Health Committee on Oct. 20th, 2016

[Dr. Evan Wood]

Really, what we need, as we have for other diseases, is a stepped care model. Some people who are opioid-addicted actually don't need Suboxone. They don't need a medication. By going to a peer support meeting or going into a recovery program, they will go into long-term recovery. They don't need an intensive medical approach.

For other people, Suboxone would be effective. If that's unsuccessful, by the current Vancouver Coastal guidelines we would look to methadone. There are other new emerging therapies using long-acting oral morphine as an agonist therapy that can extinguish illicit drug use.

For some people—again, it's almost an inconsequential fraction of the population in terms of population size—in terms of costs, it can be extremely costly. These are individuals with huge histories of trauma, oftentimes fetal alcohol syndrome, other sorts of diseases of the brain that result in compulsive behaviour, or hypoxic brain injuries. For those people, the science would suggest that for very tightly controlled programs where people get diacetylmorphine—“Heroin” is actually the trade name of a drug that was once marketed by Bayer Pharmaceuticals—there is a role. It's not like we're talking about heroin programs rolling out across the country in suburban areas, but for a sliver of the population it can add a great deal of public health and public safety in terms of being able to successfully engage people in a program. For many others, a huge group, no medication might be required.

As my colleague has alluded to, those programs don't exist, so it's really a comprehensive approach and an evidence-based medicine approach. There's a Cochrane Collaboration meta-analysis looking at the trials of diacetylmorphine prescription in demonstrating the benefits. I'd refer to that.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Ms. Kwan, you have three minutes.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you very much, Mr. Chair.

Thank you again to the witnesses.

I want to go back to the crisis we're faced with today. I know that the Vancouver medical health officer, Patricia Daly, has publicly stated that their application for an additional supervised injection facility has been hampered by delays as a result of Bill C-2. The onerous requirements in trying to move forward in upcoming facilities to save lives has been severely hampered. She has articulated that on the public record. I know that the health authority in Vancouver is attempting in the interim to get five additional supervised injection facilities up and operating in the midst of this crisis.

Dr. Evan Wood, do you know anything about that process and whether or not additional sites would be effective in saving lives?

[Dr. Evan Wood]

Yes, for sure. I mean, there are long wait times to use Insite. There are scientific papers showing that's among the reasons why people will go and inject in the alleys.

Just to describe it for people, it is a horrible life, as my colleague has alluded to. People are using water from puddles, or people are defecating in those same alleys and drawing up water into used syringes and injecting street drugs into their arms. People will often do that because they're in severe withdrawal, they're at risk of a negative interaction with a street predator if they're standing in a lineup, and they can't get into a health program, so they'll go and they'll inject on the street.

We need to scale up these programs, but as I've said and as you're hearing, the funding for these things is actually relatively small in comparison to the huge money that's going into the downstream consequences of addiction. That money would be much better spent on effective treatment programs so that we can do the public health side of things and also the recovery-oriented system of care that does not exist and really needs to be developed.

In terms of the legislation itself, it's my understanding that the federal government is working with Vancouver Coastal Health within the existing legislation, but that public health officials like Dr. Patty Daly, who are involved in that, feel that the legislation is onerous and really is not supporting any sort of positive outcome in terms of what it may have originally been intended to do.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you.

You mentioned investment into addictions and the need for a comprehensive approach. I absolutely agree. I think harm reduction is one pillar. I hate to think that if my daughter or son were addicted they would die injecting; I would want them to survive that experience and be able to move forward to the next phase, hopefully to detox treatment, and then, hopefully, to a successful life. I keep thinking about that because my constituents lose lives; they are somebody's son or somebody's daughter, and it's very real.

With that in mind and in terms of the other pillars, we now know what the issues are with harm reduction and the need to move forward. With the other pillars, I get the point about the need for additional treatment dollars. I think you mentioned, Dr. Wood, that we have $40 billion that would otherwise be spent because of addictions. If we were to invest that money into addiction prevention, treatment, and harm reduction services, what would that look like? In your dream world, what would that look like? What kind of investment do we actually need for a comprehensive approach across this country to deal with this issue in a comprehensive way?

[Dr. Evan Wood]

From a prevention perspective, unfortunately the science doesn't point a clear path forward in terms of discussing with youth in high schools. Those types of interventions have traditionally been shown to be ineffective. But from a prevention perspective, certainly a national approach to prevent the unsafe prescribing of opioids is clearly needed, and something that this committee can push for in terms of a monitoring system to ensure that prescriptions are safe.

In terms of treatment, we need accessible treatment. We are just spending so much money in terms of downstream consequences of addiction, so absolutely we need that, and we need public health approaches too, as was alluded to by Mr. Lévesque. For many people—and some I've described as very traumatized, or with hypoxic brain injuries or fetal alcohol syndrome—even if the door to treatment were open, they may not be motivated to go there.

We have prisons, and I agree that prisons are oftentimes a chance for people to turn their lives around, but in far too many cases, at great taxpayer expense, people come out of prison only to relapse and go immediately back to substance use because there's no treatment in prison. So we need a comprehensive approach.

I think we've focused way too much energy on treating this as a criminal justice issue, and we've spent lots of money there. I would argue that the war on drugs approach has led to ever more potent drugs like fentanyl, and it needs to be looked at as part of the problem.

[The Chair, Liberal, Bill Casey]

Dr. Ujjainwalla.

[Dr. Mark Ujjainwalla]

Perhaps I could add to that, Ms. Kwan.

I'm thinking outside the box. We've been approached by a group in Sweden and also a group in Kentucky. They have built facilities where the people are diverted from jail; instead of going to jail they go to these facilities. In those facilities they're very quickly encouraged to work. The state owns these things. They own companies like painting companies, catering companies, and whatnot. Then the individuals are given a sense of self-esteem and order. They have high productivity.

The guys from Sweden came and showed me that program, and it looks amazing. The same thing is happening in Kentucky. They have 2,000 beds in Lexington, where they have the same approach happening, and it's working really well. I think looking outside the box of Canada could be of use to us.

[Jenny Kwan, NDP, Vancouver East, BC]

Can I just ask—

[The Chair, Liberal, Bill Casey]

No, your time is up. You went way over.

To the witnesses, I just want to say on behalf of the committee how much we appreciate your testimony. For those of us who have not been exposed to this, this has been profound testimony. We really very much appreciate this, and we appreciate what you do.

Dr. Ujjainwalla, you've offered the committee a visit to your Recovery Ottawa.

[Dr. Mark Ujjainwalla]

Absolutely.

[The Chair, Liberal, Bill Casey]

I've asked the clerk to check to see if we can do that. I'm not even sure we can do it. We'll discuss it as a committee. If we have the time to do it, and if the committee chooses to do it, I think it would be helpful to us to see that. That's just my thought.

I want to thank you both very much for what you do. Thank you for testifying today and providing us with this information. It was very moving and very profound. Thanks very much.

We don't have anything on the schedule for committee business.

The meeting is adjourned.