Madam Speaker, last month brought with it a grim reminder for those struggling on the front lines of Canada's opioid crisis. April 14 was the one year anniversary of British Columba provincial health officer Dr. Perry Kendall's decision to declare the overdose epidemic a public health emergency in British Columbia. Unfortunately, despite a year of amplified efforts from municipalities, health professionals, and community volunteers, the overdose epidemic is getting worse across Canada, not better.
The first week of May marked the second time in less than a month that Vancouver Fire and Rescue Services reported more than 150 overdose calls in a week, responding to 168 calls. Vancouver police reported seven suspected overdose deaths for the same period.
That brings Vancouver's total to 148 lives lost to overdose so far in 2017, with 41 alone in April. Only January, with 47 suspected overdose fatalities, was deadlier in the history of British Columbia. The city is on pace to reach 400 overdose deaths this year, double the 2016 number, which was in itself a record. Overall, the province of British of Columbia is on pace for 1,400 overdose deaths in 2017; that again would be a 50% increase over last year.
In April, B.C.'s first responders once again broke the record for suspected overdose calls in a single day. BC Emergency Health Services says it responded to 130 suspected overdoses in the province on Wednesday, April 26, mere weeks ago. The previous record was 121, and that was on November 20, 2016.
Early in 2015, Downtown Eastside fire Hall No. 2 answered about 50 overdose calls a month. By December 2016, that had jumped to 438 as the opioid crisis deepened, according to data released by the city of Vancouver.
In total, Vancouver Fire and Rescue Services reported 688 overdose calls in April, the highest on record this year and a 22% increase from March. Vancouver Fire and Rescue Services has now capped the time spent by firefighters at Hall No. 2 at one year to limit their emotional and physical burnout.
Vancouver's mayor Gregor Robertson has said he feels “incredible frustration and anger” at the preventable loss of life, and directed his comments at the federal and provincial governments. He said, “This crisis is B.C.’s most tragic public health emergency in decades, and yet urgent health-care interventions that could immediately save lives are not being facilitated.” City councillor Raymond Louie has described the situation as a disaster.
As the death toll increasingly mounts, it is difficult to understand exactly what the federal government is waiting for or how it can claim progress is being made. It is time for Ottawa to stop overstating this progress and start responding to this crisis with the urgency and resources that it deserves.
Despite repeated NDP attempts to fast-track Bill C-37, the Senate delayed this critical life-saving legislation for three months. That is unacceptable in the midst of a national public health emergency.
In Canada, we had over 2,000 overdose deaths last year. That is an average of six Canadian lives lost every day. This means that in the past three months, while this bill has languished in the Senate, we should expect that at least 500 Canadians have died, perhaps preventable deaths, due to overdoses. However, given the escalation in fatal overdose rates so far in 2017, that number is likely even higher.
On the first day that the Vancouver-based facility Insite opened, it reversed 15 overdoses. Not all of those people would have died of course, but odds are that some of them would have if those overdoses had happened out on the street. Indeed, we have over a decade of clear and overwhelming evidence that supervised consumption sites save lives. There is not a shred of credible evidence to substantiate the baseless fearmongering that has shrouded this debate for too long.
Today, there will be 600 supervised injections at Insite and not one of them will result in a fatal overdose. No one has ever died of an overdose at Insite since it opened in 2003. In the immediate area around Insite, the 40 block area surrounding the facility, there has been a 35% decline in overdose deaths. People who use Insite on a regular basis are 30% more likely to enter addiction treatment.
The three months this bill unnecessarily was held up in the Senate has cost lives in our country, and that should be condemned.
In the end, I cannot imagine a more irresponsible way to respond to a health crisis than by wasting our time rehashing a settled debate on the efficacy of supervised consumption sites, when every day we delay their approval means more overdoses and more lives lost. Yet, after three months of delay, the Senate has now returned the bill to the House with three problematic amendments, motivated by those who, based on a narrow ideology, are opposed to supervised consumption sites, reject the clear evidence they save lives, and really want to obstruct or delay their opening.
These amendments, and the concepts behind them, were specifically raised, debated and rejected at the House of Commons Standing Committee on Health. They are not evidence based, they represent poor public health policy, and they are contrary to the very intent of the legislation.
I will deal with amendment 1.
Before it was amended, the bill set out a maximum 90-day consultation period with the public in order to allow the public to have its say on the site and location of the supervised consumption site. The amendment by the senators proposes to put in a minimum 45-day public consultation for these applications. There is only one reason someone would want to put in a minimum time for public consultations, and that is to slow down an application for a supervised injection site.
