Evidence of meeting #104 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was treatment.
A video is available from Parliament.
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
Thank you.
It's also important to remember that safe supply is politicized, just the way the safe consumption sites that you mentioned have been politicized. Needle exchanges were illegal during the time of HIV. Safe supply is undergoing that same moral panic and disinformation.
When you speak of what is needed and the concerns around diversion, I'm going to tell you another story. This is going to be a hard one for me to tell.
I was approached by a father at a community event last year—
Bloc
Luc Thériault Bloc Montcalm, QC
I'd really like you to talk about diversion. I don't have a lot of time, and I'm interested in hearing your thoughts on the issue and what you are seeing on the ground. Is the problem widespread? How can we address it? That's important.
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
Absolutely.
The story I'm going to tell speaks directly to diversion.
I was approached by a father in the community, and he told me he had lost his son to a fentanyl overdose in the year prior. He told me that his son died while he was on my waiting list to access safe supply—he died waiting to see me, so that I could maybe save his life. I expected this father to be angry with me. I hadn't been able to see his son. However, he wasn't angry, and what he told me next surprised me even more—and this is about diversion.
He told me that his son had stayed alive longer than he had expected, because he was able to get safe supply hydromorphone tablets from a friend he was staying with, who was willing to share with him, because his friend couldn't watch him go through the profound withdrawals of fentanyl. He wanted to help him. His friend eventually stopped giving him these hydromorphone tablets, and the son went back to using fentanyl, and he died very soon after.
As a prescriber, I don't support diversion in any way at all. I expect my patients to take the medication that I prescribe them, but the discourse around diversion forgets that diversion is a signal of unmet need in the community.
We have barely 6,000 folks on safe supply across the entire country, whereas we have tens of thousands, if not a hundred thousand people who use drugs. We know from the methadone literature that most of the time people who are doing what we call “diversion” are actually helping the people in their communities survive to see the next day.
Bloc
Luc Thériault Bloc Montcalm, QC
People are claiming that the drugs are being sold to children. Is that something you're noticing? Is it happening? If it is, how do we stop it?
Would you like to continue, Dr. Sereda?
Chairman of the Board, Association des intervenants en dépendance du Québec
Perhaps Dr. Sereda can add to this, but is the diversion of prescribed drugs something that should surprise us? No, I don't think it should. It should not come as a surprise. It's unfortunate, to be sure, but I think it is up to the prescriber, so the doctor, to clearly convey to patients the risks they expose individuals to if they sell them the drug. If it's children, of course, they will be harmed. We don't have any statistics on that.
I'm sure Dr. Sereda could provide some information. Dr. Marie‑Ève Goyer and Dr. Marie‑Ève Morin, in Quebec, also come to mind. They are both very involved in their communities and are familiar with these realities. I know they do their jobs responsibly, but the college of physicians in each province also has a responsibility to make clear to members their obligations in settings like these.
Just recently, I believe, the Collège des médecins du Québec came out with guidance on the prescription of opioids by its members. It's about greater accountability: it's time for colleges of physicians to pay a lot more attention and to monitor opioid prescribers in the country.
Conservative
The Vice-Chair Conservative Stephen Ellis
Sorry, Mr. Thériault, but your time is up.
Mr. Johns, you have the floor for six minutes, please.
NDP
Gord Johns NDP Courtenay—Alberni, BC
In the spirit of good will, I'm going to allow Dr. Sereda to comment on Mr. Thériault's question as well.
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
Thank you for that opportunity.
I was listening carefully in my headpiece, but please stop me if I've misinterpreted the question.
You're speaking about youth and the concern that safe supply is being diverted to youth. I think it's really tragic that Canadian youth are actually also being used in this polarizing rhetoric about the potential impacts of safe supply, because I do believe they're being used.
Coroners in B.C. and Ontario carefully monitor overdose deaths. There is absolutely no data to support that children are accessing hydromorphone and dying from it. In fact, we see children overwhelmingly dying of the toxic illicit fentanyl supply when they do have an overdose.
I'm the parent to a small child. Would I ever want her to be able to access opioids? No, I wouldn't. All safe supply clinicians are like that, and we take all of the precautions that are available to us to make sure that our own patients are taking the medication.
