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

10:05 a.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

I want to pass my time to Mr. Sarai.

10:05 a.m.

Liberal

Randeep Sarai Liberal Surrey Centre, BC

Thank you all for coming. I have sat in on several committee meetings and I would say to anybody who is aged 19 to 39, or to a parent, that if they have to watch any committee meeting, the two hours they spend on this would will probably be most valuable time they have ever spent, in hearing a range of testimony from people who deal with those who are overdosing, to the people who prescribe these drugs, to the people who see the health emergency in British Columbia and, unfortunately, to the people who see them die. This is probably the most profound panel I've seen on this issue, so I want to commend you on that.

Dr. Juurlink, what are the benefits of a supervised consumption service site in avoiding this opioid crisis?

10:05 a.m.

Liberal

Randeep Sarai Liberal Surrey Centre, BC

Dr. Henry, in British Columbia what percentage of the people dying from this opioid crisis are dying because of prescription-based addictions versus recreational-based addictions? Do we have any data—even preliminary?

10:05 a.m.

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

Dr. Bonnie Henry

We don't have data on that, though I can say that the crisis in B.C. has evolved, and it's slightly different from what they're seeing in Ontario right now. It's generally not prescription opioids that we're seeing as the issue; it's illicit opioids that people are buying on the street. It may have started with some diversion of illicit fentanyl, but clearly the issues right now are around illicit fentanyl that's mostly being manufactured offshore and imported into B.C.

10:05 a.m.

Liberal

Randeep Sarai Liberal Surrey Centre, BC

If somebody went to a safe consumption site and wanted to test the product that they're using, are there any detection devices that can see the level of fentanyl or if it is laced? Is there any technology like that out there that would be helpful to have in places such as safe consumption sites so that people can test their product really quickly to make sure they won't be overdosing afterward?

10:05 a.m.

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

Dr. Bonnie Henry

The short answer is “kind of.” There are ticket tests that we've done a pilot of at InSite. They're like those pregnancy tests—those little bars—but they can only detect fentanyl, not some of the other illicit opioids that we're seeing out there, and we don't know how well they work. This was just a pilot.

Some of the challenges we're having under the Controlled Drugs and Substances Act are that the people who work at InSite cannot handle the drugs, so the people themselves have to test their own drug. It's a bit tricky and complicated, and they need some help.

There are some mass spectrometer machines that can do a better job at detecting what is in substances, but again, they have to be used by somebody. That's where we think we can get helpful exemptions under the Controlled Drugs and Substances Act to allow that service to be available more widely in places. It is illegal for me to test someone's drug for them at the moment.

10:10 a.m.

Liberal

Randeep Sarai Liberal Surrey Centre, BC

Thank you.

10:10 a.m.

Conservative

The Vice-Chair Conservative Len Webber

Thank you, Randeep.

Okay, we'll move to our second round. You have five minutes each.

We'll start with MP Dr. Colin Carrie.

10:10 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Thank you very much, Mr. Chair.

I did want to bring something to the attention of Ms. Lapointe and Ms. Henry. You mentioned the pill presses and the precursors for fentanyl. I know that one of our colleagues in the Senate, Vern White, has actually had two private members' bills moving forward, and I think he's had discussions with the minister. I think we're trying to expedite moving that forward.

I'm going to take a contrarian view. It may not be popular with this panel, but similar to Vern White, who comes to the issue and takes into account the public safety point of view, as well as focusing on treatment.

Maybe I'll start with Madam Henry.

We talked about how we don't have good statistics and that even the statistics at InSite are the questionnaire type of statistics. From its website, they say that only 7% of users of InSite actually go on to OnSite, and their statistics show that only 50% stay with the treatment. So, from their own statistics, only 3.5% go into treatment. Then we have no idea how many of them actually continue on afterwards.

You're calling for the repeal of the Respect for Communities Act. I think the situation in Vancouver is very unique, an extreme situation, including before InSite. I have visited InSite and I still find the situation there to be very extreme and very sad when you move through that area. But when you talked about communities, shouldn't they have an opinion?

I want to quote somebody who takes a different viewpoint. His name is Bill Blair. When he was a police officer—now he's a politician—he said that “They have been doing [this] in Vancouver for some years and there have been [some] issues that have arisen there. I don’t know of any place in Toronto where that couldn’t have a significant negative impact on the communities.” In discussing the education part of it, he also referred to what he called “the ambiguous messaging that comes out from a society that says you can’t use these drugs, they’re against the law—but if you do [it], we’ll provide a place for you to do it.”

Do you actually think that communities shouldn't have an opinion, shouldn't have a say? I would think that if the community doesn't support a supervised injection site, it won't be successful. Calling for the repeal of that, is that really what you think?

10:10 a.m.

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

Dr. Bonnie Henry

I think communities absolutely have to have an opinion, but it needs to be an informed opinion, and informed on the evidence. There is a lot of evidence about InSite and its effectiveness, not just at saving people's lives but also its impact on crime, the impact on the community. You're absolutely right that the Downtown Eastside in Vancouver is a community like no other, thankfully, in this country. There are many challenges in that community.

