Health Committee on May 29th, 2008

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you, Minister.

May I direct my question to the Chief Public Health Officer of Canada?

The World Health Organization and the United Nations have accepted harm reduction as a component of any effective comprehensive drug strategy. In fact, they have made it so that any aid delivered by a foreign country with regard to drugs must have a harm reduction component attached to it.

Madam Chair, the question I want to ask the public health official is this. Given that the World Health Organization and the United Nations have spoken to this, given that the Parliament of Europe and the Parliament of Australia have accepted safe injection sites, and throughout Europe they have accepted them as effective harm reduction now for 10 years, given that Australia has also accepted safe injection sites as effective harm reduction and life-saving measures, does the Chief Public Health Officer of Canada agree with the United Nations, with the World Health Organization, and with the effectiveness of the science on drug policy and harm reduction with regard to safe injection sites? Is the science effective? Has it been appropriately peer-reviewed?

[David Butler Jones, Chief Public Health Officer, Public Health Agency of Canada, Department of Health]

I think the science speaks for itself. The debate speaks for itself.

Public health advocates for a comprehensive approach to issues: the gathering of evidence on promotion, prevention, diagnosis, treatment, harm reduction, and identifying and addressing any underlying factors or determinants within each and all of these areas.

Individuals, communities, health regions, and governments then choose what to fund and to support. Having been one who's established harm reduction programs, including things like needle exchange, at a time when people viewed it as potentially illegal, I understand that very well.

Public health then works with others across these realms, using what resources and evidence we have to minimize harm to the individuals, to reduce the risk to others, and to increase health and well-being. That's our job. We provide the advice, the best advice we can. Governments and jurisdictions, as appropriate, make their decisions and have their political context in which they make those decisions.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

Then, Dr. Butler Jones, based on the evidence and the 25 international peer-reviewed studies that have been done on the results of Insite, do you concur that the evidence is there and that this is an effective component of a harm reduction strategy?

Do you agree with that or do you disagree with it?

[David Butler Jones]

I think all of those activities are part of a harm reduction strategy, so I'm not disagreeing with the science at all. It is part of it, but the decision is one that governments make.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I understand that, Dr. Butler Jones; however, as the Chief Public Health Officer of Canada you have two hats to wear. One role is to speak out and to be an advocate and to protect Canadians. If you believe that the evidence shows that a particular piece of strategy would save lives and would bring people towards lower mortality and would help them to get detox and treatment, should you not advocate for that, Dr. Butler Jones?

[David Butler Jones]

First of all, there are different levels of advocacy. I speak to these issues; when these questions are asked of me, I respond to them. I have read the data. It is, as I have said, part of a public health approach to dealing with harm reduction, in addition to the important role that prevention and dealing with the basic underlying determinants are for that.

So I do speak to those issues. I do not go out and speak on every single issue. There are many, many of them, as you know.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

But then in your role as the Chief Public Health Officer, have you advised the Minister of Health that this is strong evidence and that therefore it should be included in an effective strategy to decrease addiction in Canada?

[David Butler Jones]

The minister, I think, recognizes that harm reduction is part of the strategy.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Have you asked him?

[David Butler Jones]

As other ministers who have been around this table might recognize, it's inappropriate to speak of personal advice to the minister. I've told you what my position is on my view of the science and my view of harm reduction as part of a public health approach, and of the respect in which I hold Parliament and others in the decisions they make and the way they move forward on those choices.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler Jones.

Madame Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you, Madam Chair.

Minister, since 2006, you have taken a number of actions as a result of which we are not surprised today by the tangent you want to give to harm reduction. We sense various ideologies. You're saying that yours is based on ethics, but on what ethics?

Is it a moral ethics or an ethics that aims to provide the best possible support for individuals coping with substance abuse? Exactly what kind of ethics is it?

Earlier we were talking about ideology. You weren't here at the time of the international AIDS conference; you didn't have a word to say to the public. You were absent. We waited for you; we called for you.

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

That's not true.

[Christiane Gagnon, Bloc, Québec, QC]

You came, but because you were asked to. You didn't show any leadership. The international community had looked to you.

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

That's utterly false.

[Christiane Gagnon, Bloc, Québec, QC]

Read the articles. Pardon me, minister, but, when the conference was held, I believe you had to be pushed a number of times to get there more quickly.

