Health Committee on Feb. 9th, 2017

[Colin Carrie, Conservative, Oshawa, ON]

Yes. Thank you very much, Mr. Chair.

Basically, as I was saying, we would like to make sure that the communities where these facilities will be located at least have the basic ability to have some input. If you look at my additions, what I'm saying is that:

(2.1) An application for an exemption under subsection (1) shall also include

(a) letters from both an authorized representative of the municipality in which the site would be located and the head of the police force that is responsible for providing policing services to the municipality in which the site would be located indicating their support for or opposition to the proposed site and including information related to the matters described m paragraphs 56.1(2)(a) through (e);

(b) evidence that all households within a radius of two kilometres of the site were notified of the ability to provide expressions of community support for or opposition to the proposed site for the purposes of paragraph 56(2)(e);

(c) evidence that the Member of Parliament representing the electoral district in which the site would be located was informed of the proposed application;

(d) evidence that any consultation for the purposes of gathering information related to paragraph 56(2)(e) included consultations that were held in both official languages and were accessible to persons with disabilities; and

(e) information regarding schools, churches, hospitals, businesses, and places of recreation or entertainment located within a radius of two kilometres of the site.

We heard evidence, Mr. Chair—you were here—that there are activities that go on around these sites. Our objection is that the way that it's currently written really does water it down. We've heard that for Insite, for example, the police have been directed not to charge, so when you're talking about crime rates.... Mr. Webber and I actually walked down there with police officers, and we saw criminal activity taking place right in front of us. They were told not to charge.

When police forces are making sure that public safety issues are served properly, the resources have to be there. For municipal politicians, mayors, there may be increased costs for policing. I know the number from the police association. They said that at Insite there are 100 extra police officers. Just to do round numbers in my head, that's $100,000 per officer, which is about $10 million per year. I think it's important that municipalities have the opportunity to discuss this, because ultimately somebody is going to have to pay to make sure that public safety is ensured in those areas.

This whole part that I would like to add really gets to what we think is the minimum. Communities should definitely have the ability to be consulted when these sites get put in.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Do we have other speakers on this?

Go ahead, Dr. Eyolfson.

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

Thank you.

Will all due respect to Dr. Carrie, I understand that there are all these social ills going on in these areas. We know that before these sites were established, much of this was going on anyway. These sites were put in areas where this was already an issue. Whether there have been increases in these rates in the meantime is difficult to say.

Do we know if that would have happened anyway? We don't know. We just know that these sites are put in areas where large numbers of addicts are injecting to start with.

This is a way of reducing the death rate, the transmission of infectious diseases, the finding of dirty needles, and all the other ills that come with this. Basically, as we've said, it is reducing the harm that comes with these activities.

This amendment is so over-prescriptive that it's going to more or less prevent it from happening in the first place. This basically reinserts a great number of the provisions of the so-called safe communities act, which was meant to prevent this from happening in the first place.

I can't speak for my colleagues, but I would imagine that they would agree that we will be opposing this amendment.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Go ahead, Ms. Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

I would add to my colleague's thoughts. Moving forward with a supervised injection site does alter a community. I had the opportunity to tour Insite in Vancouver earlier in the spring and see first-hand the impact it's having on the community around it.

There's no doubt that it is having an impact. The building right across the street is 90% vacant because businesses won't rent there. The apartment just beside Insite has changed its clientele entirely, the landlord reported to us.

This does change a community. When I talked to police officers there, they also told me about the difficulties they have in enforcement issues.

This committee heard from the fire department in Vancouver and the incredible impact it's having. I don't know if you recall, but the gentleman who was here testifying was quite moved by the impact taking place there and the fact that they're going to the same individuals sometimes, two, three, four times a day, saving them from an overdose just outside the site.

I think it's quite silly of us to pretend that this does not somehow have an impact on the community surrounding these centres and that the community shouldn't be included.

