Health Committee on Feb. 19th, 2019

[The Chair, Liberal, Bill Casey]

Welcome to meeting 134 of the Standing Committee on Health. We're going to hear witnesses today on the impacts of methamphetamine abuse in Canada.

I want to welcome our guests. We have, by video conference, Karen Turner from Alberta Addicts Who Educate and Advocate Responsibly. From the Canadian Drug Policy Coalition, by video conference from British Columbia, we have Donald MacPherson. From the Canadian Public Health Association, we have Ian Culbert. Thank you very much for coming. Also, from the Ontario Provincial Police, we have Rick Barnum, Deputy Commissioner, and Lee Fulford, Detective Staff Sergeant. Welcome.

We're going to begin with an opening statement by Karen Turner.

Are you ready to make a statement?

[Karen Turner, Board Member, Alberta Addicts Who Educate and Advocate Responsibly]

Yes.

[The Chair, Liberal, Bill Casey]

You have 10 minutes.

[Karen Turner]

I've been an outreach worker in Edmonton for over 12 years.

Regarding meth use in the context of prohibition, meth use is common among members of the community I work with and very common in Edmonton. Although I acknowledge that meth use is the concern of this committee, I think we should understand that meth is not chemically different from drugs that are prescribed to treat ADHD in Canada every day. Drugs like Dexedrine and Adderall are prescribed without the side effects or stigma that meth has. This is because they come in a regulated pharmaceutical dose.

Some people use meth for the same reasons. It helps them focus. Meth comes in unregulated doses, which means that the person using it has no way of knowing what is in their drug. Sometimes the doses bought on the streets are much larger than what the person would get from a prescription, and a larger dose can come with more side effects.

Meth use affects every person differently. For some, it's helpful, and they use it without any problems. Research by Dr. Carl Hart in the United States suggests that only 4% of people who try meth end up addicted to it.

There is a fear that meth can cause psychosis in some people. Meth psychosis is often a result of homelessness and poverty. During the winter in Edmonton, when the temperatures are 30 below, people who are experiencing homelessness use meth just to survive. This means using it to stay awake all night to avoid freezing to death. When people are trying to survive a long, cold winter and have no place to go, they have to stay up, often for days and nights on end, to prevent freezing to death. When people have underlying mental health issues, are homeless and have not slept for days on end, their chances of developing psychosis increase a great deal. I believe that meth use is not the largest issue but that homelessness and poverty are. It's not the drug; it's the policy.

People risk jail or prison to obtain the drug, and when they use it, because of fentanyl contamination in the drug supply, they risk overdose death. Fentanyl is not just in our opiate drug supply; it is now being found in stimulants. The fact of the matter is that Canada's drug supply is contaminated. Unless we replace the contaminated supply with a safe supply, we will continue to lose thousands of people every year. We need a safe supply for stimulant replacement programs to protect people from criminalization and the worst side effects of meth use. While people who use opiates can get access to oral substitution therapy, people who use meth have very few alternatives.

Our government needs to set up programs that provide people who are using meth or cocaine with safe, prescription forms of the same drug. There is a prescription version of meth called Desoxyn that is on Health Canada's special access program. It can be imported into Canada and used to set up a stimulant maintenance program. This is something Canada has to invest in. The same goes for cocaine, which is also used in some cases as local anaesthesia.

To combat the overdose epidemic, we need programs that provide safe versions of what people are using on the streets. This is a must if we are to save people who use drugs.

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we'll go to the Canadian Drug Policy Coalition and Donald MacPherson.

[Donald MacPherson, Executive Director, Canadian Drug Policy Coalition]

I'll begin by thanking the committee for the invitation to appear today to discuss this important issue with you.

I have been working in the field of drug policy for over 25 years at the community level and then as the drug policy coordinator for the City of Vancouver as we created and implemented Vancouver's four pillars drug strategy.

Since 2011, I have been the executive director of the Canadian Drug Policy Coalition, a partner project with the Faculty of Health Sciences at Simon Fraser University. Our vision is that of a safe, healthy and just Canada in which drug policy and legislation, as well as related institutional practice, are based on evidence, human rights, social inclusion and public health.

