Health Committee on Sept. 20th, 2016

[Colin Carrie, Conservative, Oshawa, ON]

One of the concerns, too, is there is a challenge because you don't want to provide a false sense of security. In other words, people think that if they overdose, we have this treatment we can utilize. I think that communication is going to be so important in moving forward with these types of strategies.

You pointed out that there is a loophole or a challenge with the legislation. We also had Paul Saint-Denis, senior counsel in the criminal law policy section of the Department of Justice, who told the committee that the Department of Justice would have drafted the bill differently. Here is what he said:

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.

In your opinion, should the bill be amended so that it reflects the wording described by Mr. Saint-Denis? Please explain why or why not. Would you be able to comment on that?

[Pierre Poirier]

Again, this is a very difficult question.

From a paramedic's perspective, we are always caught between the public safety and the health care models. We are absolutely, first and foremost, advocates for the patient we treat. I give you the scenario of somebody who may be impaired, who was at the scene and now wants to drive a vehicle. There is an imperative on the paramedic to prevent that, so there may be a call to the police, in terms of assistance.

The scenario for someone who is engaged in what is termed “criminal activity” provides the same kind of difficult ethical dilemma for paramedics, but for the most part, paramedics fall on the side of patient first and patient care first.

In terms of answering your question, I would offer no expertise in terms of how the legislation is crafted. I would just say that we should promote it in the best way to recognize, in how it is finally drafted, that health care providers are also protected, in terms of recourse.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Mr. Davies, go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to all the witnesses for being here today.

I come from British Columbia. I represent a riding in Vancouver, where, in our province, Dr. Perry Kendall has declared the opioid overdose a public health emergency. I think we're looking at about 800 people who are expected to die this year in British Columbia. That's more people than will die from motor vehicle accidents. It's been estimated that 2,000 people will die in Canada this year from opioid overdoses. I think we have a crisis on our hands that is not being given the seriousness that it really ought to be given.

I'm in favour of this bill. The purpose of this bill is to save lives. It's to encourage people at the scene of a drug use to call 911 in case of an overdose, and it's to remove impediments to doing so. I'll be supporting this bill because of that.

Also, I want to drill into this a bit from a devil's advocate point of view, because if we are going to treat this crisis as a crisis, then I think it behooves us all as legislators to actually bring in a law that will be as effective as it can possibly be. Where I'm going to drill into is whether this bill actually will accomplish what we want it to accomplish, and whether or not we can and should do more.

I'm going to read a brief excerpt from a letter from deputy chief Mike Serr, who is the chair of the Canadian Association of Chiefs of Police drug abuse committee. He says:

In consultation with those working in the addiction field, it was learned that the premise under which the bill was written may not be accurate.

Specifically, during a recent tour of Vancouver's East Side, staff of INSITE...were asked if clients were fearful to call police. The staff responded that the hesitation to call police was based on outstanding warrants or fear of breaching court imposed provisions, not fear of being charged with simple possession.

Dr. Buxton, in an article published in The Province on May 29, you are quoted as saying:

“...people aren't concerned they're going to be arrested so much for possession...more likely when, if the police do arrive, then they may run their names through—whoever's there—and find that they're in breach of probation or they have outstanding warrants.”

Finally, Dr. MacKenzie, if I had your testimony correct, you said that people aren't calling 911 for fear of police involvement.

My question is this. If we really want to encourage people to call the police at the scene of drug use, and this bill only grants immunity from charges for drug possession, why in God's name do we not take this opportunity right now and broaden this bill to include a broader suite of offences, including immunity from being arrested for any kind of outstanding warrants or breach of probation having to do with drug use? Would you agree with me that this would actually have a broader and more immediate impact? Is it needed?

[Sarah Brown]

Yes, I would agree with that. I also believe that having police not attend overdose calls.... There are quite a few things we need to put in place for people calling 911 to feel comfortable 100% of the time.

I think the immunity could be broadened. I understand that legislators take slow and careful steps around health, and particularly the health of people who use drugs. I'm happy that a step is being taken.

I agree with you, Mr. Davies. I think the immunity in the bill could be broadened and more people would call in that instance.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Buxton, do you have a comment?

[Dr. Jane Buxton]

Yes, I would agree, definitely. Certainly in our research we heard that it's breach of parole and breach of probation as well as outstanding warrants. I think that obviously a blanket immunity for an outstanding warrant probably is not appropriate or would be difficult, but I think your suggestion of a warrant related to drug use would be very appropriate.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. MacKenzie.

[Dr. Meredith MacKenzie]

Yes, I agree with all the concerns you've identified.

My concern would be that this would stymie this bill and the progress might be regressive. I have no legislative or legal opinion that would matter. However, is there a way to move forward with the existing wording and then make an amendment at some future time? I think that if we bring this back, as Sarah said, it may take a very long time to actually get the wording correct.

While we're waiting for the wording to get corrected, more people will die because they're not calling 911, especially in the context of what we discussed this morning, which is that we're seeing something new. There are drugs that are contaminated with substances that people do not know they're using. You get people using stimulants who are overdosing on opioids and who wouldn't even maybe have a naloxone kit around to give them that few minutes of time they needed to call 911. In addition, the way people are taking drugs is changing a bit.

I think if we wait to get it perfect, more lives will be at risk.

