Health Committee on Dec. 4th, 2018

[The Vice-Chair, Conservative, Marilyn Gladu]

Welcome to the 127th meeting of the Standing Committee on Health. Today we're studying the impacts of methamphetamine abuse in Canada.

We have a number of excellent witnesses to speak to us today. From the Bear Clan Patrol, we have James Favel, Executive Director. From the Manitoba Nurses Union, we have Darlene Jackson, President. From the Overdose Prevention Society, we have Sarah Blyth, Executive Director. From Pine River Institute, we have Vaughan Dowie, CEO, and Victoria Creighton, Clinical Director.

Welcome to all of you. Each organization will have 10 minutes for speeches.

Because James is not yet seated, we'll start with you, Darlene, for 10 minutes.

[Darlene Jackson, President, Manitoba Nurses Union]

Thank you.

“One or two hits of meth will last you hours and hours and keep you up for days. With opioids, you can totally predict what the course of treatment is going to be. We can totally handle anyone going through opioid withdrawal. With meth, in the blink of an eye it switches.”

Madame Chair and committee members, thank you for inviting me here today. What I just read to you was a quote from a registered psychiatric nurse at Health Sciences Centre, the largest health care facility west of Toronto and east of Calgary. This facility is at the forefront of managing the crisis.

I wanted to begin with it because it addresses one of the unique challenges that nurses face in treating users of methamphetamine and why addressing it will require some unique policy changes.

Nurses know that the rapid increase in meth consumption has reached crisis levels in Manitoba. The impacts are ravaging many of our communities and putting significant strain on our health care system. It's time for the federal government to show leadership on this critical public health issue. I hope that some of the information I will provide today will help you make an informed decision towards action.

Let me begin by addressing the impacts on our emergency departments and mental health units. Unfortunately, emergency departments are often the only place that methamphetamine users can access treatment. Some arrive in distress, escorted by police and gripped by a drug that can change their behaviour at any moment. Others present freely, and while they can appear calm at the outset, erratic and violent behaviour can emerge in an instant. This is not only a danger to the patient. It's also a danger to the nurses, doctors and health care providers who provide care. It is also a danger to other patients in the facility, many of whom also need emergency care. They are forced to wait longer as resources are dedicated to patients suffering from meth-related psychosis and other symptoms. In Manitoba, we lack consistent security standards at our urban and rural facilities. Although ERs in Winnipeg hospitals have security guards, training and presence varies between facilities.

Health Sciences Centre has the strongest security presence, but the nurses there will tell you that security are often overwhelmed and have been told not to intervene by management. Rural facilities are left especially vulnerable. In Portage la Prairie, Virden, Thompson and many other communities, nurses are reporting a large increase in the number of meth-related presentations. These facilities typically have no security. Nurses are directed to call the RCMP, who are also stretched thin and are often unable to respond as quickly as they are needed. Too often we hear stories of nurses who have been punched, kicked and spit on, and the meth crisis has made this situation worse.

One nurse described intervening when a patient began choking a clerk who was simply there to restock supplies. The injury that the nurse suffered as a result limited her to light duties for the next several months. A nurse from Brandon told us, “I've had a patient take their IV out of their arm and try and stab me with it. We've found knives on people. We have had people destroy our rooms.... I did emergency medicine for eight years and the last three years we saw an increase in meth, and in the last year it's just exploded.”

At HSC, nurses report seeing four to five patients per shift with meth-related issues. They used to see that many per month. Data released by the Winnipeg Regional Health Authority proves what nurses are telling us. Since 2013, there has been a 1,200% increase in the number of patients presenting to the ER under the influence of methamphetamine. The increase puts real pressure on nurses and other health care professionals. Often these patients require multiple people to observe or restrain them. One nurse told us that they've had to order more restraint supplies, that it takes a whole team of people—doctors, nurses, health care aides—and that all of the other patients are usually scared, too, which adds to the problem.

We know that the emergency departments are overcrowded. For some nurses, this crisis is pushing them to the breaking point and forcing them to think of leaving the profession or leaving units, such as emergency departments, that are increasingly focused on dealing with the drug. Chaotic environments often predicate violent incidences. The meth crisis has amplified this issue for nurses, but there are broader factors to consider as well.

