Health Committee on March 21st, 2024

[Ya'ara Saks, Liberal, York Centre, ON]

Thank you for the question.

I'll start by saying that harm reduction is health care. It is a health care service, and we know that supervised consumption sites play a key role in that. We have the data to back that up. Since 2017, safe consumption sites in Canada have seen over 4.4 million visits. They've reversed 52,000 overdoses, and close to 400,000 people have been referred to treatment through those processes.

We know that when safe consumption sites are available, we are reducing the risk of death, disease and infections among those who use drugs, and we are ensuring that they have access to a wide range of health and social services to help them on the pathway to treatment and recovery. In jurisdictions where supervised consumption sites have been shut down, we have seen an increase in overdose deaths, but those are also attributed to the very toxic, poisoned street supply.

That means that safe consumption sites also need to be well resourced, well staffed and well engaged with local communities. When we look at programs such as those in Switzerland, Portugal and other jurisdictions, we see that good resources and well-staffed harm reduction initiatives do yield good results and save lives.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you.

You spoke about what we refer to as the “wraparound services” these safe consumption sites provide. The one located in my community of Ottawa Centre at Somerset West Community Health Centre is part of a community centre, so they have that capacity. Every time I have conversations with them, they talk about the social detriments to health. They talk about adverse childhood experiences, trauma, poverty, mental illnesses and chronic pain—all factors that lead to an individual taking these substances, with all the effects that go with them.

Can you talk about that type of patient and the kind of comprehensive approach required to give them health care services that are fulsome when dealing with all those challenges they may be facing?

[Ya'ara Saks, Liberal, York Centre, ON]

Thank you for the question.

I think it's important for us to look at the Canadian drugs and substances strategy as an integrated approach. With the renewal of the strategy, which we call the “Canada model”, we are working across departments now to address poverty, housing and other social determinants of health.

What we know is that, when someone uses substances, it's a result of what.... You know, we don't say, with the trauma-informed lens, “What's wrong with you?”, but rather, “What happened to you?” That is a key component of providing the services an individual needs. We know that, in indigenous communities, there is intergenerational trauma. We see that reflected in the high proportion of substance users who are from indigenous communities.

We also know there are a myriad of factors that can result in someone using substances, whether it's prescription opioids for pain management or others. Our job, once they come to us or their local health care provider for help, is not just looking at it through a singular lens.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Welcome, Minister.

I'm going to start with a somewhat technical question. Then, if there's time, I'll ask about the RCMP seizure and try to get a little more information on that.

Budget 2023 included $144 million over five years for the substance use and addictions program, or SUAP, to fund community support and evidence-based interventions. In the fall of 2023, the government requested proposals for SUAP funding. On February 1, 2024, you said that the new round of funding proposals had been accepted, that it was under review and that announcements were imminent.

First, I'd like to know if you've contacted the candidates. Is that happening or has it not been announced yet?

Second, when you were asked about funding for safer supply projects, you said that you had contacted people in charge of all the existing programs that were expiring and intended to renew the ones with appropriate mitigation measures.

At this point, do the people who've applied know if they've received funding? What mitigation measures are we talking about?

[Ya'ara Saks, Liberal, York Centre, ON]

Thank you for the question.

[Luc Thériault, Bloc, Montcalm, QC]

I see that your companions are doing some research, so I guess my question was technical, as I said. Sorry about that. We can move on to another topic in the meantime if you don't have an answer yet.

[Ya'ara Saks, Liberal, York Centre, ON]

I can answer some of your questions with pleasure as they are pulling up some of the more technical details.

As with many programs across the federal government, the SUAP program was very highly oversubscribed, showing there was a high demand and need for services through SUAP in local communities. That being said, applicants have not yet been contacted in terms of who will be receiving funding. That will be forthcoming in the coming months.

With regard to—

[Luc Thériault, Bloc, Montcalm, QC]

Are you talking about mitigation measures?

[Ya'ara Saks, Liberal, York Centre, ON]

Yes, the mitigation issue. As I mentioned in my previous visit here, there are.... I will correct what I said previously about 21. There are 25 programs in this prescribed alternatives stream that are funded by the federal government.

A deep dive was done by officials. Jenn Saxe can go into further detail, but I can tell you that it was a deep dive to ensure that there are mitigation protocols in place to prevent diversion. These include things like patient review of eligibility for prescribed alternatives, ensuring they are on a regularized schedule and ensuring there is ongoing contact and relations with those who are in the program.

I'd also like to clarify that prescriber alternative interventions are meant for those who have deep addictions to substance use and who, without this entry point of assistance, would turn to the illegal toxic drug supply and be at high risk for overdose death.

To speak more about the deeper-dive details of what protocols were put in place, I'll ask Jenn Saxe to answer, if she doesn't mind.

[Jennifer Saxe, Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Department of Health]

Sure. I'd be happy to. Thanks.

We took a number of steps. We contacted the people in charge of all the projects and asked for information on all their procurement protocols and risk reduction measures. We then created a list of all the measures that should be taken.

That includes patient screening; efforts to better match drugs to the patient's tolerance—as we've heard, to make sure they meet their needs—in the increasing toxic drug supply; risk-based protocols for assessing patient eligibility for take-home dosing; patient monitoring; and actions to address instances of diversion, which can include switching to observed dosing, transferring to different support services and removal from the program. There are more details behind each of those, but we pulled together all of those lists.

