Health Committee on Feb. 26th, 2024

[Gord Johns, NDP, Courtenay—Alberni, BC]

First of all, I want to thank all the witnesses for the important work they do in serving our communities.

I'm going to go back to you, Dr. Sereda. You got cut off a few times on yes-or-no answers. I'm going to cede the next two and a half minutes to you if you want to follow up with some of those responses that you weren't able to complete and with anything else you'd like to add.

[Dr. Andrea Sereda]

I was thinking hard about what I want to leave this committee with.

In our program, as safe supply clinicians, we see the deaths of so many people who cannot access safe supply. We knew them and still care about them. When these people die, Mr. Johns, we identify their bodies. As I said, we call their mothers. We plan their memorials and we don't sleep, because we don't know who is going to be dead in the morning. The next day, we get out of bed. We wipe our tears and go back outside. We put our knees on the dirty pavement and do CPR again and again. We've been doing this for eight years.

I'm sorry. I used to keep a list of the dead on my office wall because I didn't want to forget them, but I ran out of room to put that paper on my office wall. Maybe I ran out of the emotional fortitude to look at it every day. I took it down and put it away because it was too much. However, even that empty space on the wall still says something to me. It tells me about the people we have not been able to save. We cannot forget these people. We cannot forget them in these rhetorical discussions we're seeing, and the misinformation. Those people are dead and we're not getting them back. We have 42,000 dead. We lost 44,000 Canadians in World War II. In less than a year, we're going to lose more Canadians than we did in the entirety of World War II.

This crisis is producing mass death and it's forever traumatizing to those of us who care for them, their families and their communities. The frontline health care workers are working so hard to save every single life we can.

If I can leave this committee with anything, it is this: Rely on the actual scientific evidence and expert evidence brought to you here, not the media, misinformation, anecdotes and stigmatizing discourse.

I want you all to picture that blank space on my office wall and the names I can no longer look at.

Thank you.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Dr. Sereda and Mr. Johns.

We have two final rounds of questioning.

Dr. Kitchen, you have the floor for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you all for being here. It's much appreciated.

You know, it's interesting. It's not anecdotal that we are asking questions here today. We're asking questions because the Canadians watching this want answers, since what's happening isn't helping. They want their children home, as Dr. Tanguay indicated. They want to be able to see their children. They want to be able to see their family members and have them back the way they were. That's the information we hear from our constituents who continually portray this to us. As much as you might want to call it anecdotal, it is our constituents around this table who are telling us this information.

Dr. Tanguay, you had some great comments. I have a number of questions for you.

You mentioned the lifetime prevalence of TBI, suggesting that there's an increased incidence of drug use because of that. Can you elaborate on that, please?

[Dr. Rob Tanguay]

I'm sorry. To be clear, that's the lifetime prevalence of people living without homes, in terms of traumatic brain injuries being that high.

Looking at moderate to severe...10% of all brain injuries are because of overdoses occurring on our streets. That's just published in the peer-reviewed literature. That's pure data that's been published and looked at. It talks about just how severely vulnerable those populations are.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

I appreciate that, because I know a 16-year-old boy who was the victim of a hit and run. He went head-first through the front windshield of a vehicle and had brain matter draining out of his left ear. He's deaf in his left ear, had multiple broken bones, multiple injuries to his face, etc., and he definitely had concerns many times in his life about where that could take him.

This happened to me. I'm that boy. It happened 50 years ago this May. Fortunately, many people helped out along those lines, ultimately.

I want to talk to Ms. Hudspith.

You talked about the pain task force. Fortunately, through my career, I put myself through education and sports to get myself to where I am today. In the time I spent at the Royal University Hospital in Saskatoon, I was with Professor Emeritus Gordon Wyant. He was an anaesthesiologist who started the pain clinic at the University of Saskatchewan. One of the things he talked about was exactly what you pointed out, the three things: pharma, psychology and physical and all those aspects of it.

I'm wondering whether you could comment a bit more on that.

[Maria Hudspith]

Thank you for the question.

I think this is one of the pieces. As Rob was saying, safe supply needs to include all these other pieces. Providing medication is one thing. We know people need other aspects of pain control.

We've talked a lot about the issue of over-prescribing opioids for pain leading us here. We know we cannot just prescribe our way out of this problem. We need to be providing wraparound services, mental health services, addiction services and pain services for people who are at risk of overdose.

I'm particularly concerned about the population of people who have been on long-term opioids for pain and who are being deprescribed and are at risk of overdose. They are not meeting the criteria for safe supply.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thanks for that. I appreciate it.

Ultimately, what we see and what I alluded to earlier is that the people who are watching us here today aren't the addicts. The addicts aren't the ones watching what's going on. It's the parents. It's the families that are watching, from the conversations we've had.

I had a conversation, in fact, just two days ago with a constituent of mine who was talking about her son who is addicted. He gets arrested, and the police have been very helpful to her, but he can't get the treatment. He can't get what he needs because he can't get into the treatment centres. He has finally recognized that he needs that aspect of it, to the point where, when we were having our conversation, he was screaming at me over the phone because of what was going on and his mother doing this. These are huge challenges.

How do we get people...? Those are the steps that we need. I think you're all alluding to it, but we first need to get health care to our constituents right from the get-go.

