Health Committee on April 11th, 2016

[Simon Kennedy]

I think the minister probably covered that well. What I might be able to add, just by way of a bit of elaboration, is that the minister met her provincial and territorial colleagues in January in Vancouver. They had a two-day meeting. They reached agreement on the priority areas they want to work on over the coming year. That work is going on now at the level of officials. For example, in my case as deputy minister, we've been having regular engagements with the provincial and territorial deputy ministers to flesh out work plans and priorities that we can bring back to the ministers.

The minister is committed to meet mid-year to take stock of progress, so our expectation would be that at some time mid-year, and certainly before the conclusion of the summer, there will be another meeting of ministers to take stock of the work that will have been done. The work we're doing now is focusing on the priorities that were agreed on in Vancouver, and they include mental health, home care, and pharmaceuticals, the various items that the minister talked about and that were laid out in the government's electoral platform. That work is happening now.

[Nick Whalen, Liberal, St. John's East, NL]

Okay.

On a slightly different topic, that of e-cigarettes, here is something that comes out of Health Canada's 2016-17 report on plans and priorities: the department has continued “to develop a policy and research approach to vaping products”.

However, the House of Commons Standing Committee on Health recommended in its 2015 report on the issue that “the Government of Canada work with all affected stakeholders to establish a new legislative framework”, possibly under the Tobacco Act or new legislation, “for regulating electronic cigarettes and related devices”.

Can you describe where you are in the policy and research approach that Health Canada is currently taking towards these e-cigarette products?

[Simon Kennedy]

What I should note is that these devices, where they have nicotine, currently are actually not legal, so Health Canada has been pursuing enforcement measures. We have been working with the Canada Border Services Agency to make sure that when product comes in that contains nicotine and that is not consistent with the rules, it gets stopped at the border.

On our efforts domestically when we are taking a regulatory action, we're obviously well aware that a lot of provinces have put in place frameworks, and we have been focused largely on product that has been mislabelled. The label might say that it's “nicotine-free” or that it doesn't contain nicotine, but in fact it does. We've been targeting our enforcement efforts.

We have been doing policy work and looking at the report of the standing committee from the last session and the recommendations it laid out. There's been a lot of work internally in the department on what options we can bring forward to the government for response. I'll leave it to the government to speak to next steps, but we certainly have examined that report carefully.

In terms of research, that would be more for CIHR.

[Dr. Alain Beaudet]

We do actually support a number of research projects to look at the harms and possible benefits of e-cigarettes. We're supporting work to study the chemical components, actually, that are released by vaping products. We're also supporting a large-scale clinical trial that started in September 2015, still ongoing, on really looking at the safety and effectiveness of the use of the e-cigarette for smoking cessation.

[Nick Whalen, Liberal, St. John's East, NL]

Thank you, Mr. Chair.

[The Chair, Liberal, Bill Casey]

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Mr. Chair.

My question is for you, Dr. Taylor. Do you know what the Respect for Communities Act is?

[Dr. Gregory Taylor]

Yes.

[Colin Carrie, Conservative, Oshawa, ON]

Great.

Just for the committee, back in September 2011 the Supreme Court of Canada rendered a decision in regard to Insite. The court specified factors that the minister must consider when assessing an application for a supervised injection site. These include any evidence related to the impact of a site on crime rates, the local conditions indicating a need for such a site, the regulatory structure in place to support the facility, the resources available to support its maintenance, and expressions of community support or opposition. The Respect for Communities Act authorized the minister to publicly post a notice of application for an exemption for a supervised consumption site and to invite comments from the public on the application.

I think it was in January that the minister okayed the second supervised injection site.

I like “supervised” better than “safe” injection site, because as I think the minister confirmed, there is no way to safely inject street heroin.

Did you follow that 90-day period as outlined in the Respect for Communities Act?

[Dr. Gregory Taylor]

That's a regulatory issue that I would pass to Health Canada.

[Simon Kennedy]

I would just note that it's a discretionary authority, and it was not exercised in that case. So it wasn't—

[Colin Carrie, Conservative, Oshawa, ON]

Do you know why the minister would not want to have input from the community when opening a safe injection site in the community?

[Simon Kennedy]

Mr. Chair, I'd probably leave that particular question to the minister, although perhaps I could try to speak to the general area.

