Health Committee on May 9th, 2024

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

I thank all of the witnesses who are here today. It's greatly appreciated.

I'll start with Mr. Pagé.

I apologize.

I speak a little bit of French, but I speak more slowly in French.

So, I will speak in English.

I found it quite interesting that your organization is called Dopamine. I find that interesting because 80% of the catecholamine content of the brain is basically what dopamine is. It deals with pleasures, satisfactions and motivation. It also deals with concentration and movement. I found it interesting how you used that as the name for your organization.

You also mentioned naloxone. The impression I got from that conversation is that it isn't readily available to a great extent in your area. Over the years, and in my discussions with paramedics, etc., that has been a big concern for paramedics: actually being able to utilize naloxone.

The concern, in some cases, when they are utilizing naloxone is that they have to step back because of the fear that the moment they give that naloxone to the patient.... When it brings that person out of the state that they're in, they often come out in a violent manner. I'm just wondering if you would mind commenting on that aspect of naloxone.

[Martin Pagé]

I hope I understood the question properly.

I was saying that it was important for naloxone to be accessible and easily distributed in the communities because there are still places where it is harder to access, unfortunately. It remains an effective antidote to opioid overdoses.

As for the fear of first responders, I would say that it is not so much a violent reaction. That is often the reaction that is perceived, but it is more that naloxone often puts a person in a state of withdrawal. I would add that despite their sometimes rather dry reaction after receiving a dose of naloxone, people are happy to know that they are still alive.

That type of rhetoric needs to be balanced out. Naloxone saves lives. Harm reduction saves lives.

That is the effect of the antidote: People sometimes end up in withdrawal. I have never heard any stories or anecdotes where a person had a violent awakening or something like that. They end up more agitated or surprised. It is about having the right intervention techniques. You have to know not only how to administer naloxone, but also how to work with the people who use drugs. That knowledge is also necessary for working in our field.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you very much.

Ms. Sturko, thank you very much for coming. I appreciate your being here in person.

You touched a little bit on treatment and rehabilitation. Canadians are watching this debate that we're having here, and a lot of them are concerned. Where are the steps that are being taken to rehabilitate? That prioritization of recovery, I think, is a very important thing.

We look at the fact that more than 23,800 people, due to drug addiction, are having hypoxic brain injuries. That's going to have a huge impact on provinces on how to deal with those individuals in caring for them. I'm wondering if you would mind commenting on that.

[Elenore Sturko]

What we're seeing in British Columbia is certainly a large number of people who have acquired brain injury as a result of overdose.

I myself have administered naloxone to people in the course of my duty. I'm a former RCMP officer. I can say that one of the things that really worried me is that, at times, I'd be dispatched to a call for a person who was unconscious with a suspected overdose, and there was no ambulance ready in B.C. It would take me five or six minutes to get there. That person, in all of that time, either has very shallow breathing, not very much breathing, or is not breathing at all. Then the naloxone—

[The Vice-Chair, Conservative, Stephen Ellis]

Ms. Sturko, I'm sorry; I have to interrupt you again. The member's time is up. I apologize for that. You can get back to it, I'm sure.

Ms. Brière, you have five minutes.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Mr. Chair.

Ms. Sturko, in your remarks, you were saying that indicators haven't been met.

I'm PS to the Minister of Mental Health and Addictions. Health Canada is monitoring B.C.'s indicators and is telling us that they are met. Could you please tell us what your sources are?

[Elenore Sturko]

What I'm referring to is what was promised by the minister and then what was delivered. I can share with you a little bit about what was promised by the minister at the time. It was that we would be getting baseline indicators and that we would have a robust set of indicators on health and public safety. The minister, who was Carolyn Bennett at the time, in May 2022, said that we would be able to ascertain not only how many lives were saved but how many emergency department visits and hospitalizations there were, and what we were hearing at the time from urban mayors about petty crime. She said that they were all the things that we know are indicators of whether we're really stemming the tide of this crisis.

