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
I think more important than diversion is the discourse around diversion that's happening in the media. Diversion is—
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
—complicated, and it requires more than a 60-second answer, if I can finish.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you. I appreciate that. I have a very limited amount of time, so I asked really quick, simple questions and wanted simple, quick answers.
B.C. recently developed some protocols that allow for recreational fentanyl to be prescribed to children in the guise of safe supply. What are your thoughts on this?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
I think that the BCCSU has very carefully consulted experts who provide addiction care, harm reduction care and the care of children with substance use disorders. I'm not aware that any children have accessed this protocol to date, but if you read the protocol, it is the same as any other kind of complicated health care for children in Canada, where two experts need to agree and the person needs to be carefully assessed for their risk and any benefit of treatment. For some children who are dependent on the toxic, illicit fentanyl street supply, physicians who are caring for them can make expert decisions on what they need for their health care.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Do you think that we should prescribe recreational fentanyl to children?
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
I think that if children are at risk of dying from the toxic street supply, which we know over 90% of deaths in youth are from, which is illicit fentanyl—
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
I'm going to turn that over to Dr. Rob Tanguay.
I wondering if you could perhaps expand on this. What are your thoughts when it comes to prescribed recreational fentanyl to children, as has been suggested by British Columbia?
Addiction Psychiatrist, As an Individual
Again, I'm of the belief of focusing on treatment and a process of such. At the end of the day, the prescription of recreational substances to anyone without a diagnosis and a treatment algorithm can be problematic, and there's really no research, evidence or peer-reviewed literature to suggest otherwise.
That being said, if it's a molecule that has stabilized someone, and it's in a guise of helping someone recover from severe addiction, then I'm all for whatever that molecule may be. It comes down to whether we're focused on treatment and what that algorithm may look like.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
One of the big questions we've been facing as we we've been looking at this is the idea of what treatment looks like. Can you describe how you approach addiction medicine and treatment, and how that can look in your practice?
Addiction Psychiatrist, As an Individual
Yes, for sure.
I work in the rapid access medicine program that I co-founded. It's Alberta's largest addiction medicine program. Everything is about meeting people where they are and with the utilization of motivational interviewing, which, in common-sense terms, is about being nice to someone. It's about listening to someone and helping them in terms of where they want to go and what they want to do when it comes to recovering from addiction, mental illness, homelessness, the sex trade or whatever they're trying to get out of. Often, these are all intertwined.
Treatment is really about a pathway—
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
You're talking about this rapid access program. I don't know that everyone is necessarily familiar with it.
Could you explain how people would access a program such as that, and how something like that actually works?
Conservative
The Vice-Chair Conservative Stephen Ellis
Dr. Tanguay, you have about 20 seconds, since we had to interrupt the questioning. Thank you.
Addiction Psychiatrist, As an Individual
They can walk in or they can self-refer. We get referrals from emergency departments, from in-patient groups, from primary care physicians, from counsellors and from psychologists. It's wide open.
We have full, complete and absolute rapid access for anyone and everyone in Calgary.
Conservative
The Vice-Chair Conservative Stephen Ellis
Thank you very much.
Go ahead, Mrs. Brière. You have six minutes.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you to the witnesses.
Mr. Letellier de St‑Just, thank you for taking part in the committee's study today.
We have something in common. You teach at Université de Sherbrooke, and I represent the riding of Sherbrooke. You said in your opening remarks that, when the previous government was in power, from 2005 to 2015, it opted to crack down on drug use and criminalize it. You said that, thanks to the measures taken by the government since 2015 and its recognition of evidenced-based decision-making, a modern approach—to use your words—was now in place.
I want to give you an opportunity to elaborate on that. Are we on the right track? What all of us here today want is to save lives and to ease, if not stop, this crisis.
Chairman of the Board, Association des intervenants en dépendance du Québec
Thank you.
Yes, of course, we are on the right track. I said that earlier. What is concerning is the desire among some to go backwards, which would be a monumental mistake. Just think where we would be if those repressive policies had remained in place after 2015: The crisis would be even more out of control than it is now.