There is no doubt that this amendment, were it to pass, will slow down the approval process and hinder quick action in the case of emergency where we may have to open supervised consumption sites very quickly, as have volunteers and activists on the ground in Vancouver as we speak. Some people in Vancouver have opened what are called “overdose prevention clinics”, right now operating courageously outside the law because they know they are saving lives. They are risking their professional credentials. They are risking being arrested. They are risking running afoul of the law. However, they are not waiting around for an application to be approved by the minister. We have had none approved over the last several years, other than this weekend when finally two were approved in Montreal. They are opening these sites to save lives now, yet this amendment, which the Conservatives have put in, would delay the opening of a site even in an emergency basis. I will get to this in a moment, but to their everlasting disgrace, the Liberal government will support that.
Amendment 2 proposes that the minister may appoint a citizen advisory committee for each supervised consumption site. This is unnecessary and redundant because community consultation is already a core criterion in the main part of the bill. The amendment is an attempt to delay supervised consumption sites and try to create public opposition to them. Last, site decisions should be health based. Community input, as I have already stated, is already provided for in the body of the bill.
Finally, amendment 3 would require a person who is operating a safe injection site to offer what is called “alternative pharmaceutical therapy” to each person entering that facility before the person consumes a controlled substance. First, that provision is very likely unconstitutional and outside the power of the federal government. Second, it is unnecessary because treatment options are already part of harm reduction facilities. Had any of those senators bothered to go to Insite and tour that facility, they would have been told that all over that facility anyone entering it is exposed to treatment modalities of all types. Third, such an amendment would be counterproductive because it could have the effect of discouraging some clients from entering and using supervised consumption sites.
Do not take my word for it. When Bill C-37 was being debated before the House of Commons Standing Committee on Health, the Liberal members of that committee said what I just said.
The Liberal member for Oakville cautioned the committee. He said:
...it's really important that we remember what we're doing here. This isn't designing the treatment programs and the whole care model around people with drug addictions. That's the province's responsibility.... What we're doing here is deciding who would be exempted from the Controlled Drugs and Substances Act because of medical conditions.
On the 45-day minimum consultation, the Liberal member for Charleswood—St. James—Assiniboia—Headingley told the committee:
I have a very quick point to the question that was asked about what the harm would be in 45 days [as a minimum consultation period] and whether it would matter.
The question I would ask in return is if there's an urgent enough need....the day that Insite opened, they reversed 15 overdoses. Multiply that by 45 potential deaths. Does that matter? I would say it does.
The Liberal member for Calgary Skyview reminded the committee of this. He said:
Time is of the essence when we are setting up these clinics. This amendment will constrain or tie the minister's hands for 45 days in terms of taking any action. Look at all the lives that may be lost in that delay.
Those are my comments.
It will be interesting to see if those members of the health committee, who sat with me when we heard from witnesses about the opioid overdose crisis due to a New Democrat amendment to study that very issue, will stand and vote with the New Democrats in opposing these three amendments that are contrary to the intent of the bill and actually make opening supervised consumption sites more difficult or more difficult for clients to access.
Those on the front lines of this crisis are unanimously opposed to these amendments because they know that they will delay the opening of critical public health facilities. Canada's New Democrats will stand with them, because we support sound, evidence-based health policy. We support these critical public health facilities that save lives. We therefore oppose these ill-advised amendments and we are deeply disappointed that the Liberal government would ignore evidence-based decision-making by agreeing to support any of them.
There is no reason to believe that this crisis is over, under control, or indeed will not continue to get worse with the proliferation of carfentanil in our communities. We need to fast-track the opening of supervised consumption sites and expand opioid substitution programs. We need better pain management regimens and substantial investments in addictions treatment across the board. These are needed to start the tectonic shift to transform how we think about addiction and to create better policies to address it after a decade of moralizing and criminalizing what is a public health issue.
First we must make long-term investments in mental health programs and addictions research. Canadian mental health experts, including the Public Health Agency of Canada, do not yet have an explicit understanding of the relationship between drug and mental health issues. Research identifying these associations will aid in defining the upstream mental health factors contributing to substance misuse. These factors can form the foundation of targeted and proactive mental health strategies, including community-based treatment and support programs for youth, indigenous people, women, and any other group that requires special support. Research shows that 70% of mental illness begins in childhood or adolescence, and those suffering are twice as likely to have a substance use problem.
In addition, national tracking of co-morbidity of mental illness and drug-related fatalities, similar to what is done in the U.S. and Australia, would enable faster access and a better understanding of trends for use in the development of targeted solutions.
