Health Committee on Oct. 6th, 2016

[John Oliver, Liberal, Oakville, ON]

They're on the minister's list, and they are trying to add the chemicals used to make illicit fentanyl to the Controlled Drugs and Substances Act. That's in the works.

[Lisa Lapointe]

Okay. Sorry.

The commercial pill presses need to be regulated.

We would advocate a good Samaritan law, which I believe has been introduced in the House. It's a small measure, but it will be a health response to overdoses. Police will no longer come, and that's focusing on the health as opposed to—

[John Oliver, Liberal, Oakville, ON]

The author of that bill is sitting at the table.

[Dr. David Juurlink]

I said in my comments and I can't emphasize it enough that I really think Health Canada needs to revisit its grounds for the indications for using these drugs.

If you find yourself in a hole, then the first thing you have to do is stop digging. Unless we stop prescribing these drugs, as we have for 20 years, this problem is not going to go away.

[Sean LeBlanc]

I would like to see increased education, especially at the public school and high school levels.

Harm reduction, frankly, saved my life.

When it comes to needle distribution, distribution of these kits, and methadone, we can't talk right now, frankly, about drugs in a real sense, because of a lot of school boards and everything. I think loosening of those restrictions would be really great.

[Dr. Bonnie Henry]

I would like to see federal enforcement and interdiction strategies around importation of illicit drugs. Anything we can do through CBSA, the Canada Border Services Agency, to try to improve our ability to prevent these from getting in and improving relationships with other countries, particularly China, where a lot of these substances are being manufactured, would be good.

[John Oliver, Liberal, Oakville, ON]

I think, Bonnie, you mentioned that you've launched social media campaigns and that you're trying to get public awareness.

When focusing on the younger population who might be looking at experimental or recreational use of these drugs versus the other sort of categories, what would be the key messages you'd deliver to younger Canadians?

[Dr. Bonnie Henry]

Number one is that these are dangerous things, so don't do them, obviously.

As our colleagues mentioned, we recognize that young people are going to try these. The messages are around how to look after each other and how to use naloxone. We have a whole campaign around “Naloxone Wakes You Up”, so that people understand the use of it and understand and recognize that when their friends are overdosing, they need to call 911. We've done a lot of work with law enforcement in B.C. to make that a positive experience, so they aren't arresting people when they respond to overdoses, which has been an issue in the past.

We've involved a lot of youth in developing these tools, and having people with the lived experience involved in helping us speak frankly about these issues to children.

I would encourage people to go to Towardtheheart.com. It's a website that we've developed in B.C., a collaboration among people who use drugs, people with lived experience, and the health sector. We have a lot of tools there for young people and for all age groups around what to do, what the risks are, and how to respond.

[John Oliver, Liberal, Oakville, ON]

I thought you gave some excellent advice as well on not using words such as “powerful”. Maybe it was Dr. Lapointe who raised that point.

I have one last question for David. This epidemic of fentanyl in British Columbia has been staggering. I think the percentage of illicit drug deaths involving fentanyl went from 5% in 2012 to 62% by 2015.

Do you have any data on the incidence or presence of fentanyl in Ontario?

[Dr. David Juurlink]

In Ontario, it has roughly doubled over the last four years. In Alberta, I think fentanyl-related deaths have gone up about 5,000% over the span three or four years. That's no longer the prescription stuff; it's the illicit stuff that's coming into Canada from China, and being produced domestically to a certain extent.

I'll make a comment very quickly. There are scarier forms of fentanyl out there. In Ontario, we aren't even testing for that. I know they're around. We're not looking for them.

[The Vice-Chair, Conservative, Len Webber]

Thank, Mr. Oliver. We're going to move on now to Ms. Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

I'm going to start with a question for Ms. Henry. You talked a bit about providing naloxone. I think we would all agree that's a very positive thing to do. One of my concerns with that, though, is that we're also talking about testing for fentanyl in these drugs that are being used, and we would like to do that.

With the combination of being able to test for fentanyl and providing naloxone kits, I would imagine that some drug users would make the decision, regardless of testing for and finding fentanyl, to go ahead and use anyway because they have access to naloxone.

I am concerned about that. It feels as though that could actually perhaps perpetuate the problem rather than solve it. I would be interested in hearing your thoughts on that.

[Dr. Bonnie Henry]

You're absolutely right. As a matter of fact, some people seek out the testing. We've heard that some of the dealers are actually sending people in to have the drugs checked, because they don't want to be giving fentanyl to their cocaine users. Anyway....

I don't think it's an issue around perpetuating use. We did a pilot study at InSite, the supervised injection service site in Vancouver. Some people didn't test. People go to InSite because they don't want to die from their drug addiction. It's an opportunity for us to intervene, to treat them with respect, to give them the chance to get off that cycle they're in. We don't see it as a way of perpetuating the use or encouraging people to use. What we find is that every day they stay alive, it's an opportunity to get off that cycle.

The naloxone keeps people alive. What we're finding is that people will check their drugs, and because you have to use a bit of your drug, if it's hard to come by and you're in that situation, you might not want to do that. We're finding that people will do it after they've overdosed to see if that was the cause of it.

It's a challenge still, because with the tests that are available for drug checking, we don't know the parameters. They're not designed for drugs. They're designed for urine testing. We don't have good drug checking capabilities yet, but we're working on it.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

Another thing that has been said across this table is that there is an emphasis on safe injection sites, safe use, safe consumption, if you will. There's a focus on substitution treatment. I'm not hearing much with regard to detox or therapy treatments where we would want to see people actually off illicit drugs.

