Health Committee on May 9th, 2024

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

Are you effectively saying that police in British Columbia are figuring out that government safe supply—or so-called safe supply—is fuelling organized crime and gangs?

[Elenore Sturko]

Yes.

Police have put out news releases and have reported in the media about drug investigations that have a nexus to organized crime. Gang activity in British Columbia is obviously a concern, so any kind of diversion or government program that would in any way put money into the hands of organized criminals and gangs is a top concern.

That doesn't mean we have to stop helping people, but when there are ways that we can mitigate risks and help stem the flow of drugs into the hands of criminals, we absolutely have to do that.

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

One other piece I find really interesting is that the overdose rates for kids in British Columbia are steadily increasing. The children's minister actually stated that she thought the federal Minister of Mental Health and Addictions was doing a great job and had faith in this policy and the direction.

We know opiates are highly addictive. We've had many doctors come and present to our committee on this. What is the impact on the families whose children started out on this so-called safe supply that they believed was safe because it has been marketed as safe?

[Elenore Sturko]

One of the most impactful and devastating stories I heard first-hand from a father named Greg. His young daughter started using drugs at age 14. She died at age 15. The widespread impact was that her group of friends was using drugs together. One of the kids in the friend group is still living. She said that they did start off by getting Dillies, which is the street name for Dilaudid, for hydromorphone. They did think it was safe.

They started to become sick. At first they started off by taking it once in a while, then they started feeling the need to take it more. Then it came to the point where if they stopped taking it, they would feel sick. When the withdrawals were no longer being managed, even just by taking the Dillies, the one girl who actually survived started taking fentanyl. Even though she had access then to OAT, she still continues to use drugs now. I know her mother very well. It is an absolutely awful journey that they're on.

There are not enough supports and services, but this is widespread. Especially when we're talking about kids or even young adults or adults, it's affecting their friend groups.

I think one of the biggest things that's really concerning to me.... If I can just read this into the record, this is actually from Purdue Pharma. This is their patient medication information. It says:

Never give anyone your DILAUDID. They could die from taking it. If a person has not been prescribed DILAUDID, taking even one dose can cause a fatal overdose. This is especially true for children.

It also says:

Even if you take DILAUDID as prescribed you are at a risk for opioid addiction, abuse and misuse. This can lead to overdose and death. To understand your risk of opioid addiction, abuse, and misuse you should speak to your prescriber

My concern is the lack of research on this—

[The Vice-Chair, Conservative, Stephen Ellis]

Ms. Sturko, I'm sorry. I'll have to interrupt you there. I think that's a good place to stop.

Next up, Dr. Powlowski, you have the floor for five minutes, please.

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

We've heard both sides on the issue of safe supply. We've certainly heard people say that there's plenty of evidence for the beneficial effects of safe supply, and by that, they meant the Canadian version of safe supply, which is getting a whole bunch of Dilaudid and going home with it.

We've also heard the opposite from members of Health Canada, who generally seem to be supportive of the idea. However, they admitted that there wasn't a lot of evidence for a safe supply in the Canadian context.

We also heard the same thing from the Stanford-Lancet Commission, which was very much against safe supply. I would note that the B.C. Provincial Health Officer, in her review of safer supply, also said that there wasn't a lot of good evidence for safe supply.

What there is a lot of good evidence for is iOAT, injectable opioid agonist treatment. NAOMI and SALOME, as Mrs. Goodridge pointed out, offered directly observed treatment. A lot of the evidence from Switzerland and the studies that are again cited as evidence for safe supply also offered observed treatment with injectable drugs—heroin, at the time.

The concerns about diversion, I think, are totally legitimate. The Swiss have this approach because of the concerns around diversion. A lot of people in B.C. continue to die because of fentanyl. That's what's killing them. Even though they get Dilaudid, it's not enough for them. They use fentanyl.

What do you think about intravenous observed treatment in this kind of Swiss model, where people can come into a treatment facility and get observed injectable doses of fentanyl?

Would you be in favour of that or at least willing to contemplate this?

[Elenore Sturko]

I wrote a letter to Minister Ya'ara Saks, which I also carbon-copied to Premier David Eby, to the effect that I actually support a call from doctors across Canada, addiction specialists, including 72 in British Columbia, who are calling for witnessed prescribed alternatives that are recovery oriented.

My purpose in coming here today isn't to stop people from getting life-saving medications, if this is what is important. I want to make sure that we understand the scope of the risk to the population. There is a population-level risk that is even identified by Dr. Henry, for example, in her report that you referred to, which was released on February 1.

If we're going to be providing treatments, which, as you stated, in Dr. Henry's report, have not enough evidence at this point to be described as fully evidence-based, we need to make sure that we're not causing unintentional harms.

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

I've heard from addiction specialists who are in favour of iOAT that our safe supply was kind of a poor man's version because iOAT, where you bring people in and you witness them getting injections, is a lot more costly. That is obviously an issue for governments. Do you think we should be putting more money into providing more of that kind of therapy versus the present kind of safe supply?