We are working with them to ensure they have the capacity to address those. They need to be able to put those measures in place so that we can absolutely reduce those risks.

[Luc Thériault, Bloc, Montcalm, QC]

What are some of the things that are being done to prevent diversion?

[Jennifer Saxe]

Right. Reducing the risk of diversion is the reason we do patient screening.

We have to make sure there are agreements with the doctor or health provider and the client. We must ensure that

clients are assessed on an individual basis for those take-home doses. We want to make sure they have sufficient capacity for witness dosing where that is needed for that individual client, and that there are regular and random urine drug screening tests.

[Luc Thériault, Bloc, Montcalm, QC]

Okay.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault. Your time is up.

Mr. Johns, go ahead, please, for six minutes.

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

Thank you, Mr. Chair.

Thank you, Minister, for being here. I'm going to quickly get right to questions.

Minister, you talked about the importance of supervised consumption sites. Will Health Canada step in to fill funding gaps for supervised consumption services given their closure and the threat of closure in Ontario and Alberta?

[Ya'ara Saks, Liberal, York Centre, ON]

I want to thank the member for his question and also for his deep and strong advocacy in working in this space. We know how important it is to him.

As the member knows, the federal government approves safe consumption sites to be opened. We do not support their overall operating funds. We can support programs through SUAP within their facilities, but I need to be clear about this: We take the lens that this is an interjurisdictional effort. That means that provinces need to be on board.

They have signed bilateral agreements for mental health and substance use supports as a key principle. We've seen 37% of the funds allocated overall in bilateral agreements, which is more than a third of their own agreements towards mental health and substance use, but it is a health care service that we continue to push local jurisdictions to support.

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

Minister, I'll just add that we have seen deaths skyrocketing in Alberta, and in Saskatchewan as well, where they're fighting safe consumption sites. That's not good enough.

I'll get to my next question.

Minister, if the government believes that substance use is truly a health issue, why is the majority of the funding for the Canadian drugs and substance use strategy going to law enforcement?

[Ya'ara Saks, Liberal, York Centre, ON]

I'll thank the member for the question.

When it comes to how we are tackling the opioid crisis, as I said in my earlier remarks, we're looking at a full continuum of supports, which includes enforcement. When we look at the breakdown of what we are doing, it's not either-or.

Also, the enforcement funding that you are referencing is across departments. It's not only Health Canada that's contributing to those amounts. In terms of enforcement, it is also the Department of Public Safety and local jurisdictions.

In terms of prevention and harm reduction, $61 million was allocated to harm reduction between 2017 and 2022. There was also $134 million for prevention in addition to that $93 million for treatment. Again, however, this is a shared responsibility, respectfully, in administering health care—

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Go ahead, Mr. Johns.

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

Thanks.

This gets right to the question that I want to ask, Minister.

You've heard me say before that disinformation in a health crisis costs lives. Incrementalism in a health crisis costs lives.

Minister, do you actually believe the funding allotted to address the substance use and toxic drug crisis at the federal level is commensurate with the scale and scope of the toxic drug crisis taking place right now in this country?

[Ya'ara Saks, Liberal, York Centre, ON]

I would say that, since 2016, the government has ensured that over a billion dollars has gone toward addressing the toxic drug supply, which is substantially more than the previous government. It allocated only $30 million to treatment at the start of its tenure and reduced that by two-thirds by the time it exited its governing term.

It went down from $30 million to $10 million. This government has put in $1 billion, in addition to the $25 billion that is part of the $200 billion going towards health care today. I would hardly say we've taken our foot off the gas, and I would reject that premise.

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

I would reject that answer, Minister, because you've spent less than 1% of what your government spent on responding to the COVID-19 crisis. If you want to compare yourself to the Harper government, go right ahead, but we know it didn't take this issue seriously.

Minister, I'm going to get to another question here. We've come out of the pandemic and we're now dealing with the cost of living crisis and greater access to mental health supports. Housing's included, and it's needed more than ever. I've talked to your predecessor about the important need for funding for tiny homes, for example, so that we get people off the streets and into safe, secure housing, so that when they're ready for help, we can meet them where they are. People can't get help when they are homeless.

How is your department working with the Minister of Housing to secure supportive and transitional housing? We know the provinces will be there should there be capital funding for tiny homes, for example, and housing.

[Ya'ara Saks, Liberal, York Centre, ON]

Thank you for the question.

I couldn't agree with you more. This is why we began to convene my counterparts on a quarterly basis on key issues between departments that overlap.

One of the important conversations we had in our first quarterly meeting was about exactly that. How were my provincial counterparts working with their local municipalities on the housing funding proposals the Minister of Housing is negotiating, jurisdiction by jurisdiction?

We continue to work across departments to highlight that there needs to be a prioritization of complex-needs housing, including for those who are struggling with substances. We're encouraging municipalities. We will also be meeting with the FCM in the coming months to ensure that avenues are open to including that in their proposals to the federal government and the rapid housing strategy, and that they are including those considerations in their funding grants to the federal government.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Johns.

Thank you, Minister.

Next is Mrs. Goodridge for five minutes, please.