[Don Davies, NDP, Vancouver Kingsway, BC]

I agree. It's the old phrase, “let's not let the pursuit of perfection get in the way of progress”.

I am concerned, and I do want to make sure we're hitting the target. If we pass a law that grants immunity for something that is not the reason people aren't calling 911, then we're not doing too much. We might make ourselves feel better, but we're not addressing the barrier to calling 911.

Could you give me and the committee an idea of what is the barrier? If there are people shooting drugs in an alley in east Vancouver right now and someone overdoses, what is the barrier for them calling 911? Is it the fear of being charged with possession, or is it the fear of being charged with breach of probation? Can you give me an idea—it's probably both—of the relative weight of each. What is the real problem here?

[Christine Lalonde, Peer Researcher, Centretown Community Health Centre]

The fear is all of that. In Ottawa, when OPS, Ottawa Police Services, shows up at the scene, usually we call the paramedics. OPS shows up for the safety of the paramedic and for nothing else. That gives them an opportunity for interrogation and intelligence, and that's what they use at that point. It's a tragedy, but what happens in saving a life turns into a witch hunt. I'm sorry, but that's the way I see it. The simple possession is not enough, like you say. I know, to get it forward, but what's it going to do? I'm not going to go back to my community and encourage this, but there's this, there's this, and there's this.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you for saying that, because that's exactly my fear. It's the law of unintended consequences.

If people think they have immunity, but it turns out the police come, they end up not being charged with possession, they get their names run through the system, and they're charged with breach of probation, then could this have a boomerang effect the other way and cause, on the street, people not to call? They don't have the sophistication, necessarily, at the moment of overdose to weigh through, “Okay, what could I be charged with, and what can't I be charged with”.

Vermont has a law that has a broad suite of immunities. Would you not agree that we should amend this law right now in this committee to use the more broad Vermont standards that cover breach of probation and other drug-related offences if we're going to make a dent and take immediate action to deal with this crisis? Would that not be your recommendation to this committee?

[Dr. Jane Buxton]

If it can be done without delays, then yes. As I mentioned, breach of probation and breach of parole should be included, definitely. That's a simple addition to have to it. I think including the warrant with regard to drug-related offences would be ideal.

The other thing to mention is that in Vancouver, where the police don't routinely turn up and where the police don't arrest for simple possession, the rate of calling 911 is far higher than anywhere else, so I think we do have evidence that it works when the message gets out. The other important thing is that we are hearing about youth who may be experimenting or people who are using stimulants and being naive to opioids and having overdoses. They're also a population that needs to know this bill has gone through, so they're not afraid that parents will be angry or they'll be charged.

[The Chair, Liberal, Bill Casey]

Thanks very much. I hate to stop you in full flight.

Dr. Eyolfson.

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

Thank you, all, for coming. I'm the emergency physician that Mr. Carrie referred to. I have worked in an inner city emergency department in Winnipeg, where there's a lot of violence and a lot of drug use. I also spent six years as the medical director of Manitoba's EMS system.

Mr. Poirier, maybe offline, I'd like to talk to you about the regulatory changes. I didn't know there were still jurisdictions in Canada where you had to call the doctor to give naloxone. Every provincial director I've spoken to said it was offline, and it was a delegated act with offline control. I'm curious about that.

Dr. MacKenzie, we talked about marginalization and stigma in regard to drug use. We know that many people in society think those who use drugs just made “bad choices” and treat people like that accordingly. Do you think this stigma affects people's willingness to seek help in regard to drug issues, including overdose?

[Dr. Meredith MacKenzie]

Yes, I definitely do. I've been working with a marginalized population for the past 16 years and that is absolutely the story that they will tell me should be true.

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

There's still a controversy today: harm reduction versus abstinence only. In regard to reducing drug use and reducing the harm of drug use, do you believe that harm reduction leads to any sort of increase in drug use?

[Dr. Meredith MacKenzie]

You're looking at naloxone specifically as a harm reduction technique, which most people would call naloxone. There's actually a study showing that it did not increase the use of drugs or the way in which people use drugs. For example, it did not increase the riskiness of the drug use.

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

Thank you.

Ms. Lalonde, thank you for coming and doing this. It must be quite difficult to come and be open about the issues you've had with the system.

Do you believe this bill would increase access for people who feel marginalized by the system because of the issues they have with substances?

[Christine Lalonde]

Not from the way it's written here.... Where it's amended in here, you're presuming that there's going to be charges. It's the assumption that there will be repercussions from trying to do this, whichever way it is, if it's calling and running away and waiting around the corner. The only solution I can offer, and that's to my own community, is to maybe call your lawyer after the paramedic is there so you have some kind of immunity. That's what we face, especially in this city.

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

We talked about the issues of broadening the law. Do you think broadening the law would help with that?

[Christine Lalonde]

Definitely.

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

Dr. Buxton, you mentioned broadening it versus delay. Would you agree that the situation right now is urgent enough to pass this without delay? Given the choice between adding those amendments with a bit of a delay or passing this now and then amending it to broaden it, what would be in the best interests of the public, from your point of view?

[Dr. Jane Buxton]

From my point of view, I think it's very difficult. I don't know how long the delay would be, but I would imagine it wouldn't be too hard to add the breach of parole and breach of probation as an amendment quickly, and then discuss the warrants at a later date. I really don't want to delay and to actually get the messaging out.