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.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Did you receive $1.5 million from the National Safer Supply Community of Practice, which deems diversion as compassionate health care?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
I did not receive that money. Certainly the Safer Supply Community of Practice received that money.
I'm aware of the diversion document that you're referring to. It was written by expert clinicians, with evidence and advice from people who use drugs.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
How can you justify that funding, though, if it's an illegal practice?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
I think you're referring to the funding for the National Safer Supply Community of Practice. It's not funded to defend diversion. It's funded to support people nationally in learning about safe supply, helping them in practice and disseminating information.
Conservative
The Vice-Chair Conservative Stephen Ellis
Thank you, Dr. Sereda.
We're going to move to Dr. Hanley.
Dr. Hanley, you have the floor for five minutes.
February 26th, 2024 / 4:30 p.m.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
I want to thank each of you for being here and for your dedication to practice and to this particular crisis.
Dr. Sereda, I'll let you carry on for a moment, but I do have questions for at least three of you. You so eloquently documented the benefits of safe supply. I do want this study to be so much more than this false argument on safe supply and its role in health care. Should politicians be making treatment recommendations?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
Absolutely not. I'm not aware of any other health condition in this country where politicians actually weigh in on whether it should be provided or not. For diabetes care, surgical care, hypertension care, politicians defer to the expert clinicians and researchers in these fields because they know that they are experts, that they want the best for their patients and that they're going to offer them treatments that are going to be beneficial. It's only in this extremely politicized rhetorical debate around harm reduction that politicians seem to think that they know better than the experts and the people who are caring for these patients day in and day out, who have a fiduciary responsibility to see that these people stay alive and do well, in both health and social outcomes.
Again, I've used the word—
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you, Dr. Sereda. I appreciate this, but I do have to move on.
Dr. Tanguay, your first words were very moving. I'm really sorry for your personal losses, and I think it speaks to many of us who have also experienced losses in our families or our communities around the country.
I was also very heartened by your answer to the question on prescribed fentanyl. First, you cautioned against such treatment without a treatment plan or diagnosis—something I think anyone involved in treating opioid use disorder would agree with—and you also said that you support the use of any molecule that helps to stabilize an individual within a treatment plan, if I can paraphrase you. I think that speaks to and validates the four-pillared approach that includes treatment and recovery.
You spoke a lot about the various pillars of treatment. You cited the important role of harm reduction, but you have argued that harm reduction needs to include mental health and addictions services, and to be better connected to community and residential treatment programs. In your opinion, under what conditions should supervised consumption, safe supply and other harm reduction measures occur in Alberta, and in Canada, for that matter?
Addiction Psychiatrist, As an Individual
I think that, at the end of the day, it's about trying to create a system that makes sense, that's interconnected and not siloed. We have harm reduction, recovery-based and mental health silos, but the reality is that there's a lack of access to any of them, and that's really the biggest problem we have. We're sitting here talking about a new treatment algorithm, which really was an experiment—and is building evidence, for sure—without actually accessing first-line treatment. Most people in Canada do not have access to first-line treatment, to mental health treatment and to supports.
These supervised consumption services should be an entry point to treatment, and they are probably one of the best entry points to treatment that we could possibly have for individuals who are most vulnerable. The concept of meeting them there is so important, but we can't just leave them there, and we can't help them—
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you. If you don't mind, I'm going to cut you off. I just want a few seconds with Ms. Hudspith.
Ms. Hudspith, thank you very much for appearing. In my previous role, I had the pleasure of leveraging your organization's expertise as we began to look at critical gaps in pain care in the Yukon territory. What do we need to do better, as a public health care system, in managing pain? Can you also talk briefly about how we support self-management of pain? I know you have been leaders in that area.
Executive Director, Pain BC
Thank you so much.
We've been making great strides on the self-management side, building out virtual care and supports to enable people to use those things. People can throw up a website, and it can have all kinds of great resources, but people often need a hand to hold as they walk through that and as they apply those learnings.
What we need to be—
Conservative
The Vice-Chair Conservative Stephen Ellis
Ms. Hudspith, I'm sorry; I'm going to have interrupt you. The time is up.
Mr. Thériault, you have two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
I'll try to be brief.
