Health Committee on June 15th, 2016

[Donald MacPherson, Board Member, Pivot Legal Society]

Thank you. My name is Donald MacPherson. I am a board member of the Pivot Legal Society. I am also, I have to confess, the director of the Canadian Drug Policy Coalition, and Pivot is one of our coalition members. I'll try not to repeat many of the statistics that have been thrown around here.

Canada is in the grips of an overdose epidemic; there's no doubt about it. One simply has to look at the numbers that Michael just told you. B.C. has indeed declared a public health emergency; other jurisdictions might consider doing the same. At a time like this, we need all hands on deck across institutional contexts, political parties, and the broader community. These deaths are preventable with timely intervention. We know that.

We know that naloxone has reversed thousands of overdose deaths since the epidemic in B.C. in the early 1990s. We know that no one has ever died on a supervised consumption site from an overdose even though many non-fatal overdoses take place in these facilities.

We know that psychosocial treatment and substitution treatments such as methadone, buprenorphine, hydromorphone, and heroin-assisted treatment can be successful in assisting people with substance use disorders. All of these interventions need to be scaled up in Canada as part of a comprehensive response to overdose deaths.

This brings us to Bill C-224, the good Samaritan drug overdose act. We see good Samaritan legislation as one component of a comprehensive public health approach to overdose that fits within a harm reduction paradigm.

Harm reduction is part of a spectrum of non-judgmental strategies aimed at reducing the harms related to drug use and connecting individuals with health and social services that they might not otherwise access. Harm reduction also places a priority on the protection of human life and strives to improve health and safety in our communities for everyone.

Most overdoses occur in the presence of other people. The chance of surviving an overdose, like that of surviving a heart attack, is almost entirely dependent on how fast one receives emergency medical help.

Michael covered some of the other data on the Waterloo-Wellington overdose response survey. I won't repeat that. However, I will add that the survey found that in over half of overdose cases, 911 was not called or the respondents did not know if it was called. In addition, recent amendments to the Controlled Drugs and Substances Act which stipulate mandatory prison sentences for some drug-related offences will unquestionably intensify fear of prosecution for witnesses of drug overdose and increase rates of preventable overdose deaths.

The good Samaritan legislation in the U.S. has parallelled efforts to improve layperson access to naloxone. The United States have scaled up since 2007, as you have heard. Good Samaritan laws complement the tremendous efforts taking place within health authorities, provincial governments, and the community to maximize the availability of naloxone, a life-saving drug which when administered to a person suffering an opioid overdose immediately reverses the overdose.

Overdose response at this level, which is perilously close to the end of life, must involve a two-pronged approach: having naloxone available and getting it to the overdose victim in a timely fashion. Seconds matter.

Good Samaritan legislation can be enhanced by operational policies within local police departments that address attendance at overdose situations. The Vancouver Police Department has an explicit policy of non-attendance at routine overdose calls. The VPD policy document reads, “There is little value in police attendance at a routine, non-fatal overdose. It would be a rare circumstance for criminal charges to arise from attendance at a routine overdose call”.

Policy should tend to restrict police attendance to overdose calls only in the event that there is specific need for public safety. Restricting police attendance at routine overdose events would support the intent of Bill C-224.

We would also add that we would encourage the government to look at the broader context and explore the idea of decriminalization of all drugs, such as has been implemented in some jurisdictions and is being contemplated in others in order to better focus our response to overdoses with health responses rather than with criminal justice ones. That's a discussion for another day.

The Pivot Legal Society is supportive of the direction of Bill C-224. The benefits of this bill include a strong signal from political leaders that the protection of life is a priority in these situations and that the imperative to call for help trumps the fact that criminalized drugs may be a part of the context of the call for help.

We don't think the legislation goes far enough and it could be improved.

We would like clarification of the language of the bill, similar to a previous statement. It wasn't clear to us that the actual person overdosing was protected under this bill.

Another shortcoming that we see is that the bill covers only possession, and not possession for the purpose of trafficking, which is quite a broad provision and would include people sharing drugs, which is common since drug use is often a social activity.

