Health Committee on May 9th, 2024

[The Vice-Chair, Conservative, Stephen Ellis]

I call this meeting to order.

Welcome to meeting 115 of the House of Commons Standing Committee on Health.

Before we begin, I would like to remind all members and other participants in the room of the following important preventive measures.

To prevent disruptive and potentially harmful audio feedback incidents that can cause injuries, all in-person participants are reminded to keep their earpieces away from the microphone at all times.

As indicated in the communiqué from the Speaker to all members on Monday, April 29, the following measures have been taken to help prevent audio feedback incidents. All earpieces have been replaced by a model that greatly reduces the possibility of audio feedback. The new earpieces are black, whereas the former earpieces were gray. Please only use a black, approved earpiece. By default, all unused earpieces will be unplugged at the start of a meeting.

When you are not using your earpiece, please place it face down on the middle of the sticker for this purpose, which you will find on the table, as indicated. Please consult the cards on the table for guidelines to prevent audio feedback incidents.

The room layout has been adjusted to increase the distance between microphones and reduce the chance of feedback from an ambient earpiece.

These measures are in place so that we can conduct our business without interruption and to protect the health and safety of all participants, including the interpreters.

Thank you all for your co-operation.

In accordance with our routine motion, I am informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

Pursuant to Standing Order 108(2) and the motion adopted on November 8, 2023, the committee is resuming its study of the opioid epidemic and toxic drug crisis in Canada.

I would like to welcome our panel of witnesses.

For your information, this part of the meeting will run from 11:00 until 1:00, and then, from 1:00 until 1:30, we shall have in-camera committee business.

On the topic, appearing as an individual, we have Sarah Lovegrove, registered nurse, by video conference; Eugenia Oviedo-Joekes, professor, school of population and public health, University of British Columbia, by video conference; Martin Pagé, executive director, Dopamine, by video conference; and Elenore Sturko, member of the Legislative Assembly of British Columbia for Surrey South. She is here in person.

Thank you all for being here.

With that, we will start our statements. You will each have five minutes. I'm a bit of a stickler for time. We'll keep on track and have a nice meeting. We look forward to hearing from you all.

With that, Ms. Lovegrove, you have the floor for five minutes.

[Sarah Lovegrove, Registered Nurse, As an Individual]

Good morning. Thank you for having me here today.

My name is Sarah Lovegrove. I'm a registered nurse and professor for the Bachelor of Science in nursing program at Vancouver Island University, VIU. I'm grateful to be joining you today from the traditional unceded territory of the Sununeymuxw First Nation, colonially referred to as Nanaimo.

I am also an activist and a member of the Harm Reduction Nurses Association, and I am absolutely infuriated by the federal Ministry of Health's decision to support and enable B.C.'s political move to walk back decriminalization.

Drawing strength from the brave university students using their voice to stand up for justice, including the powerful students at VIU, as well as those at my alma mater, the University of Ottawa, I'll be taking this opportunity today to say what needs to be said.

Much like the genocide of Palestinians in Gaza, this worsening toxic drug crisis, killing 22 Canadians each day, is a result and perpetuation of the ongoing settler colonialism and white supremacy that makes up the fabric of our governments, policies, communities and health care system.

Indigenous people are disproportionately impacted by this crisis, experiencing death and injury related to an unregulated drug supply at a significantly higher rate than the rest of the population. Substances like alcohol were introduced to the indigenous peoples of Turtle Island at the time of colonization, and have since been weaponized as a tool of coercion and control to uphold the settler state.

[Andréanne Larouche, Bloc, Shefford, QC]

On a point of order, Mr. Chair.

[The Vice-Chair, Conservative, Stephen Ellis]

One minute, Ms. Lovegrove.

Ms. Larouche, you have the floor.

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Chair, the interpreters are complaining that the sound quality is preventing them from doing their job properly.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much.

Just hold, Ms. Lovegrove. We'll see if we can make it better for you.

I apologize, colleagues. We had some problems with Ms. Lovegrove's sound originally. We thought it was good, but it's not quite where it needs to be. Our suggestion is that we'll halt her statement now. We'll come back and allow her to finish it.