Mr. Letellier de St-Just, in a very interesting document updated on February 9, 2024, you indicated that decriminalization does not guarantee safe supply. We've been talking about it for a while. You're also targeting organized crime.
There are four pillars. Do you believe that enough is being done when it comes to law enforcement and fighting organized crime? I'm asking the question because it's really the law of the jungle right now. What is happening is truly shocking. When the government is forced to take care of people and create supervised injection sites because anything goes on the black market, there's a problem.
Is enough being done? If not, what more could be done?
Chairman of the Board, Association des intervenants en dépendance du Québec
In Amsterdam, an undercover police officer who infiltrated criminal gangs told us that he spent months preparing a major operation to arrest the leaders and seize huge quantities of drugs, but the impact lasted just two hours. That's shocking and astounding, to say the least, because law enforcement isn't on a level playing field. Criminal groups have much greater resources than law enforcement does.
Are we doing enough, then? We're already doing so much more. Money laundering and arrivals at major ports, be it Vancouver, Halifax or Montreal, need to be tackled. We need to do what has to be done, but with the full knowledge that it's not a level playing field right now.
Chairman of the Board, Association des intervenants en dépendance du Québec
The only way to ensure progress would be to regulate certain drugs. For example, there's talk in Europe about regulating cocaine and MDMA. That kind of approach needs to be followed or, at the very least, considered.
Chairman of the Board, Association des intervenants en dépendance du Québec
Thank you.
Conservative
The Vice-Chair Conservative Stephen Ellis
Thank you, Mr. Thériault.
Mr. Johns, you have the floor for two and a half minutes, please.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you.
My question is for Dr. Tanguay.
First, Dr. Tanguay, I also offer my condolences to you and your family for your losses.
Dr. Tanguay, you were part of a report commissioned by the United Conservative Party in Alberta in 2020 on safe consumption sites in your home province. That study has been widely criticized for its poor scientific methodology, yet it was key to the closure of the safe consumption site in Lethbridge, which has reported a record number of fatal overdoses since the closure of the site.
Additionally, a study was published in The Lancet this month showing a 67% reduction in overdose deaths in neighbourhoods within 500 metres of safe consumption sites after they opened. It demonstrates the life-saving impacts of these sites and the importance of them.
Have your views changed since this government-commissioned report was used to leverage the closure of safe consumption sites in Alberta?
Addiction Psychiatrist, As an Individual
Just to be clear, the consumption site in Lethbridge was transitioned to an AHS one out of the not-for-profit. It's still active and still going, and never has it turned someone away.
There is a record of overdoses at all sites, whether one of these consumption sites exists or not and whether treatment is available or not. I don't think that kicking a specific small piece and saying, “Here's the answer” is always the easiest way.
The report never once said to shut any service down. It was never once written in that report to shut any supervised consumption service down, but rather that these services require support such as medical treatments, buprenorphine, methadone, mental health treatments, wound care treatments and primary care treatments. The big support is that these processes should be more than under the realm of harm reduction; they should be under the realm of health care. That was something—
NDP
Gord Johns NDP Courtenay—Alberni, BC
Do you believe, Dr. Tanguay, that there should be more safe consumption sites, including maintaining and improving the one in Red Deer, for example?
Addiction Psychiatrist, As an Individual
I believe that supervised consumption services are a part of a pathway of treatment and, like all harm reduction services, should be a part of the treatment algorithm.
I think the biggest problem we have is that we pick one little piece to focus on and think that's all we need, and that's not an answer.
Conservative
The Vice-Chair Conservative Stephen Ellis
Thank you, Dr. Tanguay.
Mr. Johns, that's the end of your round.
We will now turn to Mr. Doherty. You have the floor for five minutes.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Thank you, Chair.
Dr. Sereda, in January 2022, you produced a report that claimed that your program was successful because of a 94% retention rate, which is a surprising finding that people with addiction will return for free government-supplied drugs. It was only later during a webcast, when you were asked directly about the other 6% who were no longer enrolled, that you acknowledged that some of the 16 had died from fentanyl overdoses or from infections acquired from injection drug use. Your study also did not analyze the impacts of diversion.
How can you claim that it shows hydromorphone from your program works?