Health Committee on April 29th, 2024

[Brendan Hanley, Liberal, Yukon, YT]

Excuse me, as I only have a minute or two left. That was fantastic, thank you.

Do you think that criminal use of drugs was a factor in Danny's death and Olivia's death that you described, yes or no?

[Petra Schulz]

It was most certainly a huge factor, the fact that he had access to only unregulated substances and that he felt he had to hide his use. His dream was to join the army. That was one thing he wanted to do, and he knew that having a record of substance use would have prevented that, so he very much wanted to hide that from the public eye, but also from his family, which ultimately meant that he was alone when he died.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

In the brief time I have left, following up on Dr. Caudarella's comment, there's a bit of an us-and-them problem. How do we help to augment the idea that this is everybody's problem, a problem for all of us?

[Dr. Alexander Caudarella]

Thank you.

I think we have their attention. We have people's attention. It's not an awareness issue now. Really, this comes down to people knowing and believing that we have both the evidence and the data to move things forward.

I think this is where I've become increasingly a fan of community coalition work, which is an evidence-based prevention tactic to try to raise people's.... I don't know that people don't want to be involved. I think right now it's that they don't know what to do. We know there are a lot of things that work for prevention, treatment, recovery and harm reduction, but I don't think they know what their role is. How do we set up that skeleton, and how do we support them?

Realistically, a lot of these things are tremendously cost-effective, but—

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Caudarella. That's all the time for this round.

We now go to Mr. Thériault for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Thank you to the witnesses for their input.

Dr. Morin, you've been working in harm reduction for two decades. I don't want to waste too much time talking, since I have just six minutes. I really want to hear your thoughts.

A number of witnesses have told the committee that something had to be done to combat the crisis caused by contaminated street drugs and the near epidemic of deaths. Safe supply is one such measure, and now we're seeing that supervised consumption sites are problematic.

With 20 years of experience in harm reduction under your belt, you are now saying we need to do even more prevention work. However, you also talked about how the legalization of marijuana was, in a way, a failure.

Is it time to once again criminalize marijuana? I'd like to hear what you have to say about that.

[Dr. Marie-Eve Morin]

What a great question. Thank you. I could go on for three hours.

First, it's important to make some things clear. Treating people with addictions involves a continuum of care. Harm reduction is part of that continuum, but it's not the be-all and end-all. It's one step.

Treating comorbidities is at the other end of the continuum. We know that 50% to 70% of people with an addiction also need treatment for a mental health issue. They could have bipolar disorder, ADHD, an anxiety disorder or something else. What's more, at least 50% of opiate-dependent individuals suffer from chronic pain. Therefore, when we treat existing comorbidities, whether physical or psychiatric, it's much less difficult—not to say that it's easy—for someone to get off the substance they are using.

I want to make another point. Earlier, the discussion touched on the criminal element and the criminalization of people with addictions. I spent four years working in federal penitentiaries, and I saw first-hand that 80% of the inmates had committed an offence directly or indirectly related to the use of drugs or alcohol. That finding has been studied. When it comes to decriminalization, I would say that exposure to drugs tends to lead to increased use. A few years ago, I thought it was a more realistic approach. Now, I'm not so sure we are ready for it.

Lastly, I want to point out how ironic it is that we are seeing so many opioid-related deaths. The only known addiction for which pharmacological treatment is successful nearly 100% of the time is, in fact, opioid addiction. Methadone and buprenorphine are used to treat opioid addiction and can help someone get off opioids completely when given at the right dose to the right person.

We need to tackle the root of the problem and focus on our capacity in psychiatry and general practice to treat chronic pain. As I see it, harm reduction is one step. Any alcoholic who wants to quit drinking initially tries to control themselves, before they end up quitting for good. Harm reduction is a way to get people to potentially quit using, total abstinence, or at least reduce their use through the treatment of comorbidities.

That's what I find, but harm reduction is not the gospel. It's one tool, and sometimes, it's not the right tool. It can work for all types of addictions, but it's not the be-all and end-all.

[Luc Thériault, Bloc, Montcalm, QC]

Yes, I understand.

You're saying more should be done in terms of prevention, but there are taboos around consumption. The first is that people are going to start by using recreationally because they like it. Nobody ever says that. If we want to focus on prevention—

[Dr. Marie-Eve Morin]

That's absolutely true, but it may have been truer 25 years ago, because there were far fewer drugs, and the drugs on the market were good quality. It's sad but true.