We agree with many of the witnesses you have heard already, including the father who, in quoting Dr. Gabor Maté, laments that there is no war on drugs, that there is only a war on people who use them, which means that we are often warring against the most abused and vulnerable segments of society. We agree that this is counterproductive and harmful.

We agree with the police chief who was exasperated by the lack of health and social services and supports for people who use methamphetamine, and with the several witnesses who testified that responses to substance use related harms across Canada, even in the midst of an overdose death crisis and a growing concern about methamphetamine in various parts of the country, have been inadequate in most regions.

We agree that reducing or eliminating stigma is critical to helping support people as they make decisions about their lives.

There is a tremendous agreement across sectors that stigmatizing people with addictions is not constructive. There is also a significant consensus in Canadian society that addiction issues should be dealt with through a comprehensive health and social approach that considers the social determinants of health, as well as supporting people to manage their substance use through a variety of pathways.

Substance use is one of the most complex issues of our time and will continue to be a part of our public discourse in the future. People have been using substances since the dawn of time, and it will continue, sometimes in beneficial ways and sometimes in ways that cause harm to people who use them.

I've wondered for many years why it has been so difficult to change the way we approach these issues. As some of the committee members have remarked over the weeks, how come we haven't yet even addressed the social determinants of health, as we know we must do to make progress in this area?

I have had similar thoughts over the years. Why is it so hard to change the approach we take? Why is it so hard to shift from what historically has been an overreliance on law and punishment to one that embraces contemporary scientific knowledge of public health interventions and an understanding of how and why people use substances?

We note that the foundations of our current approach were laid in the early 1900s and have resisted fundamental change until quite recently, in response to irrefutable evidence that our historic drug policies have utterly failed to achieve their goals of reducing substance use, stopping the flow of drugs and protecting Canadians.

We saw this with the failure of cannabis prohibition over the past 40 years and are seeing this more starkly with the absolute poisoning of the illegal drug supply in North America through the onset of synthetic fentanyl and its many analogues. This is why we are hearing desperate calls from people who use drugs, those working on the front lines and an increasing number of medical health officers for a safer supply of drugs to be made accessible to people.

The history of Canada's drug policy is that it was in large part created in the early 1900s, imbued with colonial values and fuelled by racism and hysteria about opium use on the west coast and the fear of Asian workers who had worked on building the railway, taking jobs away from British Columbians.

By the late 1920s, Canada's drug policies were some of the most draconian policies in the world. Then, as now, if you were white and had power and resources, you had little fear of being impacted by those drug policies. If you were indigenous, Chinese, Hispanic, black or a poor white person who used drugs, you were very likely to be subjected to very harsh penalties. Penalties for possession were up to seven years in prison and a $1,000 fine, and whipping was at the discretion of the judge. Talk about stigma.

Our current policies sit on this foundation and to this day prescribe criminalization and punishment as a response to possession of an illegal substance, along with these consequences: stigmatization, rejection, shunning and the fear and loathing that society often heaps upon people who use criminalized substances. This is why decriminalization is an important concept to consider as we modernize our drug policies.

We also tend to conflate the worst cases of methamphetamine use with all use, when in fact most people who use methamphetamine are not necessarily problematic users. Imagine if we conflated all alcohol use with the worst, severe problematic use. Our view of having a drink would look very different in our minds.

In the Downtown Eastside where I began working in 1987, the most common homicide in Vancouver at the time involved a fight within blocks of a bar, and alcohol and a knife. There was little hysteria about alcohol-fuelled violence, but there was a local campaign to ban knives from the neighbourhood. With methamphetamine there is a tendency to focus on the drug as the problem rather than the circumstances around it: trauma, poverty, abuse, homelessness, disconnection from family and community and the many other social determinants that contribute to the health of our communities.

In closing, we have a few recommendations for the committee to consider.

We must stop pretending that problematic substance use will disappear if we magically come up with the right set of interventions. We need to accept the fact that substance use will continue to take place in our society along a spectrum of use from beneficial uses to non-problematic uses, problematic uses and, of course, addiction.

We know that most people who use drugs will not become severely addicted to them. That is clear from the evidence. And we know that most people who manage their use, or cease using drugs, do so without the help of professionals or treatment providers. There are multiple trajectories into and out of addiction and multiple non-problematic users of substances.

