Evidence of meeting #23 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was fentanyl.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Lisa Lapointe  Chief Coroner, British Columbia Coroners Service
Bonnie Henry  Deputy Provincial Health Officer, British Columbia, Office of the Provincial Health Officer, British Columbia
David Juurlink  Head, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre
Sean LeBlanc  Founder and Chairperson, Drug Users Advocacy League

10:20 a.m.

Conservative

The Vice-Chair Conservative Len Webber

You have five seconds, I'm sorry, Doctor. If you could spit a question out in five seconds, I would be impressed.

We're going to move back to the Conservatives, to Dr. Carrie.

You have five minutes.

10:20 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

I'm going to split my time with Madam Harder. I'll take ask question.

Dr. Juurlink, I think you hit the nail on the head about one of the real challenges, but you've said some controversial things. I'm going to be the contrarian, because normally we have different viewpoints on a panel, and I'm going to try to give you a hard time. I don't think you'll have a hard time with it.

You said that the crisis is created by physicians, that we basically have to stop prescribing these drugs because physicians are conditioned to help. I think that's a really good thing and there have been studies that actually show that. You mentioned the opioids on the market. When we were in government, we were heavily criticized by the former Liberal health minister in Ontario, Deb Matthews, and American governors, when we said we should take a federal approach to make all of these opioids tamper-resistant, because, if they are going to be prescribed, make it so that it's a very small population that should do that.

I believe she also said that in one of her first nation communities, 78% of the people were addicted to opioids. The comment that really scared the living daylights out of people was when the chief said that the drug pusher in his community wore a white coat.

What do you think about this whole issue if they're going to be prescribed, as Mr. LeBlanc said, for some conditions? I've had people come to my office to say, “Fentanyl kind of makes me be able to function in my day-to-day when it's prescribed appropriately”. We can argue about that. Should these drugs—the entire class—be made more difficult to access, both tamper-resistant and more restrictive for physicians to prescribe?

10:20 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Ms. Harder, go ahead.

10:20 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

I just want to create a framework for this epidemic that we're seeing, so I'm wondering, Ms. Lapointe, if you might be the best one to answer this question.

Can you comment on the demographic that we're looking at? I know that more males than females are involved, but are we seeing a specific ethnicity involved in this at a higher percentage? That would be question number one.

10:25 a.m.

Chief Coroner, British Columbia Coroners Service

Lisa Lapointe

We don't collect data around ethnicity, so I can't tell you that. We have started collecting data for the First Nations Health Authority in British Columbia, so we will be able to report at some point about the number of first nations people or indigenous people who are dying. The demographic is, for the most part, as you said, male and aged 29 to 49—sometimes a little bit older—and from all walks of life. Primarily we're talking about people who have used illicit drugs for a long time.

I want to be clear: our criteria only includes illicit drugs; prescribed drugs are not included in these deaths.

10:25 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

Thank you.

10:25 a.m.

Deputy Provincial Health Officer, British Columbia, Office of the Provincial Health Officer, British Columbia

Dr. Bonnie Henry

Because we have been collecting data on people who are surviving overdoses, the picture that we're seeing of those who have survived overdoses is different, at least in some parts of the province. As well, we're seeing geographic differences. In some parts of the province, it's more equally weighted between boys and girls, men and women, and those who survive overdoses are more often not the long-time users, but people who are more recreational users and often in private homes rather than in public places. There is a difference, and that's why this data is so helpful for us in looking at points where we can intervene to prevent ongoing drug use by people.

10:25 a.m.

Conservative

Rachael Harder Conservative Lethbridge, AB

Perhaps you could answer this question between the two of you. There are two parts to it.

One, I'm wondering why the province of B.C. is so hard hit. Perhaps you could reflect on that a bit. B.C. seems to have exponential numbers in comparison with other provinces.

Second, as part of that, why has there been such a drastic increase in the last five years? When I look at that map up there, when you show me the colours, that really hits home for me. I really would love to understand why this has become such an epidemic in the last five years.

10:25 a.m.

Chief Coroner, British Columbia Coroners Service

Lisa Lapointe

You only have a problem if you know you have a problem. That's my first response. The B.C. Coroners Service has adopted a fairly risk-tolerant approach to reporting this data. We get the data within 48 to 72 hours, and we are reporting these deaths monthly. You will not see that across the other provinces or territories. They do not collect the information the same, and if they do, they're not reporting it the same. The surveillance we're doing is letting us know there's a problem. We may find that out in other parts of the country months or years from now, when the data is rolled out.

In terms of the increasing number of deaths we're seeing, fentanyl is driving that hugely. I would say, because we are on the coast, and a great deal of this product is coming from China, that it's hitting our ports and moving into our communities that way. I think that's also why you see it in B.C. and Alberta.

If I may, I want to mention something else. You talked about treatment a few minutes ago. I didn't want to leave that, because I do want to advocate for treatment. We see, from the families we talk to who have lost their loved ones, that they banged their heads against brick walls for months, if not years, trying to get appropriate treatment for their loved ones. Sean may be able to talk about this better than I can, but there is a time when someone who is using wants treatment, wants to get off. That window is small. If that treatment is not there when they are ready for it, then they will go back and they will die, or they will continue to use. The window is lost.

