Evidence of meeting #136 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was opioids.
A recording is available from Parliament.
4:05 p.m.
Liberal
The Acting Chair Liberal Doug Eyolfson
Thank you very much.
We'll go on now to Mr. Webber for seven minutes.
4:05 p.m.
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you also to you three out there, and especially to Ms. Hedberg in Oregon, for taking the time here today. I'm looking behind you at the scene outside and I'm quite jealous of how it's looking there. We've been going through quite the snowstorm here and it's been brutal, so we're mad at you for having such nice weather.
Dr. Lapointe, you talked about analysis on the streets. We heard testimony from Deputy Commissioner Barnum of the Ontario Provincial Police. He talked about the bad batches of methamphetamine out on the streets. He said there was an urgent requirement to analyze these drugs, and he recommended that Health Canada increase its capacity to conduct timely drug analysis.
Can the coroner's office expedite any type of analysis of individuals who come in? Of course, if they've passed away, you're able to do an analysis of what killed them. Can you get a timely analysis of the type of drug? Right now Health Canada takes 45 to 60 days to analyze a drug and then to report that to the police. By then, of course, there are many deaths.
4:10 p.m.
Chief Coroner, Office of the Chief Coroner, British Columbia Coroners Service
Yes, absolutely. In B.C. we have an expedited toxicology policy, whereby the provincial toxicology centre will turn around toxicology results for us in 48 hours. It's the only service of its kind in Canada. We've worked with the lab for a number of years to get that in place. Once somebody's died, it tells us the substances in their system. I think what the police officer is talking about is that when they see a number of deaths, they want to be able to isolate the source by having tested at Health Canada. We don't have the capacity to do that. We can only do the post-mortem testing, which is valuable, and we do share that.
In B.C. there is the Drug Overdose and Alert Partnership, whereby the Crown, police, public health, health officers, the coroner's service and the provincial toxicology lab meet on a monthly basis to talk about all the things they're finding and share information. It's been fantastic in getting interventions. My colleague from Oregon recommended something similar.
4:10 p.m.
Conservative
Len Webber Conservative Calgary Confederation, AB
Thank you for sharing that information. It's certainly good to know. I think that is one big problem we have here, the fact that drug analysis is taking too long. We can prevent some deaths, I think, if we expedite that process.
Ms. Hedberg in Oregon, you talked about tapering prescription opioids by having doctors prescribe less for people with chronic pain. What's the alternative? These people need a drug. They need an opioid to relieve their pain. We've heard a lot of testimony here, and as you likely know we just recently legalized recreational marijuana, along with our medicinal marijuana. Are a lot of people converting to marijuana in the States as well and finding it to be a nice and easy replacement for opioids?
4:10 p.m.
State Health Officer, Oregon Health Authority
Thanks for the question. There were actually a couple in there.
One of them is that when we're talking about chronic pain in the United States, we also know—and we have an entirely different health care system than you do—that the amount of opioids being prescribed for pain in the United States is much, much higher than in Europe, for example. So it isn't that opioids are the only answer to chronic pain. In fact, we have to offer other things. It's true for acute pain too. If people come into an emergency department with a broken leg or sprained ankle, certainly things like ice or ibuprofen.... There are a number of other medications that could be used—not prescribing opioids.
A lot of what we're talking about is a change in expectation between a quick response, which is a pill, and something that might take longer. Certainly, physical therapy for chronic pain, for example, takes a lot longer. The idea is that there isn't one size that fits all. We have to look at a variety of things.
In Oregon, of course, we had one of the first medical marijuana programs, along with California, and we recently legalized the retail sale of cannabis or marijuana. It turns out that a lot of people who are buying retail, as you mentioned, aren't doing it just because of the psychoactive effects that they're interested in, but also for pain. They might be buying a salve to use for arthritis, etc.
The problem is, how do we get data on how much people are replacing, if you will? Are you using cannabis instead of opioids? How much? Anecdotally, we know that people say they are trying to taper off opioids and are replacing the treatment with cannabis, but that's just anecdotal.
In my mind, that's clearly an area where we need a lot more data and science. Unfortunately, in the United States, it's very hard to get that because, as you know, cannabis is a schedule I substance at the federal level. In terms of who is using what and what are the long-term effects, we really aren't even allowed to do research protocols related to people in chronic pain if you give some an opioid and others cannabis. That's an area where we really need a lot more data.
4:10 p.m.
Conservative
Len Webber Conservative Calgary Confederation, AB
I see.
I have one minute and I have a quick question for Dr. Burgess, who of course works in the inner city in Vancouver. I was down there recently to see East Hastings and also had the privilege of meeting Dr. Gabor Maté and speaking with him for about an hour. He talked a bit about the decriminalization not only of marijuana but of all psychoactive substances.
Could I have your thoughts on that, Dr. Burgess?
4:10 p.m.
