Your time is up.
Ms. Kwan.
Evidence of meeting #25 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was need.
A video is available from Parliament.
Evidence of meeting #25 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was need.
A video is available from Parliament.
9:40 a.m.
NDP
Jenny Kwan NDP Vancouver East, BC
Thank you very much, Mr. Chair.
I thank all the witnesses for their presentations.
This question is for you, Dr. Wood. In the 1990s, in my community of the Downtown Eastside, where we had an epidemic of overdoses, at that time the medical health officer declared a medical health emergency in our neighbourhood. The truth of the matter is that people die from overdoses. We had a community rally, and a thousand crosses were planted in the local neighbourhood park to mark and honour each person who died. I get it that we need to have treatment.
Coming out of that effort, a table was initiated with all levels of government—I see Dr. Hedy Fry here today at committee—and we worked together between all levels of government to come up with the four pillars approach: harm reduction, treatment, prevention, and enforcement. Coming out of the harm reduction pillar was the supervised injection facility, which was evidence-based. Since that time, the facility has demonstrated that there were no fatal overdose deaths at that site, hence the opportunities for people to get onto treatment and an alternate course down the road.
Has the supervised injection facility in Vancouver been an effective program? Can you tell us, Dr. Wood? As I understand it, there is also a place called Onsite, upstairs from the supervised injection facility. I wonder if you can elaborate on that, and then talk about the critical link that is required following Onsite and what's missing.
9:40 a.m.
Professor of Medicine, University of British Columbia, Interim Director, British Columbia Centre for Excellence in HIV/AIDS, British Columbia Centre on Substance Use
My biggest philosophical comment would be how counterproductive it can be to pit public health interventions against medical treatments and recovery interventions, because they don't need to be viewed in opposition or as isolated interventions.
I'm very sympathetic to my colleague's frustration with the sort of attention being given to public health interventions when the treatment system has yet to be developed. We need a comprehensive approach. In the absence of that, as I alluded to, we are hemorrhaging health care dollars. Each and every case of HIV infection on average costs the health care system about $500,000. Consider the amount of money that gets spent looking after somebody who has had a hypoxic brain injury and who will, because of that brain injury, have to be institutionalized for the rest of their life and cared for at the expense of the taxpayer. Chronic hepatis C infection is prevalent. Upwards of 70% of people who inject drugs have it. The pills to treat hepatis C are about $1,000 per pill. It's not just an issue of people dying and the fact that government should be responding. These are huge health care costs.
In terms of addressing those costs, Insite has been shown to reduce overdoses as well as syringe sharing and other high-risk behaviour, so of course I support it. I think everybody should, because we already have programs across Canada that, just as an example, in an effort to mitigate these harms and costs, give out clean needles to people. A program like Insite is actually what I would call a more conservative approach, in that it allows the health care system to ensure that a needle doesn't end up in a park, that young people don't see a person injecting, that an intervention is delivered in an environment where a person can be encouraged into treatment, such as it is.
Unfortunately—and I know this is a huge source of frustration among my addiction medicine colleagues—you see injection sites in the news, and it is implied that the taxpayer is investing a great deal here. I'll just share with you that Vancouver Coastal Health, of which I'm the medical director for addiction services, spends hundreds of millions of dollars every year on mental health. They spend an almost insignificant amount, less than one-sixth of that, on addiction, and a miniscule amount of that, a really inconsequential amount, on supervised injecting, which then saves the taxpayer a huge amount of money. Among the things it is able to do is that it has a detox program upstairs called Onsite, which can take in individuals, help them through detox, and transition them into treatment. They're very effective in doing so.
To people who want to pit one of these things against another, it really is nonsensical. We need a comprehensive approach. We need an addiction system of care that can meet people where they're at, and these low-threshold programs are very effective. We need a door to addiction treatment and recovery, but that door, as the literature from Europe would suggest, means meeting people where they're at. To be honest, these interventions are associated with reduced rates of injecting in the community, so I certainly support a public health approach, and it has been effective in Vancouver.