I applaud the health committee for launching a study into security and violence against health care workers, and particularly Dr. Eyolfson from Winnipeg for championing this issue. This study is an important step forward, which I hope will lead to federal investment in security services at health facilities.

The meth issue goes much further than our emergency departments. Infection control is a concern. Addiction often hinders patients from getting treatment before the problem becomes acute. We know that many users inject the drug intravenously, which can lead to infections in their heart valves that require surgery.

I tell you these stories with reservation. We must not allow these patients to be stereotyped or stigmatized. They are suffering from a terrible illness. As nurses, we want our patients to get the care they need, first and foremost.

We see broader social factors at play, as well. One nurse described the struggle by saying that there aren't enough recovery programs out there. She said that 95% of patients who come in with a meth-related complaint are observed until they're capable of walking out the door and then discharged. For these nurses and for all of us, it's heartbreaking that we can't provide more care for these people.

Public housing and poverty reduction must be part of the solution to this crisis. The province has stalled on building more social housing units. The federal government's support and leadership on this file is desperately needed.

Meth is impacting all communities, and users are presenting from all walks of life. A public health nurse who works in our wealthier suburban communities, such as River East and Transcona, told me that she has seen a dramatic rise in meth use. A nurse in Portage la Prairie told me, “It's all races, all ages. Even the people that you least suspect who drive the fanciest vehicles, who have the best jobs, they are even trying it. It's a problem.”

Some users don't realize what they're taking. Recently a group of nurses doing harm reduction by testing drugs at parties reported that they hadn't seen a positive cocaine test since the summer. People thought they were taking cocaine, but 90% of it was actually meth.

What's the solution?

Harm reduction is a critical part. Ensuring access to clean needles is important. We need to ensure access beyond business hours. Safe injection sites can also reduce the risk of infection.

We also need treatment spaces for those suffering from addiction. The Manitoba Nurses Union is a strong supporter of the Bruce Oake recovery centre, which is a long-term treatment centre being established in west Winnipeg. At our last annual general meeting, we raised $30,000 for the centre. However, even Scott and Anne Oake will tell you that this centre won't be enough to meet demand. They are a private foundation inherently dealing with limited resources.

That's why we need the federal government to step up its support to combat this crisis. We need the resources to respond. Reducing the health transfer payments from 6% to 3% was a serious mistake. Targeted mental health funding is welcome, but the current level is simply inadequate and the situation is getting worse.

In Manitoba, our addiction and health care programs and mental health programs are overwhelmed with demand. Emergency departments and addiction programs need more support to deal with the unique challenge of meth use.

Nurses have suggested dedicated facilities and programs for users of meth. Patients need a place where they will be safe when coming off the drug, and then they need access to a recovery program.

Finally, we do need federal support for security. We need dedicated, adequately trained personnel in our cities' hospitals and enhanced services rurally. Patients and their caregivers need to be kept safe, so that we can focus on treatment. Unfortunately, the longer we wait, the higher the risk that one of these violent situations will result in a more serious injury than what we've seen.

In Manitoba, the provincial government is imposing significant health cuts, including the closure of three emergency rooms in Winnipeg. To date, they have failed to offer a significant response to this crisis.

In contrast, there is an opportunity for the federal government to take leadership by offering real support and resources earmarked for addictions, mental health and security.

Thank you. I am pleased to answer any question the committee may have.

[The Vice-Chair, Conservative, Marilyn Gladu]

Thank you.

Now we'll go to James Favel, from the Bear Clan Patrol. He's the Executive Director.

Welcome.

[James Favel, Executive Director, Bear Clan Patrol Inc.]

Good morning, ladies and gentlemen. On behalf of Bear Clan Patrol Inc., and our board of directors, thank you for welcoming our voice into your house.

Bear Clan Patrol is a community-based, volunteer-driven safety patrol. Our mandate is to protect and empower the women, children, elderly and vulnerable members of our community. We do this non-violently, without judgment, and in harmony with the communities we serve.

This second coming of Bear Clan Patrol began in September 2014 in the wake of the death of Tina Fontaine, a young girl that was exploited and murdered while in the care of Manitoba's child welfare system. Our goal at the time was to interrupt the patterns of exploitation in our community to ensure that what happened to Tina would not happen to anyone else ever again.