Is it perfect? It's not perfect, and maybe you'll give me a chance to speak to our diversion protocols, which are very robust. Again, this dialogue that you see in the media and by critics of safe supply, about the children.... I think it's quite sickening that Canadian children are used in this way, because the data does not support these assertions whatsoever.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Dr. Sereda, you talked about anecdotal tweets driving the agenda and political discourse. Can you speak about the impact of that, in terms of the crisis, on frontline staff and patients, people you're working with?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
Yes. When politicians spread disinformation, people die—and people die because of many reasons. It's delaying the emergency response that we so badly need in this crisis. We can't forget that over 42,000 people have died from overdoses, and disinformation that actually slows our response to saving the next 42,000 lives is really disappointing.
I would like to have the people who spread this disinformation—politicians, media, critics—be the ones who call the mothers of the dead, because I think if that was their responsibility and not my responsibility, they would really be focusing on the emergent nature here, on the actual evidence that we have around safe supply and other harm reduction interventions. I think it would be a lot harder to play politics with peoples' lives.
NDP
Gord Johns NDP Courtenay—Alberni, BC
You talked about the cost of delays. Obviously, the government is taking an incremental approach. I would imagine that this discourse is having a huge impact on slowing the response. Can you speak about the impacts of, let's say, the delays in the SUAP funding right now getting out to those organizations and clinics, like yours, that have patients and teams that are required to deliver life-saving medicine to people?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
I think we are all waiting on the edge of our seat to know if SUAP funding is going to be renewed or extended. We're scared, and our patients are scared alongside us. My patients are marginalized in a way that suggests that they're not part of the overall community—but they are and they read the news. My patients are scared. They've been asking me, most days for the past six months, if they're going to lose their scrips, if they are going to have to return to what their lives were previously, if they are going to lose connections with their family and lose housing. If these programs end and they have to return to the toxic supply, they ask me if they're going to die, and I don't have an answer for them because I don't know if funding is going to be renewed.
For us, the clinicians providing this care, it is an absolute moral distress. We know that when people are de-prescribed opioids—as one of our speakers mentioned today—they turn to the illicit market. We have decades of data around the opioid crisis, since the early 2000s, showing that de-prescribing, predictably, leads to death.
Clinicians are in this position where most safe supply clinics have maybe a month left of funding, and we don't know if it will continue. Clinicians are stuck. Do they wean people, knowing that data shows that many could potentially die if they do so? Do they transition them to more conventional addiction treatments, like OATs such as methadone and buprenorphine, knowing that these patients have failed multiple times on these previous medications, and the fact that they failed led them to be part of a safe supply program in the first place? Clinicians don't know what to do. The moral distress comes from knowing they've been keeping people alive for three to four years on these programs and not knowing if, in a month, the people they care for, serve and love are going to die.
Chairman of the Board, Association des intervenants en dépendance du Québec
Yes, thank you. The same goes for us when we hear negative criticism. People can criticize, and they can have concerns or fears about the safe supply or supervised consumption site services we provide, but the fact remains: all these services are delivered in a highly regulated environment.
Conservative
The Vice-Chair Conservative Stephen Ellis
Sorry to cut you off, Mr. Letellier de St‑Just, but that's it for this round of questions.
The time is up. I'm sorry.
Just so that everyone's clear, the next round of questions from the Conservative side and the Liberal side will be five minutes. However, the Bloc and the NDP only have two and a half minutes, so be judicious with your responses. Thank you very much.
Mr. Doherty, you have the floor for five minutes.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Dr. Sereda, I don't believe you answered the question from my colleague earlier. Are you aware that there is safe supply being diverted at Chapman's Pharmacy across the way from your office, yes or no?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
It's not a yes-or-no answer. I would like—
Conservative
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
I'm going to decline to answer a complicated question without being given a chance for a complicated answer.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
That's fine. So you deny that it's happening across the way.
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
No, that's not what I said, sir. I said I needed time to explain.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Okay.
Do you agree that it's possible that diverted opioids are ending up in the hands of people they aren't prescribed to, or even children, yes or no?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
We have no evidence that they are ending up in the hands of children. We have no scientific data that supports those assertions.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
What's the leading cause of death in the province of British Columbia for youth?