We are concerned that the immunity provided by the bill is not broad enough to maximize the chances that a call would be made in a timely fashion.

We also believe it would be in keeping with the spirit of the bill to ensure that people who have outstanding warrants, particularly for non-violent crimes, don't hesitate to make a call that could save a life, and they should be covered under the immunity provided by the bill.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much. I apologize for cutting off both of you, all of you. Your testimony is certainly valuable.

Now we'll go to Christine Padaric. I understand you're in Calgary. Is that correct?

[Christine Padaric, As an Individual]

I'm actually from Heidelberg, Ontario, but I'm here in Calgary on business at the moment.

[The Chair, Liberal, Bill Casey]

Well, we've seen just a bit of your story, and I'm sure you can add a dimension to this that will help us a lot.

Go ahead, you have five minutes.

[Christine Padaric]

Okay. Don't cut me off.

[Voices]

Oh, oh!

[Christine Padaric]

My name is Christine Padaric and I live in Heidelberg, Ontario.

I'm honoured to be invited to speak to you today and share my story of loss in an effort to save people from going through a similar experience.

We're all aware that drug usage is rampant in our country and shows no signs of slowing down. With the introduction of bootleg fentanyl, it will only result in more deaths.

Passing Bill C-224 would help make strides towards improving the relationship between citizens and police. I know that it would save lives.

On April 12, 2013, my sweet, funny, affectionate, handsome, stubborn, athletic, pot-smoking, 17-year-old son died. He died from a pointless, unnecessary prescription overdose, which I've since learned is the leading cause of accidental death in North America. If this tragedy can happen to me and my family, it can truly happen to anyone.

The night my son overdosed, it was witnessed by a group of six individuals in their twenties. They watched him exhibit every symptom of overdose and did not do anything. That is how deeply ingrained the fear of legal involvement is when drug use is concerned.

Briefly, this is an account of the events that happened the night of April 5, 2013, from witness statements.

Austin was administered a lethal dose of morphine in the early hours by a drug dealer who crushed and held morphine to my son's nose and demanded that he snort. My son was already high from a previous tablet and so obeyed. Around 3 a.m., Austin went into medical distress. Everyone was aware of this. The six young adults discussed the situation. They put him in a tub of cold water. They talked about calling 911. However, the dealer, who was also the owner of the apartment, wanted no part of that. The dealer threatened the lives of others if anyone called 911 and because of the dealer's perceived authority, others were intimidated and feared reprisal from the dealer himself.

As well, the young people did not fully understand the signs and symptoms of an overdose or even what it means to be overdosing. They had allowed themselves to be manipulated by the drug dealer, and rolled Austin on his side on the couch in the hopes that he would sleep it off. The six individuals all slept in this one bedroom apartment that night, right next to Austin.

When the first person woke up at 7:30 a.m., she described him as looking dead. Panic ensued. The cowardly drug dealer fled his own apartment. At that point the others called 911. EMS worked on Austin for about 30 minutes, shocking him repeatedly, trying to get a heartbeat. He eventually succumbed to his injuries six days later in hospital and peacefully died with his family surrounding him.

On a positive note, Austin was able to save five adult males from terminal illness due to organ donation.

Today my mission is to shed light on the devastating reality of abuse of prescription drug use, which is rampant in our country, and find solutions to overcome this problem and save lives. I facilitate a chapter of GRASP, which stands for Grief Recovery After a Substance Passing. It's a peer support group to help others recover after the loss of a loved one due to substance abuse. Regretfully, four of the five regular attendees in our Waterloo chapter all lost sons under circumstances where a call to 911 would likely have resulted in a life saved.

I've created an organization called SKATE For Austin. SKATE stands for Save Kids Abusing Thru Education. I use SKATE as the acronym because of Austin's love for hockey and skateboarding. Under this organization, along with assistance from Region of Waterloo Public Health, I teach an overdose awareness class to high school students. I will teach it to service groups. I'll teach it to anyone who will actually listen.

