Health Committee on March 21st, 2024

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Mr. Chair.

I want to lend my voice in congratulating Dr. Lucas on his retirement.

Minister, are you aware of government-funded, so-called safe supply pills ending up in the hands of gangs?

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

I am aware that the RCMP is actively involved in seizures across the country.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Fantastic.

You've said in this committee and you've said on Twitter that you're not concerned about the diversion because it's not widespread. Can you define for us exactly what “widespread” is?

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

We look at it in terms of what prescriptions are out and who is using them across the country to get a better understanding of where diversion may be happening.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Okay. Thanks.

I've done a little bit of math. With about 4,500 people on safe supply programs in British Columbia, each receiving approximately 30 pills per day, that's about 50 million pills per year. How many of those pills diverted in a year would be acceptable to be diverted, as far as you're concerned, to make it widespread enough?

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

As I said....

Let's look at some other numbers. There are approximately 115,000 people in B.C. with opioid-use disorder, and 86% of hydromorphone pills distributed around the country are actually to cancer patients and those who suffer with arthritis.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Minister, these pills are being diverted into the hands of gangs who are profiting from the deaths of Canadians. What specific, concrete measures are you and your ministry taking to ensure that pills—and I don't care whether they're safe supply pills or other pills—are not being diverted, causing further addiction and crime in our communities?

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

As RCMP Assistant Commissioner John Brewer said, “there is currently no evidence to support a widespread diversion of safer supply drugs”, but about 14% of the total number of hydromorphone pills that are prescribed around the country are going to safer supply.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

This sounds like doublespeak to me, because we have Prince George RCMP—

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

No, it's actually the data and the numbers. It's not doublespeak.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

The Prince George RCMP have stated that they found hydromorphone that was from safe supply programs in a recent drug bust, so the B.C. top police, probably from political interference, were told to downplay it and say that there isn't widespread diversion happening. However, if it's happening in Prince George, then it's happening on Vancouver Island and it's happening in communities all across Canada that have these so-called safe supply programs.

What specific actions are you taking with your SUAP grants to ensure that no diversion is happening from these programs?

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

First of all, I would say that it's highly irresponsible to insinuate that there's political interference in law enforcement. Law enforcement does its job, as it should, without politicians getting involved—such as politicians not directing what are medical directives.

As Jennifer Saxe answered earlier, on the steps that are being taken on the federal level for our projects, we've enhanced protocols for patient screening and efforts to better match drugs to patient tolerance. We've put in risk-based protocols to assess patient eligibility for take-home dosing. We have patient-monitoring protocols in place. Actions to address diversion have included switching to observed dosing, transferring into different support services, or removing those who should not be in those programs.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Okay. Will the lack of those things that you guys just identified happening mean that you will not fund programs through SUAP?

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

That is correct.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Okay. If there is evidence of diversion that is happening from SUAP-funded so-called safe supply programs, that funding will cease.

Will it cease immediately?

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

At this point in time, the protocol measures have been put in place, and they're constantly being monitored.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

How soon after diversion is found to be happening from those safe supply programs that your government is funding will your government act to cut off that funding?

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

I will refer to Jenn Saxe.

[Jennifer Saxe]

At this point in time, what we are doing is working with all the projects to ensure that they are putting in that robust set of safeguards and measures. There will be regular reporting. We have an open line of communication with the projects, with law enforcement and with all of these. We will be regularly monitoring and then making adjustments as needed, informed by that evidence.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I think it's really sad for Canadians that the government refuses to give an answer as to what it would do and how quickly it would act if it found that something absolutely illegal were happening—to actually act to cut off funding to save the lives of Canadians. I think it's absolutely shameful that it's allowing gangs to profit from the deaths of Canadians and that it is funding it.

[The Chair, Liberal, Sean Casey]

Do you care to take a few minutes to respond to that, or shall we move on?

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

That wasn't a question, and the time's up.