We'll have to move on to Ms. Eugenia Oviedo-Joekes, professor at the University of British Columbia.

Ms. Joekes, you have the floor for five minutes.

[Eugenia Oviedo-Joekes, Professor, School of Population and Public Health, University of British Columbia, As an Individual]

Thank you very much. I will try to speak slowly as sometimes my accent might not be the best for the translators, so I apologize for that.

Thank you so much for having me. My name is Eugenia Oviedo-Joekes. I am a Latina woman. I am today speaking from the beautiful unceded territory for the Squamish people, people of the water. I am a professor at the school of population and public health. I am a Canada research chair in person-centred care in addictions.

Following up from the statement from Sarah Lovegrove, and as a continuation of what she was bringing up, one of the key things for continuing this statement is that the overdose crisis emphasizes that we need diverse strategies, and action and co-operation are key. The problems continue escalating, and we need thoughtful and intentional actions, because this is not a problem with one face. It's time to hold fast and continue moving forward, not retreat.

We have a few medications in Canada that we can use for opioid use disorder that are shown to be effective— however, they are very few. There are a couple of other injectable medications that have shown to be effective, but they don't seem to be rolled out as we expected.

As such, the way we deliver these very few medications doesn't seem to be enough to attract everybody, particularly if we leave the non-rural epicentres. We need other strategies. We need to co-operate with other geographic areas. We need to be flexible. We need to designate facilities and expand take-home doses. We need mobile, outreach, home-based models. Other methods have been established to be effective to reach people with disabilities, to reach people who have caregiving responsibilities, to reach people who are far from the facilities.

The people we see come with many other issues not related to the medication. However, sustaining the treatment, making people feel safe is the first step that we need. For that, we need more than just a couple of medications that the system feels comfortable with.

Using substances cannot be a criminal act. It's not a criminal act to drink in public. Nobody goes to jail, even if it's not allowed. All the problems that we have right now over decades and generations cannot be fixed in a few years. We need to be patient and compassionate, and revise the evidence to make decisions. We need to continue improving and not give up.

Thank you for listening.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Professor Joekes.

Mr. Pagé, you have five minutes.

[Martin Pagé, Executive Director, Dopamine]

Thank you, Chair.

Honourable members, thank you for inviting me to contribute to your work. You have heard testimony from several experts who intervene at various levels to try to stem the crisis we are experiencing. I am pleased to be able to participate directly on the ground, in a very specific, unprecedented social and health crisis context.

I am the father of two young children. I am also someone with experiential and theoretical knowledge, having worked for nearly 30 years now in the harm reduction community. I was a street worker in Toronto and Montreal and I have been called to work at the centre of many crises such as the HIV crisis, the hepatitis C crisis, the housing crisis, the COVID-19 crisis, as well as the contaminated substances crisis that we have been going through for the past decade or more.

I am here today with you as the executive director of Dopamine, a community organization deeply rooted in the Hochelaga‑Maisonneuve neighbourhood of Montreal that has been working with substance users for 30 years. The organization works with a harm reduction approach based on best evidence. In fact, data from several studies have largely shown the many positive effects of this approach on health care for people receiving these services and the community at large.

Today I want to tell you a little-known story: that of the people who founded the organization that I have the privilege of directing and representing to you today.

The year was 1991. The HIV/AIDS epidemic hit Montreal hard. In Hochelaga‑Maisonneuve, health care institutions were struggling to reach injection drug users. The head of public health launched a pilot project to prevent infection among injection drug users. The purpose of the project was to equip community actors, directly in the substance-use environments, to distribute free needles and condoms, but especially to change the fatalist attitudes and perceptions that were driven by the stigma of HIV/AIDS.

I do not need to tell you that the initiative was met with strong resistance at first. Supported by health care bodies and political bodies, it was the stakeholders, peers and people concerned who contributed to stemming the HIV/AIDS crisis. Countless lives were saved. They contributed to making the neighbourhood safer for everyone. Their courage changed the course of history.

Since then, every member of the Dopamine team continues to develop adapted, effective solutions that are focused on the real needs of people who use drugs. They continue to fight to defend and improve the quality of life, the right to health, but especially the right to dignity.