The Liberals use the tag line of “We're going to take an evidence-based approach.” The Minister of Science said that, I think, four times in the House yesterday. I'd like to know where the evidence-based approach is on this, in collecting evidence from the community organizers who are going to be most impacted by this decision. This legislation as it stands right now fails to do that.

[The Chair, Liberal, Bill Casey]

Go ahead, Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

I want to point out my colleague's comment about being overly prescriptive. I think the fact that the minister just approved three more sites proves that even with the situation we have today, these applications do go through. He's making extreme extrapolations.

One site in Vancouver, called Insite, has been operating for a number of years. The Dr. Peter site, I think, has only been up for maybe a year, so to assume we can replicate that community everywhere.... This was a very seriously affected community beforehand, and as the Parliamentary Secretary to the Minister of Justice said, there's no place in Toronto that is that bad.

He also mentioned that we don't know. We've heard the statistics that are being collected. I don't know the breakdown, but maybe our colleagues from Health Canada know. We do know that overdoses are increasing, but I've not seen the breakdown. Are these overdoses due to injections? Is it the injectable route, the oral route, the inhalation route? Are we even taking any of these things into consideration? I don't know.

All we're saying with this approach that we'd like to put forward is that we know the minister can overrule. She's going to do what she's going to do. We're just saying the communities where these are going to be placed.... We're talking about parents whose kids are going to schools and recreation centres and police officers who have to do their job in that community. Municipal politicians should have the right to be consulted. That has been proposed by this government over and over again. They've said they're going to be the government of more consultation, and I see that they're already decreasing it enough. I don't think these few simple additions are unreasonable, and the proof of the pudding is in the eating. It doesn't mean that it's going to be overly prescriptive.

Even with the 26 requirements, we've got three new ones that just came out last week. My understanding is there could be more in the pipe ready to go.

[The Chair, Liberal, Bill Casey]

Go ahead, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

I may have the singular advantage on this committee of being the only MP from Vancouver. I've lived there for the last 26 years, and Insite has been operating for—jeez, I want to say 12 years. I drive through the Downtown Eastside every week. I've been on the Downtown Eastside literally hundreds and hundreds of times, and I want to tell you something: prior to Insite opening, the rate of vacancy of businesses and the general atmosphere on the street was worse. Do you know why? People were injecting drugs on the street, in the doorways, in the alleys. Right in front of businesses, people would inject drugs and collapse in front of the door.

When Insite opened, it was in a very discreet way. I have to tell you that it was several years before I actually knew where they were. That's how discreet they are. They have taken the street drug use that would have been happening on the streets, in the alleys, and in front of businesses, and they've moved a significant amount of it indoors. I talked to members of the Chinese business association—this is located in historic Chinatown—and they had a lot of issues with this site when it first opened. If you go and talk to those businesses now, they are absolutely convinced that the opening of Insite has helped the general environment and atmosphere around Chinatown because it has moved this activity indoors.

You know, supervised consumption sites are specialized health care facilities. They provide a range of services to mitigate the harms associated with substance use. Their core functions are to connect people who use drugs with sterile injection equipment, to supervise people while they are using psychoactive drugs, and to provide overdose reversal, first aid and wound care, and referrals to other health care services. In many cases they also provide referrals to addiction treatment programs, something that I think should be part of every supervised consumption site. I really like the fact that Insite has OnSite upstairs, where there are treatment beds. Every time someone goes into Insite, they have an opportunity to go there.

I want to say that to me, the challenge before this committee is to make sure that the criteria that go before the minister before a section 56 exemption is granted should be guided by the health perspective. We don't ask the community if they are in agreement if an abortion clinic gets opened. We don't ask the community if methadone treatment should happen in a pharmacy in their community. Those are core health services. While it may impact a community, so do hospitals and so does putting in a local fire station, with trucks going in and out of the station at three in the morning. These all have an impact on the community, but we know that these are core public services. Our job here is to make sure that an applicant can get an application in and the proper factors can be taken into account, not extraneous factors that serve only one purpose.