In short, we need to know more, we need to invest more, and we need to devote more efforts to acquire the science and knowledge to address this public health crisis.
Second, we need substantial investments in addictions treatment across the board, and by that I mean significant new funding by all levels of government, in a myriad of modalities, for all distinct populations.
I will stop and point out that my Liberal colleague mentioned the $10 million given by the Minister of Health to British Columbia. That was in 2016. The current 2017 budget tabled in this House devotes zero dollars to address the emergency opioid overdose crisis in this country.
There is currently an unacceptably narrow portal for access to detox services and an appalling lack of publicly funded longer-term treatment beds. In Vancouver, where I have the privilege of representing a riding, it takes an average of eight days to access detox services. That is directly contrary to everything we know about addiction. If someone is willing to get treatment, we have to get them into treatment right away. If we wait even a day, that moment is usually lost.
In truth, effective treatment is really only available to those who can pay or are desperate enough to go into debt to access it. It is not unusual to have to pay $10,000 or more a month to receive timely access to quality addiction treatment facilities in Canada, a shocking gap in our so-called universal heath care system.
This has to change, and we must start building the infrastructure to provide universal access to essential health services for everyone suffering from substance use disorder. Different treatment modalities are needed for different populations, including treatment centres for youth, women, men, and indigenous Canadians. They must be built like any other health care facility and cover treatment for existing ones. It is time to start treating addiction as a bona fide health issue, and that means public coverage for effective treatment universally delivered.
Third, much of the opioid dependence and addiction phenomenon has been driven by millions of Canadians who cannot find effective treatment for chronic pain. This must be acknowledged and addressed.
Access to multidisciplinary pain management programs such as physiotherapy, weight loss, nutrition, massage, and counselling have been shown to improve pain treatment outcomes, as well as reduce the inappropriate use of pain medications, including reliance on opioids, which are highly addictive. Multidisciplinary management of chronic pain also has the potential to produce significant cost savings in health care expenditure by restoring lost workplace productivity and reducing hospitalization.
Access to effective interdisciplinary chronic pain treatment currently varies widely by province and territory, is particularly lacking in rural areas, and wait times are long. The cost is often prohibitive, as visits to non-physician health professionals are paid through private sector insurance or usually out of pocket. Therefore, we must prioritize the development of these chronic pain centres by supporting provincial and territorial efforts to establish and expand these programs.
Fourth, we must expand alternative treatments for people with chronic opioid addictions who are not benefiting sufficiently from available treatments such as oral methadone. For example, the SALOME study found that patients receiving medically-prescribed heroin, or diacetylmorphine, are more likely to live longer than someone receiving methadone maintenance therapy, more likely to stabilize their lives, and more likely to seek long-term treatment. Despite this, Vancouver's Providence Crosstown Clinic remains the only harm reduction treatment centre in North America where diacetylmorphine is used for treating long-term users.
This has to change, and change now. We need to encourage the opening of medically prescribed diacetylmorphine facilities across the country and ensure access to this phenomenally successful program to everyone who qualifies for and wants it. Let us be realistic. These policy initiatives will require a substantial allocation of resources after being chronically underfunded, indeed some actively opposed, by successive federal governments.
I have returned to the House day after day, month after month, and now year after year to push the Prime Minister and the Minister of Health to see the shocking scale of human suffering involved with this crisis, each time with news of a new horrifying record-breaking number for overdose deaths in my home city, province, and now across the country. On this point, I feel I must be blunt. Canadians' patience with the Liberal government has become exhausted. They no longer wish to listen to platitudes while Canadians continue to die.
Prior to the release of the last budget, the Prime Minister travelled to Vancouver and promised the crisis would no longer be ignored. He pledged, “There are no barriers to the federal government being able to do exactly what it needs to do. We will ensure resources are available”. Shockingly, budget 2017 fails to allocate the resources necessary. As former vice-president Joe Biden used to say, “Don't tell me what you value, show me your budget, and I'll tell you what you value.”
While the Liberals may pay lip service to progressive values, their funding decisions do not back them up. That is why at a recent town hall forum the Prime Minister was called out by harm-reduction worker Zoe Dodd, who accused his government of not going far enough to combat this epidemic, saying, “We need millions of dollars. I am a frontline worker who has not been on the job for the last six weeks because people keep dying around me, and I'm completely traumatized.”
These overdoses are not merely statistics. They are someone's son, daughter, sister, or brother. They are someone's mother or father, aunt, uncle, cousin, or colleague. They may even be someone we know. It is time the House came together and gave them the support they need.