I think the model of InSite as a stand-alone safe injection site is not what we're looking at in many communities. What we're looking at are what we're calling “safe consumption services”, meaning the ability of people to use it in an environment where they can obtain the health care they need if they need it. But I think we miss the very first part of our message, that this is dangerous and you shouldn't do it. As Dr. Juurlink says, people are going to use drugs, and what we have to do is to provide the opportunity for them to stay alive long enough to reach their potential in life.

I think safe consumption services do that, but they need to be integrated into the health service system. The Dr. Peter Centre is another good example of this, where they're working very quietly within the provision of other health services. It's been a very effective service. We've done a lot of work with our law enforcement colleagues in B.C., and they have talked to the Vancouver Police Department about how well this is working. People's ideas have changed, and what they need to be is informed—

10:10 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

I agree with that, but if—

10:10 a.m.

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

Dr. Bonnie Henry

—about the effectiveness of these services and how they benefit communities.

10:15 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

That's what I'm talking about—informed and good data—and we just said that we didn't have it. But InSite keeps being held up as if this is where we want to go, or that this is the flagship for Canada. I looked at the literature, and it seems that it's written by one or two different guys who keep quoting each other. There's a guy named Kerr; there's a guy, I believe, whose name is Montaner. When you're looking at it from a government standpoint, it seems that injection sites are an effort to put all the eggs into one basket. I believe the police association president was saying on CTV that as a result InSite, they've had to divert 100 officers to police and make sure that area is safe for people who are down there. If you look at the costs, at $100,000 per officer, that's $10 million per year. If you look at treatment beds, that money could treat over 1,000 people in 90-day treatment programs.

10:15 a.m.

Conservative

The Vice-Chair Conservative Len Webber

Dr. Carrie, your time is up.

10:15 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

I just want to make sure if there are any informed and good statistics out there.

10:15 a.m.

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

Dr. Bonnie Henry

I think there is some very rigorous research that was done around InSite. Dr. Kerr is one of the lead researchers in that. Those are independent research grants that he received.

As I mentioned, there are many different models that we are looking at around safe consumption that are integrated into health services and the continuum of services for people, including treatment options.

October 6th, 2016 / 10:15 a.m.

Conservative

The Vice-Chair Conservative Len Webber

Thank you.

We'll now go to MP Dr. Doug Eyolfson.

You have five minutes.

10:15 a.m.

Liberal

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

Thank you, Mr. Chair.

Thank you all for coming. This is very valuable.

As background to some of my questioning, I'm an emergency physician. My entire career was in emergency medicine, with the last eight years spent in the inner city of Winnipeg. This kind of subject has been near and dear to my heart, as it has occupied a great deal of my professional time.

Dr. Juurlink, I really appreciated the comments you made about physician prescribing practices. I see people who come in, and we get a computer readout of what they have been prescribed. It astonishes me what people are being prescribed, and when they run out of their medications, they come to the emergency department because they've run out, and they say, “My doctor's office is closed”, or worse, “My doctor is refusing to prescribe these anymore, can you do it?”

We have tried to get interventions from the College of Physicians and Surgeons of Manitoba to have some sort of prescribing guidelines and restrictions as to how prescribing practices can be more controlled. They have more or less turned a blind eye to it. They say, “Well, no, we're not in the business of just micromanaging how physicians practise medicine.”

Would you think that the colleges, the regulatory agencies in each provinces, could have a greater role in helping to change physician behaviour in prescribing?

10:15 a.m.

Liberal

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

Thank you. That is what I always thought should be the case. It's nice hearing a voice supporting it.

Ms. Henry, one of things we talked about was alluded to by Mr. LeBlanc, who I thank for his courage in showing up today and sharing his story. We talked about the justice system. Many people who use drugs are in the justice system, and the justice system has woefully inadequate treatment facilities. Would you agree that we need better drug rehab in our correctional system?

10:15 a.m.

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

Dr. Bonnie Henry

Absolutely, and one of our partners, in our response, is our correctional services, the provincial and federal correctional services. We've started with naloxone, and making it available in our provincial corrections facilities. Treatment availability is being worked on. These are really important issues.

We do see, as was mentioned, a critical period when people get out of a correctional facility. They have not had regular access to drugs in the facility, and they are at a high risk of dying from an overdose in that period of time, and so supporting them around that period of time is important.

We also hear in the correctional facilities themselves that because drugs apparently come in quite regularly, people need to use them all up very quickly prior to their being detected. As a result, there's a high rate of overdoses happening in our facilities now. How to manage those appropriately, to encourage people, and to provide the opportunity for opioid substitution and treatment while in prison is something that we think is really important.

10:20 a.m.

Liberal

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

Thank you.

I have one minute left, and I want to go further into that.

One of the benefits of a program like InSite, in addition to preventing overdoses, of course, is that users are provided with clean supplies and clean needles. That means that you're also decreasing the rates of blood-borne disease transmission, such as HIV and hepatitis.

Several months ago, it was brought up in the news that they are refusing to have anything like needle exchange programs in prisons because of a “zero tolerance”. Would you agree that a harm reduction program needs to be introduced in our correctional system?

10:20 a.m.

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

Dr. Bonnie Henry

Absolutely. That's something we've been advocating for some time. We think harm reduction is one of the important pillars in this response, and it should be in our correctional facilities as well.

10:20 a.m.

Liberal

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

Thank you very much. I only have five seconds.