I'll say it here: the only reason that the Conservatives passed Bill C-2, with their 26 criteria, was that they were ideologically opposed to supervised consumption sites and wanted to put up a lot of barriers to opening them. That's why, yes, three sites in Montreal were approved this week, 16 months after they applied. I mean, every stakeholder in the country is telling us that those criteria are making it take an extremely long amount of time. Toronto has been waiting for months. Victoria has been waiting for months and months.

Again, this is a public health emergency. I'm glad to see Dr. Carrie uses that term. The Liberals are using that term. The New Democrats encourage the use of this term. This is a national public health emergency. People are dying, and when people are dying, I think it behooves us as a committee to get a process that is fair, medically based, and science-based, one that can expedite the opening of these life-saving facilities while taking into account the proper criteria.

I think the criteria proposed by Dr. Carrie are just a continuation, in a truncated form, of Bill C-2. Putting up additional barriers by consulting groups that really don't have any particular stake in the health care aspect of this problem will simply delay the process, make it more difficult, and make it more time-consuming. In the meantime, we will see more people die even as we know that these sites could be up and running.

On the first day that Insite opened, they reversed 15 overdoses. Not all of those people would have died, but I bet that some of those people would have died had those overdoses happened out on the street. Those are the stakes that we're dealing with here.

[The Chair, Liberal, Bill Casey]

Thank you very much, Mr. Davies.

We have four Liberals on the list and eight minutes, so that's two minutes each, and we have one Conservative with three minutes.

We're going to start with Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Dr. Carrie, if there are not any households within two kilometres, why not businesses too? It says, “within a radius of two kilometres of the site”. If there is nothing in that area of two kilometres, why not everyone? Would this not be an incentive to put it in the middle of nowhere, where no one could get to it? The site should be where it is accessible to everyone.

Also, as Mr. Davies said, it is a very serious matter. People are dying.

I know that Mr. Webber said “pipeline”, and Ms. Harder said “evidence-based”. Let's do something. We are working on a very important issue. We shouldn't use these analogies. We should work on that. It's a very historic moment.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Mr. Kang is next.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you, Mr. Chair.

I agree with Mr. Don Davies that this is a national public emergency. The evidence says that 40 to 50 people are dying every day. That is the evidence.

We don't want to make this application process so onerous that it takes months to get the application to the minister. As Mr. Carrie says, the minister is going to do what the minister is going to do. Let's streamline the application process so that it gets to the minister faster. Then he or she may decide on the site of the clinic.

I don't think we should be talking about pipelines or anything else. This is an emergency, and we should be dealing with this only.

It was my friends from the Conservative side who were pushing to have this study done and to move it quickly. Now, with these kinds of amendments, they're just throwing these roadblocks in here, so it defeats the very purpose of having this legislation in place.

Thank you very much.

[The Chair, Liberal, Bill Casey]

Thank you.

Go ahead, Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

I was happy to hear that Don was able to tell me how I was thinking, because I do think that this is a health issue. We've heard over and over from witnesses in front of us that to have a successful site, you need to have community buy-in. Just as he is the MP in his community, I am the MP in my community, and I can tell you right now that I have spoken to my mayor and I've spoken to community members. There is concern about where it's going to be located if one of these sites is applied for in my community.

Don had a good statistic. He said that in the first day they saved 15 people from an overdose. My question would be how many of these people were put into treatment. My colleague, Ms. Sidhu, said that we have to do something. Well, what about treatment?

In Insite's own stats for OnSite, I think they said that only 7% of people were even offered treatment. Again, maybe Health Canada officials know how many of these people actually got into treatment, how many followed through, or how many actually completed the treatment.

