Evidence of meeting #18 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was police.
A recording is available from Parliament.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
If it were to delay it by several months, would you think it would be worthwhile doing that?
Professor, University of British Columbia; Epidemiologist and Harm Reduction Lead BC Centre for Disease Control, As an Individual
I'm concerned. We need to act now. It is just one of many other pieces of the puzzle that we're trying to help.... All deaths should be preventable from an overdose. This is one that will help and improve, but it's one of many.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
I'm sorting through these questions because so many of the questions I had prepared, you've all answered during the testimony so far. That means you're doing your part very well.
Dr. Buxton, I know you're on the spot a lot here. Some of the questions again resonate with the subject matter I know. When legislation is an abstinence-only approach and nothing else—zero legal tolerance, abstinence only—what effect do those such laws have on drug use patterns, and illness and mortality from that?
Professor, University of British Columbia; Epidemiologist and Harm Reduction Lead BC Centre for Disease Control, As an Individual
Basically, it drives people to hide their use, which means that people will hide their use and use in a much more risky way. They will not tell other people that they are using.... Harm reduction is a pragmatic approach. It really accepts people where they are and then works with people to help them work through things. Abstinence is not the answer for everybody, and we actually find abstinence can cause more damage. If people go into treatment and there's an abstinence base, if they do try using again, they're more likely to have an overdose because they've lost their tolerance. I think an abstinence-based approach may suit some people, but the vast majority really need a harm reduction approach, and opioid agonist therapy and other things to help stabilize things and help them move along.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you very much.
I believe that's my time.
Liberal
The Chair Liberal Bill Casey
Thanks very much.
That completes our first round.
Our second round will start with Ms. Harder.
Conservative
Rachael Thomas Conservative Lethbridge, AB
I'll direct my first question to Ms. MacKenzie, if you don't mind.
You made a comment with regard to young people and their use. Would you happen to have a percentage or a number that goes with the use among young people with regard to opiates and fentanyl?
September 20th, 2016 / 10 a.m.
Physician, Street Health Centre, Kingston Community Health Centres
I don't have a percentage.
I can tell you from our personal experience at our clinic that we have a number of youth, which is broadly defined now to include ages 16 to 25. The vast majority of people who attend our clinic are people who use drugs and who may use them in a riskier fashion or maybe in a fashion that's less predictable. They would use stimulants and also opioids, one or the other, and not often, so they would use intermittently.
Conservative
Rachael Thomas Conservative Lethbridge, AB
One of the other things that came up in this conversation was with regard to making sure that we get the message out. I view that as a really critical piece. It's one thing to put the legislation in place as that's our job around this table but it makes no difference for the general public and saving lives if we don't get that message out.
Starting with you, Meredith, can you comment on how we might go about doing that as a society?
Physician, Street Health Centre, Kingston Community Health Centres
If we look at the example of what Washington state did when they enacted their good Samaritan legislation in 2010, they followed that up about a year later with a survey of all the Seattle patrol officers during roll call. That survey had an incredibly high response rate of 97%. I've never seen a survey with that high a response rate. They asked those officers if they were aware of the good Samaritan legislation.
To give the committee some context, 67% of those officers who presented had an overdose in that prior year. Only 16% of those roll-call officers were aware of the good Samaritan legislation and of those 16%, only half of those were aware that it included bystanders as well as the victim in that legislation.
The police force took that information, and realized this wasn't good, and they started an education initiative that involved the narcotics police officer, public health, and the legal people to all get together. They made a video that they would show at every roll call for all new officers. I think roll call is mandatory; other people probably know more about that than me. That got the message out to every new recruit and it was repeated over and over again to police officers to make them aware of that. Federally we're lacking a drug czar, for lack of a better word, who can quarterback the need for a national response to this opioid overdose crisis. I think a part of that response would be something like getting the word out on good Samaritan legislation. That would include police, harm reduction people, and people with real lived experience, and people who are doing opioid substitution therapies. Public health would be a part of that as well.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Thank you.
Sarah, this piece of legislation is one step but it would appear to me that a bigger strategy needs to be in place. I think all of you here today have alluded to that. What else needs to be a part of that bigger strategy to tackle the problem of opioid and fentanyl overdoses here in Canada?
Harm Reduction Worker, Centretown Community Health Centre
I'm not sure how many years ago—Jane may know—Portugal decriminalized the use of small amounts of all drugs. The use of drugs is a criminal activity in this country. Their overdose deaths and overdoses have plummeted so that is one strategy. We've talked a lot about opioid substitution therapy. That includes methadone, suboxone, and even heroin prescriptions so there needs to be more access to that. Most people on social assistance don't pay for that stuff as it's covered by the provincial government but many people who are working have to pay. That was in the news last week; you may not be able to manage $7 a day for your methadone.