We must also stop pretending that prohibition of drugs will improve the health and safety of Canadians, In fact, our drug policies are killing Canadians and enriching transnational criminal organizations.

We would acknowledge that at this time in Canada, the illegal drug market is more deadly than it has ever been, and we would prepare for even worse conditions moving forward, meaning that we should scale up harm reduction efforts, not cap them or ignore them as some provinces are doing. Illegal drug markets are dynamic and changing all the time, and we need to be prepared.

We would acknowledge the importance of working with people who use methamphetamine and other drugs to begin to design programs that meet people where they are and support them.

A number of things could be implemented in relatively short order that would go a long way to ending this war on our citizens, some of our most vulnerable, and changing the environment for people who use drugs in their communities.

One, embrace innovation and experimentation. Try new approaches. Review institutional policies and practices that are barriers to engaging people.

Two, support the immediate decriminalization of possession of currently illegal substances for personal use. There is no upside to criminalizing users, given the state of the illegal drug market and the other harms that stem from criminalization, including stigma. We need to maximize connection with people, not push people into the shadows.

Three, it would be good to see more emphasis on harm reduction within the Addictions Foundation of Manitoba recommendations and other provincial strategies, given the toxicity of our drug markets, as well as highlighting the connection between harm reduction, health services and treatment resources. They are not separate. They are a continuum.

The creation of low threshold, welcoming, safe places for people who use methamphetamine where peer workers can help people access supportive services, including help finding secure housing, food, social assistance, help with resumés and job applications, indigenous cultural supports where appropriate, and help build connections to their community, would be an important part of that kind of a plan.

Four, the establishment of supervised consumption services is a powerful message to people who use drugs that we care about them and want to engage people in health services, not back alleys. No one has died of an overdose death in a supervised setting in Canada, by the way.

Five, pharmaceutical-grade methamphetamine would be provided to people addicted to meth as a temporary maintenance regime to give an alternative to the criminalized market and the need to raise the funds to buy meth from unregulated dealers on the street. Methamphetamine under the brand name of Desoxyn is prescribed as a weight loss treatment and for ADHD. Adderall is very similar to methamphetamine and used widely in society, as you heard earlier from David Juurlink.

My final point is that as part of our outreach to people who use drugs, we could also begin to ask people why they are using methamphetamine. This would include non-problematic users as well as those who are clearly addicted. Everyone starts doing something for a reason, and we need to better understand the benefits and the harms that people who use methamphetamine perceive. It would be beneficial to all of us to understand the range of reasons and experiences of people who use methamphetamine.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we go to the Canadian Public Health Association, and Mr. Ian Culbert.

[Ian Culbert, Executive Director, Canadian Public Health Association]

Good afternoon. Thank you again for the invitation to present to you today.

While the overall prevalence of methamphetamine use is low, at approximately 0.2% of the Canadian population, the impact of its use on individuals, families, friends and communities is extremely high. As Donald just mentioned, the reasons a person might use methamphetamines vary as widely as the individuals themselves. Inevitably, the outcomes are common: illness, psychosis, injury, disease and often death. In the testimony of previous witnesses today and on previous days during this study, you've heard about the need for improved harm reduction and more treatment facilities and enforcement to address this problem. These are all important steps to mitigate the current situation.

From a public health perspective, however, there is a paramount requirement to look at why people use psychoactive substances, such as methamphetamines, and to identify upstream approaches to reducing this consumption. Psychoactive substances can be used as a coping mechanism by those who have experienced trauma, violence, social marginalization or the loss of cultural identity. We also know that the social determinants of health often underlie problematic substance use. Homelessness, poverty, social isolation, racism and stigma can all be precursors of problematic substance use.

It is known that those at the lower end of the social gradient have poorer health outcomes. They tend to have higher rates of consumption of intoxicating substances, are more likely to be incarcerated and are disproportionately composed of people of colour and indigenous people. Steps must be taken to address these issues, by addressing the social determinants of health, and the harms we have caused to the indigenous peoples of Canada. I encourage this committee to make recommendations for bold action.

