Health Committee on Oct. 4th, 2016

[Rita Notarandrea]

Our group is really an organization that looks at the evidence. I think Ms. Geller has spoken to the evidence on consumption sites. We also look at ensuring that the public is protected. I think there is always a balance. Right now, in terms of the bill and what I have been told, it's being facilitated. People who are putting forth proposals are being given a lot of assistance in ensuring that those proposals are successful.

[Don Davies, NDP, Vancouver Kingsway, BC]

So you're happy with the state of affairs in Bill C-2. Is that the position of your organization?

[Rita Notarandrea]

Again, we don't have a position, per se. We ask what the evidence says about consumption sites. What does it say in terms of being part of a continuum of care? We support that it be part of the continuum of care. What we have been told is that every effort is being made to ensure that the public is protected and that those individuals who are suffering are protected.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Mr. Shean, Dr. Jane Buxton, a professor at the University of British Columbia, recently told this committee that about 82% of people in Vancouver call 911 during overdose events, but that number falls to less than 60% in regions outside Vancouver, primarily where the RCMP is the police force. Dr. Buxton attributed this in large part to the VPD's policy of non-attendance at 911 calls for overdoses. Has the RCMP explored such a policy?

[A/Commr Todd G. Shean]

I'm not aware that the RCMP looked at such a policy.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Xavier, when B.C.'s premier started a task force on fentanyl in late July, she called on CBSA to search small packages for fentanyl, but Clayton Pecknold, B.C.'s director of police services and co-chair of the task force, has been clear that this policy has not been implemented. He says, “We're still waiting for the federal minister of public safety to get back to us. We've asked very explicitly for new strategies to interdict fentanyl at the borders and to give the CBSA the tools they need”.

On September 15, the CBSA said that it is looking at new ways to screen mail but so far hasn't changed its policy. In the case of suspicious packages under 30 grams, they currently “contact the importer to request permission to open the mail. If permission is denied, the mail is returned to the exporter”. In your view, why has the CBSA not responded to the task force's request to search small packages?

[Caroline Xavier]

With regard to the limitations—

[The Vice-Chair, Conservative, Len Webber]

I will have to interrupt. I'm sorry.

Your time is up, and you'll have to wait until the next time around, Mr. Davies. I have to move on.

Dr. Eyolfson, you're next, for seven minutes.

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

Thank you all for coming. This is something that's been near and dear to my heart. I practised emergency medicine for 20 years, much of it in the inner city of Winnipeg. We've seen many of these problems first-hand.

Ms. Geller, Mr. Davies was talking about Bill C-2 and some restrictions it placed on safe consumption sites. In your view, has this bill impeded your ability to monitor the crisis by slowing down the development of safe consumption sites in cities?

[Hilary Geller]

Thank you for the question.

I think it's important to recall that before the amendments to the CDSA, the Controlled Drugs and Substances Act, known as Bill C-2—and Bill C-2 was not a stand-alone piece of legislation; It was a series of amendments to an act—

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

Exactly.

[Hilary Geller]

—there were a set of published and rigorous criteria that potential applicants had to fulfill. With or without a piece of legislation, there would inevitably need to be some strict guidelines so that the decision-maker had all the information he or she needed in order to make an informed decision and to ensure that if it was to be established, it would be properly run and properly maintained.

I think it's also interesting to note that most of the criteria, the 26 application criteria that are in the CDSA, are very similar to guidance documents issued both by the British Columbia government and the Quebec government, which were designed to inform people in their provinces about the types of information that they should be prepared to provide if they were considering opening a supervised consumption site.

What I will say is there's certainly a tremendous amount of interest out there in opening new facilities. Staff in my department have regular, very detailed conversations with those potential applicants. What I am told is that after having had those levels of engagement, the general view is: “Thank you very much. You've really helped clarify what is needed. You've helped me understand how this sort of information was provided by others, in particular Insite, and we now know what we need to do in order to submit a proper application.”