Clinical Associate Professor, University of British Columbia, Vancouver Coastal Health
I'm not sure. I think I can speak to some of the reality down there, in that we have people in our Crosstown program who are getting scheduled heroin three times a day. I've inherited quite a few of these people who were ejected from that program.
Even with injectable heroin—and we have injectable Dilaudid in our clinic—our patients still love fentanyl. They still use it in addition, and I think that has to be recognized. We can throw a lot of things at people, but for people who have been opioid stable for a very long time, once they taste fentanyl again, it's like the first time, and because people don't develop tolerance very quickly, it continues to be very enjoyable and very much a problem.
I don't know as yet. We'll see whether there's much that can replace that, other than the community itself [Inaudible—Editor]
4:15 p.m.
Liberal
The Acting Chair Liberal Doug Eyolfson
All right. Thank you very much.
We're going to Mr. Rankin for seven minutes.
February 26th, 2019 / 4:15 p.m.
NDP
Murray Rankin NDP Victoria, BC
I'd like to begin by thanking all the witnesses and in particular to salute my constituent, Coroner Lapointe. It's lovely to have you here, Coroner Lapointe.
I'd like to say for the record that I express my condolences to you and your colleagues on the loss of a truly great Canadian, Barbara McLintock, who of course worked with you for so long.
If I may, I will start with you, Ms. Lapointe. In a February 2019 article, a news piece on Global News, you're quoted as follows:
Families and communities across the province are losing friends, neighbours and loved ones to illicit overdoses at an alarming rate. The illicit drug supply is unpredictable and unmanageable, and fentanyl is now implicated in 86 per cent of overdose deaths. The almost 1,500 deaths in B.C. in 2018 due to illicit drug overdoses far outweigh the numbers of people dying from motor vehicle incidents, homicides and suicides combined.
Could you please explain to this committee what you meant when you said that the illicit drug supply is “unpredictable and unmanageable”?
4:15 p.m.
Chief Coroner, Office of the Chief Coroner, British Columbia Coroners Service
As I alluded to earlier, illicit drugs are manufactured in clandestine labs. Fentanyl primarily comes over from China, we believe. As you know, very small doses are needed compared with the amount people would have taken when they were using heroine. We believe that, for some reason, fentanyl is now being included in cocaine. Methamphetamine has fentanyl, and fentanyl has methamphetamine, as Dr. Burgess mentioned. Fentanyl has cocaine, and cocaine has fentanyl. There is no quality control where these things are being manufactured, so that's what I meant by “unpredictable”. People think they are buying cocaine, and it may be infiltrated with fentanyl. They think they are buying fentanyl, and it may have something else. There is just no control.
4:15 p.m.
NDP
Murray Rankin NDP Victoria, BC
You also were quoted this month in an article from the Canadian Press as follows:
Substance use disorder is a health issue, and forcing those attempting to manage their health issue to buy unpredictable and often toxic substances from unscrupulous profit-motivated traffickers is unacceptable.
In your view, what steps could the federal government take to ensure that people with substance use disorder aren't forced to buy unpredictable and toxic substances from the illicit market?
4:15 p.m.
Chief Coroner, Office of the Chief Coroner, British Columbia Coroners Service
It would laudable for the federal government to take a very health-focused approach, recognizing that problematic substance use is a disease. People come to problematic substance use for a number of reasons: childhood traumas, as Dr. Burgess mentioned, which we see a great deal of; the effects of colonization, which we also certainly see; other traumas that they've experienced through their life; or because it's what their friends were doing. Whatever the reason, they are now in a place where they are experiencing problematic substance use. They need the substance that they're used to.
Some people say we should just lock them up and force their treatment. That doesn't work. It hasn't worked for several hundred years.
Dr. Evan Wood of the B.C. Centre on Substance Use recently proposed a model where those who are using problematic substances would have the opportunity to buy them “guaranteed safe”. They would pay for them.
It's a little bit frightening, because people are afraid to introduce substances. There are substances everywhere, and they are contaminated, so people are dying at a huge rate. We're seeing four people per day die here in this province. If they could at least access safe substances—substances they're already using— then they could stabilize. They wouldn't have to buy on an infiltrated market. They wouldn't have to steal. They wouldn't have to prostitute themselves.
4:20 p.m.
NDP
Murray Rankin NDP Victoria, BC
And the 1,500 people in British Columbia who are going to die this year from the opioid crisis might not die.
4:20 p.m.
Chief Coroner, Office of the Chief Coroner, British Columbia Coroners Service
Yes, even if we save 10%, that's 150 people.
4:20 p.m.
NDP
Murray Rankin NDP Victoria, BC
We heard testimony in this committee by Ms. Suzy McDonald, assistant deputy minister, opioid response team, Department of Health. Among other things, she made similar points about the increasing contamination of opioid with fentanyl. You talked about that and the people dying increasingly as a result of the poisoning of the drug supply with fentanyl.
Do you think that the continued criminalization of substance use is an impediment to addressing our illicit drug supply problem?
4:20 p.m.