A very long time ago in Quebec, you prohibited a completely inoffensive book entitled Drugs: Know the Facts, Cut Your Risks. That was a matter of $1 million. That book, which had been approved by Quebec's health minister, Mr. Couillard, provided information on various aspects of the drugs in circulation, their effects, the risks they entailed, the laws involved and available help. How could a book like that lead our young people to take drugs lightly? We see that there is a mentality, a strategy behind all that. One sense is that there is censorship.

You say you're concerned about public opinion. However, I get the impression that your public opinion is the one that directs your ideological orientation. We hear other stories, regardless of whether they come from researchers or people who are working hard to fight the increase in substance abuse or to help people coping with AIDS or Hepatitis C.

I'd like you to try to defend your position. Earlier you said this was a matter of ethics. In your view, addicts need clothing and housing. I think we all need that. We aren't opposed to your strategy, but we would like to know what will happen if you implement it. As for the assistance you want to offer, you have to understand that some people won't accept it. They say it's a part of the population that is marginalized. Harm reduction can't stop all drug use. The point, for example, is to stop the spread of HIV-AIDS and hepatitis C, to see that other people aren't infected. That's one of the goals of Insite.

I think you're headed in the wrong direction, minister. Like you, I think the objective is praiseworthy, but it can be achieved without a place like Insite being closed. You say you want to support the entire network that's working in this field and to increase funding for HIV-AIDS assistance organizations, but, of the $84 million allocated in 2008, $16 million has been withdrawn. You say you encourage research for a vaccine, and I agree with you: we have to do it. However, you don't seem to be allocating resources to the field in order to better combat the spread of drug use, HIV-AIDS or Hepatitis C.

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

Allow me to respond in a few words.

As I said in my speech, it is important to make a decision that takes into account the opinions of scientists, of course, but also public policy. I said that various opinions were given by the scientific community. My conclusion is that public policy, on the other hand, is clear.

From our perspective, it's the combination of reviewing the sciences, as Dr. Butler Jones so aptly put it, and combining it with public policy that gets you to a decision about the health and safety of Canadians. That's the same method used by me, and I dare say by other ministers over the years. That's how we come up with positions.

With respect to Insite, there's a court decision and we are going to respect it. If it is overturned, then it's a different story. But if it is not overturned, the decision of our courts trumps the decision of legislators as well as the decision of parliamentarians, the decision-makers on Parliament Hill. I respect that. It's the way the system is. I was explaining to you how I make decisions based on science plus public policy—it's a combination of those. In this case, my best advice is that the science is mixed, but the public policy is clear. That's my perspective.

[Christiane Gagnon, Bloc, Québec, QC]

They are mixed, but what is the alternative? You say you want to provide people with more help to get out of drug addiction. That's a praiseworthy objective, but I don't think you're providing all the necessary tools to the various stakeholders working at the grassroots level to solve this kind of problem. You seem to be putting your head in the sand by saying you want an ideal society, without substance abuse. The substance abuse problem is present in all countries. If drugs didn't circulate in the market, people would find other ways to get them. Some people have trouble living in our society. They take drugs or sniff glue and make every effort to find a way to escape. That's a social ill.

Since you've been in your position, you haven't done enough to help the community. For example, people working in the fight against HIV-AIDS are waiting for money, which isn't available. There haven't been any calls to tender. You know what I'm talking about. The program has a budget of $16 million. You're saying you've developed an extraordinary strategy to fight HIV-AIDS, but the money isn't there. Allow me to doubt your sincerity and ability to help out society.

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

We have to increase that ability, of course. We also have to do something in the areas of treatment, housing and mental health. Each of those areas is part of a more effective policy.

[Christiane Gagnon, Bloc, Québec, QC]

Minister, why was that book withdrawn from the market? One would think you don't want people to be informed. We could address another type of high-risk behaviour, such as smoking.

[The Chair, Conservative, Joy Smith]

Madame Gagnon, your time is just about up. Could the minister please answer?

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

Read the book. Some passages aren't related to the policy of our government or of our society.

[Christiane Gagnon, Bloc, Québec, QC]

On what page?

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

The book says, here's how young people like to look at drugs, and it gives a whole list of reasons to take drugs. I don't think that's the right message, quite frankly.

[Christiane Gagnon, Bloc, Québec, QC]

You have to understand how a society works.