Mr. Tanguay, I'm wondering if you have any suggestions. What can we do differently to improve that?

[The Vice-Chair, Conservative, Stephen Ellis]

Dr. Tanguay, if you could tell us that in 15 seconds or less, that would be terrific.

[Dr. Rob Tanguay]

We have to take a good look at the Canada Health Act. The Canada Health Act does not support or include interdisciplinary care for those who need it the most. It does not include care for chronic, complex illness. It doesn't include physiotherapy. It doesn't include psychology. It doesn't include occupational therapy. It doesn't include all of our allied health. The provinces do this through their own decisions and of their own will. It is not covered under our Canada Health Act.

Quite simply, everything we want to do we can't do, because our health care act doesn't allow us to.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Dr. Tanguay.

Thank you, Dr. Kitchen.

The final word will go to Dr. Hanley. You have the floor for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks again to all of you for your really valuable contributions.

I'm going to try to keep this short for each of you.

Ms. Hudspith, I probably won't actually ask you a question, but we did leave a question unanswered. I was wondering if you would be able to submit some written answers around the role of pain care in the public health care system, and the role of self-management and the work that you've been doing in that regard.

Dr. Tanguay, again, thanks so much. It's been really helpful testimony.

I know this is not a quick question, but I'm going to make it a quick question. It's about getting OAT into rural communities. In 30 seconds or less, can you talk about the importance of that and how we can best leverage that?

[Dr. Rob Tanguay]

Absolutely.

Virtual care is absolutely paramount in this. Look, we live in Canada. We know there are health disparities. We know that part of the health disparity includes where you live. If you live in a rural area—like where I'm from, in rural, small-town southern Alberta, and northern Alberta previously—where you have to drive for hours just to see a doctor, virtual care is absolutely a way of closing that gap and making it simple.

Of course, there's working with your pharmacies. When I started treatment, fentanyl came in a green bean that was a “shady 80” or a fake oxycodone 80. It was never anything else. That's when the cookie kind of thing actually made sense. We couldn't get a pharmacist to prescribe suboxone outside of a very specific one. Now you can go to Safeway. You can to Superstore. I'm going to get in trouble for naming companies, but you can go anywhere.

[Brendan Hanley, Liberal, Yukon, YT]

I'm going to cut you off, Dr. Tanguay, but anything else that you could supply in writing would be greatly valuable.

Since we're focused on the federal government's response, can you tell me one thing that we should be doing more and that we could be doing more as a federal government to address the scale of this crisis?

[Dr. Rob Tanguay]

Yes. It's time for us to really step up and decide whether we are going to take care of our most vulnerable or not. That means looking at the Canada Health Act and deciding if we are going to cover interdisciplinary care or not. It's time to really take a look at that aspect. If we're going to cover interdisciplinary care, and that means taking care of our most vulnerable in their complex and difficult illnesses, then this is the way we're going to do it, so that they don't have to access small centres of excellence that are almost completely inaccessible.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Dr. Sereda, I'll bring the question to you. I think what I've heard is that there's far more in common between the testimonies we've heard from all the witnesses about the spectrum of approaches we need. We also know that with the number of Canadian who are dying every day, we need to do much more.

As a country, are we responding at the scale we need to? You did mention waiting for SUAP approvals, but what else? What other concrete actions could we and should we be doing as a federal government?

[Dr. Andrea Sereda]

You mentioned agreement. I think it's important that we rapidly and emergently scale up the scope of the spectrum of all interventions that people need to survive this crisis. I've been asked a lot of questions about safe supply today. Obviously, I think many Canadians could be kept alive with that approach, but we also need to rapidly scale up access to conventional addiction medications like methadone and buprenorphine. We need to scale up access to treatment on demand through bed-based treatment, if that is what people desire.

As a country, what do we need to do now? We need to stop blaming the people who are dying for the fact that they are dying. We need to stop stigmatizing people who use drugs, because that is directly impairing any kind of response we can have on any kind of emergency timeline. We need to lay all that stigma and marginalization behind us and really focus on saving lives.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

I might have a few more seconds. Can you briefly distinguish for us the difference between anecdote and qualitative research? You did highlight that briefly.

[Dr. Andrea Sereda]

Qualitative research is done by experienced academics and researchers who have been trained in qualitative methodologies. These things go through ethics review panels. The methodologies are examined and are closely followed.

Anecdote is different. Anecdote is asking one person what happened and not putting that under any kind of critical appraisal. It's not going through any kind of ethics review to see the impact of the information you're seeking on the community of a person. It doesn't go through any kind of peer review, which all qualitative research does.

Anecdote just stands alone as someone's statement. Qualitative research has a long-standing history of quality and describing people's experiences in health care.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Dr. Hanley.

Thank you to all the witnesses for taking the time to appear and sharing such valuable information with us today. I know that it will be important to our analysts as we create a report for the Canadian public as we go forward.

Members, our next meeting will be Thursday, February 29, to continue on the opioid epidemic and toxic drug crisis in Canada. That's just a look forward.

Since we started late, we've had a bit of extra time. Is it the will of the committee to now adjourn?

[Some hon. members]

Agreed.

[The Vice-Chair, Conservative, Stephen Ellis]

The meeting is adjourned.