Health Committee on March 21st, 2022

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Minister.

Ms. Bennett, last week you announced that the government was working with partners like the Standards Council of Canada to create national standards for mental health services. When are they going to be completed? How do you envision these standards being applied?

[Carolyn Bennett, Liberal, Toronto—St. Paul's, ON]

Thank you for the question.

That is $45 million that came out of last year's budget. The Standards Council does not set the standards. The Standards Council works with the people who know the most—the researchers, but also those with lived and living experience and community workers—to find out where there is a consensus that should and could be a national standard coast to coast to coast: the most appropriate care, in the most appropriate place, by the most appropriate provider in the most appropriate time.

What's exciting, at the moment, is that the integrated youth services seem to be a place where nine out of 10 provinces have begun that work of individualized wraparound services for young people up to age 26. That's an example of a national standard, an integrated youth service that would go to 26 wherever you live, so that young people wouldn't be left out.

I think there are some really good examples of national standards. It's a common statement that the provinces and territories came out with together in 2017. I'm very excited about the opportunities to do that. Perhaps perinatal mental health.... One of the things we're worrying about is wellness checks, as well as appropriate medically supervised withdrawal. There are things I've been hearing, and then I go to the CIHR and the Standards Council and say, “Do you think there's a possibility of developing a team that would work on those kinds of standards?”

[The Chair, Liberal, Sean Casey]

Thank you, Minister, and thank you, Ms. Sidhu.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you very much, Mr. Chair.

Ministers, welcome to this meeting of the Standing Committee on Health.

My first question is for you, Minister Duclos.

The 2019 budget announced $1 billion over two years starting in 2022‑23, and up to $500 million per year thereafter for the implementation of a national rare disease strategy. However, the 2022‑23 main estimates contain no funds for this initiative, although the measure is included in Health Canada's 2022‑23 departmental plan.

The [government] will also launch a national strategy on drugs for rare diseases and invest up to $1 billion over 2 years to help Canadians with rare diseases access the drugs they need.

Why isn't there any money for it in 2022‑23?

What is the status of this strategy's implementation?

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you for the excellent question.

I will give you two clarifications and then ask the deputy minister to give a third.

First, the commitment regarding the billion dollars has been made and will be respected.

Second, this commitment drew a great deal of interest, I would say even a certain enthusiasm, from my fellow health ministers throughout the country.

As for the way the billion dollars is included in the estimates, I will ask the deputy minister, Mr. Lucas, to give you an exact answer.

[Dr. Stephen Lucas, Deputy Minister, Department of Health]

Thank you, Minister.

Mr. Chair, I would indicate, in response, that Health Canada—as the minister has indicated—continues to consult and engage the provinces, territories and stakeholders. With that, we will be able to define the path forward on this work on drugs to support Canadians with rare diseases. That would allow the funding to move forward and be considered in a subsequent estimate.

[Luc Thériault, Bloc, Montcalm, QC]

I understand that currently, there is nothing for 2022‑23.

[Dr. Stephen Lucas]

In the context of the main estimates, at this point, before the start of the fiscal year, I would say that those funds have not been moved forward for appropriations. This will be considered further to consultations in the coming weeks and months.

[Jean-Yves Duclos, Liberal, Québec, QC]

Today, we're talking about the main estimates, but there are also supplementary estimates (A), (B) and (C). That means other announcements may follow during 2022‑23.

[Luc Thériault, Bloc, Montcalm, QC]

Can you give us an inkling of how the strategy's implementation is being organized?

[Jean-Yves Duclos, Liberal, Québec, QC]

As I said earlier, we work in partnership with the various provincial and territorial ministers of health. Of course, we also use expertise from outside the Canadian government. Many experts work for Health Canada, but we also work with medical experts, researchers and all Canadian suppliers.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I would like to know how much time I have left, so that I may choose the right question to ask.

[The Chair, Liberal, Sean Casey]

You have over two minutes.

[Luc Thériault, Bloc, Montcalm, QC]

That's excellent.

I have a slightly more specific question.

Minister, I think you would agree that having more than one antiviral available to us to counter COVID‑19 is not a luxury.

When I searched the Health Canada website, I saw that Paxlovid, an antiviral for COVID‑19, was submitted on December 1, 2021, and accepted on January 17, 2022. It was therefore very quick. I also saw that on August 13, an application for ongoing review was filed for molnupiravir, which has not yet been accepted by Health Canada.

