Health Committee on Feb. 21st, 2019

[Dr. Peter Butt]

I have a couple of comments. If you look at the general population, it's estimated that 10% of people who use methamphetamine will develop a substance use disorder immediately, just with one use. Typically, it's 10% within a lifetime with most substances, but the reinforcing effects of the methamphetamine are very, very strong. If you look at dopamine release in the brain with sex, it would be 10 times that with regards to what people get from methamphetamine, so it's 10 times orgasm and very reinforcing.

I'm not suggesting that this is what's going on, but it's analogous to that when you look at how intense the release of dopamine is in the brain with exposure. We also have to look at the risk factors. My colleague is absolutely right, because some of these might be genetic, some of these are epigenetic, adverse childhood experiences, trauma in childhood, exposure to the substance and then the pattern of exposure as well.

There are other people who get exposed to methamphetamine who I've had as patients who hate it. They've tried it once or twice, and they dislike it; they don't like the way it makes them feel. There are definitely individual characteristics that speak to some people and repel others.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Detective Sergeant Pearce.

[Det Sgt John Pearce]

I think the stat of 10% is what we've been using as a guideline for that. This is one of the few drugs that you try once and get hooked on for life. I think that's one of the issues we have. It's similar to an opioid. Once you're on it, not only are you addicted to the drug, but you find it that much harder to get off that drug no matter what treatment you choose to take or what path you choose to take to try to get off the drug.

Accessibility, too, is a big thing that's different about these different types of drugs: what you can get access to and what's readily available. When you go to each community—we talked about the plains—you're going to come across different types of drugs, some that aren't available and some that are readily available in other communities. I think that's a big one that plays on some of those numbers, too, because you're going to find that the numbers for the different types of drugs are going to vary across the country as well.

I would agree. That number I heard was 10%.

[The Chair, Liberal, Bill Casey]

Thanks very much.

We will move on to Mr. Ayoub.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

My questions are for Dr. Thomas in particular.

Dr. Thomas, you have a long practice of the profession in Montreal. Can you give us a picture of the situation? You have a clinic specializing in treatments related to sexual health, particularly AIDS. You have been known for this in recent years.

What is the overall situation in Montreal regarding substance abuse? We are talking about methamphetamines, cocaine or other substances to which individuals are highly dependent. It is difficult for them to stop using them. Since you are in the field, what can you tell us about the service offer?

There is also the issue of prevention. It's very wide. I only have five minutes and I really want to give you time to answer.

[Dr. Réjean Thomas]

Thank you.

The situation has changed a lot. In the 1980s and 1990s, it was certainly cocaine, at parties for example, on occasion. We were in no way seeing the addiction we've been seeing in the last three or five years.

After that, there were opioids. In Quebec, we have had needle exchange centres since the early 1990s. We did not see that this increased or encouraged drug use. On the contrary, we have seen a significant decrease in HIV and hepatitis C among people who used the services of these centres.

Then there was a decrease in the number of people using injection drugs in general. People switched to other drugs. For the past five or six years, this has been particularly the case with crystal meth. In my office, it's catastrophic. In my practice, in the gay community in downtown Montreal, this drug is the most damaging, along with the STI epidemic and HIV, diseases that have been mentioned.

We receive testimonials from people who have used crystal meth. They often tell us that, even if they want to stop, it has been so good sexually that they are dependent on it. Some people will rather tell us about their creativity, which is stimulated when they consume it. They wonder how they will ever be able to stop and whether they will be able to do so.

There are resources in hospitals at the emergency hospital centre. Then there are the resources for detoxification. However, there is little expertise for this clientele, which corresponds to a particular group, the one I see in downtown Montreal.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Do you have the impression that there is a certain cohesion in the offer of services in Montreal, but also in the rest of Canada?

Across Canada, is there an exchange of best practices? Are you being informed? Do you have to do it yourself? I suppose you do. Is there any leadership in this exchange of best practices across Canada?

