Evidence of meeting #115 for Health in the 44th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was community.
A recording is available from Parliament.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I appreciate that. Does the diversion and the reports of diversion of the take-home hydromorphone, the Dilaudid pills, concern you?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
First, the diversion that is shown is so minimal that the scientific perspective is expected for the number of people. In a big scope, there is a very small percentage of people who are struggling with opioid use disorder and who are getting the Dilaudid pills. Then possibly the number of people who might be sharing or selling the medication because that's not the medication for them, because we have few options, is a number that is expected.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
To clarify, you are not concerned whatsoever by the amount of diversion that's happening?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
It's expected.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Okay. I appreciate that.
My next question is for Mr. Pagé.
Among the 49 neighbourhood police stations in Montreal that were assessed by the City of Montreal police force in 2021, the Hochelaga‑Maisonneuve neighbourhood, where the Dopamine organization is located, ranked fourth in terms of crime rate. We are talking about 57.8 crimes per 1,000 residents.
Given the significant presence of parks, playgrounds for children, schools and the Edmond‑Hamelin park located across the street from the organization, I would like to know what measures you have taken to ensure that supervised injection centres for hard drugs such as fentanyl, crack and heroin do not exacerbate the crime situation, which is already disastrous in that area.
Executive Director, Dopamine
In fact, Dopamine's supervised injection service contributes positively to reducing consumption in public places. Harm reduction services absolutely contribute positively to the community. It should be noted that well before the organization's services were brought in, this neighbourhood was seen to be in a very precarious social situation. It is not attributable solely to drug use. It is also the result of the poverty and history of our community.
Dopamine's supervised injection service has only improved the situation, since instead of consuming in public places, individuals consume at our facility where we provide them with guidance and supervision. For example, our service has not caused an increase in the amount of material left behind in public spaces. On the contrary, we have seen a decline in that regard. There has not been an increase whatsoever. There has indeed been a decline in consumption in public places.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I saw in the news that parents are concerned about knowing that their children were close to the Dopamine centre.
What would you say to the parents whose children play so close to your centre?
Executive Director, Dopamine
I am not sure that you have accurate information about our organization, but there is no school located next to us. That being said, every neighbouring school has been notified. Dopamine has always maintained communication with its community. As our group comes from our community, Dopamine has always worked with the neighbouring families and schools. I want to clarify that there was no incident.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I am glad to hear it.
Ms. Sturko, one of the things you said that really hit me was that it was effectively a band-aid on a gaping wound. What did you see in your role in British Columbia, both as an elected official and as a former law enforcement officer, when it came to diversion? Does diversion scare you?
Member, Surrey South, Legislative Assembly of British Columbia
Yes, I have a lot of concern—
Conservative
The Vice-Chair Conservative Stephen Ellis
Ms. Sturko, if I might interrupt, you have about five seconds to answer that question. You may have to come back to it.
Member, Surrey South, Legislative Assembly of British Columbia
Sure. I will just say in five seconds that, yes, diversion is a concern. It's something I've heard a lot about, and I look forward to speaking more about it when I have longer than five seconds.
Conservative
The Vice-Chair Conservative Stephen Ellis
Thank you very much for that.
Ms. Lapointe, you have six minutes.
Liberal
Viviane LaPointe Liberal Sudbury, ON
Thank you, Mr. Chair.
My question is for Dr. Oviedo-Joekes. In my community of Sudbury, we had the highest number of opioid-related deaths per capita in the entire province of Ontario. It is a very critical issue in my community and across northern Ontario as well, where we really have a lack of resources and a lack of infrastructure. I would be very interested in hearing your thoughts on how we can better support people who live in rural and remote communities and use drugs.
Professor, School of Population and Public Health, University of British Columbia, As an Individual
Thank you so much and I'm very sorry for the circumstances in your area.
The first thing, as I was saying, is collaboration is key. There is nothing that will come from the top that can work unless we work with the community, unless we understand the values of the community and not just come in and say, take this, do this, without knowing if this community is ready and is going to accept. We have to work from there, trying to offer all the options that we can.
As I said, each group of people has particular priorities, they have defined issues that we need to work with. For some of them, if the medications are not available, people cannot travel. That will be a very key problem that has to be resolved.
Restrictions in policy will be a barrier that we are hoping we can solve with the provincial or the federal government so we can reach all the people in the community, people with disabilities who are not able to come in daily. There are all those other intersections we might have.
Sometimes women will not want to be in a place when people who have been violent to them are in the same place.
That's kind of the idea of where to go, to start working together and understand the issues in the community and see how we can build together that side.
I'm not sure if I answered your question.
Liberal
Viviane LaPointe Liberal Sudbury, ON
Thank you, Doctor.