Our role in the community has evolved, however, to include many new ways to support our community. Today's Bear Clan Patrol is active five and six nights a week doing 11 and 12 patrols per week respectively. We are active in three distinct inner-city communities in Winnipeg, and our footprint keeps growing.

Our model has been shared with communities locally, nationally and internationally. Our volunteer base has grown from 12 volunteers in 2014 to nearly 1,500 Winnipeg-based volunteers today.

So far this year, we have provided more than 30,000 hours of service to Winnipeg's inner city. We act as mentor, first responder, janitor and liaison between the community and service providers. We bring a sense of belonging and connectedness to our community members, and moreover, we provide an opportunity for our marginalized community members to step out of that role into the role of stakeholder. Amazing things can be accomplished by people with purpose, and we try to provide that purpose.

We have seen many positive outcomes as a result of our efforts, but in spite of our best efforts, we still feel the pain of loss. Even within our own ranks in the month of August of this year, we lost two of our own. Not strangers, not casual acquaintances, but two of our own Bear Clan family members were lost to addiction and overdose. Methamphetamine did play a role in both of those tragedies.

On the subject of meth abuse in Canada, I have travelled extensively in Manitoba, and to a few locations nationally. I have seen first-hand the increased rates of consumption, the increase in the level of destruction, and havoc wreaked in the lives of all of our community members. There is not one person I know that is untouched by this epidemic. The effects are being felt outside of the inner city these days, and without appropriate supports, it's only going to get worse.

In our travels through the streets of Winnipeg this year, we have recovered approximately 40,000 used syringes. We have seen a tenfold increase in the recovery of needles, year on year since our inception in 2015, from 18 syringes in 2015 to 40,000 in 2018.

We deal on a daily basis with community members in the throes of addiction, people experiencing meth psychosis, and an increase in violent crime and property crime. We're daily seeing more vulnerable people, and supports are just not keeping up.

There have been some new resources made available in Manitoba with the recent opening of rapid access addiction medicine, or RAAM, clinics. This started up at the end of August of this year. These clinics provide services to addicts on a walk-in basis, which is good, and we have referred many community members already. The only problem is that they operate two hours a day, five days a week. Given the scope and urgency surrounding the meth epidemic and the simultaneous opioid crisis that our communities are facing, those hours are terribly underwhelming.

Our patrols are conducted in the evening after most service providers are gone home for the day. When we come across people in crisis, there are very few options for us to offer. Typically, police or ambulance do a wellness check. Our main street project provides only the most basic services, essentially three hots and a cot. Even there, community members experiencing meth psychosis are not welcome because of the associated violence.

There are many things we need in our communities if we're going to make it through this epidemic. We need reliable access to resources in a timely fashion. Community development is not done nine to five, Monday to Friday. There needs to be a greater commitment. We need mental health supports to be more readily available. We need greater access to emergency shelters space. We need access to more affordable housing.

A community constantly existing in crisis mode is a community prone to all sorts of social abuses. I'm sure it's no surprise when I tell you that the biggest issue we keep coming up against is the blinding poverty that affects us and so many other communities around the nation. The poverty and disconnectedness in our community triggers addiction in our community members. That addiction feeds the random violence, feeds the rampant poverty, property crime, and it self-perpetuates: street, hospital, prison, repeat.

Safe consumption sites, needle exchange programs, 12-step programs, treatment opportunities, these are all good things, but if you're hungry or you woke up on a friend's couch that's another challenge. If you can't afford transportation to and from programming, job interviews, doctors' appointments, and even banks and shopping centres, these are beyond the reach of many of our community members.

If those underlying issues related to poverty are not addressed, there will be no meaningful progress. If poverty alleviation is not part of whatever strategy we employ, we are not going to get anywhere.

For the record, it is easier to get bongs and crack pipes in my community than it is to get good and healthy food, and by that I mean we have two chain stores in our community that sell produce and wholesome foods, but we have two dozen stores or more that sell bongs and pipes in our community. The store at the corner of my street even sells the Brillo piece by piece to feed that. This is a problem.