For example, the Government of Canada should develop an action plan to fulfill all the calls to action from the Truth and Reconciliation Commission in the next four years; increase investments in social housing, using a housing first model; fully explore the potential of a basic guaranteed income; support families in raising their children by adequately funding early childhood education and care in every jurisdiction of our country; and, as recommended by the Canadian Association of Social Workers, promulgate an act of Parliament that includes principles similar to those found in the Canada Health Act, to help guide Canada's social transfer and other social investments, and make possible shared performance indicators across our country.

These are just five upstream recommendations that will help slow the number of daughters and sons whose lives are torn apart by methamphetamine use.

It is also important to recognize that problematic substance use is a health condition that can be managed and successfully treated for those who are ready. Unfortunately, methamphetamine use, as has been mentioned, is a very difficult condition to treat. Psychosocial counselling and behavioural-management approaches can be effective, but there are simply not enough drug treatment services in Canada to meet the demand. Further exacerbating the situation is the lack of national standards for private drug-treatment services, leaving patients and their families vulnerable to questionable treatment regimens that cost thousands of dollars.

Unlike opioid-use disorder, where medication-assisted treatment is available, there are currently no accepted drug-based therapies to treat problematic methamphetamine use. Given the millions of dollars spent in the United States on this type of research, I find it unlikely that such a silver bullet will be discovered.

Despite these confounding circumstances, there are actions the Government of Canada can take to relieve some of the suffering associated with methamphetamine use, in the short term. These recommendations are from the Canadian Public Health Association's 2017 position statement on the decriminalization of personal use of psychoactive substances, which I believe was circulated in your background packages.

When CPHA speaks of decriminalization, we are speaking of the simple possession and use of drugs. I'm not talking about the property crime or physical violence that often accompanies drug use. I'm not talking about the large-scale trafficking and manufacture of drugs. Problematic drug use is a health issue that has, for the past 40 years, been recast as a public safety issue. There absolutely are public safety components to this, but for the individual, it is a health issue. If you want to make the necessary changes to reduce the impact of illegal drug use in this country, then you need to treat it as a health issue and act accordingly.

One step in accepting methamphetamine use as a health issue is to decriminalize possession for personal use and to provide the necessary health promotion, harm reduction and treatment services necessary to address the needs of substance users.

To that end, the Canadian Public Health Association calls on the federal government to work with the provinces, territories, municipalities, and indigenous governments to decriminalize the possession of small quantities of currently illegal psychoactive substances for personal use and provide summary conviction sentencing alternatives, including the use of absolute and conditional discharges.

Decriminalize the sale and trafficking of small quantities of illegal psychoactive substances by young offenders using legal provisions similar to those mentioned earlier.

Develop probationary procedures and provide a range of enforcement alternatives, including a broader range of treatment options, for those in contravention of the revised drug law.

Develop and improve access to harm reduction and health promotion infrastructure, so that all those who wish to seek these services can have ready access, and increase the availability of high-quality treatment services to meet the demand.

Finally, provide amnesty for those previously convicted of possession of small quantities of illegal psychoactive substances.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you.

So far, everybody has been within time. That's perfect.

Now we go to Deputy Commissioner Barnum, from the Ontario Provincial Police.

[Deputy Commissioner Rick Barnum, Deputy Commissioner, Investigations and Organized Crime, Ontario Provincial Police]

Thank you, Mr. Chair, and good afternoon, everyone. Thank you for your invitation to be here today.

I'm joined today by Staff Sergeant Lee Fulford, who is an expert in methamphetamine production, packaging, trafficking and things of that nature. I'll share the task of making comment this afternoon with him.

The OPP is involved in the International Association of Chiefs of Police, the Canadian Association of Chiefs of Police, the Ontario Association of Chiefs of Police, and an organization called the Canadian Integrated Response to Organized Crime. These groups are dedicated to reducing the harmful impacts of organized crime and drugs. CIROC is currently exploring the impacts of meth on public safety and our communities, and how it is investigated. The OPP is also embedded on a CACP special purpose committee researching the impacts of decriminalization on public safety.

