Health Committee on April 6th, 2017

[Colin Carrie, Conservative, Oshawa, ON]

No, I did not. Could I please clarify? I think you're misunderstanding.

The question is on marijuana. The science is very clear and I think we all know that the brain develops until age 25. There have been all kinds of leaks coming out of your caucus that you're bringing legislation forth soon. Canadians expect the Minister of Health and Health Canada to be looking at the health and safety side of it, not ease of delivery or access.

On the neonicotinoid issue, the agriculture committee was clear, saying that it wasn't based on the best available science, but you still upheld that ban. The concern is whether you are going to be basing the age of access to marijuana on science or special interest groups, and I think Canadians need to know where you stand on that.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Okay. Thank you for clarifying. I think I understand your question a little better now. Your question is in terms of the concerns about young adults' brains and cannabis and whether we will use science as a guide. Is that right?

[Colin Carrie, Conservative, Oshawa, ON]

Yes.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

One of the things that I think all colleagues have to understand is the science as it relates to the data that we have around the use of cannabis amongst Canadians. You know that we have the highest rates of use in the world.

The most recent data that has just come out, scientific data, is that the group with the highest use in the country is the 18- to 24-year-old population, in which case, 30% of Canadians in that age group currently use cannabis. Here's where the science is important to us: to recognize that these young Canadians are using cannabis to a very large extent.

Of course, our legislation is not tabled yet, but we need to recognize that reality and that truth. When you see the legislation come forward, I'll think it's important to recognize that when we take a public health approach to a matter such as cannabis, we need to not confuse the legalization of products with whether products are completely without risk.

A whole range of products available to Canadians, including tobacco and alcohol, are substances that are absolutely not without risks, and in the case of tobacco, in fact, have well documented risks associated with them. One in two users of tobacco will die because of that.

Because a product is legal does not necessarily mean that it's without risk. That, taken together with the information we have about the high rates of use, means that sometimes in the smart, science-based public health approach we have to say to Canadians that there are products available, but science says there may be risks associated with them and we have a responsibility to educate Canadians and make sure they're kept safe.

[The Chair, Liberal, Bill Casey]

Mr. Carrie, very quickly, please.

[Colin Carrie, Conservative, Oshawa, ON]

There is still a lot to be learned, and just as I said, from the point of view of health and safety of Canadians, I think if you look at the statistics over the last 10 years, the use has gone down for that age group. I think it was 40%, down to 33% now. Perhaps what we were doing in the last decade has helped to decrease the numbers.

The concern, Minister, is that if you are going to be putting legislation out, you can compare it to alcohol, you can compare it to cigarettes that are already out there, but why would we want to start a new product where we're very sure that up to age 25 it can have devastating health effects? Why would we choose an age that is perhaps seven years earlier than that?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Well, as I say, I don't want to presuppose what the legislation is going to look like. I'd be happy to give you some more details on that once the legislation is available.

[The Chair, Liberal, Bill Casey]

Madam Minister, I understand you have to leave, but if you had eight more minutes, we could complete a whole round of questioning. If you don't have that time, we understand.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Where is my team? Do we have to go? Yes?

If you'll forgive me, I'm a few minutes late already for my next meeting. You know I will be happy to come back.

[The Chair, Liberal, Bill Casey]

Okay. Thank you very much. We'll look forward to that.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Dr. Eyolfson, you're up.

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

Thank you, Minister, for coming. I'll start asking my questions of the board, since you have to leave, but again, thank you.

This is in regard to the increased funding for mental health. Dr. Philpott and I share the same profession. Mental health is a very important predisposing factor for a number of other issues. We know that, for a lot of people with substance addiction problems, in fact, it comes down to a mental health problem. A large proportion of the homeless have an inadequately treated mental illness. There are a lot of people whose untreated mental illness puts them in the justice system.

This is a bit of an assumption, but I think we can reasonably make the assumption that these investments in mental health would have some savings on these other services, like the justice system, drug abuse and addictions, and homelessness. Is there any estimation of the projected savings to these systems from these investments in mental health?

[Simon Kennedy]

I don't have immediate access to the information. There is a presumption that there will be downstream savings to the health care system and elsewhere, but we still have to do some work with the provinces and territories to determine exactly where the funds will go. The government has indicated—and certainly there's been a lot of support among the provinces and territories for investments in youth, in particular, so we have a sense that will be an area of priority. We still have some work to do to figure out exactly, jurisdiction by jurisdiction, where the funds will go. We'll probably need to do some of that before we can get a better handle on exactly what it might mean in each jurisdiction.

I don't know...maybe the Public Health Agency wants to talk a little more broadly about this issue.

[Dr. Theresa Tam]

I cannot speak to specific figures. Obviously, if we were on the upstream side—taking a public health perspective and looking more at prevention and promotion, particularly in the young—the lifetime savings are going to be quite significant for sure.

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

All right. Thank you.

This is going to be a similar question in regard to investments in harm reduction. Perhaps there's some data because we've had some limited experience with this. We do know and we've talked a lot about supervised consumption sites and the prevention of fatalities when people overdose. We also know that there is a harm reduction aspect in the supply of clean injection equipment, which means that this would prevent the transmission of blood-borne diseases. We know that a single infection of HIV is going to cost several hundred thousand dollars in the life of a patient, while a single case of hepatitis C, if adequately treated, is going to cost several hundred thousand dollars a year per patient.

In the supervised consumption sites that have existed, is there any data on the decrease in the rates of transmission of blood-borne diseases in these centres?

[Simon Kennedy]

I don't have immediate access to the detailed figures, but there is a substantial body of evidence that shows the efficacy of these kinds of facilities when they're properly set up and run. That would include the Insite facility here in Canada. Obviously, there's been work done over the last 10 years or so to look at the impact of that facility.

I'd be happy to do it again, but I had been asked a similar question some time ago by the committee. We've actually tabled a fairly substantial amount of the empirical evidence here, so I'd be happy to share that again directly. There's a large body of academic and other research studies that show pretty definitively that supervised consumption sites lower crime, reduce rates of infection, and reduce rates of overdose. As a ministry, we're confident that the data shows that these are effective facilities.

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

Thank you.

Is there a figure, even just ballpark, on the annual costs of operating Insite? Do we have an estimate somewhere in that?

[Simon Kennedy]

I'm sorry, but I don't have that immediately available. We may be able to get that to the committee.

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

Okay.

I'm hoping to see, at some point in the future, whether we have data to show that we are saving the costs of each of these cases of HIV or hepatitis C and how much this offsets the costs of running these centres.

Thank you.

How much time do I have?

[The Chair, Liberal, Bill Casey]

You're about a minute over.

Mr. Davies, you have three minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

In response to a 2015 Auditor General's report, Health Canada pledged to develop an internal report by July 2016 to analyze clinical care access in remote and isolated first nations communities in comparison to access to health services by non-first nations communities in similar geographic locations.

I'm wondering if you'll give an undertaking to provide a copy of that report to this committee?

[Simon Kennedy]

Yes, what I can say is there has been active work under way to respond to the Auditor General's report, so I can certainly give you an update on where we're at with that.

[Don Davies, NDP, Vancouver Kingsway, BC]

I just want an undertaking that, when the report is done, the committee will get it. Can you give us that undertaking?

[Simon Kennedy]

Can I take that back and come back to the committee? I don't know what state that report might be in at the moment, but I can assure the member that we are working very diligently on the AG's recommendations, and I'd be happy to provide whatever we can.