Health Committee on April 15th, 2024

[Sonia Sidhu, Liberal, Brampton South, ON]

My question is this: How can we work together to support our frontline law enforcement officers to respond to this crisis? Besides this question, is there any other...? You mentioned Health Canada. Can you elaborate on that?

[Fiona Wilson]

Well, certainly we have a number of things we do to try to assist our frontline officers. You make a very good point that at the end of the day, they are the ones dealing with the tragedy associated with the toxic drug crisis in terms of a frontline response, along with, of course, all the people who are impacted—the loved ones and the family and friends of people who are dying. Anything we can do to support those members, and that includes naloxone kits being issued....

Quite frankly, I think the most frustrating thing for our members right now is seeing situations where they do not have the tools to adequately respond. At the end of the day, our frontline members want to be able to deal with these problematic circumstances of public consumption, and I think that would be the single best way to support them: to give them those tools so that they would be able to do their jobs when there are community concerns about problematic drug use.

[Sonia Sidhu, Liberal, Brampton South, ON]

I have one other question.

In your testimony, you said that 85% of deaths are from fentanyl. Do you think an education campaign needs to be addressed with other organizations working on the ground?

[Fiona Wilson]

That's a great question.

I always talk about decriminalization as being one tiny piece of a much, much larger puzzle, and in order to put that puzzle together to see what the picture is, we need increased education and increased prevention. We also need some harm reduction services, such as having our members carry naloxone kits, and we need safe injection sites. Really, it's a multi-faceted approach to this problem. It includes safe supply initiatives, but any one thing on its own is not going to be effective.

I can't tell you how supportive police in this province are when it comes to increased education, increased prevention and an increase in health services, such as treatment on demand.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Sidhu.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Ms. Huggins, earlier you said that we are facing a public health crisis and that we have to take a comprehensive approach and take into account the social determinants of health. For some time now, we have been talking about the connection between the decriminalization of drug possession and public use of drugs. How can we find solutions to this problem using a harm reduction approach?

For example, are supervised injection sites inadequate, too few in number or too unattractive to encourage people to use in those places rather than anywhere else in the public space? Do these people have enough housing or places to go? When someone goes to a McDonald's, a subway station or a hospital to inject drugs in the winter owing to the cold, it's because they have nowhere else to go.

Tell us about some of the solutions you're looking at in that regard that would be part of a comprehensive approach based on the social determinants of health.

[Rachel Huggins]

Thank you very much for the question.

I think you're very much correct. I think Deputy Chief Wilson actually mentioned it. It is an all-encompassing approach.

You mentioned things like why individuals aren't using the supervised injection sites. I think the role of a whole-of-community approach that includes health, justice and police is really to do that kind of assessment, not only to understand what you need in your community but what those individuals may want or need at a different time with whatever issue they are dealing with.

There are quite a number of resources that we have identified as having an impact on an adequate health response. Housing has been mentioned, and supervised injection sites and location. I think the issue is that we need to all work together, with collaboration among health, police and social services to determine what is required and what those individuals in that community need.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Huggins.

Thank you, Mr. Thériault.

Go ahead, Mr. Johns, please, for two and a half minutes.

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

This is a question for Ms. Wilson.

In terms of diversion of opioids, can you tell me about what's also happening with opioids prescribed for chronic pain and other conditions that you're seeing on the street, in terms of what's prevalent and what's changing?

[Fiona Wilson]

We see both. There's no question about that. We know that about 20% of patients who are prescribed hydromorphone, for example, are in a bona fide safe supply program, while about 80% of them are prescribed for pain outside of addiction issues.

We also know that about 50% of the hydromorphone pills that we come across can indeed be attributed to safe supply. That's just in recognition of the fact that someone who's on a bona fide safe supply program has a more regular significant supply of hydromorphone.

My biggest concern when it comes to pills is the number of organized crime groups that are producing counterfeit pills. I saw a photo of this just last week, and you could not distinguish the counterfeit pill from the real prescription pill. The problem is that we have no idea what's in the counterfeit pill, and it could absolutely be deadly.

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

Thank you so much.

Deputy Commissioner McDonald, you've had an exemplary career. Do you find it offensive or insulting that it might be suggested that your testimony was misleading here at this committee or that it might be influenced by a provincial election?

[D/Comm Dwayne McDonald]

Thank you for the question.

No, I don't take offence. These are critical issues that have to be discussed. I understand the concern that police agencies could be directed or influenced, but I don't take exception to that, and I'm more than willing to answer those questions.

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

Ms. Huggins, we've not had a summit on the toxic drug crisis, yet we've had a summit on the auto theft issue. Do you believe that the toxic drug crisis deserves to have a national summit at a first ministers meeting, and do you believe we should reinstate the expert task force on substance use?

[D/Comm Dwayne McDonald]

Was that directed towards me?

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

It was directed to Ms. Huggins.

[Rachel Huggins]

I'm sorry. I didn't hear the beginning part of the question. Thank you for the question.

I think there is a lot of value in having that expert task force reconvened. I think that now that we have had the experience of decriminalization in British Columbia, there are lots of things that the whole country can learn, and we need to learn from it. The task force is definitely needed, and I think that you will see lots of support for it across the country.

I also think that a national summit is important. These are issues that affect every corner of the country, and there needs to be that exchange you heard about from Dr. Day. It's a very different approach in Alberta. We hear from British Columbia about the different issues that are facing law enforcement and the public unrest, so definitely a summit is important and will help us in the future to determine what elements need to be included in any type of approach.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Huggins.

Dr. Ellis, please go ahead for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thanks very much, Chair, and thanks, everyone, for being here today.

Dr. Day, we talked a bit about the amounts of drugs that have been decriminalized, and we throw around this amount of 2.5 grams of fentanyl. I've spoken about it in committee here as a former physician, but you're a current addiction specialist. Maybe it means more coming from you if you put in perspective how deadly that amount of fentanyl actually is.

[Dr. Nathaniel Day]

Thanks for that question.

I think I'll put it this way, Dr. Ellis. There are published case reports in the literature of people dying of an overdose from the accidental administration of three milligrams of hydromorphone in a hospital setting. There are multiple cases of that, and that's why it's a high-risk medication and why we go to so much effort to label things as morphine versus hydromorphone. Hydromorphone is extremely potent and could kill a person with no trouble if they don't have opioid tolerance.

Fentanyl is 50 times more potent that morphine, and that number of grams of fentanyl is certainly an amount that could easily kill one or more people.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thanks very much for that, Dr. Day.

To me, it would seem slightly ridiculous to allow people to have 2.5 grams of fentanyl when routinely, in the emergency room, if we were going to use it for a procedure to reduce a dislocated shoulder, we might use 200 micrograms.

Is that a fair statement?

[Dr. Nathaniel Day]

That's absolutely correct.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that.

To Mr. Ng, the criminal operations officer, you talked a bit about precursor chemicals and the difficulty in having them listed as illegal in Canada. Does law enforcement regularly communicate to the Liberal government that we need better and quicker action on that?

[A/Commr Will Ng]

Thanks for your question.

Through the chair, we have communicated to government through the law amendments committee and a number of other committees to advocate scheduling those precursors. So far, I think it's still a work in progress.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much.

Through the chair, this goes to you again, sir: Do you have any idea how long that's been in progress now?

[A/Commr Will Ng]

It's been brought to my attention for over two years.