So you're absolutely right that treatment is a critical piece of this. It has to be available for people and it has to be at no cost. We also know that families have spent tens of thousands of dollars, if not hundreds of thousands, trying to access treatment for their loved ones. Not everybody has that kind of money, so that's a very good point.

10:25 a.m.

Conservative

The Vice-Chair Conservative Len Webber

We'll move on now to MP Darshan Kang for five minutes.

October 6th, 2016 / 10:25 a.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Thanks to the panel members.

We were talking about prevention and education. I know an organization in Calgary called Drug Awareness Foundation Calgary that has been doing open houses and trying to educate people against drugs. But every time they have an open house, there is concern that when they're trying to educate people not to use drugs, that may encourage young people to try drugs. It becomes a kind of double-edged sword.

Do you think we're doing prevention and education in a proper way so that we don't encourage youth to get into drugs?

10:30 a.m.

Deputy Provincial Health Officer, British Columbia, Office of the Provincial Health Officer, British Columbia

Dr. Bonnie Henry

We can look at this in terms of other things we've done. We can look at how we've educated children around alcohol use. From studies we've done in B.C., alcohol use is actually decreasing in teenagers. Around cigarette use, smoking is just not done anymore in that age group.

We've talked to students about these things. We've talked to them about marijuana, for example, and we've talked to them about drugs. They say, “Oh, we never hear anything. Since we don't get information in a formal way in school, we hear about it on the streets. We hear untruths, and that's what makes it tempting to us.”

I think we do need to talk to people in a very forthright and open way about drugs, about their uses, their benefits, and their harms, so they can make those informed decisions. When we do it right, we've seen that it works.

10:30 a.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Is there enough getting done? It took five years to come to this fentanyl crisis. Couldn't we have seen it back then, when the crisis was brewing?

As well, is there another drug on the horizon that you think could be after this one? Are we being vigilant about any other drugs?

10:30 a.m.

Deputy Provincial Health Officer, British Columbia, Office of the Provincial Health Officer, British Columbia

Dr. Bonnie Henry

You'll notice there was a peak in the 1990s, and that was when crack came into B.C. We've been looking at that for some time, and that peak was mainly confined to the Downtown Eastside. We were seeing a lot of people dying.

The response was quite different. We have a partnership in B.C. that has been looking at this data, the coroner's office and others, for a number of years. We did see things coming up.

We finally reached the point that we declared the emergency because all of our usual measures to try to intervene, to increase awareness on the street, to make sure that people know what's happening, via a number of campaigns, weren't going anywhere. We needed a much broader partnership to try to address these crises as the deaths were coming up.

10:30 a.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Why is it right across the province? That's mind-boggling.

10:30 a.m.

Deputy Provincial Health Officer, British Columbia, Office of the Provincial Health Officer, British Columbia

Dr. Bonnie Henry

A variety of factors have led to increased use. We've seen issues related to economic conditions in certain parts of the province. I think our understanding that it was no longer confined to, or just a problem in, one part of the province was one of the reasons we declared an emergency to address it.

10:30 a.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

We've been talking about Bill C-2. I think the Minister of Health is going to look at the barriers in Bill C-2.

Dr. Juurlink, you said something about doctors prescribing medications. I know some people will go from doctor to doctor to get OxyContin, for example. They will get it, and sell it too.

How can we control the medications? Is there some kind of mechanism in place, so the doctor knows that—

10:30 a.m.

Conservative

The Vice-Chair Conservative Len Webber

Thank you, Doctor.

Our final questioner today is Mr. Davies. You've got three minutes.

10:35 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

A few years ago, the public safety committee did a study on the rate of addiction and mental illness in the federal correctional system. The conclusion we came to was that 80% of inmates in the federal system had an addiction.

Would an increased use of drug courts and treatment diversion programs in the justice system be a positive measure to help people entering prison have a chance of dealing with their addiction?

10:35 a.m.

Chief Coroner, British Columbia Coroners Service

Lisa Lapointe

That's a very good question. There's a drug treatment court in Vancouver, and I haven't seen the data coming out of that. I know anecdotally from those who work in that field that they believe it's very successful.

I can tell you, I have worked in the provincial correction system, and at the time I was there around 2006, 2007, and 2008, we found the same, that 63% of those in jail had either a substance abuse and/or mental health disorder, and generally both.

It's very challenging treating those with substance abuse or mental health disorders in jail. It's not an optimal place for people. Again, if you want to adopt a health approach, if somebody has an illness, putting them in jail isn't the best way to treat them.

Absolutely, we need to be looking at novel ways of treating populations that really are just going to cycle back through the jail.

10:35 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Mr. LeBlanc, in your experience and that of people you know, if people were facing a criminal charge and had an addiction, if they were given the opportunity to avoid the corrections system and go into treatment, would that be something people would choose?

10:35 a.m.

Founder and Chairperson, Drug Users Advocacy League

Sean LeBlanc

I think so for the most part. I think it needs a bit of tailoring, though. The drug court right now is pretty well abstinence-based. When people are failing, they're still being punished for their original crimes. In a lot of cases, though, it's worked really well for people. There are a lot of limitations though. People can't work when they're on it, and people are unable to attend school while they're on it because of the time commitment involved. I think if we could make a couple of adjustments, it would be even more successful.

10:35 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Dr. Juurlink, I want to come back to you. You said there was no national system of surveillance in Canada and even the number of Canadians who die annually from opioids is unknown. How do we fix that? Who should be collecting the data and how do we do that?