Thank you, Mr. Chair.
Good morning. On behalf of Dr. Sharma and Brent Diverty, I'd like to thank you very much for the opportunity to appear today.
As you know, British Columbia is at the epicentre of the current crisis of drug overdose and deaths, with the B.C. Coroners Service reporting that there was a 62% increase in illicit drug overdoses from January to August of this year compared to the same period of last year. According to the B.C. Centre for Disease Control, if this trend continues, B.C. could see 800 illicit drug overdose deaths by the end of the year, with nearly half of those expected to involve fentanyl. Yet, the most recently available national data from the Canadian tobacco, alcohol and drugs survey did not show increases in the use of the most common illicit drugs.
What has changed?
What seems to be accounting for the unprecedented rise in deaths is the increased presence of fentanyl on the illicit market, an opioid that is significantly stronger than morphine. According to the B.C. coroner, there were 264 illicit drug overdose deaths where fentanyl was detected from January through July, a 222% increase from the same period in 2015. lnsite, one of two supervised consumption sites in Canada, recently began providing test strips as a pilot project at their site so that users of their services could test their drugs. They report that 86% of those samples tested positive for fentanyl.
As you'll no doubt hear from the CEO of the Canadian Centre on Substance Abuse, the Canadian Community Epidemiology Network on Drug Use flagged that deaths linked to fentanyl have increased markedly across the country. As you will no doubt hear from our colleagues from the RCMP, this also reflects what law enforcement is seeing.
While illicit drug use has always been a high-risk behaviour, with the exact composition and strength of the substance being unknown, fentanyl has increased those risks immeasurably. As British Columbia's provincial health officer, Dr. Perry Kendall, has said, no one is immune. People with long histories of drug use are overdosing, as are people trying drugs for the very first time.
In terms of critical actions to deal with the immediate crisis of overdose and deaths, many experts are calling for three things: increased availability of naloxone, increased availability of supervised consumption sites, and increased availability of treatment, including medication-assisted therapies.
Health Canada is responding to each of these three calls to action. We have made naloxone more widely available by removing the requirement to have a prescription. This was the first time that Health Canada initiated the removal of the prescription requirement for a drug to respond to a public health need. In addition, the Minister of Health issued an emergency order on July 5 to allow immediate access to the more user-friendly nasal spray form of this medication. I'm pleased to note that yesterday it was announced that the department has completed its expedited review of this nasal spray form of naloxone, thereby regularizing its availability in Canada.
In the case of supervised consumption sites, evidence has shown that, when properly established and maintained, they can save lives, all without increasing drug use and crime in the surrounding area. These supervised consumption sites decrease the number of deaths by overdose, and they can redirect injection drug users to health and social services. In addition, they reduce public drug use, rates of infection, and unsafe syringe disposal.
I would like to note that Health Canada has heard concerns with regard to the legislative requirements contained in the Controlled Drugs and Substances Act related to the establishment of supervised consumption sites. Further to direction from our minister, we are working closely with potential applicants to explain the legislative requirements in order to ensure there are no unnecessary barriers for communities that wish to open such a site. In addition, we are looking at the legislation to assess whether amendments may be advisable.
In this context, it is important to recognize that the application review and authorization process seeks to ensure that supervised consumption sites are established based on evidence and with sufficient support so that these sites will be properly maintained. These rigorous criteria protect the health and safety of both the clients and staff and give confidence to the community that there is a process in place to ensure that these facilities are operating responsibly.
Health Canada is also supporting access to medication-assisted treatment options. For example, a regulatory amendment was recently published to allow for the consideration of applications for medical-grade diacetylmorphine under Health Canada's special access program, as scientific evidence supports the use of heroin in select cases for the treatment of chronic relapsing opioid dependence. This same type of medical treatment with heroin has also been used in several European countries under very specific circumstances and provides a treatment option for the very small percentage of patients who have not responded to other treatments.
This winter, we also intend to consult stakeholders on the regulatory requirements for physicians to obtain an exemption to prescribe methadone in order to determine whether that requirement is an unnecessary barrier to treatment.
Health Canada also recognizes the importance of research to assist us in making evidence-based decisions, including as it relates to medication-assisted treatment.
Through the Canadian Institutes of Health Research, we are making important investments in research to help build the evidence on which key policy decisions are made. The OPTIMA study is just one project the CIHR is supporting. It will compare and evaluate the effectiveness of two treatments for prescription opioid dependence—methadone and the combination of buprenorphine and naloxone—with the goal of generating practice-based evidence that will inform patient care and improve health outcomes in Canada.
Beyond the harm reduction measures described above, I anticipate that others, including the RCMP, will highlight the importance of addressing the supply side of the opioid crisis.
Within the purview of Health Canada, the intention to put forward regulatory amendments to control six chemicals that are used in the illicit production of fentanyl was announced last month. The comment period for this regulatory proposal closed yesterday, and we will be moving forward expeditiously to control these precursor chemicals. The Minister of Health has also stated that she intends to bring forward legislative options for consideration on the issue of pill presses.
Stepping back from the immediate crisis of overdose and death, it's important that the numerous individuals and organizations with a role to play in addressing various aspects related to the root cause of the opioid crisis come together. It's only by taking a collaborative, comprehensive, evidence-based, and sustained approach that we can make a difference in the long term.
Important foundational work is well under way. Following the 2014 HESA report on the government's role in addressing prescription drug abuse, the report of the Canadian Centre on Substance Abuse, “First Do No Harm”, and the input of many stakeholders, budget 2014 funding of $44 million over five years has allowed many of the initiatives identified in these studies to move forward.
I will give just a few examples. Updated opioid prescribing guidelines will be available early in the new year. Nineteen new inspectors have been hired and are on track for over 1,000 inspections of community pharmacies. Public awareness campaigns have been run. The Canadian Institute for Health Information is using $4 million in funding to strengthen surveillance and data collection. The first nations and Inuit health branch of Health Canada is investing $13 million over five years to increase support for improved training for community-based addictions workers and to establish crisis response teams.
Building on this, Minister Philpott called on the department in April to look at all possible options to take action in addressing this crisis. That work led to Minister Philpott's announcement in June of a five-point action plan that aims to influence the root causes and reduce the potential for harm, both in its most extreme manifestations as an overdose death but also for so many other Canadians who experience harm from problematic opioid use.
Given the challenges and complexities of this public health emergency, it's clear that our response to the crisis requires leadership among many different players, as well as a coordinated approach. To quote the Canadian Medical Association in a statement they made last year, “The unfortunate reality is that no single level of government, no single health provider group and no single sector of our society can resolve this complex crisis on its own.”
For this reason, the Minister of Health and the Honourable Eric Hoskins, Ontario's Minister of Health, as co-chairs of the conference of federal, provincial and territorial ministers of health, will be co-hosting a conference and summit in the middle of next month to discuss the current problem of opioid misuse in Canada and to identify further potential ways forward. The smaller summit following the conference will bring together individuals and organizations who have both the authorities and the commitment to take concrete action in combatting the opioid crisis.
I'd like to thank the committee for the opportunity to speak to you today.
My colleagues and I will be pleased to answer all your questions
Thank you.