Chief Coroner, Office of the Chief Coroner, British Columbia Coroners Service
Without a doubt. People who are suffering are criminalized and it doesn't help them. It fills the jails. It fills the courts. It gives the police way more work than they want, and at the end of the day it doesn't help them.
4:20 p.m.
NDP
Murray Rankin NDP Victoria, BC
Thank you for your testimony.
I would like to turn to Dr. Susan Burgess.
You were quoted in November on CBC as follows:
We're still at a loss with how to deal with [methampthetamine] in our clinics. Every day, we have to certify someone who is just totally violent, out of control and very, very impaired from this drug. There is no dedicated treatment for methamphetamine addiction. Unlike heroin or other opioids, there aren't effective forms of substitution therapy, such as methadone or suboxone, to treat it. [Methamphetamine] was for us the clinical crisis that was most difficult to deal with. We used to say: give me a heroin addict anytime. That's easy, we've got something to do. But we've got nothing for cocaine or crystal meth in the same category other than treating the psychosis.
In your view, how could the federal government better support frontline health care providers with respect to methamphetamine use?
4:20 p.m.
Clinical Associate Professor, University of British Columbia, Vancouver Coastal Health
I'm not quite sure. However, I do think we can respond better to the psychiatric issues in a better way with more psychiatric medication. That's the problem for us having to stabilize anyone who is a methamphetamine user. All of us have tried other stimulants, Ritalin and so forth, and it makes absolutely no difference in our community. That is not the easy answer.
We have to deal with the results of that use and, unfortunately, because of the strength of opioids, people will often use it to counteract the depressant effects of an opioid to keep themselves a little safer. However, it gives you wonderful energy. You have increased libido. If you happen to be schizophrenic and you use crystal meth, all of a sudden you feel like a king. What a wonderful feeling for someone who may have been institutionalized and has difficulty making it through a day.
It's very complicated, but we do have to address those very tragic psychiatric side effects.
4:20 p.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Chair, and thank you all for being here. It's very disturbing testimony, and thank you for working hard in that field.
Last night, I was listening to CBC News. It was reported that 10 babies had died with syphilis. In seven of the cases involving infants, the mother was using a substance like meth or injecting drugs. Can you comment on that?
4:20 p.m.
Chief Coroner, Office of the Chief Coroner, British Columbia Coroners Service
Certainly, one of the outcomes we see from substance use is folks living very marginalized lives. When they are in the throws of addiction or problematic substance use, they have marginal housing, they have no income and they have very little resources, so the infants of women who are pregnant are, of course, at risk.
They're not accessing health care. They're living chaotic lives trying to get their next fix, for lack of a better word. From my chair, that's certainly one of the impacts you would see. For infants born into that environment, there is no prenatal care or very little.
4:25 p.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
After they are born, the baby experiences withdrawal. How do you cope with that? Can the doctor from Oregon Health Authority comment on that?
4:25 p.m.
State Health Officer, Oregon Health Authority
I was going to comment on the first point. You had brought up the issue that I had talked about earlier, which is the “syndemic”. We don't compartmentalize many of these things, but we have to look at them as a whole.
In Oregon, we've seen sharp increases in syphilis in general. Much of that is among men who have sex with men, but many of them also have sex with women. We're starting to see an overlap of those congenital syphilis cases. When we talk to those folks, many of them are also using opioids, meth or other drugs as well. Again, it's very difficult to say the issue is syphilis because the issue is not only syphilis. It's also these other drugs and disinhibited behaviours that people have. That's in general.
When you're talking about the infants, you're absolutely right, infants born addicted to drugs is a real problem. The neonatal abstinence syndrome that we're seeing takes a huge amount of health care dollars. These babies need to be monitored very closely for withdrawal, and even after that, they have a lifetime of problems, so it is part of a larger issue.
We can't just focus on individuals. We really need to think about the larger context that is causing them to both use drugs in the first place and/or have this disinhibited, if you will, sexual behaviour that's leading to this increase in syphilis.
4:25 p.m.
Clinical Associate Professor, University of British Columbia, Vancouver Coastal Health
Maybe I'll just describe some of the response to pregnancy in drug-using women in Vancouver.
We have, in the inner city, a specialized group of nurses, doctors and outreach workers to track and bring prenatal care to our drug-using ladies, and to offer them treatment at B.C. Women's Hospital on a specialized ward called FIR where they can be and are stabilized. They often go back and forth, but they're always known and tracked, and the ward is where they can deliver their children as safely as possible, with rooming in and support for the baby in the withdrawal phase as well.
It's a long-recognized problem for us in our community and there is a lot of effort being made to support women who are pregnant and who happen to be using substances. That said, a number of my patients, particularly those who are HIV-positive and for whom intensity is absolutely essential to prevent transmission to the infant, we can still have them deliver on the sidewalk. However, usually we're there.
It's an intense process and we try to keep people unpregnant as much as possible, but there is a specialized service for them that seems to be quite effective.