Health Committee on Nov. 29th, 2018

[The Chair, Liberal, Bill Casey]

I call the meeting to order. Welcome to meeting 126 of the Standing Committee on Health. We're starting a new study today, and I'm sure we're all going to learn a lot, as we always do with these committees.

We welcome our witnesses and appreciate their time and expertise in this area, and we look forward to their remarks. Today's meeting is in two sections. We're going to hear from one panel first, and then we're going to suspend for a few minutes and have a second panel.

For the first panel we have Health Canada, represented by Suzy McDonald, assistant deputy minister, opioid response team—imagine—and Michelle Boudreau, director general, controlled substances directorate. From Public Safety and Emergency Preparedness we have Trevor Bhupsingh back. He is director general, law enforcement and border strategies. We also have Kimberly Lavoie, director, drug policy. From the Royal Canadian Mounted Police we have Chief Superintendent Paul Beauchesne, serious and organized crime and border integrity.

My understanding is that, among you all, you're going to have a 15-minute opening statement. I guess you're going to have to fight it out among yourselves as to who's going to go first.

Who's first? Suzy. That's great. You have 15 minutes.

[Suzy McDonald, Assistant Deputy Minister, Opioid Response Team, Department of Health]

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.

[The Chair, Liberal, Bill Casey]

Thanks very much.

You have a few minutes left, if someone else wanted to add a comment.

I wanted to ask a question for clarification. You mentioned crystal meth, meth and methamphetamines. Are these all the same thing?

[Suzy McDonald]

Those are all the same thing. In fact, there is a whole series of other words that we also use to describe this category. Meth, crystal meth and methamphetamines are all a category of drugs that are amphetamines, which can also be referred to as speed. The idea is that it accelerates your overall responsive system, as opposed to opioids, which depress that system.

[The Chair, Liberal, Bill Casey]

We'll go right to questions now, starting with Dr. Eyolfson for seven minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you very much.

Thank you for coming.

It's quite an honour to be able to do this today, because I had asked that the committee study this. I come from Winnipeg, and I spent 20 years as an emergency doctor in Winnipeg. One of the really surprising and rather frightening things is the rate at which this has taken off. I last practised emergency medicine three years ago, in the inner city at Health Sciences Centre. It really wasn't a big issue then. It was something that I didn't see. The substance itself has been around for.... I learned about it in residency 20 years ago. For a lot of reasons that we're still trying to figure out, it's just exploded.

Ms. McDonald, has anyone been able to figure out why there has been such a sharp increase in the use of this particular substance?

[Suzy McDonald]

I'll start, and then colleagues might have things to add.

The reality is that when it comes to all substance use, it is very difficult to determine the how and why people are using various substances in Canada. We can say that you are right that in fact there has been an increase. While we don't have exact data on who is using and why they are using or why they may be shifting use, we have some things that can provide a bit of insight. One is our drug analysis labs. From 2007 to 2017, there has been a 365% increase in the product seized and analyzed by labs at Health Canada related to methamphetamine, so we know it is being used broadly on the street. We know as well that those highest rates are in Saskatchewan, followed by Alberta, Manitoba and New Brunswick.

The other very interesting part for us is this idea of polydrug use. I think many users are in fact in this area of polydrug use. In Manitoba in particular, there were 35 deaths in 2017 related to methamphetamine, of which eight could be directly related. The rest had some sort of polydrug use associated with it. In 2016, there were four deaths associated with it.

Perhaps what's scarier is that there were 108 opioid-related deaths. Of those we see that there is a meth-opioid interplay. We also see meth being increasingly contaminated with fentanyl, just as other opioids are being contaminated with fentanyl. I believe that the increasing number of deaths related to methamphetamine use, just like the increasing number of deaths related to opioid use, is directly related to the poisoning of the drug supply with fentanyl.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Yes, sir.

[Trevor Bhupsingh, Director General, Law Enforcement and Border Strategies Directorate, Department of Public Safety and Emergency Preparedness]

Thank you, Chair.

Maybe I could add a few other comments to my colleague's views on this.

I think the other thing in terms of the unpredictability around the how and the why is largely that it's a marketplace as well and there's a constant flow of sometimes poorly regulated chemicals, which can be easily procured. To the extent that they are available, substances will go up and down in terms of usage. It's very difficult to really predict in terms of the cost, which is another factor for use. The cost of methamphetamine varies tremendously across the country. For example, on the west coast, where you could argue there may be greater access to precursors, the cost is somewhere between $30 and $50 a gram, whereas on the east coast, I understand it to be in the neighbourhood of three times to four times that cost for a gram.

All that is to say that market conditions and the availability of drugs is also a factor in the equation of figuring out what drug will be prominent. That is very hard to predict.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

This sounds analogous to the change we saw in the market in the late 1980s, I believe, with cocaine. From what I understand, the classic cocaine hydrochloride that was sniffed was about $200 a dose, and when crack was developed, it was at something like between $5 and $15 a dose. That's what introduced cocaine to the inner city. It sounds quite analogous.