In your opening statement, you said we need to be flexible in dealing with the opioid epidemic and toxic drug crisis in Canada. Tell us, what does “flexible” look like for all of the agencies and levels of government that are involved?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
When we work with the prescribers and they want to do person-centred care, they know that certain clients require an opiate medication that they cannot prescribe because it's not indicated for opioid use. In downtown Vancouver you are going to be an advocacy group and you are going to be able to prescribe off-label, but in other places, you don't have that support. You are alone, so you can prescribe only a few things. You don't have prescribers.
The idea is to have the flexibility that we can have all these medications, that we know are evidence-based, available. Then when you have a client coming to you, you can have a conversation with them and say, don't leave, I have something for you. This is the medication that is going to be the best fit for you.
Maybe that person is not ready for take-home medications, but work with them. Maybe that person is ready for somebody going with them or a family member helping. There are so many ways to work with people who are not supervised or just left on their own.
Did that answer your question?
Liberal
Viviane LaPointe Liberal Sudbury, ON
Yes. Thank you, Doctor.
I noted that you are a tier one Canada research chair in person-centred care in addiction and public health. Can you share with this committee your thoughts on how Canada can improve our decision-making based on evidence-based practices here? What are some other models perhaps outside Canada that we could be looking at in terms of good, evidence-based practices?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
The first thing is there is evidence that the so-called “experiment” did save lives. The BCCDC published in the British Medical Journal that it saved lives. If we are going to dissent, let's dissent with the truth. It is totally fair to dissent, but let's dissent with the truth so we can build, not going backwards. Let's build because we are always short on services.
We have decriminalization that works in every country. People going to jail because they use substances doesn't work, maybe in China.... Let's build and do it better, not worse.
There are little things that we achieve; we need to do it better. What can we do better? What can we add to this? That's kind of the idea. If you disagree with that measure, build something on top of that. Let's not destroy the little things that we are building together.
At the end of the day, we are in this together. When people die, they don't have a party patch here. They just die. Most of the people who die are poor people.
Conservative
The Vice-Chair Conservative Stephen Ellis
Professor, I'll have to stop you there. Your time is up, but thank you for that. I appreciate it.
Professor, School of Population and Public Health, University of British Columbia, As an Individual
Thank you. Sorry, I didn't know I was out of time.
Conservative
The Vice-Chair Conservative Stephen Ellis
Colleagues, we are going to try one more time. This will have exhausted all possibilities. It's a bit unusual, as I said, but with Ms. Lovegrove, we have tried disconnecting and reconnecting.
Assuming it's the will of the committee that we'd like to hear from Ms. Lovegrove, if possible—I see general agreement with that—she does have two minutes left, so we will try that again.
Ms. Lovegrove, you have the floor for two minutes.
Registered Nurse, As an Individual
Thank you very much.
As I was saying, I feel called to share my experience on the complex ripple effects of this public health crisis within the context of a concurrent national health care crisis and provider shortage. Canadian nurses are leaving the front lines in droves as a result of burnout, moral distress, moral injury and trauma, and I'm speaking to this specifically today because I am one of them. I left my job in the Nanaimo emergency department—
Conservative
The Vice-Chair Conservative Stephen Ellis
Excuse me, Ms. Lovegrove, could you speak a little slower, please? Perhaps that may help. Thank you.
Registered Nurse, As an Individual
Okay.
I left my profession altogether with severe post-traumatic stress disorder in 2018, having worked through the first peak of fentanyl poisoning deaths and at the time of Nanaimo's largest homeless encampment, Discontent City.
The devastating psychological impacts of participating in countless failed resuscitation attempts, witnessing discriminatory and stigmatizing treatment of people who use drugs, having sick patients leave before receiving treatment due to fear of criminalization, and not having the necessary resources to care for people in the way I was trained to do nearly killed me. It left me hopeless, thinking that I would never have the capacity to return to this profession that I love so dearly.
Due to the increasingly toxic and unpredictable nature of the unregulated supply, people who use drugs are being injured and are dying at escalating rates in ways that we have never seen before, and, frankly, in ways that Canadian health care workers are not prepared to deal with. This is happening because of decades of bad drug policy that reduces people who use drugs to less than human.
Now, as a teacher, I'm obligated to armour my compassionate young nursing students in preparation for a career that will most likely injure them as well. I will reiterate that this is a public health crisis, not a political opportunity to garner votes during an election cycle. The politicization of this crisis is killing people, and the reactionary implementation of policy is only feeding stigma and contributing to the fearmongering spread of dangerous misinformation.
In the past few months, B.C. has seen a marked decrease in toxic drug deaths, but after this week's decision to recriminalize substance use, it breaks my heart and spirit to know that even more people will die.