Today, there are more drugs, more kinds of drugs and contaminated drugs. Young people also mix substances. I don't know a lot of addicts who use only one drug. What I'm seeing is people who are addicted to multiple drugs.

As I said, harm reduction is a tool, but it's not a panacea. We have to tackle the root of the problem and treat comorbidities.

[Luc Thériault, Bloc, Montcalm, QC]

I was thinking of Vancouver, where the authorities are making another attempt to get the public drug use situation under control.

I understand what they're trying to do, but is legislation the better approach?

Municipal authorities could have passed a bylaw to let the police exercise discretion to avoid both stigmatization and substance use issues.

Apparently, people are using in waiting rooms. Are people using in waiting rooms in Montreal?

[Dr. Marie-Eve Morin]

People are using everywhere, you know, even in public washrooms.

I think backtracking would be tough. I don't want to be pessimistic, but the doors have been opened, and it'll be very hard to close them. I don't know how we're going to do it.

Personally, I think we'll need more social workers, outreach workers, psychologists and addictions workers to direct people with substance use problems to mental health or psychiatric care.

I think it would be very difficult to enforce a law. It would be a bit like trying to stop people from driving faster than 100 kilometres an hour on the highway. It's against the law, but everyone tolerates it.

In my opinion, it would be tough to walk things back without dealing with the comorbidities, the mental health and crime issues that go hand in hand with substance use, especially when people are experiencing psychosis or withdrawal.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Morin.

Next is Mr. Johns, please, for six minutes.

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

Thank you to all of the witnesses for being here.

I will speak to Ms. Schulz, first, extending my condolences as well for Danny on the eve of the anniversary of his death. You and the mothers and families know better than anybody how dangerous the toxic illicit drug supply is right now and what it's like to support someone with substance use disorder.

We have seen the numbers in B.C. somewhat plateau at about 5% year over year in the growth of overdose deaths. No overdose death is good. We have seen Ontario at 6.8%. They also have safe supply there. It's a very small amount in both provinces. I think it's less than 2.5% of people who have access to a safe supply overdose. In Alberta the numbers have shot up by 17% in your home province. In Saskatchewan, they have increased by 23%. A neighbouring state, Alaska, a Republican state, has seen an increase of 45% year over year. They have just surpassed B.C. for toxic drug deaths per 100,000, and Alberta is on a trajectory to pass B.C. by June.

Can you tell us what's going on in your home province and why there is such a spike in Alberta, Saskatchewan and possibly Alaska?

[Petra Schulz]

What is happening in my province is heartbreaking. We have seen a government with a myopic focus on treatment. Trust me: treatment is important. We love treatment. We love recovery as families, but we have to make sure that people are well and alive.

Even within that treatment model, a recovery-oriented system of care has been in place for four and a half years, yet, as you outlined, we have some of the highest increases in the country.

I recently tried to get somebody into detox. You have to show up at detox three days in a row at 9 o'clock in the morning to get the person in. Explain to somebody using stimulants that they will get up early, go with me three days in a row, and maybe on day three I'll get them in.

The recovery community in Red Deer has a six-month waiting list. My dear friend, Esther Tailfeathers is from the Blood Tribe in southern Alberta, where the government closed the consumption site. Lethbridge now has a per capita rate that is three times that of other communities. It was the only site that had inhalation. More people have moved to inhalation, and we don't provide these services throughout.

In southern Alberta, in Lethbridge, the Blood Tribe was promised a recovery community three and a half years ago. They have one ceremonial shovel in the ground, but no building forward.

Not only is it a myopic focus on what is called “recovery”, but it's in name only. It is actually not available to people who need it, where the drug supply is getting more toxic, and you see it in the increases.

For me, the true measure of success of any policy approach is when my friends don't have to arrange funerals. That is a true measure of success. Our board chair, Traci Letts, is just planning the future funeral of her son. As long as this is going on, the model is not successful, and Alberta's model is failing us. When people push recovery without harm reduction, without addressing prevention—nobody's talking about prevention anymore.... I'm glad my fellow speakers have raised this point.

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

We had the B.C. police chiefs here, we had the deputy RCMP commissioner here. They were very clear in terms of the decriminalization model in British Columbia, which has been going for only 18 months, that they wanted tools to move people along.

They were also very clear, and Ms. Wilson said:

...we all agree that we do not want to criminalize people by virtue of their personal drug use. Those days are gone. We want to support a health-led approach.