In light of this new crisis, I am speaking to you in favour of recognizing the evidence and the science and I stand by the many experts working in the four corners of the country in order to contribute positively to solutions that are courageous to be sure, but necessary. It is high time that we come back to a pragmatic and humanist approach, instead of fuelling a polarizing debate on Canada's situation based on moralist, anecdotal and sometimes false approaches that only maintain the status quo. It is high time that we have courageous conversations and get to work on the ground, where human lives are lost every day.

We are asking for a number of measures to be taken in that regard.

First, we are calling for the overdose epidemic to be declared a public health emergency across the country.

Then, we must also pursue and guarantee a safer, pharmaceutical-grade supply based on the substance chosen by each individual.

It would also be important to provide increased support to the organizations to facilitate the implementation of supervised consumption services across the country.

We are also asking to ensure that naloxone is broadly available and easy to access for all communities.

What is more, the leadership of people who use drugs needs to be substantially included in all the work that concerns them.

Finally, we must advocate in favour of decriminalization, even the full legalization of drugs.

I would add that we need to look at, even rectify the way the war on drugs has been used to disproportionately criminalize groups such as racialized individuals, first nations communities, people living in extreme poverty, as well as queer and trans individuals, who are bearing a lot of the consequences of this war right now.

I invite you to come sit down with us. I invite you to come talk with those who are grieving. I invite you to come see all the efforts being made to reduce the number of deaths and to save lives in our communities. We need pragmatic and humanist policies for our communities to live.

Thank you from the bottom of my heart for listening.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Mr. Pagé.

Ms. Sturko, you have the floor for five minutes.

[Elenore Sturko, Member, Surrey South, Legislative Assembly of British Columbia]

Good morning, everyone.

As the B.C. official opposition shadow minister for mental health and addictions and recovery, I'm here today to address the profound failure of British Columbia's illicit drug decriminalization pilot and its dangerously labelled “safe supply” program. These initiatives, while presumably rooted in good intentions, have, unfortunately, yielded alarming consequences due to what many forewarned as a lack of preparedness and vigorous oversight.

In February 2023, at the outset of this pilot's implementation, I warned against the B.C. NDP government's lack of preparation and failure to meet several criterial prerequisites outlined in the federal government's letter of requirements. These included expanding treatment capacity, engaging key stakeholders, and developing monitoring and evaluation frameworks. Here we are, 15 months later, witnessing the ramifications of not meeting those requirements. My worst fears, that British Columbia was entering into an experimental policy without the necessary infrastructure safeguards, have materialized. The results have been nothing short of a disaster.

Former federal minister Carolyn Bennett promised British Columbians, “a robust set of indicators as well on both the public health and the public safety that we then will monitor in real time”. However, these commitments and transparency for real-time data have not been met. The absence of comprehensive data collection has directly compromised public safety, leaving our communities vulnerable, and it's British Columbians who are suffering the consequences. Commuters are being exposed to toxic drug smoke on public transit; children find discarded drug paraphernalia in playgrounds; and nurses, who should be safe in their workplaces, suffer assaults and exposure to toxic drug smoke within hospital walls. All of this is occurring while the B.C. NDP government fails to provide equitable and timely access to health and social services to people suffering with addiction.

Despite early warnings from law enforcement, critical safety and enforcement issues were overlooked, and the pilot program was allowed to commence without mechanisms in place to respond to problematic drug use and without the ability to deter behaviours that put others at risk. Moreover, the diversion of hydromorphone from the so-called safer supply program has persisted unabated since 2020. It took three years and substantial pressure from the medical community before a review was conducted in 2023. This review confirmed what many warned about: widespread diversion and limited evidence supporting the program's efficacy. Despite these findings, the B.C. NDP government continues to misleadingly promote this as “safer supply”.

