Health Committee on Oct. 25th, 2016

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

Thank you, Mr. Chair.

Thank you, ladies and gentlemen. It's tremendous knowledge that you possess, and you have some of the answers in front of you, I guess. The problem is, how do we coordinate all of that and have a footprint that means something?

A lot of what Mr. el-Guebaly was saying is that we're pushing a bubble through society here. As you said, there have been addictions throughout history. You talked about heroin and alcohol, and now it's designer drugs. How do we ever get ahead of that bubble and start to make a real difference? What's it going to take? I know that funding is a big part of it, but how do we put that money on target to see results that then draw more funding? That's the key with government funding: to show those early results to start building on those successes.

Ms. Hopkins, you talked about some successes you've had. How do we get that message out?

[Carol Hopkins]

We've demonstrated the results.

[Dr. Nady el-Guebaly]

[Inaudible—Editor] I'm unaware of a prevention program that has been tremendously successful, and when I hear—

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

I understand. There's no magic bullet.

[Dr. Nady el-Guebaly]

There is no magic bullet. I think at the moment some of the programs that provide the best data have, first of all, two levels of prevention: primary prevention for everybody in the schools, for example, and having that there, and then the second level, for people who we identify as being at risk. That starts with children whose parents are already using drugs.

My personal preference would be to start with the people at risk as being a good prevention program, but I don't have a magic prevention program.

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

Ms. Hopkins.

[Carol Hopkins]

As I was saying earlier, a number of pilot programs have been tested and have demonstrated good evidence, but there has never been any continuity to those programs, and the investment in them has often been short term. We do have a demonstration. We do have the evidence. There are a number of journal articles showing that this is the type of evidence you're looking for. Some of these speak to the success of programs like those in Sioux Lookout in northern Ontario.

We have the evidence from the drug utilization prevention and promotion program, which didn't get sustained in the long term. The youth treatment programs and the residential treatment programs also have good data, but lack the resources to make the difference that they could.

For example, with that network of resources, they could be a part of the solution in supporting youth when they go home. There could be added resources for web-based mental health services or social-media-based services. We don't have that capacity right now to reach youth. We have the implementation of a brand new helpline, which is fantastic, but it's not enough. We still need to keep going.

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

A lot of it is the continuity.

[Carol Hopkins]

Continuity is lacking, yes.

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

I understand your concern with project-by-project and year-by-year funding. You never get the critical mass that lets you start to roll towards the finish line to show you can actually do it.

I think it was Chief Day who mentioned the aftercare and how important it is to maintain the continuum.

[Chief Isadore Day]

Yes.

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

How do you see that rolling out? Will this be done on site, with a combination of elders and mentors and community-based—

[Carol Hopkins]

Yes.

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

—aftercare, along with professionals?

[Chief Isadore Day]

It's all of the above. I think we have the solutions already. It's all here.

I think there's a social contract required in this country. This addiction affects everybody. It's not just in the remote areas. It's everywhere. We need a new configuration of shared responsibility matched with investment spending that is innovated to address the issues of today. That hasn't happened yet. We're still passing the buck.

We're still looking for data. We're still looking for solutions and approaches, but we need to approach this from a perspective of shared responsibility. I think it's incumbent upon this committee to call for getting everybody at the table at the same time to reconfigure a shared responsibility and put the investment into it.

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

There are also some gaps and overlaps when you consider that on-reserve is federal, while off-reserve people slide into the social services at the provincial level. Of course, there are a lot of cracks to fall through in between. How do we streamline that operation so those cracks shrink?

[Chief Isadore Day]

That's where first nations come in. We are the experts. We understand the landscape of the multi-jurisdictional overlaps on primary health care and on policy. We have the ability to do that. I think we need to be involved in the solutions, and we need to be there at the table to help configure those solutions.

[Gerry Ritz, Conservative, Battlefords—Lloydminster, SK]

Dr. Chase.

[Dr. Claudette Chase]

I just wanted to speak to the fact that we have the evidence of prevention in this room: good nutrition, good education, solid housing, and an overall sense of well-being. As the dominant culture, we have deliberately not allowed this in the first nations and our indigenous peoples in Canada. I think the evidence for prevention is strong before us all. We just need to acknowledge it and support what my colleagues have talked about: a new social contract.

[The Chair, Liberal, Bill Casey]

Your time is up, Mr. Ritz.

[Dr. Nady el-Guebaly]

I have something that I would like to add. Taking the kids out of their culture and sending them somewhere by plane somewhere else is an utter disaster. Unfortunately, I've seen Health Canada do that several times. If there's a crisis, they send kids somewhere else. We've had this experience in Calgary with people from the northern communities coming in. I'm not too sure what the recovery rate there was, but I think it was very close to zero. Establishing programs within the people's communities is critical.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Dr. Eyolfson.

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

Thanks very much to all of you for coming and for your valuable input.

I apologize, but I had to step out for a moment, and on a slightly unrelated note, I understand that there was an implication that the legalization of marijuana might lead to an increase in marijuana laced with fentanyl. From what I understand, part of the purpose of the legalization is that you would have a legalized, regulated, and inspected supply chain that would in fact prevent this. This is one of the reasons for legalizing it. When you're buying it from a legal source, you don't have that problem. I wanted to clarify that this was behind that strategy.

Going back to what we were talking about before, there are a couple of different physicians groups, the College of Family Physicians, and the Indigenous Physicians Association of Canada, and there is a guide, “Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada”, which was released in 2016. It noted that there was unintentional racism that would manifest in the way of erroneous assumptions. Again, having been in the health care system for 20 years, I'd say that not all of it was unintentional. It said that these assumptions would change how health care providers, all the way from first responders up through nurses and physicians, might affect care.

Ms. Hopkins and Mr. Day, in your experience, has this kind of racism in the health care system affected how victims of addiction are treated?

[Carol Hopkins]

I'd like to go back to my earlier comments related to methadone. We've had significant issues related to methadone clinics and risk to first nations communities.

I believe in methadone. It's an absolutely necessary part of the solution. But when the solution is absent of and disrespectful of first nations governance, who then have to carry the burden of risks related to methadone in that community, that, to me, is racism, as is telling first nations people that once you are on methadone, you are on methadone for the rest of your life, meaning you can no longer go home. You can't take your new children to meet their grandparents in the isolated remote community. You have to live in an urban environment, in poverty, outside of a family system of support. That's racism.

We have seen evidence where first nations people have been moved from methadone to Suboxone, to being opiate replacement therapy-free and living well in their communities. The connection to land, to people, their lineage, and their language, is critical for their overall wellness. I offer that as an example.

[Chief Isadore Day]

I'll be very quick on this.

We met last week with about 40 to 50 service providers, dental, vision, and rheumatology. What we were doing, sir, is asking questions about providing service to first nations under the non-insured health benefits program right now and what the problems are, and every one of them was experiencing the same thing. They were saying that they want to treat the issues and they want to deliver solutions, but they can't because there are constraints and policy guidelines that are based on the Indian Act system. That is very much at the root of the problem, because this is a race-based program.

What we're finding is that the situation and the impacts are exacerbated by racism at the institutional level within the funded program of non-insured health benefits. The joint review right now is critical. I think the committee should take a very close look at the outcomes there and deal with racism at the source.