They're very clear that they don't want to go back to criminalizing people.

They also cited:

They're not dying from diverted safe supply and they're not actually dying from diverted prescription medication; they're dying from fentanyl, coke and meth, and that's where we really focus our enforcement efforts.

They also called for more safe consumption sites and expanding them to include inhalation, and they also made it clear that:

...this is not just a law enforcement issue: It's a public health crisis that demands a compassionate and comprehensive response.

Lastly:

The RCMP continues to support all efforts to ensure that an overdose emergency is dealt with as a health and medical emergency.

When you hear that and you see it in testimony, and politicians come out of a hearing like that and they want to attack decriminalization and call it or safe supply as the root cause for this toxic drug crisis, how does that make you feel, as a mother of a lost loved one?

[Petra Schulz]

I feel anger and frustration, but I also feel disbelief that somebody, who is the leader of a national political party, can share information that is not factual and does not align with what has actually happened on decriminalization or on safe supply. I urge you all to look at the evidence that shows the effectiveness of those measures, and that's where we have to focus back.

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

I have a very short question.

Have you, Moms Stop the Harm, met with all of the political leaders in this country, and if anyone's missing, why?

[Petra Schulz]

Mr. Poilievre is missing. I've reached out to him again, saying that we tried a year ago to meet with him. We've written to him several times.

I saw Minister Saks this morning. She made time. With you, I know I can reach you when I need you, but Mr. Poilievre has not heeded our calls for a meeting. We'd very much like to talk to him. We'd very much like to tell him what we feel about families, what we experience. We live this every day—every day—and it is time that he opened his door and engaged in dialogue with families who represent thousands of Canadians who have suffered this loss.

[The Chair, Liberal, Sean Casey]

Thank you. That's all the time for you, Mr. Johns.

Next we have Mr. Doherty, please, for five minutes.

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

Thank you, Mr. Chair.

Ms. Schulz, I appreciate your testimony here today. I don't know whether you've heard my interventions here. I have a brother who lives on the street and is addicted to drugs. I've lost a brother-in-law to overdose, and as a matter of fact I've many family members who are addicted to drugs, and it is.... When you're living it every day you don't know, when that phone rings, whether that's going to be the day you hear that your loved one has been found dead—my brother or brother-in-law—so we relive that each and every day.

Our leader has been very clear that we believe in recovery. We believe that if somebody like you or your son were ready for treatment, that a bed will be there. You don't have to wait six months or show up three days in a row. That's what our leader believes in, and it can be spun every different way.

I do want to thank you for your testimony today, but I want to ask you, do you believe that we should have safe supply of hard drugs like heroin, cocaine, crack or meth on the streets?

[Petra Schulz]

Not on the streets, no, but that is not what anybody is proposing—

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

Should we instead invest dollars in having a bed for recovery? If you need it, it's there.

[Petra Schulz]

It's not a one or the other. We need both.

My son wanted treatment. I made an appointment with his counsellor and with his doctor, but he was dead the very same day I made the appointment. If we don't keep people alive and well, we can have all the treatment beds: They will be empty when everyone is dead.

With treatment, it has to be a choice. It has to be evidence-based. If we focus on abstinence only, the guidelines from CRISM tell us that opioid agonist treatment is what is most effective.

The streets are not paved with safe supply. In Alberta, 98% of the deaths from opioids are from unregulated drugs; 2% are from regulated substances.

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

Dr. Mathew, can you explain to this committee your concerns regarding the government-funded, so-called safe supply?

[Dr. Nickie Mathew]

Sure. One thing that we should look at is the supply of opioids in a population. If you look at the countries that had the highest overdose rates in 2020, the number one country was the United States of America. I think it was around 271 deaths per million population. This is also the country that had the highest supply of opioids among the population.

Fentanyl is an important aspect of this, but how do people end up overdosing on fentanyl? Oftentimes the story is that people started with legal substances that were prescribed, and then they become addicted and develop a tolerance, and then that no longer works for them. They shift to the illicit market at that point, because they need something stronger.

I mentioned 2020, and in that year, the rate of overdose deaths in British Columbia was 340 per million. It's much higher than what's occurring in the United States. It's much higher than in any other province in Canada. As of last year, it's gone up to, I think, 444 per million, so there's been a massive increase as well. What I worry about is the supply of opioids among the population.