For our part, we have begun to collect and distribute produce and baked goods directly to community members. Last year we did 21 tonnes. This year we've done 55 tonnes so far, and I fully expect we'll deliver 60 tonnes by the end of the year. Last year we provided $35,000 in temporary work placements through our volunteer base. This year we did more like $90,000 in temporary work placements. We're very proud of these stats but, sadly, we're only scratching the surface. The need in our communities far outweighs our capacity to provide currently. It's time to change the way we value people. It's time for us to start working together in a much more meaningful and collaborative way. There needs to be a real shift in our thinking and it needs to happen now.

[The Vice-Chair, Conservative, Marilyn Gladu]

Thank you very much.

Now we're going to go to Sarah Blyth, the Executive Director of the Overdose Prevention Society, for 10 minutes.

[Sarah Blyth, Executive Director, Overdose Prevention Society]

Thank you, Madam Chair.

Thank you for having me here today.

I want to start with a personal story about going to California in the nineties to work and living with a bunch of young people. Lots of people went to school. Everybody had jobs in the sports, entertainment and music industries, and everybody was using meth and speed in order to get through school and the pressures of working all the time.

I think what had happened was that it just became so common and so easy. Now all across the States people are using crystal meth, and it actually just recently came here. It's actually quite easy to access in the schools, as well, these days. My son's in school, and he says drugs are just so easy for young people to get access to that it's incredible. Also, it's not surprising that if young people are using drugs, they would use them later on in life.

I'm the executive director of the Overdose Prevention Society, located in the Downtown Eastside of Vancouver. Our facility includes an outdoor smoking area that seats 13 people, and it's one of only two in Canada. We also have an indoor area that seats 13 people, which is an injection area. We see up to about 700 people a day at our site.

We're located in one of the two alleys that are most used by drug users in Canada. It's one of the busiest sites. It's on par with InSite right now.

At our site, no one's ever died. Around half of our participants use crystal meth now. Many use it in conjunction with heroin and fentanyl, including speedballs, which are both at the same time.

The reason people use crystal meth is that obviously it takes away some of the pain and suffering, but it's cheap and lasts longer than most other drugs. In the Downtown Eastside, many of the drug users are most regularly using what's cheapest and easiest to attain, and crystal meth is definitely one of those.

People who use stimulant drugs like meth and cocaine are also at risk of overdose from fentanyl and other contaminants. Safe supply means pharmaceutical-grade stimulants that are easily accessible to people. Therefore, getting people safe access to drugs that include crystal meth would probably be one of the better things you could do just in terms of a stimulant that's not going to be contaminated with everything under the sun. A lot of the behaviours and illnesses people are experiencing are from the contamination.

They use laundry detergent and pig dewormer. There's fentanyl in the crystal meth. There's everything you could possibly imagine, and we have no idea how some of these affect behaviour or even people's livers. The long-term health effects of that are just incredible.

It's really in the Downtown Eastside, especially, that everything's made out of garbage. Anything you can imagine is in there, and it's really quite horrible. We know that, because we test the drugs. We do testing of drugs and we can test up to, I think, 100,000 different things, so we can see that they're highly contaminated.

We see people who have been awake for days quite frequently. This can lead to psychosis, paranoia, violence, hallucinations and hospitalization. Unfortunately, hospitals don't have the capacity to deal with this.

The other night we brought in a woman who's homeless and who uses our site frequently. She also volunteers with us. She uses a combination of drugs. It took one of our volunteers four hours waiting at the hospital for her to get in, and she was released immediately untreated and came back to us. I've been down there working for 12 years, so I'm capable of helping people in these situations, but it's really challenging.

It's really difficult that the hospital system can't accommodate it. It's just overwhelmed with other situations, including the overdose crisis in general.

Recommendations to improve health outcomes for drug users would be safe alternative prescriptions with known potency and ingredients, safe harm reduction supplies, safe smoking sites... People are turning to shooting drugs because there's no place to be seen safely using smoked drugs, so they're injecting them or just learning to inject them. It's really important that we give people a safe smoking area, which in B.C.... Actually in Edmonton they have a state-of-the-art facility, which I don't think is necessary. You can have some of these as really basic pop-up services in the crisis that can help people immediately and are not that high a cost.

