Health Committee on Nov. 29th, 2018

[Dr. Matthew Young]

Though the rise in methamphetamine harms observed over the last 10 years is not as great as those associated with opioids, this increase should not be ignored. The federal government could capitalize on those investments already made to address the opioid crisis by using them to address the increase in the use of methamphetamine.

These measures include continued prioritizing and investing in better data and knowledge sharing on drug use and harms in Canada through continued development of the Canadian drugs observatory, which the committee heard about in the previous session, and support for the Canadian Community Epidemiology Network on Drug Use; investing upstream to reduce inequities in the social determinants of health and increase resiliency and self-efficacy in youth; reducing stigma by promoting understanding of substance use as a health issue, increasing the availability and accessibility of an evidence-informed, client-centred continuum of services and supports; supporting interventions to reduce harms specific to methamphetamine use, such as outreach education, needle exchange, pipes that reduce burns and cuts and other methods to reduce the spread of communicable disease; and finally, investing in low threshold housing.

CCSA will continue to coordinate collective efforts, connect partners, gather and share evidence, identify emerging issues and address stakeholder needs according to our mandate.

On behalf of Dr. Fandrey and the CCSA, I would like to thank the committee for the opportunity to speak today on this important issue. We will be pleased to respond to your questions.

[The Chair, Liberal, Bill Casey]

Thanks to all of you for your presentations. It's certainly an incredible situation that you're dealing with. Hopefully, we can add something to help you.

We're going to start our seven-minute rounds with Mr. Ouellette.

I know that you'll keep your questions succinct, but if we can keep the questions succinct and the answers succinct, we might get through this.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

I'm going to ask all my questions right off the bat and let you answer them.

How many beds are actually needed? If you had all the resources you needed in order to address this issue—because it is a huge safety concern in the inner cities and also in indigenous communities—what would you need?

Should we have other models such as recreation for youth, like the Icelandic model? I know that AYO was talking about that. What's the value versus the safe consumption sites in terms of some of these other questions? What do you want the federal government to be doing?

[Dr. Ginette Poulin]

If I may, I'll begin. Certainly, I would say that all of those are important aspects.

Again, one of the things that's a challenge within Manitoba is that geography-wise we're spread out, and the tendency is for services to be concentrated in the Winnipeg region. We know that we need more and better local services throughout the provinces. When we're talking about beds, I would say that we need to support services so that they're local throughout, and it could be proportionate, certainly, to populations.

Again, to the rest of the services, my concern is that when we look at only withdrawal management or only treatment beds, they're only one spoke in the wheel. We need all of them to function together for that wheel to turn.

You also mention, for example, other things such as investing in extracurricular activities and other supports. We know that people who are engaged in activities have purpose. They have things to build their confidence and to build their skill sets. They're less likely to be seeking highs and pleasures from other ways, and they have less time for diversion. Certainly, those would be things that we would enforce.

There's one of the things from the federal aspect that I think would be nice if there are going to be funds. For example, as Damon mentioned, we can look at models—for example, with our Manitoba Liquor and Lotteries—where a certain percentage that is given has to be provided to services such as the Addictions Foundation of Manitoba, among others, and to organizations that are actually providing those services. Then we can see the accountability and the transparency of those funds and see them go directly to services. I think that's something that's certainly helpful.

I don't know, Damon, if you want to comment further on that.

[Damon Johnston]

No.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

How much?

[Dr. Ginette Poulin]

Like I said, if we're already under-serviced at 5.2% in terms of our mental health and addictions and the Virgo report is saying to increase it to 9.2%, I would say even higher, to 10%—

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

What are the wait times?

[Dr. Ginette Poulin]

Wait times are variable, because people in the north might be accessing services down south. Again, that's where that concentration is.

We do need to improve access more equitably throughout the province, which can in turn help to reduce that wait time, and to also look at transition instead of people cycling through: showing up four or five times repetitively in emergency, for example, getting into detox, but then not having the bed and treatment to follow that. Then there are breaks in that continuum of care. From the health perspective, I guess, we need that seamlessness to be in place to help support this. I think it's kind of multifactorial in that way.

I wouldn't be able to say specifically how many per location.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Dr. Young.

[Dr. Matthew Young]

Is there a specific aspect that you'd like me to comment on?

[Dr. Ginette Poulin]

Any of the above.

[Voices]

Oh, oh!

[Dr. Matthew Young]

Certainly, further investment in treatment is important, absolutely. Treatment is usually delivered at the provincial level, so it's difficult for me to just give a sum. Certainly, though, further investments in treatment are required.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Does anyone believe that the meth problem could expand beyond the prairie provinces?

[Dr. Ginette Poulin]

As we look at other trends, certainly things move, and I would say that there's a kind of “drug of the day”. We know absolutely that the jurisdictionals don't fit with just the borders. We see movement, and I certainly would see that as a possibility—absolutely.

[Dr. Matthew Young]

Yes. Oftentimes, it's about supply and demand. As supply increases and moves into different areas and people have access, that's very possible.

We have seen an increase in all provinces. We've focused on the western provinces, but there has been an increase in all provinces. It's not something that's uniquely affecting—just particularly affecting—the western provinces.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

What's the impact on indigenous communities?

[Damon Johnston]

Again, someone mentioned that there's a lack of data in some places. We don't have any numbers about the scale of methamphetamine use in our community. We know it's high.

I'm located right downtown, on Higgins Avenue. We have a park beside our centre. We've taken as many as 300 needles a week out of that park.

We're seeing, as I said earlier, direct impacts on some of the families we're working with. A mother will become a user, and then the children are apprehended. The healing period for the mother can be very extensive. I've been working with one family for over three years. Finally, they got the mother to a better place.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Damon, you live in downtown Winnipeg. What's the impact on the neighbourhood and life in the downtown core?

[Damon Johnston]

It's huge. You see people on the street every day struggling to survive. Some die. It's right in your face. I mean, you can't ignore it.

[Robert-Falcon Ouellette, Liberal, Winnipeg Centre, MB]

Does it make you feel safe? Is it safe?

[Damon Johnston]

No, absolutely not.

Again, because there are different approaches in each province and territory, in the Manitoba example, we don't have a provincially approved safe injection site. Some organizations are doing this on their own. They have a room set aside and they try to accommodate that need.

There are some other things going on. I'm part of a large group set up by one of our local business leaders, called the alliance for public safety and community wellness. One thing we're looking at is the Calgary model of a 24-7 drop-in centre, so that people who are on the street, who have nowhere to go, can avail themselves of a multiplicity of new services—things like managed alcohol programs, etc.

Again, often the place where a certain government is, sometimes is not as amenable to making these things happen as in other jurisdictions. That's why you see these differences.

[Dr. Ginette Poulin]

I was going to add that, with homelessness, that's really important too. We are seeing increasing homelessness within Manitoba. Crystal meth is a strategy to help maintain your equities on the street, meaning that you stay awake longer, you can fend off people who might be a threat and you can survive on the street. That is a tool, in that aspect.

Again, when it comes to harm reduction, we certainly haven't fully embraced that within Manitoba, and I think that is a challenge. When it comes to the first nations populations, anecdotally, while we don't necessarily have all the data, I can say that at least 50% of the people accessing care for crystal meth locally within AFM are certainly first nations.

That's just to give you an anecdotal number.

[The Chair, Liberal, Bill Casey]

We have to go to Mr. Lobb now.