In the collaborative spirit of the way we do all our work around controlled substances in Canada, I'll be giving remarks on behalf of my colleagues, but we're all happy to answer questions, obviously.
Thank you very much, Mr. Chair.
My name is Suzy McDonald. I am the assistant deputy minister for the opioid response team at Health Canada, but I'm also responsible for the regulation of controlled substances in Canada and the federal government's approach to drug and alcohol use under the Canadian drugs and substances strategy.
Problematic substance use is an ongoing health and safety concern in Canada. While the opioid crisis and cannabis legalization and regulation are often top of mind for Canadians, Health Canada is very much aware that a growing number of people are also struggling with methamphetamine use. In particular, we know that provinces such as Alberta, Manitoba and Saskatchewan are seeing increased reports of methamphetamine use, hospitalizations and interactions with law enforcement. Some first nations communities are also reporting significant health and safety issues related to meth use.
Methamphetamine is generally an inexpensive drug that can produce a short-term or a long-term effect, depending on how it is taken. It can be smoked, snorted, swallowed or injected. It can increase attention and energy and create an overall feeling of well-being or euphoria. However, its use can also lead to addiction and harmful effects, such as paranoia, aggressiveness and even psychosis. A methamphetamine overdose can cause convulsions, cardiac arrest, stroke and, in some cases, death.
We know that people use stimulants for a variety of reasons. These can include for personal enjoyment, to relax, to socialize, or to cope with pain, stress or other related trauma. Compared to other substances used in Canada, such as alcohol, cannabis and opioids, rates of meth use are relatively low. However, we are seeing reports that other drugs are sometimes mixed in with meth, including highly potent opioids like fentanyl, which further increases the potential for harm and increases the risk of fatal overdose. In fact, available data for some jurisdictions suggest that meth may be playing a growing role in overdose deaths where polysubstance or dual-substance use is involved.
The Government of Canada is concerned about all forms of problematic substance use, and we are taking action through the Canadian drugs and substances strategy, through our four pillars of prevention, treatment, harm reduction and enforcement.
In terms of prevention, we know that we need to take a broad approach, which includes both informing Canadians about the risks of meth use and addressing the underlying social determinants related to its use. This is a role that all levels of government undertake in Canada, along with a large number of non-governmental organizations.
We also know that public awareness campaigns will not suffice, as social determinants of health often underlie problematic substance use. For example, we know that homeless individuals or lower-income individuals are at greater risk of harm related to problematic substance use.
We also know that substances can be used as a coping mechanism by those who have experienced trauma, violence, social marginalization and loss of cultural identity. For aboriginal people, that may include the loss of language and culture, racism, discrimination and the intergenerational trauma of residential schools.
Through the Canadian drugs and substances strategy, the federal government is committed to working collaboratively to better address the social determinants of problematic substance use and develop upstream efforts to help prevent problematic substance use before it begins.
Moving on to the issue of treatment, the evidence clearly shows us that problematic substance use is a health condition that can be managed and successfully treated for those who are ready. Unfortunately, methamphetamine use is a very difficult condition to treat. To date, the most effective treatment options for methamphetamine use include psychosocial counselling and behavioural management approaches. Unlike opioid use disorder, where medication-assisted treatment is available, there are currently no drug-based therapies to treat problematic meth use. This is an area where more research would be useful.
I know from my experience in managing the federal response to the opioid crisis that there are simply not enough drug treatment services in Canada to meet the demand. To help address this gap, the federal government committed $150 million for an emergency treatment fund to help improve the availability of treatment options in Canada, including for those struggling with methamphetamine use. To date, five provinces have signed bilateral agreements with the federal government under the emergency treatment fund, including Saskatchewan, which is using some of the funds to enhance treatment services for people seeking help for substance use disorders, including crystal meth use.
ln addition, the federal government has made a number of investments in federal budgets to support expanded mental health and drug treatment services in first nation communities, including $200 million over five years, and $40 million ongoing, provided in budget 2018.
Harm reduction is a key factor of the federal approach to the opioid crisis. Unfortunately, there is no similar range of options for harm reduction related to methamphetamine use. More specifically, there are no drugs that can reverse the effects of a methamphetamine overdose, as in the case for an opioid overdose, which can be treated with naloxone.
The most common evidence-based approach in methamphetamine harm reduction focuses on reducing the risk of blood-borne infections, such as HIV and hepatitis C, which can be contracted by sharing drug-using equipment, such as syringes and pipes.
The Canada Public Health Agency is investing $30 million over five years through the harm reduction fund to reduce those risks by supporting projects in Canada that will help reduce the transmission of HIV/AIDS and hepatitis C among people who share equipment for using drugs by injection and inhalation.
