Evidence of meeting #105 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Elaine Hyshka  Associate Professor and Canada Research Chair in Health Systems Innovation, School of Public Health, University of Alberta, As an Individual
Meldon Kahan  Associate Professor, Department of Family Medicine, University of Toronto, As an Individual
Bohdan Nosyk  Professor and St. Paul's Hospital CANFAR Chair in HIV/AIDS Research, Faculty of Health Sciences, Simon Fraser University, As an Individual
Marie-Ève Goyer  Physician, Clinical and organizational support team in addiction and homelessness, CIUSSS Centre-Sud-de-l'Île-de-Montréal

12:10 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

At a previous meeting, regarding law enforcement and the fight against organized crime, some witnesses told us that the fourth pillar of the intervention plan was having very little effect; they felt we needed to consider somewhat more radical means regarding legalization.

Is that what you mean when you raise, for example, the fact that safe supply, supervised injections and supervision centres aren't enough to limit mortality and fight this incredible public health crisis that's going on right now?

12:10 p.m.

Physician, Clinical and organizational support team in addiction and homelessness, CIUSSS Centre-Sud-de-l'Île-de-Montréal

Dr. Marie-Ève Goyer

What I'm trying to say is that there won't be a single solution to such a complex and weighty problem, a crisis involving so many deaths. Many of us have talked about existing solutions that are not being sufficiently implemented. That seems to me to be the easiest part to solve, because we know what the solutions are. We just need to implement more solutions, pour in more money and train health care professionals.

I'm going to repeat one last time that we're currently experiencing an opioid-related crisis. You can come out of medical school without knowing how to prescribe methadone. That seems inexplicable to me, and it shows the extent of the stigmatization of these clients, who are not receiving the care they need. That's the end of my sidebar.

To answer your question, there's that part, which seems pretty clear to me, at the tip of the iceberg. However, underneath the iceberg, we're actually touching the limits of the war on drugs. We've been trying to deal with it for years. We've invested thousands of dollars in the war on drugs, and we're losing even more ground. I'm not a public policy expert, but in my opinion, it's time we did things differently and looked for creative solutions.

12:10 p.m.

Bloc

Luc Thériault Bloc Montcalm, QC

Some people argue that safe supply should be stopped because it can lead to drugs being diverted onto the illegal market. That's not what you're saying. Just because there's a collateral problem doesn't necessarily mean we should end the safe supply. At the same time, you're criticizing safe supply by saying that it's not going as it should.

12:10 p.m.

Physician, Clinical and organizational support team in addiction and homelessness, CIUSSS Centre-Sud-de-l'Île-de-Montréal

Dr. Marie-Ève Goyer

You've asked me several questions. I'll try to answer them briefly.

I think there are several false equations relative to safer supply.

First, I want to reiterate that the use of this practice is currently minimal. Few doctors use it, and few patients receive such a service. If we're really going to implement a safe supply measure, we'll need a lot more of it, as we do with other treatments.

Next, I want to say two things.

First of all, there are examples of hard drug legalization in Canada that we could learn from.

Secondly, before we even do it, let's remember that criminalization currently targets hyper-vulnerable people, who are being pushed into prisons, who are losing their housing and who have mental health problems.

I just want to tell you that we're continuing to make life more precarious for people who are currently vulnerable and already in very precarious situations. We should first consider the preliminary steps, such as reviewing the criminalization component.

12:15 p.m.

Conservative

The Vice-Chair Conservative Stephen Ellis

I'm so sorry to interrupt, Dr. Goyer; time is up.

Thank you very much, Dr. Goyer and Mr. Thériault.

Mr. Johns, you have the floor for six minutes.

12:15 p.m.

NDP

Gord Johns NDP Courtenay—Alberni, BC

Thank you, Mr. Chair. I want to thank all of the witnesses for their important testimony and the work they do.

Dr. Hyshka, you talked about the need for the federal government to declare a national public health emergency. It's something that the NDP has also been calling for. We saw the federal government recently host a summit on auto theft. However, it hasn't done anything like that for this crisis. You talked about how you have lost more lives in Alberta from the toxic drug crisis than COVID. Yet, we have seen the spending and effort by the federal government on the toxic drug crisis as less than 1% of that on COVID.

Do you believe the federal government is doing enough in rolling out a plan with a timeline and resources? What do you believe is necessary to respond to this crisis in the short-term?

12:15 p.m.

Associate Professor and Canada Research Chair in Health Systems Innovation, School of Public Health, University of Alberta, As an Individual

Dr. Elaine Hyshka

I don't want to get bogged down in debating the specific legal mechanisms of declaring an emergency or not. Obviously, we need to recognize this for what it is, a public health emergency.

We need to substantially increase federal spending. We also need look at.... Currently, almost 60% of federal spending for the Canadian drugs and substances strategy is going towards law enforcement efforts. We need to see if that is getting us the best value for money in terms of improved population health outcomes. We are not resourcing enough, provincially or federally, social programs, health care, and a whole host of other options that can potentially be more effective at supporting people to stay alive, achieve recovery and get well.

