Health Committee on April 29th, 2024

[Dr. Nickie Mathew]

Sure. Thanks for the question.

Something that would worry me is that what is provided will not be able to compete with the illicit market. The illicit market is often described as a "poison" drug supply. From the data available, it seems the market is supplying the demand of the end-consumer. When Paul Janssen invented fentanyl, one of the reasons was that it would have a fast onset and offset. For the end-user this means this drug does not have legs, meaning it does not provide the end-users with the duration of intoxication they seek. As a result, in B.C. roughly 50% of the drug supply has another type of drug in it, which is called benzodiazepine, that would provide the duration of intoxication. This makes the drugs provided more toxic. Because we have to think of safety, I'm skeptical that we can provide legal forms of drugs that the end-consumer will use to displace the illicit supply.

Going to your question, I think it will be difficult for the legal market to supplant the illicit market, because we have to think of safety. For instance, if someone overdoses and passes away, more people will actually go to that drug dealer to buy drugs from that person, because they have stronger stuff and that's what's sought after. Safety is not sought after as the primary end-goal of the end-consumer.

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

Thank you. I appreciate that.

Dr. Caudarella, one of the main arguments that have been used by the proponents of the so-called safe supply is that it will offset the illegal and black market. We actually have a bit of a case study here. Cannabis was legalized six years ago. Approximately what percentage of the market in Canada today is legal versus illegal?

[Dr. Alexander Caudarella]

One of the things we struggle with a lot in this country is knowing exactly how much people are using, and who is using what. It's one of the issues, for example, around opioids too. We don't actually know how many people are using opioids in this country.

When it comes to cannabis, there have been a few estimates. To the best of our knowledge, it seems to be that the legal market in the past five years has captured probably about 50% to 60% of the black market switching over, with price being one of the big factors, as well as availability.

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

Thank you. I appreciate that.

I think this is all part of this proof point. If we're going off of this as if somehow people are choosing these drugs because they're safe, we need to recognize that addiction is a medical condition and people aren't necessarily making the logical decisions we would hope they would make in these situations. This is part of the challenge.

Dr. Mathew, you're on the ground in British Columbia. Do you think the request by the premier of British Columbia to roll back a lot of the decriminalization is a good decision or a good request?

[Dr. Nickie Mathew]

I think it's taking all the information in, and comparing what happened with Portugal. Again, in Portugal it wasn't public drug use that was allowed; it was that either you would face legal sanctions or you would go into treatment. Seeing what's happened in Oregon as well, and also seeing what's happened in British Columbia, overdoses have only increased with decriminalization. It's an intervention that's been placed on the entire province, and we haven't seen the outcome. Again, I commend the premier for pivoting once he's had more information.

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

Thank you.

Considering this, Mr. Chair, I'd like to move a motion that I put on notice last Friday:

That, given

(a) a statement from the office of the federal Minister of Mental Health and Addictions and Associate Minister of Health states that there will be a meeting with British Columbia's Minister of Mental Health and Addictions to discuss drug decriminalization;

(b) three municipal councillors within the Greater Vancouver Metropolitan area have indicated they will bring motions to their respective councils to formally call on the provincial and federal [governments] to end the drug decriminalization pilot;

pursuant to Standing Order 108(2), the committee add an additional two meetings to the study of the opioid epidemic and toxic drug crisis in Canada to discuss decriminalization; and that the Minister of Mental Health and Addictions and Associate Minister of Health and Health Canada be invited for no less than two hours; and British Columbia's Minister for Mental Health and Addictions and DJ Larkin of the Canadian Drug Policy Coalition be invited for no less than two hours.

I think it is absolutely incumbent on us as legislators, when we've had such a huge development happen in the last few weeks in the conversation around decriminalization, that we look into this. We haven't heard from the federal government on where they're at. What we have heard is that the Minister of Mental Health and Addictions says that she is not planning to take any immediate action.

We have heard that the police in British Columbia do not have the tools they need to keep people safe. We have heard that addictions have gone up. We have heard that overdose deaths have gone up. We have heard that there is crime, chaos and disorder running rampant in our communities.

I think it is absolutely incumbent on us, especially as we've been undertaking this study, to continue looking into this. This has developed quite quickly since we had Fiona Wilson, the deputy police commissioner from the Vancouver Police Department, come to state that they had no tools to be able to do their job. I would ask that we be able to have this study go forward and expand this so that we can have those ministers come in and explain from their perspective how we should go forward in this, so we can make sure that all Canadians are safe and that British Columbians are safe.

There are six people every single day who die in the province of British Columbia due to overdoses. It's incumbent on us that we take every single one of those lives seriously and that we do everything we possibly can as legislators to make sure that both public safety and public health are being taken into account.

I would ask that people support this motion.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge.

A very similar motion was put on notice, but because it directly and clearly relates to the matter we're studying, the motion is in order. The debate is on the motion.

We have Dr. Powlowski and then Dr. Ellis.

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

I note that we had pretty extensive discussions a couple of weeks ago about the disorder caused by public use of drugs. I'm very happy to see the announcement by the premier of B.C. to again criminalize the public use of drugs.

I personally don't disagree with this, but there's a whole raft of other issues related to the opioid crisis. Indeed, we're talking with some of the experts on a lot of those other issues. I think there is going to be a need, and I probably would agree to extending the study, but it would perhaps be on other issues as well.

Given the importance of the witnesses we have here and the fact that we'd like to ask them other questions and address other issues related to the opioid crisis, I'm moving a motion to adjourn debate.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Powlowski.

As we know, a motion to adjourn debate is not debatable and must go directly to a vote.