Another key component to harm reduction is addressing stigma toward people who use drugs. In particular, the visible physical effects of methamphetamine use, coupled with sometimes very erratic and unpredictable behaviour, create a highly stigmatized image. This perception creates barriers when accessing treatment and other harm reduction and social support services, and it is something that we are committed to working to reduce to help ensure that people get the support they need.
For example, the Good Samaritan Drug Overdose Act encourages people to seek help in the event of an overdose by providing some legal protection for those who experience or witness an overdose. We hope this act will reduce the fear of police attending overdose events and encourage people to help save a life. As part of budget 2018, the federal government invested $18 million over five years for actions to address stigma toward people who use drugs, including a national anti-stigma campaign, which has just been launched, and training for law enforcement officers. Although much of what Health Canada is doing on stigma is done in the context of the opioid crisis, we are confident that it will also have a positive impact in other areas.
Drug regulation and enforcement is the fourth pillar of the Canadian drugs and substances strategy and remains a critical part of the federal government's approach. It encompasses a wide range of activities, including enforcement, regulation of activities with controlled substances and precursors, border control, financial surveillance and tax audit measures to reduce the profitability of drug trafficking.
Methamphetamine is controlled under the federal government's Controlled Drugs and Substances Act, as are many of the chemicals used in its production. Given that many of these precursors are legal substances, it can be difficult to control their availability and diversion. The RCMP is working in close partnership with chemical industry partners through the national chemical precursor diversion program to identify suspected criminals and organized crime groups that attempt to acquire precursor chemicals that can be used to produce methamphetamine. Health Canada continues to work with its partners, including the Canada Border Services Agency and the Royal Canadian Mounted Police, to examine options around scheduling and control of novel precursor materials.
While some methamphetamine is produced in Canada, a proportion of methamphetamine consumed in Canada is likely trafficked into Canada from other countries such as Mexico. The Canada Border Services Agency continues to work closely with its international and domestic law enforcement partners to disrupt the methamphetamine supply at the border.
Our partners at Correctional Services Canada are also taking a number of actions to reduce the demand for illegal substances, including methamphetamine, among the federal incarcerated population. These include preventing contraband from entering federal prisons, increasing awareness of the harms from problematic substance use and supporting innovative and effective treatment and harm reduction approaches, such as the recent implementation of a prison needle-exchange program.
I'd like to touch on one final area of the Canadian drugs and substances strategy, and that is the serious role of evidence. Evidence is the foundation of everything we do.
Supervised sites are another part of the government's harm reduction approach. Although the use of meth in supervised consumption sites varies widely across the country, preliminary data shows that up to 40% of visits to some sites in western Canada are by people who come to use methamphetamine.
The federal government supports high-quality research on substance use through the Canadian Institutes of Health Research and the Canadian research initiative on substance misuse.
The Canadian Institutes of Health Research are currently supporting a pilot project to identify effective interventions to reduce methamphetamine use among men who have sexual relations with other men, an activity that has been associated with an increased probability of contracting HIV/AIDS.
In addition, the substance use and addictions program is a federal grants and contributions program that provides $28.3 million annually to provinces, territories and non-governmental organizations that support evidence-informed and innovative initiatives targeting a broad range of legal and illegal substances.
While it is difficult to paint a detailed picture of the scale of the methamphetamine problem in Canada, we are committed to working with provinces and territories and key stakeholders to fill gaps in our knowledge. Health Canada, the Public Health Agency, Stats Canada and other organizations are exploring targeted data and research initiatives to better reach marginalized populations.
We are also working toward developing and implementing a Canadian drugs observatory that would act as a central hub to provide a comprehensive picture of the current drug situation in Canada, identify emerging drug issues before they escalate, track public health interventions and other control measures, and facilitate data sharing.
In closing, I would just like to say that we are deeply concerned about the growing number of Canadians who are struggling with methamphetamine use. Through the Canadian drugs and substances strategy, we will continue to work with provinces, territories, indigenous leadership and communities, people with lived and living experience and key stakeholders to address the issue using a comprehensive, collaborative and compassionate public health approach based on the latest available evidence.
Last, we have recently launched an online public consultation to inform potential next steps on the Canadian drugs and substances strategy. This consultation closes on December 4. We look forward to feedback from Canadians on how we can improve our approach to substance use issues in Canada, including our actions to address methamphetamine. At last count, I think we had more than 1,200 responses to that, so we expect a fair amount of analysis to happen.
In closing, thank you again for the opportunity to appear before you today to discuss what we believe is a very important and growing issue in Canada. We look forward to the presentations to this committee from other stakeholder groups and to the committee's forthcoming report and recommendations.
My colleagues and I would be happy to answer any questions you may have.