Evidence of meeting #135 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was methamphetamine.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Peter Butt  Associate Professor, College of Medicine, University of Saskatchwan, As an Individual
Réjean Thomas  Chief Executive Officer, Clinique médicale l’Actuel
Sergeant John Pearce  Sarnia Police Service
Eileen de Villa  Medical Officer of Health, City of Toronto
Jayne Caldwell  Policy Development Officer, Toronto Public Health, City of Toronto
Robert-Falcon Ouellette  Winnipeg Centre, Lib.

4:40 p.m.

Liberal

The Chair Liberal Bill Casey

Okay, thanks very much.

That completes our seven-minute round. Now we'll go to our five-minute round. We're going to start with Dr. Kitchen. Welcome.

4:40 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you, Mr. Chair.

Thank you, everyone, for being here today.

Dr. Butt, as full disclosure, my riding is the southeast corner of Saskatchewan, and my home town is Estevan. I also spent time at Royal University Hospital in Saskatoon.

I appreciate your comments and your presentation. You talked about the federal roles, particularly about issues such as taxation, charitable donations, philanthropy, mental health and proceeds of crime. You also mentioned education a little earlier, and I would like you to expand on that, what that education is. Are we talking about public health announcements, school-based education, media blitzes?

4:40 p.m.

Associate Professor, College of Medicine, University of Saskatchwan, As an Individual

Dr. Peter Butt

Education involves all sectors of society, and one of the challenges we have is, yes, it is important to get that education to the public, particularly with youth, because with some of the potency of these drugs, particularly with illicit fentanyl, they try and they die. They don't have a substance abuse disorder. They're experimenting. They're adolescents. I didn't have a full brain when I was an adolescent. It goes with the state of life.

The point is, we need to be able to provide them with education, but we also need to encourage them to get engaged with other prosocial activities so they are not bored, they have recreational, cultural, artistic, sports and other pursuits. Part of it is also providing other activities to youth. The education is important, as well as the education of the teachers, or whoever is doing this. There might be an interface between the schools and the public health sector, but the education there is important.

There is also that wider level of education. The Canadian Centre on Substance Use and Addiction has done work on infographics and so on for parents to have this conversation with their children so they are better equipped to discuss this around the dinner table.

There is also education with regard to health care professionals, because we have stigma entrenched within the health care system. More can be done there. We are seeing within Corrections sometimes this dynamic tension between correctional staff and therapy staff. More education would be helpful there. People have their roles, but we need to be able to think about ways of breaking down the friction between those roles to have synergy rather than a sense of conflict.

There is also education of health care providers. Some of these individuals are treated very poorly within hospitals, particularly if they have a concurrent mental health and addiction problem. They might go into a mental health facility, and if they slip and use, they are kicked out. If their depression gets worse, if their psychosis gets worse, they get treated. This is not rational health care service. We need to be thinking much more rationally, using the evidence and applying it in improving our systems of care.

That is a fairly broad answer to your question on education.

4:40 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

I appreciate it. I like your comments about education not only for youth and adolescents, but also for our primary health care practitioners, which is also part of the whole equation. We shouldn't just be focusing on one part of it. A number of areas need to be educated in the whole area.

4:40 p.m.

Associate Professor, College of Medicine, University of Saskatchwan, As an Individual

Dr. Peter Butt

I couldn't agree with you more. In primary care, it's important to have health care providers who are meeting population health needs. At a primary care level, just as if you had an extensive older adult community, a geriatric community, you'd want services appropriate to that community.

Also, if you're providing services to a community that's heavily impacted by mental health and addiction issues, you'd want addiction counsellors as part of your primary care system, so it's a multidisciplinary approach.

4:45 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Detective Pearce, I appreciate your comments, but one thing you said that really caught my attention was when you were talking about how it is easy to manufacture the drug, and one of the things was, it was more attractive because of Hollywood. My concept of that is this has become glamorized by Hollywood to be an everyday, simple little thing and people see that all the time. I wonder if you could quickly expand on that.