What else? Supervised consumption sites; thank you. These are places where people can inject. People are at a higher risk of overdose when they're injecting quickly and when they're trying to hide their injection. They might be doing it outside in public, in a Tim Hortons washroom, or in an alleyway. They're going to take more risk and they're going to be more likely to overdose. A lot more education needs to be done post-treatment. Jane alluded to this earlier. When people finish addiction treatment the reality is that a number of people will relapse in the first year of their treatment. They are at a very high risk of overdose in those instances. Similarly, they're at a very high risk of overdosing coming out of jail or a hospital where they haven't used for a number of months. A lot of education needs to be done at those opportunities.
Physician, Street Health Centre, Kingston Community Health Centres
I was just going to mention with the other things that we need real-time surveillance of drug use. We have no idea of what's going on across the country. Most of our data is at least two years old by the time it comes to us from the Office of the Chief Coroner.
Physician, Street Health Centre, Kingston Community Health Centres
Also, we need to do something about how we prescribe medication in this country. There needs to be a national approach.
Harm Reduction Worker, Centretown Community Health Centre
The pharmaceutical companies need to be involved. One of the reasons why we're facing this fentanyl crisis is because OxyContin's formula was changed a few years ago. We squash one drug—we squashed OxyContin, or we changed the chemical makeup of OxyContin so it couldn't be tampered with—and then another one pops up in its place. In this case it's fentanyl.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
Ms. Brown, my questions are about the fear of prosecution. It is suggested that fear of prosecution is a barrier to calling 911 in the event of an overdose. How real is this fear? Would removing the barrier to calling 911 really mean anything to drug users? Have you been keeping some kind of record of how many drug users have been calling for an overdose and what kind of impact this is going to have on more people calling?
Harm Reduction Worker, Centretown Community Health Centre
The relationship between the people who use drugs in this particular jurisdiction and the police is not a good one. There's not a lot of trust, so the community often takes care of itself. They try to manage the overdose on their own without calling 911. There was some earlier discussion about having people dragged onto the front porches of houses. Then 911 is called and the person hides in the bushes and waits for the paramedics to arrive. The fear is very real.
People will make decisions or they'll hesitate or they won't call.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
As a front-line worker, you have first-hand knowledge as to how removing the barriers to calling 911 might help in overdose situations. The problem, however, is not the law. It is making drug users aware that it's safe to call for help. Can you tell us what needs to be done to make drug users aware of this legislation?
Harm Reduction Worker, Centretown Community Health Centre
There are a number of ways that we can communicate if this bill is passed. We can communicate this bill to people who use drugs. I am one of maybe 30 people in the city—maybe 40 or 50 really—who have daily contact with people who use drugs. We also have a very large peer network of people who are doing research, like Christine, who are working in harm reduction fields. That's a really great network to disseminate information about this bill. Methadone clinics offer another opportunity, as do pharmacies.
I think my concern with communication around this bill is that police are communicated to about the passage of this bill and the immunity outlined in this bill, that police are aware of this and that they actually follow through with it.
I'm a bit concerned. There was something mentioned earlier about police discretion. I actually worry quite a bit about police discretion and would like to see them have a bit less discretion.
My other concern is for the community of experimenters, people who are newer to the drug scene, and we've alluded to that at this meeting as well, younger people, people who are trying drugs for the first, second, or third time, people in party situations. They are not people that I see. Most people that I see daily are well established in their drug use. The folks who are newer to it need to be communicated to. I suppose in that instance it would have to be a much larger public message, perhaps through advertising, perhaps through billboards.
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
Don't you think that if the law enforcement agencies came forward that would be a much more effective way to communicate with people who are doing drugs? I think we should have a concerted approach around educating them, so that they know they will not be charged if they call the police. If it came from the police or a law enforcement agency, I think that would have a bigger impact.
Harm Reduction Worker, Centretown Community Health Centre
Do you mean if the police departments were telling people who use drugs, “We won't charge you”?
Liberal
Darshan Singh Kang Liberal Calgary Skyview, AB
This would be some form of education that should come from them, too. I'm not saying that they tell them, “If you use drugs, we won't charge you.” I know what you're getting at, but I think the people are afraid of the police.
They are not afraid of the first responders on the medical team. There should be some form of education on that side too, somehow, such as having an open house. It's not the police; it's not saying, “If you do drugs, we won't charge you” within the context of some overdose. It's just to let people know their rights.
Harm Reduction Worker, Centretown Community Health Centre
My concern with the police disseminating the information again is around trust. The community of people who use drugs need to hear it from people they trust. They need to hear from someone they can trust that their health and safety is a priority and that they won't be charged.