Beyond that, in the short-term, there are many things the federal government could do immediately to try to bring down the death rate. First and foremost, please do not cut the existing funding for safer supply programs. We know, from the evidence from different treatment studies, as well as emerging safer supply evidence, that if you abruptly cut people off their prescription medications, they are at a much higher risk of death.

Sustain that funding, and continue to innovate in that area to look for more effective solutions, including non-prescriber models of safer supply. We just had a study published by a compassionate club in B.C. that showed very early and promising results in reducing mortality.

Beyond that, we could be looking to improve safer supply programs by working with pharmaceutical companies and regulators to identify medications that would more effectively meet people's needs, potentially reducing the risk for diversion.

We really need to look at a national project around decriminalization. I can't think of a stronger form of stigma than criminalizing someone. We talk a lot about needing to end stigma, but then we continue to criminalize people for their health conditions. In B.C., there is an imperfect decriminalization pilot happening. We need to have a national conversation about what this would look across the country. We need to, first and foremost, say that this is a health issue. We need to stop criminalizing people, and that needs to happen across the country. It's not fair that people who use drugs in B.C. are potentially not subject to criminal charges, but they are everywhere else.

I would also like to see an overhaul of SUAP. The way that investments are currently made is not as effective as it could be. We need to be looking at ongoing operational funding for evidence-based services as part of a core suite of options for people across the country. Federal funding could play a huge role in ensuring equitable access to treatment across the provinces, such as equitable access to safer consumption services and other really proven interventions.

I also want to highlight—and I'm not sure if the committee has heard this evidence—that in Alberta and B.C., the majority of people who die from drug poisoning are dying after smoking drugs. Yet, very few supervised consumption services across the country allow people to smoke drugs within them. A pretty quick change that could happen is for the federal government to subsidize supervised consumption services to make the renovations required to accommodate supervised inhalation.

That would have an auxiliary benefit of bringing more of the public drug use—which has been concern across the country due to a whole host of factors, including the lack of housing—indoors. It would bring that public drug use inside. Certainly, this is a big issue in Edmonton where I'm from. Many people are smoking drugs outside of supervised consumption sites, because they cannot smoke them inside. If they go down and have an overdose, they know the staff will run outside to help them. That's not an effective way to respond to a crisis. It's something that could be addressed pretty quickly in the short-term, and would save lives.

12:20 p.m.

NDP

Gord Johns NDP Courtenay—Alberni, BC

Much has been made of the Alberta model that's oriented on recovery and treatment. However, recent data has highlighted that overdose rates in Alberta are rising fast since it was put in place, much faster than in British Columbia.

Can you maybe talk about why you think that is? You have about 60 seconds.

12:20 p.m.

Associate Professor and Canada Research Chair in Health Systems Innovation, School of Public Health, University of Alberta, As an Individual

Dr. Elaine Hyshka

I think it's always the result of multiple factors when we're looking at trends in drug poisoning. Some things that we're seeing in our province are concerning. There's been a substantial reduction in the number of people using supervised consumption sites. It's about half of what it was before the pandemic. I think it's because of the lack of incorporating inhalation, as well as a number of the closures and relocations of the services that have disrupted connections to care for people who use drugs.

We are also seeing, as mentioned, a lot more deaths in public spaces. We need to be addressing homelessness and unstable housing. I think if people had safe places to live, with proper services and wraparound care, they wouldn't be dying of drug overdoses on our streets.

Beyond that, we have relatively low rates of opioid agonist treatment coverage for a province of our size. Only about 14,000 Albertans in quarter three of 2023 were being dispensed opioid agonist medications. That seems to be quite a low coverage rate. I think we need to also do more to expand access to opioid agonist treatments in our province.

Of course, I don't know why Alberta hasn't moved to trial a safer supply. It is potentially a very powerful tool, as Dr. Nosyk spoke to, to reduce mortality amongst the subset of people who use substances. We need to use every single tool we have to address this generational and staggering crisis.

12:20 p.m.

Conservative

The Vice-Chair Conservative Stephen Ellis

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

We'll turn now to Dr. Kitchen for five minutes, please.

February 29th, 2024 / 12:20 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you, Mr. Chair.

Thank you to the witnesses for being here. I'm sorry that we had to deal with some of the protocols of the House, unfortunately, with interruptions, etc., but I appreciate your being here. You all made some significant points in your opening presentations that I think we all wanted to hear.

Dr. Goyer, you talked about something that I agree with 100%—diagnosis first, which then leads to treatment. I appreciate that comment, because I think it needs to resonate a lot more with people.

Ultimately, I think what we're looking at here is that we need to be recovery-oriented. I think that's being missed. Recovery orientation needs to be one of the biggest focuses we have. I come from Saskatchewan. I come from a very rural area. I have with me basically the OAT standards from the College of Pharmacy Professionals, as well as basically a map of what's going on in Saskatchewan right now in terms of where doctors are even trained to do it. That's a huge aspect: How do we make certain that we have that access to these rural areas? To me, I see that the focus is apparently on the big cities and not rural Canada. That's important.