I just want to go eight months later. There was another press conference in British Columbia, and that was at the outset of the pilot project. At that time, Minister Bennett said, “I would say that we need at least three months to be able to get this sorted out...also, I think as we let people know what indicators have been chosen”. Eight months later, they didn't have the indicators chosen, it seems. “if people have ideas or they have other indicators that they would like, whether it's a small business or whether people are saying, you know.... What would be other things that we could be measuring that would help determine the efficacy?” One thing that was in the letter of requirements was that the amount of treatment and health care would be scaled up.

There was a study that was released by the Journal of Community Safety and Well-Being, and it stated that, just prior to decriminalization coming into effect, 64% of the communities served by the RCMP in B.C. did not have any access to any drug rehabilitation or treatment. That means that the majority of British Columbian cities did not have any access to these services. While that is not the only service that should be provided, it was one of the requirements to scale up these to make sure that we were ready. As stigma would be driven down and people could be connected to services, they would exist. Unfortunately, they just haven't existed.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Okay, but all of these indicators are posted, and Health Canada confirmed that they are meeting the letter of requirements.

[Elenore Sturko]

Well, the other part of it, too, is that, in the beginning, Minister Bennett promised citizens of British Columbia that we would have a dashboard that was going to be updated monthly. The dashboard would be publicly facing and it would be monitored in real time. The context of the data collection was then altered, and that was allowed to become a selective snapshot. I can tell you that I'm very concerned. One of the pages of the snapshot of April 2024, which is the most recent one, provided the number of treatment beds and individual clients who are served. Unfortunately, the snapshot is from the fiscal year 2022-23, so it only captures 59 days of decriminalization.

For us to be able to say at this point that they've captured data that would suggest they could understand fully that people have access to more treatment.... There are no indicators on whether or not that was successful or whether or not people stayed in those services, and it's very concerning.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

I have some quotes that came from you in October 2023. You said that this government has introduced a safe supply where they're giving hydromorphone. They gave it to individuals to help get them off illicit drugs and that we need to continue exploring. You also said that this government was said to be exploring options for pharmaceutical alternatives to illicit drugs, and that that's what they should be doing. You said that you absolutely support harm reduction.

I would like to know if you still stand by these quotes?

[Elenore Sturko]

I think that what's important to note are the concerns I've raised over the duration of my time as a member of the Legislative Assembly. They is a lack of evidence of the efficacy of the program and certainly the absolute failure to look at things that are potential harms to the community.

While it's important that we continue the research and finding ways to treat people and to ensure that they can be protected from overdose through things like pharmaceutical alternatives under supervision and witnessed programs, very little data, if any at all, in British Columbia has been collected on things like the diversion of safe supply, which is of extreme concern to me.

[The Vice-Chair, Conservative, Stephen Ellis]

Ms. Sturko, I have to interrupt you again. I apologize.

Ms. Larouche, you have two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Mr. Chair.

I will turn to Mr. Pagé again.

I would like to come back to your comments on coexistence. There is a lot of talk about coexistence in places that have organizations like yours. To improve coexistence between people who are suffering with addiction and the rest of the population, should we have supervised injection sites?

We were talking about your expansion plans. Tell us why it would be important to have more supervised injection sites and supervised inhalation sites for improving coexistence.

[Martin Pagé]

It is important to have harm reduction services for the simple reason that these projects have been in operation for many years. We are talking here about safe injection sites, but we could also be talking about prevention for infectious diseases such as hepatitis C.

When drug users in a community are in contact with workers in the community services sector or the health care sector, we can do prevention work that will have long-term positive effects. What is more, it improves coexistence since the people are no longer hiding in an alley or a park to consume their substances. Instead they are going to safe, clean sites that are free from stigma, both day and night. That is why we want to increase these services.

We also need to have good communication. I talked about that earlier. Community organizations need to have enough funding not only to keep the services going, but also to have workers who are in communication with the people in the community. I am thinking here about the street workers, the community workers, or even people working with the schools. We need other intermediaries to ensure healthy coexistence in a community.