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

There's been a bit of a change in philosophy over harm reduction, safe consumption sites. We do know that previously there was a lot of opposition to it. The one in Vancouver was the only site for a long time simply because its status was unknown. It was being appealed to the Supreme Court. We didn't know if it was going to exist anymore.

If there had been less objection or less resistance to harm reduction throughout the past few years, would that have made it easier for surveillance and treatment to get ahead of this problem earlier with the crisis?

[Hilary Geller]

Surveillance and treatment are two different things.

I will say on the surveillance side—and it's no secret that we and colleagues here refer to it—we don't have a terrific system of surveillance at the national level. The development of surveillance systems, I think, is variable across the country. In places like B.C. it's excellent, in other places, it's not quite there. That is something we're working on. That's what I would say on surveillance.

On treatment, I think it's always been recognized that treatment is incredibly important. There was a significant investment into treatment in the 2014 budget coming out of the work of this committee and the work that Rita had referred to earlier on in “First Do No Harm”. There is certainly more that can be done both in terms of work on medication-assisted therapy but also treatment indicators, work on first nations. I'd say that is continuing to be a focus of ours.

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

Thank you.

My next question is for our colleagues from the RCMP. Thank you for coming. I particularly like seeing you here, being an RCMP brat myself.

There have been different philosophies on drugs, and from the legislative and law enforcement perspective there has sometimes been the tough-on-crime approach and the zero tolerance approach. There are others who have said this zero tolerance, tough-on-crime approach has sometimes made things worse in driving people underground to not seek treatment.

What would your views on that be? Do you think that primarily criminalizing these activities is making things worse by driving them underground?

[A/Commr Todd G. Shean]

Thank you for your question.

Your being an RCMP brat, and my son just completed his second-year residency. He wanted to be an emergency room doctor, so I think we have something in common.

What I'd like to share from a law enforcement perspective is that when asked, we will inform discussions around any legislation, and our role is to enforce the legislation that our government puts forward. That's essentially where we stand with that. Often we're asked about it as new legislation comes forward, and we will certainly provide input if requested, and then our role is to enforce the laws that our parliamentarians have decided are the laws of the land.

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

We only have one safe injection site in Canada right now. From the law enforcement point of view, has law enforcement in the B.C. area seen any increase in crime due to a safe consumption site?

[A/Commr Todd G. Shean]

I'm not aware that we've done a specific study with regard to a crime increase around a supervised site, so I wouldn't be able to give you an answer other than that I'm not aware of any particular study being done in that regard from an RCMP perspective.

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

All right. Thank you.

I think I have about 15 seconds, is that right?

[The Vice-Chair, Conservative, Len Webber]

Yes, 15 seconds.

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

That's probably not enough for another question, so thank you very much.

[The Vice-Chair, Conservative, Len Webber]

Thank you.

We'll go to our second round now with five-minute questioning.

We'll start with Rachael Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

This question is for the Canadian Centre on Substance Abuse.

You talked about needing to strike a balance between the safety of the public and wanting to pursue some sort of safe injection venue, let's say, for those who use drugs. With regard to finding that balance, what would you say are some of the challenges that are posed with regard to the general safety of the public?

[Rita Notarandrea]

When I talk about treatment, we've been focusing on safe injection sites and safe consumption sites. There is an array of treatment options and I do want to say that when I talked about those standards from the WHO and UNODC, there is a variety of treatment options for the treatment of substance use disorders.

I do want to say that we need to look at interventions that are based on the evidence. Those are all the options available for people who are suffering from substance use disorders. As part of the bigger bucket of substance abuse disorders, there are those who are suffering from an addiction to opioids. What I am saying is that we need to look at all options to effectively treat the individual when they present with all of the complications that come with addiction. We need to have a comprehensive approach. We have to help them in terms of their disorder and we have to meet them where they are and keep them safe as well.

[Rachael Thomas, Conservative, Lethbridge, AB]

As part of a comprehensive approach, then, it seems that it would be appropriate to have a prevention mechanism in place. That should be a part of that comprehensive approach. What about getting people off addictive behaviours, out of addiction? Is that part of this comprehensive approach and what would that look like?