Strategically, the OPP has taken the position of focusing on organized crime groups rather than specific commodities. Organized crime groups have a propensity to deal with a variety of commodities. These commodities range from trafficking in humans and firearms to trafficking and production of a variety of drug types, such as methamphetamine. Investigative projects can be international, national, or community-based. We have ongoing projects investigating organized crime groups, including Outlaw motorcycle gangs and traditional organized crime groups as well. For example, we're currently working with our international partners to disrupt methamphetamine coming from organized crime groups in Mexico, which is being imported into Canada as we speak.

A recent example of a locally based project, closed earlier this month, focused on the relatively small community of Hawkesbury, where we seized 4,000 meth tablets, over half a kilogram of cocaine, 16 fentanyl patches, along with various weapons and approximately $250,000 in cash. This project resulted in 20 individuals being charged. This is one example of many similar-style projects taking place across Ontario at this moment. Think about the impact and the message this sends by removing these dangerous elements from within these communities. We have other successfully completed projects that targeted the distribution of methamphetamine into our first nations communities.

Regardless of the investigations, meth is the one consistent commodity found. It has permeated into every one of our communities. Seizures of meth have only been on the incline since 2010. In 2010 there were only 15 occurrences in which meth was seized within the province of Ontario, followed by 453 occurrences in 2015, rising to 890 in 2018.

All drug investigations require Health Canada drug analysis to identify and confirm the types of drugs being trafficked. Mid and high-level undercover purchases require rush analysis in order for the undercover officer to provide feedback to the trafficker. For example, in Project Anarchy a significant amount of drugs was purchased and the delay in determining the purity or concentration of the drugs threatened to compromise our investigation. By that I mean that if we are attempting to buy pure cocaine and we actually purchased cocaine that's cut with some sort of filler, our credibility with the trafficker is compromised, as we're seen as not knowing what we're doing in purchasing or selling a product. Traffickers test their products themselves, whereas we rely on drug analysis.

In addition to the need for expedited analysis of drugs seized operationally, there is also an urgent need to obtain analysis results for drugs seized at the scene of overdoses. This ability can quickly identify deadly substances in our communities so we can alert the public and our partners, such as health care, hospitals, and things of that nature.

We recommend strongly that Health Canada increase their capacity to conduct timely drug analysis, given their unique role, and provide more comprehensive, overarching drug trend reports. It is difficult for police to unequivocally know what is on the streets of our communities and rapidly respond to public safety issues when analytical results are not provided for 45 to 60 days.

The uptake in meth use can be partially attributed to a decrease in price. In 2016, a kilogram of meth was worth approximately $34,000, and in 2018 it was $25,000. We are already seeing a further decrease in 2019 to levels as low as $15,000 for 1,000 grams of methamphetamine. Depending on your location in Ontario, the cost for a meth tablet can range from $1.50 to $10. Geographic location within Ontario determines the form of meth from powder to pills.

In our communities, the OPP are in frequent contact with substance users on a 24-7, 365-day basis. From our preliminary observations of overdose calls for service, it is not unusual for individuals to be using multiple drugs, including meth, cocaine and fentanyl. From the review of our data, there were 59 suspected drug overdose fatalities during the last third of 2018 alone in OPP jurisdictions. Nine occurrences, or 15%, were suspected to have been linked to methamphetamine.

Our work is not only focused on investigations. At a more local level, the OPP has adopted a model of collaboration—the community mobilization and engagement model—which brings a variety of community services together to support the needs of vulnerable persons, including those addicted to substances. We're also focused on highlighting the Good Samaritan Drug Overdose Act and embedding its spirit into our culture. We need to break the stigma associated with substance use disorder and mental health. We know addictions and mental health know no bounds and are non-discriminatory.

Law enforcement is often criticized for criminalizing individuals suffering from substance use disorder, which further stigmatizes them and marginalizes vulnerable populations. The OPP strongly advocates for increased efforts centred on prevention and education, and increased access to treatment. Our communities are unique. Enforcement, prevention, treatment and harm reduction resources vary from community to community. Increased access to social and health services must be available for all Ontarians regardless of their location. The OPP would welcome additional pre-charge diversion opportunities and partnerships to defer those dealing with substance abuse issues to health care professionals.

Let's tackle the topic of decriminalization from a public safety perspective. It's important for policing organizations, including the OPP, to be engaged in discussions on legislative amendments to address illicit drugs and their use. Legislation must not remove the police's ability to investigate street-level crime, which provides the required intelligence to target those who traffic, produce and import harmful substances.