[Dr. Réjean Thomas]

I find that, in Montreal, it is completely insufficient. Crystal meth is not a drug like any other. It destroys people very quickly. Even if cocaine is used more, the consequences are not at all the same.

There is little expertise and few resources. That's one of the problems. In Montreal, a community group gives lectures here and there.

There was talk about education earlier. If there are educational campaigns on cannabis, there may well be campaigns on crystal meth as well. Education campaigns aimed at the general public are also important, and the federal government certainly has a role to play.

This is not well known. There is little expertise, and few doctors are interested. Those who work in the mental health field do not know those who work in addiction. Then you end up with a particular group of gay men. These are all double and triple expertise.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I have barely 30 seconds left.

Do your resources come mainly from the provincial government?

[Dr. Réjean Thomas]

Yes, but—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

There are resources that come from the federal government and that go to the provincial government, particularly in Quebec. However, you don't have a direct link with the federal government, right?

[Dr. Réjean Thomas]

No.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Right.

Thank you, that answers my questions.

[The Chair, Liberal, Bill Casey]

Okay, thanks very much.

Now for our very final question we have Mr. Donnelly for three minutes.

[Fin Donnelly, NDP, Port Moody—Coquitlam, BC]

Thank you, Mr. Chair.

Dr. de Villa, you recently presented a report to the City of Toronto's board of health entitled “A Public Health Approach to Drug Policy”. One of the recommendations in the report is that, “The Board of Health call on the federal government to decriminalize the possession of all drugs for personal use, and scale up prevention, harm reduction and treatment services.”

Could you explain why you made that recommendation and tell the committee a little bit more about that recommendation?

[Dr. Eileen de Villa]

I think we've tried to allude to this already, myself and others around the video conference. I feel, and I think the evidence demonstrates, that there are significant harms associated with prohibition and that there is a good rationale for looking at drugs and drug use through a health lens rather than through the lens of criminal justice. We've heard that it creates all kinds of problems, cyclical problems, arrest-and-release cycles within the criminal justice arena. I think, in fact, what we're talking about is a multifactorial health issue. We would have greater success in creating a relationship and establishing effective roots through to prevention and treatment if we were to actually adopt a health approach to it.

I can say that there are other jurisdictions around the world that have taken this approach and have demonstrated great success. Portugal is one of them. They had significant issues with injection drug use in their population. In 2001, they decriminalized the personal use of all drugs, and 16, 17 years later they have significantly reduced the challenges they face with respect to drugs and drug use in their society. It's not perfect, but they're certainly going in a better direction than we are.

[Fin Donnelly, NDP, Port Moody—Coquitlam, BC]

That was going to be my second question, so that's great, you've already addressed that one.

Have you had any preliminary reactions from the board of health in terms of how they're taking your report and what next steps look like?

[Dr. Eileen de Villa]

The board of health did approve that report and they did make the call to the federal government.

[Fin Donnelly, NDP, Port Moody—Coquitlam, BC]

Has there been a response yet? I'm sure it's too early, but are we anticipating a response?

[Dr. Eileen de Villa]

I look forward to receiving that response.

[Fin Donnelly, NDP, Port Moody—Coquitlam, BC]

Perhaps this report will be part of instigating a response.

[Dr. Eileen de Villa]

I hope so.

[Fin Donnelly, NDP, Port Moody—Coquitlam, BC]

Do you have any final recommendations for the committee in the 30 seconds I have left?

[Dr. Eileen de Villa]

I think that, again, you need a fulsome response. I would treat this as a health issue rather than a criminal issue. I think we've done a great deal of harm and I think we've burdened our health care system. I can't speak enough to the determinants of health: supportive housing, prevention, upstream interventions. That's not to say that safer consumption services and harm reduction services aren't important. They are further downstream. They're important, they're life-saving, but we need to shift our focus higher upstream, to be more preventative.

[Fin Donnelly, NDP, Port Moody—Coquitlam, BC]

Okay, thanks very much.