4:45 p.m.

Det Sgt John Pearce

Yes, that's what I was alluding to. Several television series and movies have glamorized it. Take even the word “methamphetamine”, to the point where we talk about “crystal” methamphetamine; as we talked about earlier, the people watching are possibly comparing it with other drugs—recreational drugs like cocaine, or even marijuana, for that matter, and stuff like that. They don't realize what's involved with this type of drug, the compounds that go into it, and the highly addictive “one-time use” type of attraction that will happen as a result of experimenting with it recreationally.

The big thing is that the market itself is making the product look more attractive to appeal to more people and to attract different types of socio-economic age groups. They're making it look that much more appealing and less dangerous, so to speak.

February 21st, 2019 / 4:45 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

[Inaudible—Editor] It's not a recreation.

4:45 p.m.

Liberal

The Chair Liberal Bill Casey

Time's up. Sorry.

Mr. Robert-Falcon Ouellette.

4:45 p.m.

Robert-Falcon Ouellette Winnipeg Centre, Lib.

Thank you very much, everyone, for coming today. I have a number of questions, and I'd like to start with the gentleman from the University of Saskatchewan.

Mr. Butt, I'm wondering if you have any ideas surrounding the loss of economic productivity, more as it's related to the cost of providing health services to people using meth. I'm wondering if you have any information on the costs related to someone using opioids, or on the cannabis-related or alcohol-related costs, with regard to the health care system.

4:45 p.m.

Associate Professor, College of Medicine, University of Saskatchwan, As an Individual

Dr. Peter Butt

I am not an economist, but I can tell you that most of the cost with regard to substance use disorders is the loss of productivity and the economic impact. When we look at the demographic in Saskatchewan, at least, it's older rather than younger now with regard to methamphetamine. It's the slightly older twenties and thirties as opposed to the teens and twenties. You're dealing with people in their twenties and thirties who are losing their most productive years. As well, unfortunately, their children are being lost to care, because they are unable to look after them.

With regard to the health care costs, I think we're seeing significant costs because of our inadequacy in addressing the health care needs of individuals. People are in and out of detox, in and out of treatment centres, in and out of emergency departments and in and out of acute-care wards in the hospital. They're not getting effective treatment long enough, and that actually leads to an escalation in costs. It's not efficient at all.

For instance, with IV drug use, we often have people being admitted to hospital with abscesses of joints or bone infections that require six weeks of IV antibiotic therapy. If we are not able to provide a stable environment for them to complete six weeks of IV antibiotic therapy in a very structured environment in a hospital ward.... These are individuals who might have been previously hunting and gathering on the streets. We need better behavioural management to keep them there for six weeks and address some of their root issues. If they are not able to be retained there, they leave, they come back, and the infection is worse. They're not able to complete the antibiotic therapy. They leave and come back. So it might take 12 or 24 weeks to complete six weeks of antibiotic therapy, simply because we are not providing the behavioural management and support they require.

This is why it's difficult to answer your question. So much of the cost is due to our inefficiency.

4:45 p.m.

Winnipeg Centre, Lib.

Robert-Falcon Ouellette

I'm wondering if you could also discuss your harm reduction sites that are funded by the Saskatchewan Ministry of Health and the Saskatchewan Health Authority. From what I understand, you provide clean needles and inhalation supplies. What does that include? Was it easy to set up?

4:50 p.m.

Associate Professor, College of Medicine, University of Saskatchwan, As an Individual

Dr. Peter Butt

The needle exchange programs have been going on for some time. Really, needle “exchange” is a bit of misnomer, I think, because it's needle distribution and needle recovery, and includes counselling and support, vaccinations and access to all the other services that are there. It's outreach and engagement with a community that is otherwise very marginalized and out of care's way. If we are not putting ourselves in their environment, care isn't accessible.

