Health Committee on April 29th, 2024

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

In your opinion, will decriminalization and so-called safe supply fix our opioid crisis?

[Dr. Nickie Mathew]

I'll start with decriminalization. If you look at decriminalization, there are different models for it. It's important to distinguish the two. For instance, you had a model like Oregon's, which was very similar to what they did in Vancouver, where they allowed public drug use. What they found was that between 2022 and 2023, there was a 45% increase in overdose deaths, which was the highest increase of any state. That's why this past March Oregon repealed their decriminalization.

Portugal had a different model. What they did with decriminalization was to have people either face legal sanctions or go into treatment. There was sort of a coercion into treatment, and that's the shift that Oregon has made. I actually commend the B.C. government, because when they found more information, they were able to pivot, as well. Regarding—

[The Chair, Liberal, Sean Casey]

Thank you. I'm sorry about that. You took a pause at about the five-minute mark and allowed me to jump in. I'm sure that you'll get a chance to expand upon your answer.

Thank you, Mr. Doherty.

Next we have Ms. Sidhu, please, for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you to all of the witnesses.

Thank you, Ms. Schulz, for sharing Danny's story. No mother should go through what you went through.

The opioid crisis affects people from every walk of life. Given the stigma attached to substance use, we can understand why professionals, people in school and people with families are afraid to even admit they're using drugs.

Could you expand on this? Why is it important to remove stigma and barriers to care?

[Petra Schulz]

Thank you for your kind words.

Stigma is a barrier to getting help. As long as substance use is as deeply stigmatized as it is now, people will hide their use, and we know that men are disproportionately affected among the victims; about 80% are men. Stigma makes it harder for people to reach out. Any measure that we take to reduce the stigma means that people feel more open even to discussing it with a friend or a family member, or a student may reach out to a teacher.

Nothing stigmatizes people more than the criminalization of substance use. We know that a criminal record affects what you can do for education, where you can travel, where you can live and what you can study. That is just such an enormous barrier that we can remove with decriminalization.

[Sonia Sidhu, Liberal, Brampton South, ON]

You talked about education. At what age does education need to start about the awareness of drugs?

[Petra Schulz]

It should be age appropriate. I'm an educator, and I get this question a lot. We should discuss substance use when we discuss other issues young people need to learn about, like how to address alcohol and safe sex, and we should not separate it out. Put it in the entire package when we discuss, at an age-appropriate level, of course, with our young people how to keep them safe, and we should focus on, as much as possible, reducing.... Abstinence is always a goal when we talk to young people.

When we take a harm-reduction approach, that also means they stay safe. As we all know, we'll never get all teenagers to abstain from having sex, but we want them to be safe. By the same token, we want teenagers to be safe if they use substances.

[Sonia Sidhu, Liberal, Brampton South, ON]

You have been a strong advocate of a person-centred approach to care.

What do you think about that and the community-led approach for youth?

[Petra Schulz]

Community-led approaches are really important because the community is not only those who have experience, but also the ones who can carry it forward. That is why it is so important to include affected communities.

Something that is not often talked about is that in some of our communities in Canada, substance use is even more stigmatized. It's important to take the messages into these communities, in different languages and with people from the community.

[Sonia Sidhu, Liberal, Brampton South, ON]

You also talked about misinformation.

Do you want to elaborate on that? What kind of misinformation is it?

[Petra Schulz]

For example, it's saying that the streets are plastered with safe supply. They are not. Alberta shows you that. Even in British Columbia, we hear that from the chiefs of police. We hear that from the chief coroner. Safe supply is not what is killing people; unregulated drugs are.

That is something we hear over and over again from certain corners—that people are dying because of safe supply.

The other thing is that decriminalization causes social disorder. When people are unhoused and have no safe place to use, they will use in public, whether it's in British Columbia, Alberta, Ontario or any other province or territory in this country.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Dr. Caudarella, I have a question for you.

What types of treatments or services must be available for individuals using substances in response to physical or sexual abuse, or any form of trauma?

[Dr. Alexander Caudarella]

Thank you.

In health care, we talk about trauma-informed care, which is this idea, essentially, that not everyone will disclose their trauma to begin with, so it's about opening that door and treating everyone in a way that is sensitive and appropriate. I think we probably need something fairly similar when it comes to substance use and making the assumption that any person could potentially have a substance use disorder and may need some help.

This is where understanding.... People want to be resilient. People want to be able to bend and bend back. I think that being able to build that out is probably one of the most important things we can do for people from a trauma-informed lens. We need to be having a lot more conversations about how we build skills.

Even when we talk about some of these prevention programs that, for example, have done amazing things like reduce by half the initiation of drugs or alcohol, it's really about skill-building. It's about building communication with families. It's about helping people survive better in the world.

More than anything, it's about being able to meet people at the moment they are in.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Caudarella and Ms. Sidhu.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Morin, you said that we should avoid taking an ideological stance when deciding on a strategy. I agree with you.