If there has been any mistake made, it has been the lack of emphasis on addiction treatment going back to the 1990s. That's something that we're trying to dig ourselves out of now in terms of some of the interventions I talked about. These include training health care providers and developing standards and guidelines, but from an evidence-based medicine perspective, the supervised injecting facility has certainly been effective. We need a more comprehensive approach, obviously.
9:45 a.m.
NDP
Jenny Kwan NDP Vancouver East, BC
Thank you.
To follow up on that, it's clear that supervised injection facilities and harm reduction approaches save lives. They address a whole range of other community impact issues as well.
You spoke about the issue of treatment. Onsite provides support for that, but then, coming out of Onsite—I know this to be a problem in my own community—people don't have better alternatives to go to. I often think that other, more long-term treatment options are not available, and hence we create quite a challenge within the system. People can get into a situation where there's a revolving door.
With that in mind, Dr. Wood, could you elaborate on what needs to be done in the next phase? In the meantime, we are faced with yet another crisis with fentanyl usage. Deaths are occurring in our communities, not just in my community, but throughout the country. Could you comment on Bill C-2 and whether or not that bill should be repealed?
9:45 a.m.
Professor of Medicine, University of British Columbia, Interim Director, British Columbia Centre for Excellence in HIV/AIDS, British Columbia Centre on Substance Use
In terms of your first question, Onsite is located in the Downtown Eastside, so you're exactly right: it's a place where people in crisis, whose lives really are a living hell, see the opportunity for something else. They get a bed, but then what next? Obviously we want to get people out of the Downtown Eastside. Investments in recovery-oriented systems of care have not been there. Unless you have $20,000 to go into an expensive treatment program, the door just isn't there. Wait lists are long. It makes absolutely no sense.
I'm not a lawyer, and I don't want things to get politicized in terms of Bill C-2. I just think there's been a lot of misinformation. I've seen how, when these things become oppositional, people get entrenched in their thinking. They put their blinders on. They don't understand that by focusing on preventing public health interventions, it doesn't achieve the objective of another thing coming forward. I just haven't seen that. I strongly encourage everybody to try to get beyond historical partisan issues around this crisis and to focus on what's best. Clearly that will be an evidence-based approach.
It was alluded earlier that it will cost a lot of money. I would just reiterate the point that we're spending that money. We're spending it on emergency rooms, on HIV and hepatitis C wards, and on programs for people who've had hypoxic brain injuries. There's also a cost to productivity, and of course the cost to families who have lost a loved one. The money is being spent on downstream consequences.
If we can reduce those costs through public health programs that are proven effective, of course I support that, but we need a more comprehensive approach in addition to that, one that involves an effective treatment system. Training health care providers and establishing guidelines and best practices: it's a clear way to identify where those investments should be and then move forward.
9:45 a.m.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
Thank you, Mr. Chair.
I would like to thank the three witnesses for being here this morning.
I am not in the medical field but I can see that this is truly a warning sign. I am surrounded here by doctors, so the medical aspect could easily be discussed.
I will talk instead about the social aspect of the approach, despite the potential weaknesses. Human beings are not perfect. At least, that is what my 50 years of experience have led me to conclude.
Dr. Ujjainwalla, from what I know, drug dependence occurs in all social classes. It strikes all classes indiscriminately. Anyone can become drug dependant. Is that correct?
Is drug dependance more prevalent though in a particular class or among people who are less fortunate in life? I am thinking for instance of people who do not have a lot of support and who enter a cycle of dependency with no way out because there is no family support and social assistance is inadequate.
Have you seen that to some extent in all your years of practice?
9:50 a.m.
Medical Director, Recovery Ottawa
Yes. I believe addiction, like any other disease we face in medicine, crosses all the borders. If you're diabetic, it doesn't really matter what your income is. In a general sense, addiction, encompassing substance abuse that includes alcohol and other drugs, affects everybody.
For 25 years, as I told you, I dealt with professionals only. Every quote-unquote person suffering from addiction was either an MP, an MPP, a physician, a lawyer, an accountant, a dentist, a pharmacist. That was one element, and I can tell you first-hand that I treated hundreds.
