Health Committee on Oct. 20th, 2016

[Dr. Mark Ujjainwalla]

Those are amazing comments. I'd throw it back to the politicians here. You tell me why it's not happening. It was good and now it's gone. So that's the question and it's a rhetorical one. I appreciate your comment.

If the will is there, if the people want to help these individuals, then you can do it. If you don't see it as a problem, and you don't live it or you don't understand it, then how are you going to develop a comprehensive treatment program like we are talking about? I think that's the job of this committee, to make Canadians aware of what the disease of addiction is and all the different components of that—the public health components and all the other things that Mr. Lévesque was talking about—so that we don't see it as a band-aid.

However, I agree with my colleague that we don't want to be fighting public health against addiction medicine, against specialists, against social workers. We need to work as a team. I find what has changed now is that we're not working as a team. It's so regionalized. There's so much bureaucracy in it. Everybody is worried about their jobs and stuff. People have ideas such as, “Okay, I'm a harm-reduction guy.” It's like the Leafs against the Habs, a harm-reduction guy against a treatment guy. That's ridiculous. What we need to do is work together and realize that there are different strata. Just as in all medicine, some people need to be in an ICU and some people can be treated as an outpatient.

Here is the problem and why I brought these things in. With what we presently have, if you want to see a psychiatrist, it's a two-year wait to see one. How's that going to work? You want to see an addiction doctor, and there isn't one. So how's that going to work? You can't get into the psychiatric hospital.

That's my point. If we open these doors again, as they used to be in the seventies and eighties, we can be proud of that system and we can develop it. It's not complicated. It's just the ability to say the political will is there and the will of Canadians is there to change this.

[The Chair, Liberal, Bill Casey]

Thanks very much. The time is up.

That completes our seven-minute session. Now we'll go to the five-minute session, with Mr. Webber, Dr. Eyolfson, Dr. Carrie, and Dr. Fry.

Mr. Webber, the floor is yours.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

Thank you, Mr. Lévesque, for sticking around. I appreciate that. I just want to talk a bit about your facility and where you are at with PROFAN. How difficult is it for you to get the antidote of naloxone?

[Guy-Pierre Lévesque]

Actually, we have naloxone because we have what we call a collective prescription from Dr. Massé from the département de santé publique de Montréal. Under this condition, we were able to have this naloxone. It's vials and injections. It's a kit that has everything in it that you need. To get it, people have to take the training, actually, at this time. When the legislation is done, it might change.

[Len Webber, Conservative, Calgary Confederation, AB]

So you go through this two-part training that you explain, and there's even a shorter-term training, and you can train dealers. Once they get this training...although I find it difficult to understand how you can train an addict, in a five-hour course, how to put naloxone in his system.

[Guy-Pierre Lévesque]

First, we know that people who are using are hustling for money, so we give out a compensation amount. Let's say, if it's short training, it's $25; and if it's for the whole day, it's $50. That way, we know the person can manage to get their drugs if they need them.

[Len Webber, Conservative, Calgary Confederation, AB]

They get those drugs from you. You hand them out to the user.

[Guy-Pierre Lévesque]

We don't give out drugs.

[Len Webber, Conservative, Calgary Confederation, AB]

The naloxone is what you're referring to.

[Guy-Pierre Lévesque]

The naloxone is in a community group of pharmacists.

[Len Webber, Conservative, Calgary Confederation, AB]

Yes.

[Guy-Pierre Lévesque]

I think there are five of them, and it's designed so that people can come out of our facility with a card—we issue a competency card—and they go to the pharmacy and get the naloxone. That's how it's being done.

[Len Webber, Conservative, Calgary Confederation, AB]

All right. Then cost-wise, who pays for that?

[Guy-Pierre Lévesque]

At this moment it's paid for through the département de santé publique, so it's the ministry. It was a trial for the first year; with the results, a second year; and now we're on the third year.

[Len Webber, Conservative, Calgary Confederation, AB]

Are you a safe injection site as well?

[Guy-Pierre Lévesque]

No, we don't carry safe injection sites. People can use in our facility. It's there. We have supervision training and we're able to answer to those.