We must not create tension within the community with respect to harm reduction projects, whose purpose, I repeat, is to save lives and maintain a quality of life during periods of consumption.

Let's not mix up these two concepts, even though they go hand in hand. We have to establish good communication with the community, but especially provide services that save lives. So—

[The Vice-Chair, Conservative, Stephen Ellis]

I am sorry to interrupt you, Mr. Pagé. I know that two and half minutes is not long.

Thank you very much.

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

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

Thank you, Mr. Chair.

Ms. Sturko, welcome. As British Columbians, we have a responsibility, I think we would agree. We have to get a handle on this toxic drug crisis. I appreciate you being here today.

I'd like you to tell us what the death rate for toxic drugs in British Columbia was in March 2023, and what it was one year later in March 2024, according to the B.C. coroner's service.

[Elenore Sturko]

I don't have [Inaudible—Editor].

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

Okay. I'll tell you. It was 46.2 in 2023 and it was 40.3 in 2024. That difference means the saving of hundreds and hundreds of lives in British Columbia.

Now, as Ms. Brière asked you, you have been on record...and I know in conversations with you before, you've said things like, “We're not backtracking on the need for harm reduction”; “With our whole hearts, we want to save people”; and that you support decriminalization and harm reduction.

You weren't clear in your answer to Ms. Brière. Have you changed your position on decriminalization? Given these figures, why would you not be supportive? Though we need to tweak and improve the program, why would you not be supportive when lives are being saved?

[Elenore Sturko]

First of all, yes, I have changed my opinion of decriminalization. I want to be clear, too, that it is important to note that there have been, even in previous years or months, decreases in overdose deaths, even several months in a row, only to be then followed by increases. This is certainly the case. I've heard people on this committee speaking about this before.

I can tell you that in multiple years we have seen trends like this before, only to spike up in other months, then to be followed by, again, year after year, the worst records for overdose deaths that we've seen.

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

I'm sorry. It is my time, and it's very short.

I wanted to ask you about Moms Stop the Harm. Have you met with them?

[Elenore Sturko]

No, I have not.

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

These are our families of victims of the toxic drug crisis. They have been very strong on having a range of services, including harm reduction, decriminalization and safe supply.

Why would you not meet with them to hear those families out and understand the importance of having a variety of tools to lower the death rate, which I think is something we would agree needs to happen?

[The Vice-Chair, Conservative, Stephen Ellis]

I'm sorry, Mr. Julian. You're well past time. I apologize for that. I ask all members to watch their time closely.

Ms. Sturko, hopefully you'll have time to answer that at some other point. Of course, you could submit your answer in writing to the committee.

With that, we'll move on to Mrs. Goodridge.

You have the floor for five minutes.

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

Thank you, Mr. Chair.

Ms. Sturko, you're going to stay in the hot seat for a little bit longer.

You haven't had an opportunity to explain your concerns around diversion due to some of the time constraints. As someone who lives in the Lower Mainland and represents a Lower Mainland riding, and as a former law enforcement officer, how concerning is diversion to you, and what have you seen on the ground in British Columbia?

[Elenore Sturko]

My concern with the diversion of safe supply is twofold.

The first concern, and probably the one that has hit me the hardest, really, is the impact it has had on young people. I've met with physicians, but I've also met with the parents of young kids who have succumbed to overdose.

One of the first dads I met with was named Dave. His daughter died of a fentanyl overdose. At the time of her death, she had several bottles of safe-supply hydromorphone in her bedroom that were not prescribed to her. In talking to him, he said his daughter had started with cannabis and then moved on to experimentation with other drugs.

That was alarming to me. I think that, given the fact that there hasn't been any study, really, in British Columbia about the impacts of diversion of hydromorphone on the overdose crisis, it's needs more attention.

The second concern I have is we are seeing now, in British Columbia, that diverted hydromorphone is being discovered by police in their drug investigations. Police have even testified, I think, to this committee, that there is a nexus between some of these investigations and organized crime.