In addition, any legislated reforms being considered will need to prevent criminal organizations from being able to manipulate the law to continue to further victimize substance users. Like many complex societal issues, no single group or organization has the expertise to provide the solution alone. We must work collaboratively to address the availability of these deadly drugs through enforcement while our health partners focus on providing harm reduction and treatment for individuals suffering from addiction.

I'll now turn our remarks over to Detective Staff Sergeant Fulford.

[Staff Sergeant Lee Fulford, Detective Staff Sergeant, Organized Crime Enforcement Bureau, Ontario Provincial Police]

Thank you.

Our projects have revealed that the primary source of meth is both Mexico as well as domestic production. The OPP has invested significant resources to effectively investigate and dismantle production in Ontario. The OPP has an internationally recognized clandestine laboratory investigative response team. This team quickly responds to dismantle clandestine labs anywhere in the province of Ontario. In addition, they also provide training to emergency services personnel on how to react and respond to toxic and other dangerous hazards usually found at clandestine laboratory sites.

There is a risk of toxic exposure, environmental damage and chemical explosions to the public and first responders, including police, fire and other emergency services personnel who must respond to these scenes. The one-pot method of meth production occurs throughout Ontario. The entire reaction is done in one container with recipes available on the Internet, and takes one to two hours to produce. All the precursors, chemicals and reagents are available commercially through pharmacies as well as hardware stores. This method is efficient at producing methamphetamines.

Since December 2012, a number of incidents involving this process have been discovered inadvertently by police or through other investigative means. This method poses a significant increased risk to the public and law enforcement due to the extreme fire hazard associated with the process. Significant and coordinated police and emergency services personnel are required to carry out the complex, meticulous and hazardous job of investigating and safely dismantling clandestine labs.

On average, a small synthetic clandestine lab that produces less than one ounce per cook cycle can require one full day to dismantle, and in excess of 20 emergency services personnel, whereas an economic-based lab that has the potential of cooking multiple kilograms per cook cycle requires an average of three full days to dismantle. Due to the size of the toxic sites, emergency services personnel required for the duration of the cleanup can be in excess of 45 emergency services personnel members, including police, fire and ambulance.

Greater intelligence related to incoming shipments and purchases of precursors and lab equipment is required. We applaud the work of the RCMP's chemical diversion program to identify precursors, but we call for increased notifications from them. Enhanced collaboration, particularly in Ontario, where the RCMP does not have provincial jurisdiction, will aid in disrupting the production and distribution of these deadly substances.

The production of one kilogram of methamphetamine produces six kilograms of toxic waste. This waste is usually disposed of through careless dumping, resulting in environmental contamination and health hazards to the public. There have been several incidents of chemical waste and precursor chemicals being found abandoned along roadside ditches. Some of these locations are littered with empty containers of acetone, iodine, isopropyl alcohol, caustic soda and ephedrine. For example, over the winter of 2018, the Caledon OPP detachment received eight dump-site calls for service in their jurisdiction. They appeared to contain the waste of economic-based labs of methamphetamines.

In closing, the OPP is well positioned to proactively investigate organized crime and to respond to clandestine labs. To further enhance our impact and promote public safety, a formal collaboration between public safety partners domestically is required to ensure that critical information-sharing relating to precursors and lab equipment occurs in a timely fashion.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you all very much.

I'm surprised to hear the call for decriminalization from almost everybody. I think it was all of the witnesses.

Anyway, we'll start our questioning now with a seven-minute round with Dr. Eyolfson.

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

Thank you all for coming.

This has been very interesting testimony from all of you. I wish I had more than seven minutes. I could probably spend all day asking the questions that were generated by this testimony.

Mr. MacPherson, I'll start with you. You mentioned underlying mental health issues. I'm an emergency physician and I understand how many people with underlying mental health issues do turn to illicit drugs. Would you find it helpful if, as a society, at a national level, we were increasing funding and resources dedicated to primary care mental health for better mental health outcomes? Would this contribute in the long term to helping this and other illicit drug problems?

[Donald MacPherson]

In the long term, yes. I think we underfund addiction and mental health services to a great extent across the country.

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

Thank you.