[Len Webber, Conservative, Calgary Confederation, AB]

Do you have equipment there in order to test the drug to see if it's safe?

[Guy-Pierre Lévesque]

No, we can't test drugs right now, because we could be arrested for holding the drugs.

[Len Webber, Conservative, Calgary Confederation, AB]

I'm going to quickly jump over to Dr. Wood,

Dr. Wood, of course you've been to Insite and Onsite. You've worked in British Columbia. I have a stat here that I want to put out. In 2015 there were over 263,000 visits to Insite. Of those 263,000 visits, 464 were referred to the Onsite treatment centre to get further help. That's only 7%. I find it quite surprising that it's so low. Can you comment on that at all?

[Dr. Evan Wood]

I'm happy to. First of all, the number of injections are not unique individuals. Insite isn't for everybody. The people who use it tend to be homeless, street-entrenched, and live within a couple of blocks. In the Downtown Eastside, it's estimated there there are only about 4,700 people who inject drugs. Onsite has 12 beds.

To answer your question, as I think you've heard, the door to a functioning addiction treatment centre is not there. Many people have successfully entered into recovery through Onsite, but it can be viewed as a sort of a crack in the door to a whole other reality that simply has not been invested in.

Insite has saved lives. It saves the health care system money. But we haven't realized the opportunity to address this concern comprehensively, because there hasn't been an investment in addiction treatment in accordance with the scale of the problem. The money has gone to the consequences of addiction.

[Len Webber, Conservative, Calgary Confederation, AB]

Just quickly, do you have the equipment there at Onsite or Insite to test the drugs they bring in for safe injection?

[Dr. Evan Wood]

No, but I think it would help if we addressed regulatory issues there, because we've seen this shift toward fentanyl. The average patient of mine is not looking for fentanyl. Fentanyl is a market force. People with a background in economics can understand that it's cheaper, it can be imported, and it doesn't have to be grown with a poppy. It's a market force because of the long-standing illegality of these drugs. Organized crime is seeing an opportunity and exploiting it. The market could be influenced through drug testing.

[The Chair, Liberal, Bill Casey]

Time's up.

Dr. Eyolfson.

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

Thank you, Mr. Chair.

Thank you both for coming. Thanks in absentia to Mr. Lévesque. I appreciated all the comments very much.

Dr. Ujjainwalla, I practised emergency medicine for almost 20 years in Winnipeg, much of it at the major teaching hospital downtown. I could not agree with you more that during training we did not receive nearly enough training in addiction. The only addiction training I received in medical school was a two-hour instruction on what to do if one of your own colleagues was addicted. I knew what number to call if I found out one of my colleagues was addicted to drugs. That was pretty much all I learned about it in medical school. I learned more in residency, because I did a five-year emergency residency. Most of what I learned about treating addiction was due to the fortunate coincidence that some of our physicians were part-time emergency physicians and part-time addiction specialists. I learned most of my addiction medicine from them during shifts, just during conversations, which is not a well-structured way to learn a very important topic.

I agree that we don't have the proper facilities we need. Family doctors don't know what to do. They send them to us. People come to the hospital expecting to be admitted for their morphine or fentanyl addiction. We tell them that we have no place to admit them. We don't have a program to admit them. Internal medicine won't admit them. We can't keep them in our emergency department. We can give them a prescription for clonidine and give them a referral, which is going to take weeks to months. That's all we have.

I initially disagreed, Dr. Ujjainwalla, with what you had said about harm reduction, but maybe I misunderstood. I think we would both come to the agreement that it's not the only pillar of treatment. If you had nothing but safe consumption sites for drugs, then you're not addressing the problem. I think you and I would both agree with that. But we talked about it being a band-aid solution. As I said in an earlier meeting, when I'm in the emergency department and someone is bleeding, they need the band-aid. When someone comes in stabbed, yes, they shouldn't have been stabbed, and that should have been prevented, but they're stabbed and they're bleeding.

Would you not agree there's a role for it in saving lives, improving outcomes, but in addition more investment in addiction is needed?

[Dr. Mark Ujjainwalla]

Sorry, a role for what?