Dr. Kahan, you talked a little bit about rural areas. I'm wondering if you could comment. Basically, when we look at best practices and things that we need to look at, is it valuable to be putting in a safe supply, or more so for an OAT program?

12:20 p.m.

Associate Professor, Department of Family Medicine, University of Toronto, As an Individual

Dr. Meldon Kahan

I think it's unfortunate that there's been this binary discussion of safe supply or no safe supply. I don't think that's what the focus should be. I think the focus should be on ensuring that safe supply is actually safe for individual patients and the public.

This idea of prescribing large numbers of take-home tablets is actually harming people. It's leading to unnecessary and deadly bacterial infections. It's leading to diversion, which increases the use of hydromorphone and then ultimately fentanyl among youth and among people on OAT, and other problems. This can be practically and feasibly made safer by having hydromorphone tablets. The issue is not hydromorphone versus methadone. The issue is take-home versus not take-home. If you allow take-home, and people are clearly involved in the drug trade, you'll have diversion. It will harm people. Have supervised hydromorphone, supervised methadone and supervised injection opioid agonist therapy. That's what's needed.

In terms of rural communities, it really is a very bad situation, at least in Ontario. Some of the OAT providers are these large corporate chains that do not provide high-quality care. Even physicians who want to provide good care have limited access to case management and mental health resources. Some rural communities have no OAT at all. Some pharmacies neglect or refuse to dispense OAT. That is a problem. I think it's very unfortunate that SUAP has put all their resources into safer supply, yes, and other initiatives, while downplaying opioid agonist treatment. I think that needs to be changed. There needs to be a balanced approach.

12:25 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Thank you. I appreciate that. I do appreciate how, in your presentation, you've been very clear and educative as well. You talked in language that Canadians can listen to, as opposed to the researchers. That's what I think people who are watching this meeting want to hear. They want to hear it in their language, not in researchers' or technologists' language. While I may understand it, there are others who don't, so I appreciate those comments.

One of the things that was brought up in our last meeting had to do with talking about issues of dealing with pain. What I learned back many, many years ago was three steps dealing with basically pharma, psychology and physical. Those three aspects need to be addressed when dealing with patients.

I'm wondering, Dr. Goyer, I realize you have very little time, but I would like your thoughts along those lines, please.

12:25 p.m.

Physician, Clinical and organizational support team in addiction and homelessness, CIUSSS Centre-Sud-de-l'Île-de-Montréal

Dr. Marie-Ève Goyer

When it comes to tackling complex problems, such as addiction or pain, pharmacology of course has its place. Complex problems call for complex answers. This goes back to what we were saying earlier about the importance of having a complementary set of services and care to treat chronic pain and addiction.

We need to go further than the simple pharmacological approach, including the use of physiotherapy as well as putting in place psychological services and multidisciplinary teams to manage—

12:25 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

Mr. Chair, I'm sorry for interrupting, but I have a point of order.

I'd like to move a motion as amended.

12:25 p.m.

Conservative

The Vice-Chair Conservative Stephen Ellis

Sure. Go ahead, Dr. Kitchen.

12:25 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

I'd like to move a motion:

That the committee invite the Minister of Health and the Minister of Mental Health and Addictions to each appear for a one-hour meeting on Supplementary Estimates (C), 2023-24, and that the Ministers appear before the end of the supply period ending March 26, 2024.

12:25 p.m.

Conservative

The Vice-Chair Conservative Stephen Ellis

Thank you very much.

Colleagues, the difficulty, of course, is that I was the one who moved the initial motion. That makes it incredibly difficult for that to continue.

We all know that the bells are ringing at the current time. To continue this committee, we would need unanimous consent to do so. My concern, of course, is if we do not do that it will effectively be the end of the meeting, given the amount of time to get to the chamber, vote and then come back.

I am at your service as the chair of the committee. Is that the will of the committee to continue?

12:25 p.m.

Some hon. members

Yes.

12:25 p.m.

Conservative

The Vice-Chair Conservative Stephen Ellis

Thank you, witnesses, for understanding that there is a bit of machinery in motion here. I appreciate that.

Just so that everyone is clear, the bells are ringing in the House so there will be a vote after that. I suspect that that will probably be the end of the meeting with respect to timing, but we'll see when that comes.

At this moment, then, Madam Brière—

12:30 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

To my motion—

12:30 p.m.

Conservative

The Vice-Chair Conservative Stephen Ellis

I already said no.

Ms. Brière, you have the floor for five minutes.

12:30 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

I have a point of order, Mr. Chair.

12:30 p.m.

Conservative

The Vice-Chair Conservative Stephen Ellis

Very well, Dr. Kitchen, go ahead.

12:30 p.m.

Conservative

Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK

I think if you canvass the room, you would see that there is unanimous consent to make that amendment.