The truth is that the high cost is to continue on with these crises the way that they are, criminalizing people and having people do crime and survival sex trade, women putting themselves at risk. That's going to be the high cost for Canada in the long term. Really what is needed is to do the right thing by giving people safe places to use, treated by professionals, safe access to drugs that won't harm them or cause damage to them. It will reduce crime, all these things that I think would be really important.

Rehabilitation includes a safe supply and detox that includes safe drug alternatives, getting people onto something that's not going to hurt them long term. There are a lot of people who we see who have mental and physical health conditions, permanent conditions that are really painful, like terminal cancer, who may need something for the rest of their life. They're self-medicating with things that are going to hurt them and actually make things worse for them. We really need to figure out how to help these folks. There are a lot of simple ways of doing it.

Thank you.

[The Vice-Chair, Conservative, Marilyn Gladu]

Thanks very much.

We're now going to the Pine River Institute. We'll start with Vaughan Dowie for 10 minutes.

[Vaughan Dowie, Chief Executive Officer, Pine River Institute]

Thank you, and we'd like to thank the committee for the invitation.

My name is Vaughan Dowie. I'm the CEO of Pine River Institute. I'm here with my colleague Dr. Victoria Creighton, who is our Clinical Director.

We thought that the best contribution we could make to the committee's deliberations is to talk to you about the importance of adolescent treatment services, particularly residential treatment for youth in need of service for addictive behaviours. To provide you with context, let me tell you a bit about Pine River Institute.

Pine River Institute is a residential treatment program for adolescents with addictive behaviours and, frequently, other mental health concerns. We serve a population of adolescents between the ages of 13 and 19. We are mandated to accept both girls and boys from across Ontario. Our main campus is located just outside of Shelburne, Ontario, about 100 kilometres northwest of Toronto. We operate 36 beds, 29 of which are funded by the Ontario Ministry of Health and Long-Term Care. For those 29 beds, we have a wait-list of more than 200 youths.

Our program is unique in Canada. All our students begin with the wilderness phase of the program, either in Muskoka or Haliburton, depending on the time of year. We're now in the Haliburton time of year. They then move to our campus. After a time there, they spend increasing amounts of time back in their home communities to practise what they learned in the program.

After transition from the residential program, we offer aftercare support. Our program works not only with the youth. Family involvement in the program is a requirement of admission. We require our families to be engaged in the program through workshops, retreats and regular parent groups over and above the work they will do with their child.

Pine River is involved in ongoing research. In particular, since our inception 12 years ago, we've invested in ongoing outcome research. We track a number of indicators, particularly those involved with substance use, school or workplace engagement, contact with the legal system, hospitalizations and other crisis indicators such as running away. We track these indicators pre-admission and after discharge and every year thereafter until the youth turns 25 to measure whether the change that takes place is maintained. We publish these results annually as a way to inform our funders, potential clients and other stakeholders of our outcomes. I have brought a few copies of the most recent report with me if anybody would like a copy.

Pine River's clinical philosophy centres on trying to increase the maturity of the youth who we see. We believe that the youth in the program have delays in maturity. This can be caused by trauma or other obstacles. We define maturity to include a future orientation; a social ethic; emotional regulation; the ability to be autonomous and not be part of a puppet relationship, either as a puppet or as a puppeteer; empathy; plus, a lack of narcissism. Often these elements are also described in some literature as part of “healthy emotional intelligence”.

The Pine River program has a variable length of stay. By that, I mean that unlike other programs in the sector with a fixed time for treatment—21 days, 90 days, four months, whatever—we allow our students to complete the treatment at their own pace. Our average length of stay is about 14 months.

As for substance use, the majority of our students are polysubstance users. They will use whatever is available. We do ask about the drug of choice. The number one drug of choice is cannabis, but of interest to this committee for the purposes of this hearing, we ask parents prior to admission what substances the youth is using, and the results for methamphetamine were the following.

In 2015, 2% of our parents reported meth use for their child. In 2016, again it was 2%. In 2017, it was 5%, and in 2018, it was 16%. Contrast that to our students' self-report of what they are actually using: in 2015, it was 18% for meth use; in 2016, 53% reported meth use; in 2017, the number was 22%; and, so far this year, we're at 16%.