Switching gears a bit, we've talked about harm reduction, which is something I've always known about, and I really appreciate how much misunderstanding there was about it. A lot of people thought that harm reduction—supervised consumption sites and needle exchanges—enabled or increased use. From my reading of the academic literature, you did not actually increase use of these substances. You just simply decreased the harm with them.

I understand that there's very good data that supervised consumption sites do lead to improved outcomes with opioids. Is there evidence of the same benefit or a similar benefit in regard to meth?

[Suzy McDonald]

The evidence we have is not necessarily related directly to opioids. It's related to people who come into supervised consumption sites to use those various products.

Indeed, you are right. There have been a fair number of studies done and we have a very good literature to indicate that supervised consumption sites overall reduce harms and don't increase crime. There's no increased level of activity around those sites.

The emergence of supervised consumption sites in Canada is relatively new, and we are collecting data. As part of the work we do with each supervised consumption site, we ask them to report in so that we'll be able to have a much better understanding as time flows about the use of methamphetamine and harms related to that.

What I can say is that if you are using a substance within a supervised consumption site, you have immediate access to harm reduction measures. While naloxone indeed works for opioids, having practitioners present if you're having another type of overdose is very helpful in terms of being able to call for help or for immediate assistance. Those harms we expect will be reduced, but there have been no studies directly related to that, to my knowledge. Michelle might be able to correct me on that.

I think the other piece that's interesting to note is that people who are using methamphetamines are using supervised consumption sites. I mentioned that in my remarks. In fact, we are seeing increased methamphetamine use at supervised consumption sites in Kelowna, as an example. In areas where opioid use had been quite prevalent, we are seeing some shifts happening, and we're monitoring that very closely.

The other piece related to supervised consumption sites and harm reduction, as you know, is that because methamphetamine is used in a whole variety of ways, including through injection drug use or sharing of products, the ability to have drug-related items available for people coming into supervised consumption sites drastically reduces the risk of any kind of infection happening. Furthermore, it often puts people into contact with direct treatment providers or other health care providers.

The ability for people to come into those supervised sites, whether they're using an opioid, methamphetamine or cocaine, means that they have access to a wide range of services. That's why we have been putting a real emphasis on trying to ensure that people are not using alone and that we're able to get help for them immediately if needed.

[The Chair, Liberal, Bill Casey]

We have to move along now.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

[The Chair, Liberal, Bill Casey]

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thanks very much.

I want to build off a question that Dr. Eyolfson asked around the safe injection sites. Your number was that 40% of the people coming into safe injection sites now are using some form of methamphetamine. Is that correct?

[Suzy McDonald]

Not exactly. It's 40% of people in Kelowna, but the numbers vary drastically across the country and this data is not perfect data. It's being reported by supervised consumption sites, and we have some sites that have been reporting longer than others.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay.

[Suzy McDonald]

For example, we see that in Montreal cocaine remains the drug of choice. In Ottawa, it's hydromorphone. Again, in Vancouver, it remains heroin and other related opioids.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Fair enough. I just wanted to make sure that I had the number correct or incorrect.

For the cold medication that is used in crystal meth, if you don't have that, can you still make crystal meth, or do you need that cold medication as part of the recipe?

[Suzy McDonald]

I will let Michelle answer that.

[Michelle Boudreau, Director General, Controlled Substances Directorate, Department of Health]

Thank you.

The cold medication that you're referring to probably is pseudoephedrine, or the brand name Sudafed. People will sometimes call it that.

Certainly that is sometimes considered the faster way of making methamphetamine. However, the interesting thing with methamphetamine is that it is in a sense a chemically created product. If you think of Sudafed or pseudoephedrine as the precursor, then you can back that up and create a precursor to a precursor.

That's the challenge for us. There's always some creativity in other types of precursors.

[Ben Lobb, Conservative, Huron—Bruce, ON]

When there's a seizure at a lab or from a street dealer, do they test that to see what the combination is in the meth that has been seized? Do you have a way to see if that pseudoephedrine is in there?

[Michelle Boudreau]

I'm not sure if my colleagues from law enforcement would like to answer that.

I could try, but I'm just wondering if you'd like to take that.

[Chief Superintendent Paul Beauchesne, Chief Superintendent, Serious and Organized Crime and Border Integrity, Royal Canadian Mounted Police]

There is one thing I could add, if that would help.

I'm certainly not a chemist, but what I can say is that when we go to these clandestine laboratories, a lot of the time we will find packaging of ephedrine, so we know that's an ephedrine that was used maybe in that process. In terms of chemical analysis, it's not—

[Ben Lobb, Conservative, Huron—Bruce, ON]

This is part of my issue. I would say that there are drug makers probably around the world, but specifically in North America, who are making this product and it is going into the creation of this issue.

You can only do what you do, but why aren't we trying to focus more on that, to try to take that element right out of the equation? I'm not blaming anybody. I'm just saying that if this is one of the components to this disaster, why aren't we going at the drug companies to be accountable for every ounce that they're creating?

It just seems to me that they have free rein to do as they please. They're part of the problem is what I'm trying to say.