If this were any other health condition—let's say it's diabetes—we wouldn't just be saying, “Here, inject yourself. Get your insulin on the street. By the way, we'll slap you around, and if you're okay, if you're cognizant, we'll put you back out on the street to commit four to eight crimes to do it again.” I think that's an issue we have to be cognizant of. This is not just about doing something; we have to be responsible.

All I'm saying with my amendment, which is not unreasonable and is not a roadblock, is to just allow the communities where these sites are going to be located to have a say. Ultimately the minister will decide, but if something of this magnitude.... You can't extrapolate the experience in Vancouver and start transporting that around the country. We've heard that it's going to be unique in every situation. We just have to be cautious, because we don't want to put people at risk and we also don't want them to defer their treatment.

If there is a Band-Aid solution, perhaps we should be focusing on the conversations with the provinces and territories when the minister is sitting down for the new health accord. I know we had $500 million per year in our anti-drug strategy. Part of that could be utilized for treatment. Maybe the minister, over a 10-year period, could allocate $5 billion towards treatment. Maybe she could sit down and work with our provinces and territories within their jurisdictions to make sure that these people, who have severe health conditions and whom we all want to save, get the help that they need.

[The Chair, Liberal, Bill Casey]

Thank you very much.

I just want to say I don't get a chance to debate here or talk.

Oh, I'm sorry. Go ahead, Dr. Eyolfson.

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

There's one last thing I'd like to say.

When Dr. Carrie asked for the evidence that this works, well, there are exhaustive literature reviews and position statements from the Canadian Medical Association, the World Health Organization, and—I would have to double-check this—Centers for Disease Control, which all agree that harm reduction is not the end of treatment but that it is an essential pillar of it, and that people will die without it. You do not increase the rate of drug use with these centres; you simply reduce the harm. That is the evidence. That is clear. I would just like to add that to this debate.

As you say, it's unique from centre to centre. Some centres don't need it. In Winnipeg, where I'm from, they may not need one. They're not sure that there is an area where large numbers of people are overdosing with intravenous drugs. If there is no need for this centre there, then there will be no incentive, and there's not going to be any push to open one. This will be done where it's needed. In Vancouver, they saw the need. In Montreal, they saw the need, and again I go back to the evidence by reputable organizations like the Canadian Medical Association, the World Health Organization, and the Centers for Disease Control that this does save lives.

Thank you.

[The Chair, Liberal, Bill Casey]

Okay.

Dr. Carrie, you have 19 seconds. Just take your time.

[Colin Carrie, Conservative, Oshawa, ON]

I'm not going to be arguing the evidence with Dr. Eyolfson. What I am simply stating is that as he said, certain communities may feel that this is something they would like to have in their community. What we have now with what the Liberals put in front of us is the bare minimum. What I'm suggesting is to give communities the right to be consulted legitimately before this gets put into their community. We know that the minister can overrule whatever happens.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Go ahead, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to bring the committee's attention back to the wording that's before the committee. The “application for an exemption...shall include evidence...of the intended public health benefits...the impact of the site on crime rates; the local conditions indicating a need for the site...and expressions of community support or opposition.”

I want to be clear. Although I understand Dr. Carrie's amendment, I think it expands on those criteria. Those criteria are in the act and are part of any consideration and discretion by any health minister, so when we talk about whether it's appropriate for a particular community or where it should be located in that community, that's squarely dealt with in the proposed section where we're supposed to have regard to the local conditions, and again, yes, we all agree that the community should have some portal to express its opposition or support to this, and we recognize that, and that's why it's in the section as well. I understand it's probably not as expansive as Dr. Carrie would like, but it is there.

[The Chair, Liberal, Bill Casey]

All right, we're going to decide.

Shall CPC-1 carry?

(Amendment negatived)

The amendment is negatived.

I just want to say that everybody here at this table wishes we didn't have to discuss this subject, and everybody has strong feelings. Everybody's done a lot of homework on a very complicated bill. We're all generally going in the same direction, so I think we're.... I just want everybody to remember that.