In terms of the people we see in the opiate and cocaine world, unfortunately, the amphetamine world, the consequences of the use of their drug, which they may start.... Believe it or not, I have two professional hockey players as patients who injured themselves playing hockey. They're just regular guys who broke their arm. They went from bad to worse. This happens to many people when they get dependent on the drug.
9:50 a.m.
Liberal
9:50 a.m.
Director and Founder, Méta d'Âme
Yes, Mr. Chair, I have a comment, and I would like to make it before I have to go. I have to leave, and there might not be questions for me, so I'd like to comment on what's being said, if I can.
9:50 a.m.
Director and Founder, Méta d'Âme
First, I want to say something. I came here with an approach to react to overdoses, but in our facility we have a drop-in centre with peers and community workers, and we also have apartments. We reach out to people who are homeless. We try to bring them to treatment and also into a program that runs over three years with a plan of action to change. That's one thing we do.
The other thing is this. When we're talking about safe injection sites, it would be a big approach for Canadians to talk about consumption rooms, so that way you don't have only people with needles in those places but also people who smoke crack and use other substances.
There is also a reaction to different things that bother society in downtown Vancouver, downtown Montreal, or here in Ottawa. Treatment is also a reaction. Naloxone is also a reaction. I think it's very important that we start educating our young as soon as possible, starting from the lower grades, with an approach of harm reduction, not with an approach of prohibition. It is the worst thing to do; it makes it tempting for people to use.
Also, I want to say that all users are not always in the streets. They also live in houses. I want to say also that people who use drugs get worse and worse in their condition if their conditions in life are bad. If you don't have proper work, a proper amount of income, you're not staying in an environmentally safe place, and you don't eat properly, you will go down very fast. It's very important to understand that. If you have the capacity to sustain yourself with a good quality of life, you might not end up downtown. You might have your addiction for many years before you seek treatment.
From my experience, not all users want to go into treatment. Some don't see themselves as sick people, so it's very important to consider that also when you implement programs in Canada.
Thank you.
9:55 a.m.
Liberal
The Chair Liberal Bill Casey
Thank you very much. Thank you for coming. I know you have to leave early, and we appreciate your contribution today.
9:55 a.m.
Liberal
The Chair Liberal Bill Casey
Mr. Ayoub, you still have three minutes and 24 seconds....
Yes, Mr. Webber.
October 20th, 2016 / 9:55 a.m.
Conservative
Len Webber Conservative Calgary Confederation, AB
Mr. Chair, this is just a point of order.
Mr. Lévesque, are you leaving right now?
9:55 a.m.
Conservative
9:55 a.m.
Conservative
Len Webber Conservative Calgary Confederation, AB
I just have a couple of questions for Mr. Lévesque.
9:55 a.m.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
Thank you, Mr. Chair.
I will be brief. After 25 or 30 years of professional and practical experience, I can say that the same problem still exists today, 25 years later. It might even be worse since it is on the rise. The bandaid solutions that were used 10, 15 or 20 years ago no longer work. Yet it seems that more of the same thing is being done all the time to try to fix the problem.
We hear about multidisciplinary and intervention teams as part of a preventative approach. What are we waiting for to have a Betty Ford Centre, as you mentioned, Dr. Ujjainwalla?
Over all this time, what has been the impact of your work with respect to government action? For my part, I have been here for barely a year. Actually, yesterday was my one-year anniversary and I am very happy to be here. Seeing all of this, though, I have to wonder what kind of world we live in.
I think I know part of the answer. I think it costs less to use bandaid solutions, to close one's eyes and say that the last five years went smoothly.
Mr. Lévesque, I think you are part of this bandaid approach. I do not mean to criticize your approach. It is extremely important because it can save lives in the short term. Yet it does not solve the problem.
Would it be wrong to say it is a vicious circle? You talked about water and a lifeguard. We might rescue someone, but we know they will swim again. Yet if the person does not know how to swim because they have not been taught, their problem has not been solved.
What should we do? There is the political aspect and the financial aspect. There are limits to everything, but what should we do? What must the government recommend in this regard? I will give you a minute or two to answer these questions.