You talked about teens and the importance of prevention.

I'll give you my two and a half minutes to talk to them. What would you say to them before they get to your clinic, so that they don't end up there?

[Dr. Marie-Eve Morin]

In all humility, I've been working on prevention in schools since 2005.

Earlier, someone asked when we should start talking to kids about these issues. If conversations about drugs and sex haven't happened by the time a kid is 12, I think that's the right time to start. Those conversations need to start in grade 7.

Young people are smart. They should not be underestimated. We have to use straightforward, easy-to-understand language, to let them know how toxic these substances can be. We have to teach them that, for all of us, life is about making free and informed choices. I think the problem is that young people don't have enough information. We can make sure they're informed by talking to them in plain language and explaining the facts.

There was a discussion about skills earlier. Young people are capable of learning. Their brains are sponges. Young people aren't being informed these days. Schools still take a repressive approach. But we can tell young people what substances are. We can tell them that substances can feel good, but can also be risky. For example, people who use MDMA may have panic attacks or suffer from a neurological syndrome. Cannabis use increases the risk of psychosis. Alcohol consumption can result in a coma. Taking opioids is like playing Russian roulette. We know now that when you use opioids, you don't get a second chance.

Yesterday, I attended my favourite patient's funeral. She was 48 years old, and she died of a fentanyl overdose even though she'd been an injection drug user for 20 years. It doesn't matter if you're a first-time user or a long-time user. In her case, it was just bad luck.

I think young people are much more tuned in than we think, and we need to trust them. If we tell them the truth, they'll make better decisions. A lot of young people make these choices because they don't know better or their friends dare them or pressure them.

Unfortunately, many copy their favourite artists. We know that rap culture in particular promotes Xanax and lean, which are also opioids. We all had our childhood idols, and they all had their habits, but I think that celebrities are promoting really dangerous things nowadays, including opioids and benzodiazepines.

Number one, young people need to be informed. As soon as they turn 12, they're able to understand.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Morin.

[Luc Thériault, Bloc, Montcalm, QC]

In terms of experience—

Am I out of time already, Mr. Chair?

[The Chair, Liberal, Sean Casey]

Yes, you're almost at three minutes.

Mr. Johns, you have two and a half minutes.

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

Thank you.

We heard the expert task force on substance use from Health Canada. They made it very clear, with unanimous recommendations, to support decriminalization, safer supply, treatment on demand, recovery prevention and education, and to scale up all those areas. They were unanimous. They had the police chiefs association, health experts, indigenous leaders on substance use, and people with lived and living experience. The police chiefs of Canada put out a report that reflected that as well.

Portugal delivered a model of that, which included a coordinated, compassionate and integrated approach.

Right now, we have a government that's taking an incremental approach in a public health emergency. We have politicians who are spreading disinformation—

[A voice]

Like yourself....

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

—in the middle of a public health emergency. Both cost lives.

I don't appreciate being heckled here at this committee, Mr. Chair.

Secondly, we put forward Bill C-216 to take a health-based response to the toxic drug crisis, hoping it would get to committee and at least have an opportunity to be looked at.

We have had a summit on the theft of autos, which is, of course, an important issue, but this is the leading cause of death in my home province for those under the age of 59. There's still nothing. We have not had the government declare a national public health emergency. We were glad today in question period to finally see that they're going to reinstate, under our pressure, somewhat of a form of the expert task force on substance use. That's a relief.

Portugal implemented an expert task force and the politicians were heroes because they got out of the way. They let the experts lead instead of ideology.

Can you speak, Ms. Schulz, about the importance of listening to the experts and letting evidence-generated policy lead versus ideology and politics, and about how that is costing lives?

[Petra Schulz]

We see it again with the Alberta model. That is failing because Alberta has chosen to keep a focus on only a narrow scope of opinions, whereas when we let the experts lead, we look at all the available evidence and follow that.

Having experts lead means that we can have people in the room who use drugs show us what works for them and what is effective.

That is what has also happened in other countries. I was recently at the United Nations Commission on Narcotic Drugs, where I was amazed that the U.S. put forward a policy that had the words “harm reduction” in it. For the first time in the history of the United Nations, harm reduction was one of the pillars that was included. Switzerland talked about how it continues to provide safe supply.

The world is moving in that direction. Canada cannot move backwards.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Schulz.

Next we have Mrs. Goodridge, please, for five minutes.

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

Thank you, Mr. Chair.

Thank you to the witnesses for taking time to be here today.

I'm going to start with Dr. Mathew.

In 2021, you published a piece in the British Medical Journal based on some discussions you had with a convicted drug dealer in B.C. The person said that many people who use drugs seek out fentanyl. He even said that when people see someone overdose, they want to go to buy from that person's dealer, because they know they'll get the stronger, better stuff. This seems to indicate people seek out stronger drugs as opposed to a “safe drug”, even if they know it could kill them.

I was wondering if you could explain this a little bit.