[The Chair, Liberal, Sean Casey]

All right. Maybe the next person will afford you that opportunity.

Mr. Powlowski, you have five minutes, please.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

First of all, I'd like to give notice of a motion:

That, pursuant to Standing Order 108(2), the committee undertake a study on the treatment and prevention of cancer in Canada, including the state of current research on diagnosis and treatment of cancer; that the committee allocate up to [eight] meetings to this study; that the committee report its findings and recommendations to the House; and that, pursuant to Standing Order 109, the government table a comprehensive response to the report.

I wasn't going to go here, but I heard the testimony.

Jennifer, I know you're locked in conversation there, but you talked about diversion and safeguards for diversion. I don't want to make my 30-plus years of being a doctor totally useless. I listened to the safeguards and I have some questions.

You said, “patient screening”. I've been doing this for 35 years. When I started, I used to think I could tell who was reliable and who wasn't. I remember literally seeing a nun come in who wanted benzodiazepine or some narcotics and stuff. I said, “Of course. She's a nun. I'll give her a prescription. She is honest.” Then a guy came in with a lot of tattoos and a muscle shirt, and I said, “Well, I ain't giving them to him, because he's unreliable.” In the 35 years since, I have not figured out beforehand who is going to be reliable and who could possibly be selling it. I would say that, even if you get to know your patients well, you don't know. Even when little grannies come to you and say it's because of their bad arthritis, you don't know whether they're selling it. I've heard from the cops that they know places where old people go and sell to dealers.

As to an agreement, if somebody is going to sell their drugs.... I don't think you're going to trust them to make an agreement with you and sign a paper. It's not, “Okay, you can trust them now.”

As to regular urine tests, they are positive-negative. I've seen those. I worked in a clinic that does them. It's positive or negative, so if you give somebody eight Dilaudid tablets to take home, all they have to do is take one, then go and sell the other seven. Their urine is going to be positive one way or the other. That wouldn't seem to me to be all that reliable.

I think you had some other safeguards. I think there was a protocol for dealing with diversion occurring. Do you have other protocols?

Let me mention briefly in passing that I think the British Columbia officer of health, in reviewing the safe supply situation, recommended that the fallback position be observed treatment. I am not sure what the recommendation is on observed treatment.

Ya'ara Saks repeatedly mentioned Switzerland. In Switzerland, all the studies on heroin-assisted treatment are for observed treatments. Certainly, in talking to a lot of experts in addictions.... They've been looking for the same thing, which is observed treatment, possibly with intravenous fentanyl or oxycodone. However, it doesn't seem as if there is funding there for it at the moment. Is there contemplation on providing more funding?

In fact, some of the addictions people I talk to have said that going home with the pills is the poor man's choice, because they don't have the money to do observed treatment, which is where the evidence is.

I got off topic.

If there are more safeguards, you can talk about that. Also, what is the plan in terms of the possibility—for the real, hard-core addicts, as in Switzerland—that they are provided with directly observed treatment rather than pills to take home?

[Jennifer Saxe]

I have a couple of points, and thanks for that question.

I think it's important to note that it's a suite of measures. It's not one or the other. Part of those measures include, absolutely, having the capacity for witnessed dosing based on assessment or any indication that there may be diversion. It includes random and regular urine drug screening. As part of these projects, some of it is witnessed dosing. It's not all just hydromorphone tablets. There are some injectable programs. There are a variety of different medications.

We are also requiring that projects provide a range of backbone medications so you could reduce the amount of additional safer supply or prescribed alternatives that a health care professional may want to prescribe to a patient.

It's a range of measures that are being taken. There must be a capacity to witness, depending on the assessment, and to work with them. There are projects that absolutely have injectable and other observed dosing.

I will note that in Switzerland, with heroin-assisted treatment—and I'll pass it on to my associate deputy, who was just there—they have witnessed as well as carries. All of this is being undertaken with regular monitoring, reporting and evaluation, which will inform our work.