Good morning.
I'll be doing my introduction in English, but my talk in French. I'm happy to take questions in English or French—whatever works best.
First, thank you for having me here. I also thank you in the name of my patients, who are dying very regularly.
I'm happy to see that we are all together in the same boat now, trying to find solutions together. It's very important for me and my patients.
I'm an “all addictions” doctor now. I have been doing this for 20 years as an in-patient and outpatient doctor. I have a master's degree in public health and a certificate of added competence in addiction medicine.
I am the chief of addiction and homelessness medical services in downtown Montreal. I have been working for many years now in the low-threshold opioid use disorder clinic. I'm an OAT prescriber. I'm a safer supply prescriber.
I am also the director of the ESCODI team, which would resemble what you know about BCCSU, or META:PHI in Ontario. What we do in my team is offer clinical tools and build guidelines for the whole province of Quebec.
I'm also a co-chair for CRISM. I had a chance to work abroad with Doctors of the World to help implement OAT in low-threshold countries.
What I want to say to you today, in two parts, is very similar to what has been said so far. First of all, as a physician, I like to have a clear diagnosis before discussing treatment. The current diagnosis, in 2024, is not a diagnosis of drug diversion or a diagnosis relating to pharmaceutical products, but a diagnosis of drug contamination on the illicit market.
I'd like you to imagine an iceberg. On top of the iceberg, there are deaths from opioid overdoses. My colleagues have set out very clearly what needs to be done. We know a number of things that work. We need to promote them even more, and above all we must not back down. We need to move towards things that work, not only access to treatment and molecules such as methadone, but also a safer supply. We can talk about this again if you like. At the moment, we're not doing any real safer supply. What we do is prescribe drugs, under the supervision of professional bodies, in a clear, highly defined clinical context for specific patients, following a rigorous assessment.
What works? Supervised injection services, access to consumption equipment and naloxone, and drug analysis services. We must have these services now and everywhere. In 2024, it's not right that most emergency departments in Canada don't have access to treatment or takeaway naloxone. It's not right that, in most provincial prisons, inmates don't have access to treatment and that you can leave a Canadian medical school without being able to prescribe methadone. So there's a real urgency to put in place the things that work. That's the tip of the iceberg.
What lies beneath? My colleague, Dr. Hyshka, addressed this very well. We need to ask ourselves who is currently dying. We need to think about social inequalities in health and the social determinants of health. Our health care system is neither truly accessible nor truly universal. Our health care system is inverted, whereas it's the people who are the sickest and have the most comorbid health problems, such as people with mental health problems, the homeless and first nations people, who should be the first to receive integrated and comprehensive services.
We need to ask ourselves why this is still not the case, despite the crisis. So we're going to have to talk about stigmatization and control, in other words, public health policies that control substances. We need to be creative and innovative in revising our public health policies. We need to talk about decriminalization. We need to realize that our current policies perpetuate social inequalities in health and perpetuate the vicious circle of poverty and marginalization. As such, we need a robust response that focuses first and foremost on those who are most likely to die and who are most vulnerable.