We are on CPC-2. Who is...?

Go ahead, Ms. Harder.

[Rachael Thomas, Conservative, Lethbridge, AB]

Mr. Chair, in this amendment I tried to balance two things. One is the timeliness, because I do understand that this is in fact a response to the opioid crisis, which I'll say is in fact urgent. At the same time, though, I want to balance that with the need for a public voice. The Liberals campaigned on and have stressed over and over again in the House how important consultation is and how important an evidence-based approach is. My hope would be that we would be able to come to a consensus today with regard to this amendment, given that it is important to both sides.

My amendment is this:

The Minister may grant an exemption under subsection (1) not earlier than 45 days after the day on which the Minister provides public notice, in the form and manner determined by the Minister, of any application for an exemption under subsection (1 ). The notice shall include the period of time—not to exceed 90 days—in which members of the public may provide the Minister with comments.

The change that's taking place here is that I'm advocating for a minimum amount of time during which we would allow the public to respond to a public notice. The way the piece of legislation reads right now, it simply says that the minister can give up to 90 days. I would say then that the minister could choose just to do zero days, which means she has not consulted or allowed the community to be consulted at all, which seems very counter to what the Liberal position is. I would say that a minimum of 45 days seems appropriate to allow the community the opportunity to consider a supervised injection site being put in place and to respond to the minister.

Again, I'm not taking away any authoritative power from the minister. At the end of the day, she gets to consider the thoughts that are brought before her and then make a final decision based on that information that is presented. I think this current government has demonstrated its desire for consultation, whether it's through pipelines or through putting national strategies in place at various times. I guess I'm a little bit confused as to why there wouldn't be more emphasis placed on allowing the public a voice with regard to something like a supervised injection site, which is going to alter the community in which it is located.

Further still, the minister was directed in her mandate letter to consult with Canadians, so again it would seem fitting for that to occur on all legislation going forward if it is in her mandate letter. I could quote that for you, but in the interest of time I won't be doing that today.

My statement is this: I certainly believe that this amendment is in alignment with the Liberal position with regard to seeking public input, doing consultations, and allowing individuals to take an interest in a change that's going to take place in their community. It's not a motion that stands in the way of the supervised injection sites being put in place. It's just simply a mechanism by which we can elicit further input from the community, which I think always strengthens the decisions that we make. Based on the platforms that have been put forward, I would expect you to agree.

I know my community is considering a supervised injection site and is taking the steps forward to look at that and to gather evidence for our need. I don't stand for or against that personally, but what I do stand for is bringing the community into that procedure and making sure that our different organizations are informed and given a voice.

For example, I want Canadian mental health at the table. I also want community mental health at the table. I also want Alberta Health Services at the table, along with our mayor, but also I want other community organizations such as our homeless shelter at the table because I believe that all of these organizations will have a role to play in the care that is provided to these individuals. As we're stating at this table, a safe injection site or a supervised injection site is only one of the pillars.

If we were to move forward with that without consulting with these other organizations or with community members, then it weakens it because it doesn't give them an opportunity to share their feedback and how they might further engage in the process going forward.

With that, I leave this in front of you to say that giving public notice a minimum of 45 days ahead of time allows for a broader consultation and for community organizations to partner with one another, rather than being left in the dust or blindsided. A community effort is what's going to strengthen this and allow all pillars to be obtained.

[The Chair, Liberal, Bill Casey]

Go ahead, Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

I do not with agree with Ms. Harder's comment.

First of all, the consultation is reaching out to a broad range of people. These consultations are already done, and it's a broad range of people. They put the consultation in there.

This amendment would remove the minister's discretion and prevent sites from being approved in an urgent situation. We don't need a delay of extra days, particularly if there's urgent need of a site.

Also, it is important to note that one of the five criteria in this bill already includes community consultation. It is important, but it's sufficiently covered off in the proposed legislation. It includes all the broad information in there.