[Elenore Sturko]

It's a “pay now or pay later” scenario. And what is the cost of a life? When we reduce these things to what will it cost and we look at the human cost, six people a day in British Columbia are losing their lives. I think that if there are alternatives that can protect the public from diversion, make sure that we're ramping up things like prevention strategies and actually warning people that it is not safe to take other people's medication and actually safeguarding the public.... Of course, we need to invest in a whole scope of services, but also in social supports, housing, things to help people become stable so that if they do access medical programs they have the social stability to maintain their use of those programs.

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

Maybe I can ask the same question to Professor Oviedo-Joekes.

Should there be more facilities that would allow directly observed treatment, including potentially intravenous and/or smoking drugs as an alternative to the present safe supply with pills that you go home with?

[Eugenia Oviedo-Joekes]

That is definitely an alternative. This option should not just open new facilities, but integrate them with the services that are already there. Opening new facilities can be costly. If you integrate them with the services, you make it mainstream. Then people who leave a treatment can go to another if they are ready to switch from injectable to oral medications.

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

Thank you.

[The Vice-Chair, Conservative, Stephen Ellis]

Colleagues, just so everyone has an idea of where we are, it appears that we have at least one more round, which will take us about 25 more minutes or so.

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

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

After nine years of this NDP-Liberal government, we have tragically seen over 42,000 overdose deaths, rising child overdose deaths and rates.

Do you think that the Trudeau government is doing a good job at managing this crisis, Ms. Sturko?

[Elenore Sturko]

No, I don't think governments at either level, provincially or federally, are. I think that not enough emphasis has been put on prevention, certainly. We keep having these discussions about individual services. While they're important, what we really need to do is start developing a true framework for the country and for individual provinces that is a recovery-oriented system of care that has strength in all four pillars, not the one-legged stool of simply trying to look at one service option at a time but vastly scaling up all parts of the pillars, including enforcement.

One of my greatest concerns is the lack of prevention and education. I'm especially troubled to see young kids and families and especially having to meet with families of people who've lost a child. I really want to be strong in my statement here today. This isn't about stopping people from getting help; this is about making sure that when people reach out for help, first of all, it's there, and that in any treatment options and pharmaceutical options that go forward we make sure that we're not increasing the risk to other people.

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

Actually that's a great segue to my next question. What is the approximate delay or how readily accessible is detox in your riding or B.C. more generally, and what is the wait time for government-funded treatment in your province, approximately?

[Elenore Sturko]

Unfortunately, and I do have some notes on it, it's incomplete data. Here we are talking about a government that has had almost a decade in power. In our province we've been in a public health emergency for eight years. I heard the comments today about whether Canada should declare a public health emergency. I want to be clear that it does not help you to declare a public health emergency unless you treat it like an emergency. In our province, to have declared a public health emergency and then have no data on wait times for treatment, to have so many communities without access to services, even scaling up things like access to OAT.... We just saw when the province came and asked Prime Minister Trudeau to roll back on his decriminalization parameters—

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

I was proud they finally decided to copy something Alberta was doing and rolled out the virtual opioid dependency program.

[Elenore Sturko]

Yes, but why would it take that long?

Here we were eight years into an emergency, and only at the 11th hour of a failed experiment were we introducing something that could have provided access to a variety of medications and treatments to people across the provinces, particularly in locations where they don't have bricks and mortar services. It's disturbing.

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

I often get messages from moms who are having a hard time because their children are addicted to drugs. Just today I got a message from a mom who wrote, “I'm so sorry it has been so long. I've been in survival mode fighting to save my daughter. Her 13-year-old friend just died yesterday here in rural British Columbia from overdose at the local hospital after the local hospital released her from an overdose on Friday. Please help us. I can't bear going through another child's funeral. These children deserve so much more than this ignorant system. Doctors should have held her under the Mental Health Act until she could have gone to detox. Another family ruined, many who loved her traumatized and more deaths to follow if something doesn't change.”

That message, as a mom and as someone who sits there....The fact that that beautiful 13-year-old child couldn't get into detox and was released after having an overdose at 13 speaks to how broken this system is.

Ms. Sturko, have you seen any increase in detox capacity in the last two and a half years or five years?

[The Vice-Chair, Conservative, Stephen Ellis]

I'm sorry, Ms. Sturko, but please answer very briefly.

[Elenore Sturko]

The increase has not been notable—only incrementally marginal—and, in fact, when it comes to youth, we know that the only complex mental health and addictions treatment centre that was located in Vancouver is actually closing.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much.

Now we'll turn to Ms. Sidhu.

You have the floor for five minutes, please.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you, witnesses, for your testimony.

Mr. Chair, before I proceed to my question to the witnesses, I have one matter I want to address. Hopefully it won't take much time.

Given the comments of Pierre Poilievre last week in which he suggested he would use the notwithstanding clause if given the chance, the petition tabled by Arnold Viersen on Tuesday to restrict abortion access in Canada and the anti-choice March for Life in front of Parliament Hill today, I feel it is relevant to move the following motion, of which I had given verbal notice on February 15.

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

I have a point of order.