Good morning, Chair Ron McKinnon, Vice-Chairs Luc Thériault and the Honourable Michelle Rempel Garner, and members of the Standing Committee on Health.
My name is Dr. Nadia Fairbairn. I am a clinician scientist and an assistant professor in the department of medicine at the University of British Columbia. I am here on behalf of the British Columbia Centre on Substance Use, a provincial organization with a mandate to develop, help implement and evaluate evidence-based approaches to substance use and addiction throughout the continuum of care, from prevention to treatment to harm reduction to recovery.
I've been invited to speak here today with regard to the impact of COVID-19 on mental health and substance use for Canadians. I will focus on substance use, while acknowledging the intersectional impacts of this pandemic on population levels of depression, anxiety, domestic violence and adverse childhood experiences, among others.
Let's look at alcohol, our most commonly used substance in Canada and one that was responsible for $15 billion in health and social costs in Canada in 2018. Alcohol intake in excess is linked to increased mortality, cancer risk and other chronic conditions, although many Canadians and clinicians are unaware of Canada's low-risk alcohol drinking guidelines.
A recent Nanos poll found that pandemic-related alcohol consumption is increasing across all age groups in Canada. A recent CIHR study found that nearly one in four respondents reported consuming more alcohol, both in quantity and frequency, during the pandemic. The issue is particularly pronounced among 18- to 34-year-olds, with nearly half reporting an increase. Nearly one in 10 Canadians who drink alcohol says that they have had issues with controlling their ability to stop drinking since the start of COVID-19.
Due to time limitations, I'm not able to comment on other legal drugs, such as tobacco or cannabis, but these are also responsible for mounting health and social costs and harms during COVID-19. We know with certainty that increased consumption of substances is associated with an increased burden of social harms, health harms and dependency.
Why is this happening? Consuming substances like alcohol is a way for some people to manage or control their stress, as well as symptoms of depression or anxiety, during the pandemic. In addition, recognizing our societal dependence on alcohol and fearing the fallout from restricting access to alcohol during times of public health lockdown, most provinces, except P.E.I., declared liquor retail an essential service. This was a sound decision, given that, without proper care, alcohol withdrawal can be a life-threatening condition. In order to ease the financial burden on the hospitality industry, municipalities also relaxed restrictions on access to liquor by permitting restaurants to offer alcohol for takeout with take-away food. Retail markups on liquor were also reduced.
In the case of illegal drugs, the situation is dire. The overdose crisis continues to have a significant impact on Canadian communities and families. With an average of 11 deaths and 13 hospitalizations every day between January 2016 and March 2020, it is one of the most serious public health crises in Canada's history.
During COVID-19, overdoses and fatal overdoses across Canada are occurring at the highest rates ever recorded. Deaths in British Columbia hit new highs over the spring, including a monthly record of 181 illicit drug toxicity deaths in June. Five years into the declaration of the public health emergency in the province, the province is now on pace to see the highest number of overdoses in one year. Alberta revealed in September that 301 people in the spring died due to overdose—also a record. In Ontario, overdose deaths jumped by nearly 40% in the first months after COVID-19 hit the province, on pace to extend to 2,200 overdoses—the highest on record. Overdoses have taken far more lives than COVID-19 has in these three provinces, which are the hardest hit by the opioid crisis, yet our response has been muted in comparison. Even more so than with mental health, the unmet needs, already large, are increasing.
On a personal note, this has been the most challenging time to practise addiction medicine. I have had to make several calls to families and loved ones following the loss of a patient to overdose during the pandemic, and my heart goes out to each of them who are suffering and grieving. It is every community in Canada that is being affected.
There are many reasons why overdose deaths have gone up during the pandemic. First, contamination of the illicit drug supply with synthetics, fentanyl and its analogues, as well as other poisonous substances, such as the very potent benzodiazepine etizolam, has driven the overdose crisis in Canada since 2016.
During COVID-19, changes in the illegal drug supply, as supply chains have been disrupted by travel restrictions and border measures, have led to further poisoning of the drug supply in Canada. At the same time, there has been less access to supports and services for people who use drugs, as well as hesitancy to seek treatment through the health care system due to concerns regarding COVID-19 risk in health care settings.
This has led to reductions in the use of harm reduction services such as supervised consumption sites, as well as reduced access to treatment services such as detox and recovery beds. Substance use, including relapse rates, has increased as many struggle to cope with stress during this difficult time.
There are a number of actions that can mitigate the increasing harms we're seeing due to substance use during the COVID-19 second wave in Canada.
We need to raise awareness of the potential harms of alcohol use and encourage people to follow safer consumption and lower-risk drinking guidelines.
We need to understand and anticipate that the pandemic may lead to an increased risk of relapse for those in recovery from substance use disorders. We need to improve screening and treatment of people at risk for relapse to substance use and to improve access to evidence-based treatments and recovery-oriented services as part of a comprehensive system of care for addiction.
There is a pressing need for more evidence-based clinical guidance and more training of health professionals to equip them with the knowledge of care for substance use and addiction to build capacity in the health system. Access to pharmaceutical alternatives is needed to prevent overdose and other severe harms caused by a contaminated illicit drug supply.
Finally, I agree with the chief public health officer of Canada, the Canadian Association of Chiefs of Police, and Moms Stop The Harm, a network of Canadian families impacted by substance use-related harms and deaths, that to mitigate the pressing harms of substance use and in order to be able to treat addiction as the medical condition it is, the decriminalization of people who use drugs is essential, as was unanimously endorsed by Vancouver City Council just last week.
I would like to thank Ms. Cheyenne Johnson and Dr. Perry Kendall at the BC Centre on Substance Use, B.C. Minister of Health Adrian Dix and B.C. Provincial Health Officer Bonnie Henry for their leadership in B.C. during this time of need.
Thank you very much for your attention.