The administration of Paxlovid is known to be restricted because of interactions with other drugs, due to one of its components, ritonavir. Molnupiravir is known to have fewer restrictions related to interactions with other drugs, as it does not contain ritonavir.

My question is simple: when will molnupiravir be approved? Why is the process taking so long? Is there a lack of human resources to do the work required for its approval?

[Jean-Yves Duclos, Liberal, Québec, QC]

First of all, you won't be surprised to hear my congratulations for your serious work, Mr. Thériault. Not only is this serious work, this is a serious problem.

Second, you rightly noted that Health Canada gave its approval quickly. One reason in particular was that the department worked with its international partners. I believe we were among the first four countries in the world to approve Paxlovid and the second country in the world to administer it.

Third, provinces and territories already had a fairly large stockpile of Paxlovid and are starting to use it clinically rather effectively. In the last few days, we have had encouraging news regarding the availability of the drug in Quebec's pharmacies.

Fourth, for any other drug, including the Merck company's drug, Health Canada's concerns and obligations are obviously based on the safety and effectiveness of that drug.

If you want to know more, I could turn to the experts at Health Canada.

[Luc Thériault, Bloc, Montcalm, QC]

Absolutely.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault and Mr. Minister.

Next is Mr. Bachrach.

Welcome to the committee. You have the floor for six minutes.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Thank you very much, Mr. Chair.

Thank you to the committee for allowing me to ask some questions on behalf of my colleague Mr. Davies.

It's good to see you, Ministers.

My first questions pertain to the toxic drug crisis that is being experienced across the country, particularly in my home province of British Columbia, and is leading, as everyone here knows, to a devastating number of deaths in communities of all sizes.

Minister Bennett, my questions are for you as the minister responsible for mental health and addictions. Do you believe that criminalization contributes to the stigmatization and marginalization of people who use drugs?

[Carolyn Bennett, Liberal, Toronto—St. Paul's, ON]

Yes.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Do you believe that the criminalization of substance use causes disproportionate harm to racialized and indigenous communities?

[Carolyn Bennett, Liberal, Toronto—St. Paul's, ON]

I think we know that we have to move from a criminal justice system to a system that sees substance use as a health issue, and we will do everything we can to support them there.

I think, as you have said, that the toxic drug supply means that the most immediate remedy is going to be a regulated supply of drugs for people using drugs. That's what we've been announcing, being able to invest over $60 million to be able to do that...pharmaceutical-grade drugs so that people don't have to go to the streets and use the toxic, poisoned and deadly drug supply.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

I agree, Minister, that this is certainly an important component of the solution, but the reality is that the criminalization of drug users keeps some people away from early treatment and from prevention services due to a fear of being arrested, being labelled or being outed. Do you recognize the role that criminalization is playing in this toxic drug crisis?

[Carolyn Bennett, Liberal, Toronto—St. Paul's, ON]

As you know, the office of the public prosecutor has issued a guidance document that asks police forces across the country not to charge people. That has been a practice now across the country, so people aren't as worried about being charged, because it isn't happening.

However, at the moment, in speaking with Mayor Kennedy Stewart, there is concern about the confiscation of the drugs, even if people aren't being charged. We are looking at all the international models to figure out the best way forward to end this national public health crisis.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

I accept that, Minister, but the reality is that, despite the practices of some police forces, there are still drug users out there who have criminal records and experience stigmatization and marginalization as a result of those records. There is still the fear that, because drug use is still criminalized in Canada, people who use drugs could suffer legal consequences, and that criminalization prevents them from accessing the health services they need.

Do you recognize the role that criminalization plays in the current toxic drug crisis?

[Carolyn Bennett, Liberal, Toronto—St. Paul's, ON]

At the moment, for me, the toxic drug crisis is about getting a safer supply of regulated drugs to these people. There is no question that the pilot projects that will come forward, hopefully in British Columbia, in Toronto and Vancouver, will be able to put an evidence-based framework around what you're describing. We have moved from one to 38 safe consumption sites, and we're able to invest in all of these programs across the country, four of them last week, on safer supply.

The other piece we're hearing a lot about is that our safer supply programs are being prescribed by physicians, and there is a real movement to look at other ways of getting a safer supply, maybe using compassion clubs, pharmacists, and other ways of doing this. That's what we're hearing as a priority for people using drugs.