I'll ask both Mr. MacPherson and Mr. Culbert about this.

You've talked about harm reduction. This is something I have advocated since very early on in my mandate, again from my experience at the street level in the emergency department of an inner city.

Now, we know that in Canada and the United States as well—even more so in the States—there's a lot of resistance to harm reduction at the societal level. In some jurisdictions, it's at the political level. In my own province of Manitoba, the provincial government is still dead set against harm reduction. They don't believe in supervised consumption sites.

I'll ask you first, Mr. MacPherson, then Mr. Culbert. Can you suggest to us an approach to clear up these misunderstandings in the public and in the political sphere on this?

[Donald MacPherson]

It's not easy to have these discussions with some sectors of society. What we learned in Vancouver in implementing the four pillars drug strategy, which had a very big focus on harm reduction, was that if you get people together in a room and really talk about the common goals, you'll find that more often than not, they all agree that they want to save lives and to reduce infections and infectious disease transmission.

It takes a lot of dialogue. It's very difficult to have these discussions in partisan political forums because, unfortunately, drug policy is a subject used for political gain. That's very sad, especially at a moment in our history right now when so many people are dying. There's so much evidence that harm reduction helps people and actually saves lives.

While we're building these long-term systems of treatment that you were referring to in your last question, we really need to acknowledge that tonight, on the streets of our country, people are in desperate need of support and life-saving services. It's not an either-or. Trying to articulate that continuum, I think, is one of the things we have to really get better at doing, and not play one part of the continuum off against the other. We need them all. We need services now, this evening. We need, of course, to build that system of treatment of mental health and addiction that you're referring to.

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

Thank you.

Mr. Culbert, do you have anything to add to that?

[Ian Culbert]

I would say that at our current place in time, there are some people who are ideologically opposed to thinking differently about the situation in which we find ourselves. They think that people who use drugs inappropriately have no one to blame except themselves and that if they want to get out of it, they should pick themselves up by their bootstraps.

I equate it in certain way to those who are opposed to vaccinating their children. Nothing you can say to some people will convince them of the science that's clear, so we stop wasting our breath in certain directions and look for other non-traditional allies who can support you, such as public safety players who are on the ground, see the impact of drug use and, while historically may have been of the same mindset, have come to realize that there has to be a better approach.

Look for those new allies who can strengthen our argument and work with us moving forward.

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

Thank you.

How much time do I have, Mr. Chair?

[The Chair, Liberal, Bill Casey]

You have one minute and 59 seconds.

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

Great. Thank you.

Mr. Barnum and Mr. Fulford, we talked about decriminalization of these substances. I think there's been a misunderstanding. Certainly when anyone advocates for decriminalization, as was described in our testimony today, not of large-scale trafficking, not of the crime associated with it, but just for simple possession, there are those who counter that these advocates want to legalize all drugs. I'm hoping we can get over that.

It sounds like both of you understand that, and I think every one of our witnesses understands that. We're not talking about legalizing all drugs when we talk about decriminalization.

Mr. Barnum, in your testimony, you said that what you need is an ability to deal with the organized crime surrounding the drug trade. Again, in my previous practice, I took out more bullets due to the drug trade than I care to count.

Do you believe that if we were to decriminalize simple drug possession in small amounts for personal use, it would interfere with the ability of the police to deal with these large-scale criminal activities with drugs?

Mr. Fulford, you could make a comment on that as well.

[D/Commr Rick Barnum]

From my position, I'm not sure. I think it's tricky. When we talk about decriminalization, it's important to look after the users who are on the street and have no other alternatives. We absolutely agree with that and would support that ahead of any investigation into somebody who's trafficking these drugs.

It's also important to recognize that we fully support the wraparound essential services that need to exist before decriminalization happens. Our position would be absolutely to look after those who are in dire need and are addicted, but don't take away our tools to do investigations and find out who's dealing at street level, which can lead to who's dealing above street level and up and up. We can't start at the top in these investigations. It would be nice, but we can't start at the top.

That's essentially our point on that.

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

Do you have anything to add, Mr. Fulford?

[S/Sgt Lee Fulford]

No, thanks.

[The Chair, Liberal, Bill Casey]

That's good, because your time's up.

Mr. Webber.