communities. This project is training local educators on the youth drug prevention initiative, engaging youth in the youth advisory councils, and delivering in-class education programs that increase the awareness of harmful effects of drug use and provide youth with life-coping skills to help build resiliency and ultimately avoid substance abuse.

Thank you.

[The Chair, Conservative, Daryl Kramp]

Now we will go to Ms. Davies, for five minutes.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much.

I want to follow up on a couple of my earlier questions. First of all, we only have two such facilities in Canada. There's InSite and then the Dr. Peter Centre, as I mentioned, in Vancouver. Does Health Canada consider them to be health services, health facilities?

[Diane Labelle]

We did find that these types of services were health services.

[Libby Davies, NDP, Vancouver East, BC]

When I asked earlier about what other health services would have to go through such extensive criteria, Ms. Geller I think replied that because the federal government doesn't deal with health services, it's provincial, you don't know about what other criteria, and I accept that.

It leads me to think the Supreme Court of Canada decision didn't dictate that the minister had to have all of these criteria. The minister's role is for an exemption under the Controlled Drugs and Substances Act, which is federal of course, so that's entirely appropriate. That's why InSite and the Dr. Peter Centre presumably had to come to the federal government.

It's very possible, and in fact it might have been more logical and rational, that the federal legislation could have said if there's provincial approval or support, if there's municipal approval or support, the minister will give the exemption. So with all of this nonsense of a to z, and principles, and this and that, in actual fact the minister's requirement for the exemption could have rested on this is a health service, it's a provincial requirement, and that's where it ends up being.

Am I correct that this would have been an acceptable course of action from the court ruling?

[Hilary Geller]

We've been guided in crafting this legislation by the Supreme Court decision where the Supreme Court said there were five factors that must be considered in making a decision on an exemption. What this bill does is it elaborates on those.... It doesn't elaborate on those factors, it details very specifically what an applicant needs to provide in order to give the decision-maker an indication of how those factors are being met.

[Libby Davies, NDP, Vancouver East, BC]

It's an interesting use of the word “elaborate”. I would say it more than elaborates. It takes us to the ultimate position of criteria, almost into absurdity in terms of what is required because what the Supreme Court decision said.... And I know we're all reading it and quoting different bits and pieces, and you're right it did talk about the appropriate balance between public health and safety goals, but then it said the minister should generally grant an exemption where the evidence—not opinion—indicates a supervised injection site will decrease the risk of death and disease. That seems pretty straightforward.

So how did we end up with this elaborate concoction of criteria that seem to go far beyond what is reasonably to be expected from the Minister of Health to give an exemption only on one element, which is the Controlled Drugs and Substances Act? Is it really not a provincial jurisdiction because it is a health service?

[Diane Labelle]

It remains that the exemptions are exemptions to the Controlled Drugs and Substances Act, and the Controlled Drugs and Substances Act is at the federal level. The exemption powers are with respect to exemptions from a federal law.

The Supreme Court did not put that into question whatsoever.

[Libby Davies, NDP, Vancouver East, BC]

And I'm not disputing that either.

[Diane Labelle]

The action by provincial authorities is neither contemplated nor authorized by the CDSA. The minister is not inserting herself into provincial services. She is not asking that these be set up or not set up. The provinces and the local authorities can work towards that goal.

Ultimately the minister must decide if the exemption to the criminal law power is in accordance with public health and public safety goals that underlie the reasons for the CDSA and whether granting that exemption or not is also in keeping with section 7 of the charter.

[Libby Davies, NDP, Vancouver East, BC]

I would say on the contrary though that the minister is setting himself or herself up to be the ultimate authority on whether or not something is approved, and even then it's not clear because it's so discretionary.

It could have been--

[The Chair, Conservative, Daryl Kramp]

You're out of time, Ms. Davies. Thank you very much.

We'll now go to Mr. Falk, please. You have five minutes.

[Ted Falk, Conservative, Provencher, MB]

Thank you, Mr. Chairman.

I'm going to get back to some of my earlier comments and questions about the community involvement that's articulated in this proposed legislation.

Could you tell the committee how this proposed legislation would allow for a broad range of stakeholders? Could you describe the range to provide their opinion on an exemption application for an injection site?

[Suzy McDonald]

As we've already noted, there are three levels of consultation. One is the letters of opinion that would be required from the PT ministers responsible for health and public safety, local government, local public health officials in the province, and the head of the local police force. This is obviously relevant to the establishment and operation of the site and assessing how public health and public safety concerns would be addressed.

Two, consultations would also be required with professional licensing authorities for physicians and nurses and community stakeholders. These consultations allow those who are involved in the community, who might have insight into how these communities are being impacted, to bring forward their ideas and their opinions through the consultative process. Applicants would also be required to address any concerns or provide a description of how they would address the concerns that are raised by these community members.

Three, and we've talked about it a bit before, is the 90-day public comment period that the minister could choose. This would really impact the community in the broadest sense. It considers the views of those working and living in the communities, and those who would be impacted that the applicant might not have reached out to through either the letters or their consultations with the community stakeholders.

[Ted Falk, Conservative, Provencher, MB]

Could a really broad range of participants and stakeholders provide comment, data, or research?

[Suzy McDonald]

Some of those are laid out in the criteria, and we're quite clear on the ones that are needed there. Indeed, with regard to that 90-day public consultation period, a broad range of stakeholders, particularly those working and living in those communities, would be consulted.