I believe drugs are part of our society today and we need to equip our young people with the knowledge to make informed decisions and to recognize an overdose if they witness one. The steps are basic: quiet stimulation to determine if the person can be aroused; call 911; perform rescue breathing and/or administer naloxone, if available; put the person in the rescue position until help arrives.

I've done my own informal study during these training sessions with the students and I've learned that girls are far more likely than boys to call 911. I've also been told on two separate occasions that teens were at a party where someone went into distress. In one case 911 was called, and in the other case the individual did regain consciousness. Both individuals who approached me said that everyone is more careful in Elmira.

Elmira, Ontario, is the town where my son died, and also where he went to high school. Everyone in Elmira is much more careful at parties today since Austin's death, and the revelation that he did not have to die.

I am also a member of a number of harm reduction committees with the Region of Waterloo. I've created an overdose map of Canada online where I post details of those lost to overdose to show visually the crisis we are in.

I strongly support Mr. McKinnon's proposed bill, Bill C-224. It's one more step we can take toward harm reduction in our country. Because people fear being arrested, risking parole, being charged with drug possession, having their parents notified of their actions, etc., a lot of work will be required to educate the public if this bill is passed. It will take time for law enforcement to gain trust. I was told by doctors that in all likelihood, my son Austin would be alive and well today had one of the six people present that night called 911 at the first sign of distress instead of allowing Austin to suffer for seven long hours.

I'm speaking on behalf of all parents when I say I do not want to see anyone lose their child because someone else was afraid to call 911.

Thank you for allowing me to speak.

[The Chair, Liberal, Bill Casey]

Thank you for your testimony.

The clerk has pointed out that when we change panels, we revert to the original time, so we have seven-minute sessions for questions, starting with Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much for your testimony and for sharing your very moving personal story with us today.

My first question for all of you is around communication.

Thirty-five states in the U.S have introduced this kind of legislation, almost all in the last year. I think Washington was the earliest back in 2012. They're all experiencing difficulties with communicating this and reaching out to teenagers, to users, that protection is in place for them.

Do you have any thoughts on how to reach out to this very diffuse population to share that this legislation is passed?

[Donald MacPherson]

It's the same in Vancouver with the non-attendance at overdose calls. Not that many people know about it. There is getting legislation through and then there's the commitment by the government and its agencies filtered down to the community to communicate it. For this legislation to mean anything, people have to know about it and they have to trust it. That starts the minute something is passed. What's our communication strategy?

We're there to help. Waterloo is there to help. Others are there to help. It needs to be a focused effort.

[Michael Parkinson]

I would concur that education and training for people in enforcement of justice and for people who are afraid of enforcement of justice and those in between would be essential to ensure success of this bill, that people are going to pick up the phone and call 911.

As to how to do that, across Ontario and across Canada, my personal experience is people are committed. There's a tremendous amount of human and social capital. People are willing to step up and help out. If there are resources—there's not always money—but with support from the federal government from the get-go you can deploy those resources and reach those people. Admittedly, people who are using Illegal drugs or engaging in illegal acts are a little trickier to reach, but it's not impossible.

I suspect in the U.S. it's probably an afterthought.

[John Oliver, Liberal, Oakville, ON]

Recognizing the signs and symptoms of an overdose early on that the person is getting into difficulty...I think about the work we've done on recognizing heart attack and stroke. Do you think the epidemic of this kind of overdose is large enough now that it would warrant that kind of public health initiative?

If we pass this legislation and people understand that it's acceptable to call and they're not going to be punished for it, is it worthwhile beginning through public health—and our PHAC body here could initiate it. Is it a big enough problem that it would warrant that degree of national attention?

[Michael Parkinson]

I would suggest yes.

Today would be the second best time to undertake that kind of endeavour. Christine is an exception in Canada in that she has talked about losing her son, Austin.

There are 6,000 victims in Ontario in a 15-year period, and 99% of them are not speaking out. The work that Christine and others have done in Elmira to provide that education in collaboration with public health really makes a difference. It makes it okay to talk about this.