I do want to make something clear. I'm not suggesting that decriminalization is the way to fix the problem of the illegal drug market. That's not the purpose of decriminalization. The purpose of decriminalization is to give people access to services. Dr. Tanguay and Dr. Sereda mentioned this: We are here to provide services and save lives. All the law enforcement, anti-money laundering and border control measures are essential, but the important thing today is to recognize that neither the decriminalization effort in British Columbia nor the introduction of diversion measures will, on its own, break the hold that criminal groups and the black market have.
To do that, we have to go further. That is why I encouraged you to consider the issue in a thoughtful way. It's the right thing to do. I know the word “legalization” is scary to a lot of people, but we did it for cannabis, and the recent report card for those first five years is very positive. Why not think about taking that next step for certain drugs or even all drugs?
I just got back from a conference in Amsterdam, where the city's mayor brought together representatives from big cities around the world to discuss their objectives with respect to organized crime and the illegal drug trade. Organized crime plays a major role in the illegal market in Canada. Let there be no doubt. Perhaps the situation is less violent in Europe, but criminal groups are in control. Something has to be done, but we must keep moving in the direction that was taken in 2015. All those measures must stay in place.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Do you think that a model based on the four pillars of prevention, that stronger legislation is a good idea?
Chairman of the Board, Association des intervenants en dépendance du Québec
The four pillars of prevention, the four pillars of the Canadian drugs and substances strategy are definitely important. Fortunately, the strategy was reworked and updated. That is the model we should be following.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you, Mr. Letellier de St‑Just.
Dr. Sereda, in your opening remarks, you said your job was to keep your patients safe. I'd like you to talk more about the beneficial impact of safe supply on your patients.
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
That is a wonderful question. Thank you for giving me an opportunity there.
My patients are the focus of my work. I'd like to tell a couple of stories, if I have time in the moment.
I'm going to start with a story about a woman who was diagnosed with palliative AIDS. She lived on the street. She had no health care. She repeatedly came into the hospital with pain and was turned away over and over again because she was labelled a drug-seeker.
Eventually it was discovered that her pain was actually due to the consequences of HIV and the infections she had related to AIDS, so she was admitted. At that time, she was told she was palliative—that nothing could be done to help her. She was discharged to the street and back to homelessness with a palliative AIDS diagnosis, no medications and no support.
It was at this point that our team had a chance to intervene. We brought her into care. We prescribed her safe supply and her fentanyl use completely stopped. She is now housed. Her AIDS is no longer AIDS; it is well-treated HIV with a controlled viral load. She is now volunteering in harm reduction programming.
What she needed was that support to move away from the toxic supply, so that she could focus on health issues as well. She makes really great cupcakes.
Do I have time to tell you another story?
Another woman I want to tell you about was also palliative. This woman was deemed to be palliative because of endocarditis, which is a severe heart infection. She was in the hospital and she needed surgery. She needed to receive two new heart valves in order to survive. At that time, the surgery team did not feel she was a candidate because she was a drug addict; she had done this to herself and she was going to do it again.
Again, at this point our team intervened and there were some strong advocacy discussions—
Conservative
The Vice-Chair Conservative Stephen Ellis
I'm sorry, Dr. Sereda. I'm going to have to interrupt you there.
The time is up, but maybe someone on your team will come back to that.
Thank you.
Mr. Thériault, you may go ahead for six minutes.
Lead Physician, Safer Opioid Supply Program, London InterCommunity Health Centre
Thank you very much for that opportunity.
We intervened with this woman. We advocated and we put her on safe supply as well, which extinguished her fentanyl use. She was able to receive her two new valves.
She was only 21 years old when she was told she was going to die from endocarditis. That was more than four years ago. She's 25 years old. She no longer uses fentanyl. She is still on prescribed safer supply. She is housed. She also volunteers with us and she has returned to college. She really enjoys singing, dancing and knitting in our clinic.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Dr. Sereda.
Safe supply and supervised consumption sites clearly emerged in response to overdoses, the opioid crisis and fentanyl contamination in drugs.
Safe supply, however, has given rise to another problem: the diversion of prescribed safe supply drugs. I want to give you a chance to share your thoughts on the problem. I'd like you to discuss that and tell us whether it's something we need to deal with, given what you've seen in the last year. What should we be doing? Enlighten us, if you would.
Dr. Sereda, you can go first since you didn't get a chance to finish what you were saying about that earlier.
Mr. Letellier de St‑Just, you can go next.