Tuesday's announcement from the federal government, which modifies B.C.'s section 56 exemption to prohibit public drug use, is a stark admission of the failure of government at both levels—the failure to properly consider public safety, and confirmation of the danger and disorder that's been unleashed by this experiment. The modifications shift this crisis back onto the shoulders of police, who are being asked to move people along but with no services to move them along to. It's merely a band-aid on a gaping wound, addressing public drug use while doing nothing to address addiction itself. This policy U-turn does not address the core issues but instead serves as political damage control, an attempt by government to mask the catastrophic outcomes and divert attention from the harms of their policies.

This was an experiment that was doomed from the outset by a failure to provide social services, access to life-saving treatment, housing and health care. Over the past 15 months it's become painfully clear that the decriminalization policy has not saved lives and reduced drug overdoses, and instead has propagated harm and disorder throughout our communities. As we discuss these developments, we have to recognize that this isn't just a policy failure: It's a humanitarian crisis that continues to claim six lives a day in B.C., and we cannot continue on this path. The decriminalization and safer supply experiments have proven ineffective and dangerous, and it is time for us to reject these policies. It's unacceptable to launch into population-level experiments, ignoring obvious harms and being selective in the collection of evidence.

We need strategies that focus on comprehensive treatment options, social supports and robust public safety measures that genuinely protect our communities. We must develop policies rooted in evidence, prioritize public health and provide real solutions to the drug crisis affecting our province and our country. We must prioritize recovery, uphold safety and secure a safer and healthier future for everyone.

Thank you.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Ms. Sturko.

Ms. Lovegrove, we are going to try this again.

Madam Larouche, let us know if there's any issue.

Ms. Lovegrove, you have two minutes remaining.

[Sarah Lovegrove]

I just want to make sure everyone can hear me okay.

Considering that we are sitting at the crux of both Mental Health Awareness Month and National Nurses Week, I feel called to share my perspective on the complex ripple effects of this public health crisis within the—

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Chair, I rise on a point of order.

[The Vice-Chair, Conservative, Stephen Ellis]

Excuse me, Ms. Lovegrove.

We have a point of order from Madame Larouche.

[Andréanne Larouche, Bloc, Shefford, QC]

The interpreters are complaining that the sound is not good enough to allow them to do their work.

[The Vice-Chair, Conservative, Stephen Ellis]

My apologies for that to all of you in the committee. We thought we had it fixed, but clearly we do not.

There's a point of order from Mr. Julian.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Mr. Chair, could the technicians have a look at Ms. Lovegrove's connection?

Also, if the connection is secure enough, could you ask her not to speak so quickly? I think that is also part of the problem.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much for that, Mr. Julian.

I think we've attempted many of those things, but we'll continue to do that. If we're able to resolve the issue, then we will. We have checked the Internet connection. We have checked its speed. We've done the headset check, etc. For reasons unknown, it doesn't appear to be working.

Given that, we will halt that at this point. Again, I extend apologies to the witness and to the committee on behalf of all of us.

That being said, we will continue to work on that in the background, colleagues, and hopefully resolve that as the time goes on.

If it's the will of the committee if we do resolve it, then I think it only fair that we allow Ms. Lovegrove to finish her statement, if that works. It will be a bit unusual, perhaps a bit clunky, but we will do it anyway.

We will start a round of questioning now.

Mrs. Goodridge, you have the floor for six minutes.

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

Thank you, Mr. Chair.

I want to thank all the witnesses for being here today and providing their testimony.

Professor Oviedo-Joekes, I understand that you were involved with both the NAOMI and SALOME studies, which are used as the evidence that brought forward the safe supply programs.

My understanding is that both of those studies used witness dosing. Is that correct?

[Eugenia Oviedo-Joekes]

Yes, that's correct.

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

Based on that, a study that would use witness dosing, how can it be used as evidence to support giving take-home pills of 30 to 40 Dilaudid hydromorphone pills a day?

[Eugenia Oviedo-Joekes]

First of all, the study, as you said, was injectable. We do hope that people who are ready for it can take the doses with them in the cases that are indicated by the prescriber in a conversation with the physician. There was always the intention that as clients evolve, the treatment will evolve with them.

We did have—

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

Did the study look at that evolution?

[Eugenia Oviedo-Joekes]

No, we didn't. We had a trial, and the trial ended. We did show that for our participants injectable was more effective than oral.