Health Committee on Oct. 6th, 2016

[Lisa Lapointe]

Absolutely.

I heard our Minister of Public Safety say recently that we cannot arrest ourselves out of this situation. We know that approach—the shaming, blaming, and arresting of people—has not worked. It significantly has not worked. In fact, the deaths and rates of overdose have only increased. Treating this as a health problem, such that if somebody becomes ill from a drug they call an ambulance and are treated at a hospital, is the only way we are going to save lives.

In keeping with the treatment aspect as well, if you develop a terminal illness, or an illness that is potentially terminal, a cancer, for example, you expect that you will be treated and that treatment will be available. If you become addicted to drugs, treatment should be available.

[Don Davies, NDP, Vancouver Kingsway, BC]

Let me pick up on that, both Ms. Henry and Ms. Lapointe.

I'm going to speak bluntly here. There seems to be a division in this room and with this government on Bill C-2. The government seems to stubbornly refuse to acknowledge that it needs to make any changes to Bill C-2 .

Ms. Henry, the words you used were that Bill C-2 contains extreme barriers. Hon. Hedy Fry, when she was the Liberal Health critic, said that Bill C-2 was designed to avoid the opening of safe consumption sites. I think Dr. Perry Kendall has said that too.

I'm going to ask you directly. The Liberal government seems to suggest that the problem isn't with Bill C-2. It's just explaining the requirements to groups, and if we can facilitate that, we can get more safe injection sites.

The facts are that we have two injection sites in the country, InSite and the Dr. Peter Centre. There is not a single site that has opened in this country in the last year and a half. We have one application currently, and that's from the City of Montreal. With the Toronto Board of Health, everybody is telling me that with the barriers, it takes months and hundreds of hours to get an application in.

My question is, what are the barriers in Bill C-2 that you think are unnecessary?

[Dr. Bonnie Henry]

I could talk for a long time on that. Some of them are outlined in the written report that we sent in.

There are about 25 different pieces of Bill C-2 that I find are barriers. One of the key ones is requirement for opinions from neighbourhoods that are not necessarily based on fact, and the types of opinions that need to come in. It's a challenge to get those, because it reopens questioning around supervised consumption services and their worth. It's a challenging part.

The other part that is just ridiculous is that you have to name every single person who will work in the facility, and none of them can have a criminal record. People like Sean would be excluded from working in a site, which we think is ridiculous, because peer support is really important and it helps.

There are a whole variety of them that I can certainly list for you.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks. Maybe you could send those to the committee, all the barriers that you see—

[Dr. Bonnie Henry]

We can do that.

[Don Davies, NDP, Vancouver Kingsway, BC]

—because what jogged me was this connection of it being a health issue, not a policing issue. You have to get the approval of the local chief of police. What other medical or health service do we have in this country that you have to get the chief of police to sign? Shouldn't that be a medical decision, not a criminal decision?

[Dr. Bonnie Henry]

I believe so, and it's the opinion of the chief of police. I will say that we have had a lot of positive response from the policing services in B.C., including the RCMP E Division.

Through the minister, Health Canada has expressed interest in working with us on trying to overcome some of these barriers, but we do still feel that repeal or an extensive revision of Bill C-2 would be most appropriate.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Juurlink, I want to give you a chance. You've talked about there being no national system of surveillance in Canada. Even the number of Canadians who die annually from opioids is unknown. You've talked about the CCSA. You've called that an inadequately resourced non-governmental organization. They've made 58 recommendations that you say have not been prioritized or implemented. What can you tell us about those recommendations? Have they been implemented? Which ones do you think ought to be implemented?

[Dr. David Juurlink]

I think some of them have. I'd have to direct you back to the CCSA itself for the status of the various recommendations.

I guess my point in making that comment earlier was that of those 58 recommendations, by definition some of them are more important than others. I have one in front of me here:

Improve and promote access to treatment, which should include: i. Pharmacological interventions; ii. Psychosocial support and counselling; and iii. Withdrawal management programs.