I am of the belief, and I would be interested in hearing your thoughts on it, that every single person on this planet is very valuable and born with incredible potential. I'm also of the belief that this potential can only be fulfilled if that individual is given the opportunity to be healthy. It would seem reasonable for me to then believe that using illicit drugs certainly prevents that individual from being able to realize his or her full potential.

With that belief in mind, I am clearly an advocate for treatment that would help people get off illicit drugs and be able to step into their full capacity as people. So I wonder, why not focus on treatment? Why not focus on helping people overcome these addictions which most of them probably don't want anyway, and help them step into their full capacity as people and reach that potential with which they were born? Why not take that approach and put our energy and money toward that instead of these other things?

I understand that there are intermediate stages. I understand that. I just wonder why that isn't part of the conversation at this table.

Ms. Henry, I'd like to start with you.

[Dr. Bonnie Henry]

It is a large and very important part of our conversation. I'm sure that David will talk about this. The challenge is that we need to have immediate actions to prevent people from dying so they can get to that point. You're absolutely right. Sean just said it: nobody grows up wanting to be addicted to these drugs and wanting to die on the street from fentanyl. That is not people's aim in life. For example, we have found through InSite—where we have InSite and OnSite—that treating people with respect, getting them to the point where they are managing their addictions and not dying from them, helps them make that shift and get into treatment and off drugs.

I think one of the challenges we have is that we're stuck in an anachronism around detox and treatment that is based on alcohol and on 28-day abstinence programs for alcohol. These do not work for opioids. The physiological dependence on opioids and what they do to your body and your mind are very different from alcohol addiction. Opioid substitution treatment is a way of getting people off illicit drug use. It is used instead of detoxing, which is something that puts people at great risk of overdosing and dying and is very traumatic and difficult. The substitution treatment is not meant to be lifelong for most people. It's a period of time that allows them to get off the illicit drugs and to then taper off the substitutes in time.

[Rachael Thomas, Conservative, Lethbridge, AB]

Sorry, in the interests of time, I'm just going to interject here quickly. I had the opportunity to go to InSite in the spring. I talked with the director there and asked him if there were any endeavours to help people get off drugs, and he said, “No.” He said the success of their program was if they could help people inject safely, full stop. So I asked if there were any partnerships with organizations—

[Dr. Bonnie Henry]

What you were talking about was the philosophy of InSite itself, the services—

[Rachael Thomas, Conservative, Lethbridge, AB]

—that might help people, because I understand that different organizations can work together in partnership to achieve that goal. He said, “No.” That's very disappointing for me because I can see the value in a safe injection site, but again, it has to be only an intermediate solution.

How is it that we can then work collaboratively between organizations to further help people.

[Dr. Bonnie Henry]

I think you have misunderstood his approach. The purpose of InSite is not to tell people they need to get off drugs; it's to help them on that day. However, there's an OnSite detox treatment program that's actually based in the same building. So InSite does have the philosophy that these are opportunities to find ways to support people to get off drugs, as well. I've visited it many times, and I know that the philosophy in the injection room is not that they're going to tell you every time you come in that you should stop doing this. It's to say, “How are you doing today? Can we help you today?” But there are definitely connections with allowing people to get off drugs, and there's an OnSite treatment program there. We are looking at the whole spectrum of how we respond.

[The Vice-Chair, Conservative, Len Webber]

Thank you, Ms. Henry.

We're going to move on to MP Don Davies now.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to all of you for being here today. It's very cogent, powerful testimony.

Ms. Henry, we know that Dr. Perry Kendall, the senior medical health officer for British Columbia, has declared a public health emergency in the province. He is quoted as saying that “an effective collaboration with the federal government could really have major impact on reducing overdose deaths”.

Could you briefly explain to us what led Dr. Kendall to declare a public health emergency in British Columbia, and do you believe that we need a national public health emergency declared?

[Dr. Bonnie Henry]

That's a very good question.

I'm Dr. Kendall's deputy, and we made this decision in consultation with our colleagues in the coroners service. We have a network of people who have been watching this.

The reason we declared an emergency, as this graph shows, is that even though we had probably the best detection, monitoring, surveillance in the country for this, we were not making an impact. We had a take-home naloxone program, but people were still dying. Two people a day are dying in our province from these overdoses.

We felt we needed a much more comprehensive response, and we needed the ability to collect information that we couldn't collect under the current legislative framework in B.C. It was having more data to help us understand who was being affected, where they were being affected, and where were the programs, the points of intervention, that we could set up.

It was partly to raise awareness and partly to give us those extra powers to be able to gather more information to help us respond in a more coordinated way.

Vivek Murthy, the U.S. surgeon general, has sent out a letter to every single provider in the U.S. about the issues they're having. We are not the only ones being affected by this. Canada has the second-highest rate of prescribing of opioids in the world. The U.S. is just ahead of us. There are a number of states that are having similar—

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Henry, do you think we need a national public health emergency—

[Dr. Bonnie Henry]

I do. As the coroner reported, we are not measuring this across the country. It is affecting our entire country. I would like us to have a national approach to this, and I think national leadership would be very helpful.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Lapointe, the Vancouver Police Department has a policy of not attending at 911 calls for overdoses, and the RCMP testified on Tuesday that they've not even considered such a policy. Should they?