Shall the debate on this motion now be adjourned?

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

I request a recorded division.

[The Chair, Liberal, Sean Casey]

We'll have a recorded division, Clerk, please.

(Motion agreed to: yeas 7; nays 4)

We're moving on with questions. Next up is Madame Brière for five minutes.

Mr. Doherty.

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

I believe Ms. Goodridge had 30 seconds prior to moving the motion to extend this study.

[The Chair, Liberal, Sean Casey]

From the stopwatch I'm looking at, by the time she moved the motion, it was very close to the time. It's certainly not enough time to allow for a question and answer, so I'll recognize Ms. Brière.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Mr. Chair.

Good afternoon to all the witnesses. Thank you for joining us today for this important discussion.

Dr. Caudarella, can you explain to us how detox and forced abstinence increase the risk of death for someone battling addiction?

[Dr. Alexander Caudarella]

Thank you for the question.

Detox has been used to treat addiction for a long time. It's still used to treat a lot of substance addictions, one of the most common being alcohol addiction.

However, we know that abstinence reduces opioid tolerance. When a person comes out of detox, their risk of dying within a month or a year is higher. We see the same thing in prisons and other situations where people are forced to abstain from drugs. For example, when a person is released from prison, their risk of death is 10 times higher than a person who was not forced to wean off drugs.

We know that opioid agonist treatment is necessary in detox and treatment centres and in prisons.

Thank you.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you very much.

Dr. Morin, you talked a lot about comorbidity. We know that substance use can exacerbate mental health problems, but, on the flip side, people will use drugs to forget about their mental health problems. What should be treated first, the mental health problem or the substance use problem?

Which problem do you think should be dealt with first? Should they be seen as two separate issues that nevertheless have an impact on each other?

[Dr. Marie-Eve Morin]

That's the big question, the chicken or the egg. Everyone is asking that question.

Let's start by putting things in perspective. There are two types of mental health issues related to drugs.

One is the presence of comorbidities and self-medication. The most common example is alcohol use in response to anxiety disorders. A lot of people with anxiety self-medicate with alcohol. Anxiety was there first, and substance use problems came later.

The other is substance-induced disorders. For example, a lot of teenagers appear to have ADHD symptoms, but those symptoms are actually induced by cannabis use. In other words, the symptoms are triggered by substance use, not the other way around.

I would say that it's important to try to diagnose the primary disease, if there is one, and to treat that at the same time as the substance use problem. We shouldn't be doing what we used to do, which was ask patients to stop using for six months and provide care only at the end of that period. That doesn't work anymore. Addiction and the mental health problem, if there is one, must be treated together. That's called concurrent treatment, or management of comorbidity.

Your big chicken-and-egg question remains unanswered. Sometimes prolonged abstinence provides answers, as in the case of bipolar disorder or psychotic disorders.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you very much.

In response to a question from my colleague, Mr. Thériault, you explained how you would reach out to young people to do prevention and education.

However, we heard earlier from another witness that, when people turn to drugs like fentanyl and even more potent drugs, they're not looking for safety.

What are your thoughts on that?

[Dr. Marie-Eve Morin]

People are chasing the buzz. Remember, people use for two reasons: to increase pleasure or to relieve suffering. It's rarely for both reasons at the same time.

We learn a lot from peers. When I go to conferences, I bring a person in their twenties who has come out the other side. I bring a young adult who experienced prostitution, street gangs, youth centres, opioids and all kinds of other substances. I'm not in the spotlight at these conferences; those people with lived experience are. When a 22-year-old who was in jail, who experienced youth centres, prostitution and drug dealing, tells their story, that hits home for young people way more than anything a doctor could say.

That's my way of doing things, and it works very well. These conferences make an impression on young people. They remember the person who came out the other side while they were still young. That's my angle.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Morin.

Next is Dr. Ellis, please, for five minutes.

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

Thank you very much, Chair.

Thanks, everyone, for your answers thus far.

I really want to focus a bit on prevention, if I could. I'll start with Dr. Mathew.

You spoke a bit about prevention. I realize that you're a forensic psychiatrist, so if it's outside your scope, feel free to say so. It would appear that substance use disorder is a problem that could start very early, but it perhaps is something that we need to spend some money on with respect to prevention. We can talk about resiliency, we can talk about exercise, we can talk about friendship and we can talk about meaningful lives and all those things. Are there programs out there right now, funded by the federal government, that are talking about prevention? Do you know that answer? If you don't, that's fine. Perhaps you could talk about how you see prevention.

[Dr. Nickie Mathew]

I work in addictions and I also work in forensics. I do both.

There are education campaigns to help people understand the toxicity of the drugs out there, but there are other programs available. For instance, in Iceland they had a program where they gave vouchers to families to put their kids in extracurricular activities. As well, I forget the age of the kids, but under a certain age for teenagers there was actually a curfew. People were encouraged to not go out at night and were encouraged to engage in sports. This dramatically reduced the alcohol and drug use in that country.

The other thing I would mention is lowering the amount of opioids in the street supply. I think that's important primary prevention. There are also things like access to therapy and early treatment so that the substance use disorder, or the mental health disorder that can cause the substance use disorder, doesn't progress to something where a substance use disorder becomes severe.

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

Thank you very much.

Dr. Morin, I have the same question for you.

[Dr. Marie-Eve Morin]

Can you repeat the beginning of the question? I think it's similar to what I said to Madame Brière.

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

It is very similar.

Do you now have federal government money funding prevention at the current time? Are you receiving any federal government funding for the prevention that you're doing? Can you talk about what a good prevention program might look like?