The proposed leads there are health care institutions. That can't happen fast enough. This is a three and half year-old document. It should be happening everywhere now. That's why I think that the assigning of priority was something that should have happened and did not.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Doctor.

[The Vice-Chair, Conservative, Len Webber]

Next is MP Sonia Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you to all the presenters.

Dr. Juurlink, you mentioned opiate prescription by physicians. What kind of restrictions need to be placed on the doctors who are prescribing opioids?

[Dr. David Juurlink]

What kinds of prescriptions should be implemented for physicians? You'll get very different—

[Sonia Sidhu, Liberal, Brampton South, ON]

What kind of restrictions need to be—

[Dr. David Juurlink]

Restrictions?

[Sonia Sidhu, Liberal, Brampton South, ON]

Yes, on the physicians when they prescribe—

[Dr. David Juurlink]

Are you asking what restrictions I would advise?

[Sonia Sidhu, Liberal, Brampton South, ON]

No, can you talk about any preventative measures? You said that one in eight deaths of those aged 25 to 34 in Ontario are due to opioid overdoses, so what kinds of preventative measures are you thinking of, such as physicians not being allowed to prescribe higher opioid doses?

[Dr. David Juurlink]

I think there are certainly different constructs, but from the prescribing perspective, I think as a physician I am conditioned to want to help my patient. I see pain all the time, and I'm scared of the other drugs, and I've become comfortable with opioids because of what we've been taught, much of which is untrue. What I'm saying is that I think physicians need to be re-educated—de-educated—about these drugs.

[Sonia Sidhu, Liberal, Brampton South, ON]

What kind of education do you think needs to be utilized.

[Dr. David Juurlink]

Education should focus on the fact that the goals of a drug are to impart more benefit than harm, and opioids very frequently don't do that. They can be beneficial to some patients in the long term, but the higher the dose goes the less likely that will happen. That's why I think doctors shouldn't be allowed to prescribe ridiculous doses of 200 milligrams or 300 milligrams. It's inconceivable that someone is benefiting from that.

I also think that when these high-dose formulations are used as directed, like the OxyNEO 80 and the high-dose fentanyl patches, you are exceeding the threshold dose from the old Canadian guidelines—a dose above which it's very likely that harms exceed benefits. It shouldn't be happening, yet it still is. It's a cultural thing now. We've been doing it for 20 years, and we have to stop doing it.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. LeBlanc, you said that we need to educate our kids about harm reduction. At what age does this need to be taught? Is it in elementary school or middle school?

[Sean LeBlanc]

I see, at least in Ottawa, children as young as 13 even getting into fentanyl. There seems to be no progression. When I was young, people would start with marijuana, then alcohol, and kind of progress their way up. They're starting at fentanyl and these hard-core opiates at a really young age, so yes, I would say that education about it should start in junior high school, at grade 7 and 8.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Ms. Lapointe, you referred to language. Is there any strong language with respect to heroin that would have an impact on the crisis? Is there a great impact with the language? Can you outline any other example of how language and definition have impacted the crisis in B.C.?

[Lisa Lapointe]

Before I answer that, I'd like to emphasize that we have a dearth of research in this area. We do not have evidence across the country as to exactly who's dying, when they're dying, and why they're dying. We don't know, for example, how many people who are currently dying were prescribed opiates. If you're going to implement evidence-based solutions, you need evidence, and we do not have that. I would certainly call on this committee to seek some investment in the research.

To answer your questions, one of the things we hear anecdotally from the people are working with illicit drug users is that the language around stronger drugs, more powerful drugs, will cause a certain segment of the drug-using population to seek out those drugs. We're talking about people who are now actively seeking fentanyl because it's a better high, because it's stronger than the heroin they've been using, for example.

I also want to be clear that the drug deaths that we're seeing in B.C. are not just from opiates. Cocaine is also often involved. Alcohol is often involved. We are starting to do the research to pull out the different substances, but without knowing exactly what substances are killing people and how they started to use those substances, I would argue that we really can't implement any meaningful solutions.