4:50 p.m.

Winnipeg Centre, Lib.

Robert-Falcon Ouellette

Do you see a lot of needles being spread around Saskatoon or Regina? In Winnipeg, for instance, a lot of needles are finding themselves in school parks and back alleys, and in vast quantities. We have to pay or get volunteer groups like Bear Clan to go around and clean up a lot of these needles.

4:50 p.m.

Associate Professor, College of Medicine, University of Saskatchwan, As an Individual

4:50 p.m.

Winnipeg Centre, Lib.

Robert-Falcon Ouellette

They're sometimes getting pricked, and these are volunteers doing this work. Is it the same situation in Saskatoon and Regina?

4:50 p.m.

Associate Professor, College of Medicine, University of Saskatchwan, As an Individual

Dr. Peter Butt

It's less so. When that does happen, it hits the media very, very quickly. We have drop boxes, like recycled mailboxes, in high disposal areas. If you have a particular park, an alley or some place where you're finding needles, particularly in the spring when the snow melts, then that's where you need to have these disposal boxes. Also, of course, the needle programs strongly encourage people to bring them back.

4:50 p.m.

Winnipeg Centre, Lib.

Robert-Falcon Ouellette

Also—sorry to the other witnesses—you also mentioned you have neighbourhoods that are blacklisted as too dangerous, and they create health care deserts. I was wondering if you could explain what you mean by places that don't have enough health care.

4:50 p.m.

Associate Professor, College of Medicine, University of Saskatchwan, As an Individual

Dr. Peter Butt

This is an extreme frustration. We have areas in the city, homes and addresses, where home care will not go. They say it's for occupational health and safety reasons, and these addresses get on a list that never gets revised. Essentially the inner city becomes blocked for home care services, because people won't go there to provide those services, and then they wonder why they go to the hospital in order to get basic care. It's a travesty. It's criminal, I think; yet, there are other people who have the outreach and the harm reduction skills who can go and work with the population. We need to partner people, and if they don't have the confidence or the skill set to provide services in different neighbourhoods, then get people who can. These people need the care.

4:50 p.m.

Liberal

The Chair Liberal Bill Casey

Thank you very much. That's amazing information.

Now we're going to go to Ms. Gladu for five minutes.

4:50 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Thank you, Chair.

I'm going to start with the doctors on the call.

We heard testimony the other day that said only 4% of people who try methamphetamine get addicted to it, which I think is in conflict with what I heard today, which is more in line with what I experience in Sarnia. For all four of you, starting with Dr. de Villa, how addictive is meth, and is it really something you could use multiple times and not worry about getting addicted to?

4:50 p.m.

Medical Officer of Health, City of Toronto

Dr. Eileen de Villa

I think this question of addiction and addictive tendency is one that has a fair amount of individuality to it. What I was trying to address in my comments is that there are many reasons that people engage in drug use. I think really getting to the heart of it and getting to prevention requires really looking at the underlying factors and how we then prevent them.

I can't let the opportunity go by without saying that I want to address something you said earlier in respect of the cycle of arresting and releasing. I think we heard some good rationale from other colleagues around the video conference that criminalization does create problems, and in fact, causes more. One method—you're right—is detox. Providing detox might be a treatment option, one option that would certainly help arrest or stop that cycle from continuing, but not criminalizing drug use would also be a very, very effective method of stopping that cycle.

4:50 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Dr. Thomas, could you comment on how addictive you think meth is? The statistic that I quoted said 4% of the people who tried it would get addicted. Does that sound right to you?

4:50 p.m.

Chief Executive Officer, Clinique médicale l’Actuel

Dr. Réjean Thomas

It's a very high addiction. It looks to me like heroin at the moment, and we don't have methadone; that's the problem. We don't have easy ways to stop it. They come, they start, they try, they do everything, but it's very highly addictive.

4:55 p.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Dr. Butt.