We take from that a couple of conclusions. First, generally speaking, the use of methamphetamine has been much greater than suspected, even by parents who are really concerned about the behaviour or the habits of their kid. Second, while the numbers seem to fluctuate with our clientele, it's a significant factor in the drugs they choose to use.

As the committee tries to integrate the various perspectives regarding the issues that arise out of methamphetamine use in Canada, here are the take-aways we'd like to leave with the committee.

One, it is imperative to invest in services for young people in order to address the underlying issues as soon as possible. Not only is it the right thing to do, but it makes good economic sense.

We work with the DeGroote School of Business at McMaster University to look at the social return on the investment made in the youth in our program as a result of government funding. The answer was somewhere between seven and 10 times return on investment. I've also brought copies of that report if anybody would like to have it.

There needs to be a significant expansion of accredited residential resources aimed at youth. Our waiting list of over 200 speaks eloquently about the lack of quality resources for youth in this age group. Very often, governments hesitate to invest in residential programs because it's the most expensive end of the continuum, but working with youth who are abusing substances is so important because, as time goes on, the problems become more ingrained, thereby making change in their lives and brains more difficult. This approach is as important—if not more so—for methamphetamine as for any other substance.

Public education should always be a component of any substance use approach and should provide real and believable information about the impact of the substance to young people. Otherwise, we rely on word of mouth and bad information that often minimizes potential harms.

We commend the committee for its interest in this important subject. The complexities of the issues that are linked to meth use and abuse require a multi-faceted response. Within that response, we ask the committee to remember the need for effective youth treatment services as part of our national approach.

[The Vice-Chair, Conservative, Marilyn Gladu]

Thank you.

Now we'll go to our first round of questioning. We're going to start with my colleague, Robert-Falcon Ouellette, for seven minutes.

[Robert-Falcon Ouellette, Winnipeg Centre, Lib.]

Thank you very much, everyone, for coming here today. I really appreciate it.

We only have seven minutes. I have a number of short questions I'd like to ask each and every one of you.

James, I was wondering if you could discuss a little bit more the “street, hospital, prison, repeat” cycle that you were talking about. As well, I'd like you to discuss the stores that sell more crack pipes, the only two grocery stores in a certain radius, and what that does to an environment and how people access quality food.

[James Favel]

We're living in a food desert in our community, and one of the biggest problems that we're having is with the corner stores that we have in our community. Everything is overpriced there, and you can't get really good, wholesome food in those stores. Crack pipes, bongs, papers and all that kind of stuff are all there, but the food is not. There's a Safeway, and there's a Sobeys cash and carry in our community. Those are the only stores accessible inside our community limits. The Sobeys cash and carry is kind of off in a corner that is hard to get to for most community members.

Sorry, what was the other question?

[Robert-Falcon Ouellette]

Street, hospital, prison, repeat....

[James Favel]

Right. That's what we're seeing. We're seeing our community members come out of prison, get back into the addiction, get caught up in trouble, go to the hospital and go to prison. It just keeps happening over and over again. We have two volunteers currently who are going through that right now. Last night, I was dealing with it until three o'clock in the morning.

[Robert-Falcon Ouellette]

Are you saying that there's not enough support when people are actually released from prison?

[James Favel]

There's not enough support when people are released from prison. The EIA system is kind of punitive. In our community, it's about $100 per month for food for people coming out and need that service. If you're coming out of prison and you're given $97 a month to survive, it's not going to bear positive results.

[Robert-Falcon Ouellette]

Thank you very much, James.

Darlene, I have a few questions here. You mentioned that nurses have suggested a dedicated place for users. Can you discuss that a little more?

[Darlene Jackson]

I think what we recognize is that meth is a different drug than opioids. It is incredibly addictive, it is incredibly accessible and it is inexpensive. We understand that the treatment for someone struggling with a meth addiction is going to have to be totally different from someone with a different addiction. It needs to be long term. I can certainly respond to James when he speaks about the RAAM clinics, the rapid access clinics. I think they're a wonderful idea. However, two hours per day is not adequate.