To answer your question, yes, absolutely.

I've met too many parents who thought they'd just let their daughter sleep it off, or a wife who thought her husband was just really tired: he's snoring; she'll just let him sleep it off. The next time they check on their family member, they're dead or in deep distress.

[John Oliver, Liberal, Oakville, ON]

Mr. Saint-Denis, is the definition of overdose contained in the proposed Bill C-224, an acceptable definition? Would doctors and the police agree with that as well? Is that a standard accepted definition?

[Paul Saint-Denis, Senior Counsel, Criminal Law Policy Section, Department of Justice]

It appears to me to be satisfactory, but I must tell you that perhaps my colleague who works at our legal services at Health might have additional views on that.

[Norma Won]

I'm not sure I have additional views, but that definition does work in a health context.

[John Oliver, Liberal, Oakville, ON]

Again, to all of you, is there a need to educate the police forces as well if the bill is passed so that they are arriving...? What happens often in neighbourhoods gets passed around very quickly among kids.

Have you seen a need to educate the police forces?

[Paul Saint-Denis]

The bill is drafted in a peculiar manner in the sense that it directs police not to charge, which is not something that we would typically do in terms of, certainly not in terms of criminal legislation.

We would suggest rather, if we were drafting it—if this were a government bill—that the person who meets the criteria here is not guilty of committing an offence rather than say that the police shall not charge. There are two reasons. One is, that is not the way we typically draft legislation. Two, we try to impose or restrict police discretion as little as possible.

One of the concerns that this particular provision poses for police is if they do charge by accident, but they do charge, does that make them liable? Are they civilly liable for having laid the charge on the individual who meets the criteria set out here?

As I say, we would have approached it a little differently.

[John Oliver, Liberal, Oakville, ON]

Instead of saying “not to be charged”, you would have said “is not to be found guilty”.

[Paul Saint-Denis]

That's correct. We would have said along the lines of a person who—and set out the criteria—is not guilty of an offence as set out in section 4(1). That would be the typical approach that we would have taken.

[The Chair, Liberal, Bill Casey]

Ms. Harder, you're going to split your time with Mr. Carrie. I'll let you know at three and a half minutes.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

My question is also for Paul.

Could you help me interpret a part of subclause 2(3)? Right now, it would seem that it applies to everyone at the scene. As a legal expert, can you comment on how broad this descriptor is?

Would there be another commonly accepted legal term that might narrow that scope a bit to those that are immediately around the individual who is suffering from the overdose?

[Paul Saint-Denis]

You're right in that it is very broad. As an example, if an overdose were to occur at a rave party, there may be dozens of people there. Would the precision here apply to everyone at the rave? Perhaps there's a way of narrowing it.

Again though, it does depend on the bill's sponsor's intention. Listening to his explanation, my sense was that he thought that it should apply to a fairly broad category of individuals. Perhaps that is his intention.

My concern would be that it would cover off a number of people who would have had nothing to do with seeking assistance. This bill targets the person who calls for or seeks assistance for someone who is overdosing or the person who is overdosing and seeking assistance for himself.

To provide an exemption from the possession offence for virtually everyone else who is in an undefined space might make it a little difficult for police to actually interpret what that means. If you were to characterize it or limit it to “in the immediate vicinity”, that would help to some extent. You would then end up with a somewhat similar problem in that you would have to define what “immediate vicinity” would mean. At least it would be some measure of constraining the application of this provision.

[Rachael Thomas, Conservative, Lethbridge, AB]

Would it be too restrictive if we were simply to say “the individual who makes the phone call for help”? Would that be too narrow?

[Paul Saint-Denis]

It would do that, but then again, listening to the sponsor's explanation, there may be information available from people who did not seek the assistance but who may be able to provide assistance to the responders. I think you want to balance this between its being too restrictive and too broad. Perhaps something along the lines of “in the immediate vicinity” might be the sort of balance you are looking for.