When you're referring to the second site, you're talking about Insite's latest authorization, or...?

[Colin Carrie, Conservative, Oshawa, ON]

Wasn't it the Dr. Peter Centre?

[Simon Kennedy]

Generally speaking, at least, I can say that with regard to the last two facilities, Insite and the Dr. Peter Centre, there was extensive input provided, including letters and those sorts of things. I mean, it was—

[Colin Carrie, Conservative, Oshawa, ON]

I think the minister was appointed in November, and I believe she okayed it in January, so there wasn't 90 days. I'd love to have the department provide the input that was received for the decision-making process. The minister has been very clear, and I think the Liberal government has been clear....

Do you know somebody named Hilary Geller?

[Simon Kennedy]

Yes, Hilary Geller is one of my assistant deputy ministers.

[Colin Carrie, Conservative, Oshawa, ON]

She was at the United Nations, and there was quite a lot of applause for it, I guess, but she said, “With one long-standing supervised injection site already operating in Canada, we have recently approved a second, and anticipate”—she did use that word—“that there will be others in future.” I think the minister has been clear that she is open to having these.

My concern is that 90 days is not a lot of time to consult with the public when you're opening up these sites. I don't know if the minister is aware, but many of these addicts are not people of means, and I believe four to eight crimes are committed for these addicts to get their hit for the day. By putting a site in a community, especially a community that has not had the opportunity to give input on whether they feel that, as I read earlier, it would increase crime levels.

In terms of getting input from the department, I think there is a concern, as in my community, that the government may be trying to anticipate putting these safe injection sites or supervised injection sites across Canada. She's taking advice from you guys; that's what she said. Will you go over the Respect for Communities Act with her, and kind of state the importance of listening to community members and the police in the community? If they are committing acts to get these hits, it would make sense to me that they would be committing crimes in the communities where the facilities are.

Would you commit to that?

[Simon Kennedy]

As the minister noted when she gave her remarks on this issue, what is maybe not broadly known to the public is that even prior to the Respect for Communities Act, there was a series of requirements that needed to be met before Health Canada could actually authorize one of these facilities. There is the Controlled Drugs and Substances Act—

[Colin Carrie, Conservative, Oshawa, ON]

But you didn't follow that. Right?

[Simon Kennedy]

The specific authority to establish one of these sites is to issue a section 56 exemption. Health Canada has always had a very involved process before issuing a section 56 exemption for this kind of activity. It's not like they're just handed out.

As the minister noted, what the Respect for Communities Act arguably did was codify in some detail the kinds of steps Health Canada would normally have followed in making a determination of a section 56 exemption. For example, when Insite received its first approval many years ago, there was a very detailed review. I can assure the committee that when these recent decisions were taken, they were taken after quite a bit of review of the evidence in the applications from the providers. Insite, for example, provided a very extensive, very detailed application—

[Colin Carrie, Conservative, Oshawa, ON]

Don't you think that would be biased, though? Wouldn't that be biased, if it was coming from the facility?

There was the ability to post for 90 days to let the community know this decision was going to happen. The minister has been clear. She welcomes, or anticipates, opening more of these across the country. If the government wants to put one of these sites in my community, and the potential illegal behaviour that would occur with that, considering that addicts are not people of means and they need to commit crimes to achieve.... This is not pharmaceutical-grade heroin we're talking about; this is street heroin. This could be kerosene that somebody is injecting into their veins in front of a health care professional.

The minister said quite clearly that her priority is the health and safety of Canadians. She talked about the health accord, etc., but it seems her first actions are things along the lines of legalizing more street heroin injection. I'm really concerned about this, Mr. Kennedy. I hope the department reviews.... Communities would really like to have some input into this.

[Simon Kennedy]

In the case of the recent applications, as I noted and as members would know, there is a requirement to solicit letters from various stakeholders in the community. In the case of these facilities, it was quite evident there was a large body of support for these facilities.

From an evidentiary point of view, because obviously Health Canada as a regulator tries to look at the analytical evidence, there are more than 80 such facilities that have been established around the world. In Europe, for example, there's a very large body—

[Colin Carrie, Conservative, Oshawa, ON]

Do they use street heroin, though, Mr. Kennedy?

[Simon Kennedy]

—of literature that these kinds of facilities actually help to reduce crime rates, help to reduce overdose deaths, and those sorts of things.