I've worked in emergency. I've worked in health care for years, and it's like anything else. When someone who has an addiction makes the decision that they want to make a change in their life, it has to happen there. You can't say to them, “I can have a treatment bed for you in three months” because then they're back out on the street, and they've lost that need for change. We need to be very proactive. We need to be ready. When that client is ready, when that patient is ready, we need to be there for them to provide that care. It needs to be long term, and there needs to be support after treatment to ensure that they maintain.

[Robert-Falcon Ouellette]

In the emergency wards, because there are meth addiction issues—you said four to five a day—what does that cause for the users, or other patients, who want to go to that facility, for children and others who might want to go down to the Health Sciences Centre or any other health care emergency ward?

[Darlene Jackson]

Our emergency departments have been closed. We've lost two and we're going to lose a third one, which is going to mean our city has three access points for emergency.

One issue we've identified is that the Health Sciences Centre is in the core of the city. Many residents who live in that core area do not have access to a taxi or a bus to get to an urgent care facility or a walk-in clinic.

Despite the fact that our government and our regional health authority in Winnipeg says, “The right care at the right time in the right place”, the bottom line is that many of our individuals who live in those areas don't have access to the right care. They have no way to get there. They go to the closest facility, which is our Health Sciences Centre, because they have no choice. There's nowhere else for them to go. To take a cab to Victoria General Hospital is absolutely out of their range of income.

Saying that you need to be at the right place at the right time for the right care is a platitude. It doesn't work for the communities in that area. I think part of the issue is that many of our patients who present with a meth-related issue are volatile. Things can change. On the spin of a quarter, their whole demeanour changes. Often they need a lot of resources to ensure they're safe and to ensure care providers and other patients are safe, which means that the wait for other patients in our emergency departments is longer.

[Robert-Falcon Ouellette]

Thank you very much, Darlene.

I have two final questions: one for Sarah, and one again for Darlene.

You talked about training. I was wondering if you could, in about 30 seconds, discuss the idea of training for nurses and other health care professionals, and how it needs to be increased.

Also, I'd like Sarah to discuss self-medication for pain, and pharmaceuticals and how people obtain legal pharmaceuticals versus illegal drugs.

You have 30 seconds each.

[Darlene Jackson]

I'll try to be brief. Brevity would be my friend.

I think we definitely need to look at specific training for meth-related issues for hospital personnel, and that is much bigger than violence prevention. We need to talk about how to safely protect yourself and your other patients and families. That's a big issue, because our government and our employers have not invested in that. As one nurse said, “We didn't learn how to deal with meth in school, and we have no way of learning how to deal with it now, unless someone takes the time to teach us.”

[Robert-Falcon Ouellette]

Sarah.

[Sarah Blyth]

We have a place called the Crosstown Clinic in Vancouver. Probably no one has heard about it, except maybe Don and a few others. It gives safe access to heroin to about 100 people. It's injectable, and there are doctors available there to help them. It's a very small program, and it's shown that people using that program every day gets them back to sort of a normal life.

Having that for stimulants would probably be really great. I mean, it would be a great idea, because getting people using stimulants when they know what their dose is.... A lot of times, people don't know what the dose is, so if they take a stimulant, we don't know how strong it is. If they take a really strong stimulant, don't know what the dose is and don't know what's in it, it is more likely they're going to have a psychotic episode or go into psychosis immediately, especially if they're injecting.

[The Vice-Chair, Conservative, Marilyn Gladu]

I have to cut you off. That's your time.

Now we're going to go my colleague, Ben Lobb.

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

Thanks very much.

The first question I'd like to ask is this. There was a recent case in Ontario where a 27-year-old was charged with trafficking many drugs. Some of the stuff he had was 316 grams of meth, 149 grams of heroin, 5.6 kilograms of cocaine and 8.1 kilograms of marijuana. The Crown attorney's proposing a six- to eight-year sentence. His lawyer thinks a five-year sentence would be appropriate for this drug dealer.

I know you're not here to give opinions on the legal system, but my point is that 316 grams of meth is 316 doses of meth. He's wrecking tens if not hundreds of lives, potentially, and costing the system tens of millions of dollars—maybe hundreds of millions of dollars—and his sentence, potentially, could be five years. Is that right, or do we need to look at that as well?