Evidence of meeting #119 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A recording is available from Parliament.
12:35 p.m.
Bloc
Sébastien Lemire Bloc Abitibi—Témiscamingue, QC
Mr. Chair, the French interpretation is no longer available.
12:35 p.m.
British Columbia Provincial Health Officer, As an Individual
The French translation came on in the middle of.... I couldn't....
12:35 p.m.
Liberal
12:35 p.m.
Bloc
12:35 p.m.
Liberal
12:35 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Let me try to continue.
Dr. Henry, in your report, you also mentioned the fact that a lot of people who treat addictions were frustrated by the fact that Dilaudid wasn't really helping a lot of the real hard-core users who continued to use fentanyl, and they died from fentanyl.
Given the success with IOA observed treatment, and given the possible concerns with diversion, why aren't we moving more towards directly observed treatment if necessary with intravenous drugs and getting away from from going home with a bunch of Dilaudids like we're doing?
12:35 p.m.
British Columbia Provincial Health Officer, As an Individual
I'll go to the second question first because I think that is a really important thing, and that is one of the recommendations that came out of my report.
Yes, injectable therapy is working for some people. It's very difficult to get into. There are a very small number in terms of access to programs, but we also know that people's use of drugs has changed over time, and people are not injecting as frequently. We know that smoking is the much more common way that people are using drugs now, so we need to have formulations that people are able to use in that way. We've heard from people who use drugs that it's what they need as well. To be able to separate them from the toxic drugs that are on the street right now, we need to ramp up those programs. My recommendations are that these start as directly observed therapy programs, but it needs to be accessible to people.
The other problem that we have is that we can't prescribe our way out of this. We have to have ways that people can develop those relationships with a clinic. I think the Hope to Health clinic is a good example of this. People can get the medications that they need to keep them on that road, away from using the street drugs as much as possible and in the formulations that they need.
It should be witnessed as a way to start. Then, you develop that relationship over time and that trust with people, because we also know that it's very difficult for people to stay in these treatment programs when they have to go in multiple times a day or every single day. If something happens where they need to be with family or they miss the bus, or there's something dramatic happening that day and they don't get their dose, that's when we know that people go back to accessing what they can find on the streets, for example.
Absolutely, I think these are the things that we...and I've recommended that we look at how we scale up access to the prescribed substances that people need and will use. That's another way of minimizing diversion, which is a symptom of unmet needs.
12:40 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Henry and Dr. Powlowski.
Mr. Lemire, you have the floor for two and a half minutes.
12:40 p.m.
Bloc
Sébastien Lemire Bloc Abitibi—Témiscamingue, QC
Thank you, Mr. Chair.
I want to thank all the witnesses for being here.
Ms. Drouin and Ms. Morissette, when we talk to workers on the ground, they say that the best way to limit the scale of the crisis is to reach out to users. They say that any measure that establishes and maintains a connection with users is a step in the right direction.
The workers also tell us that the services must be available when users need them. This obviously means having workers on the ground 24 hours a day, seven days a week.
Could you comment on this?
12:40 p.m.
Regional Public Health Director, Direction régionale de santé publique de Montréal
I can start answering your questions.
That's exactly what we mean by the continuum of services. Community organizations that work on the street need to build trust and help people understand what supervised consumption services entail. Supervised consumption centres also have peer helpers.
Supervised consumption services are community services supplemented by nursing services. These services help us move a step further and talk about health care. As we know, on top of the overdose issues, these clients aren't used to asking for other types of care, such as treatment for wounds or infections. They don't know how preventive services work.
These centres are staffed by qualified people with whom the clients can develop a relationship of trust. These qualified people liaise with specialized rehabilitation services and services that provide treatment solutions.
That said, after establishing the relationship of trust, the workers can, if necessary, refer people to services that provide treatment options. They can also refer people to services that provide mental health support. They also liaise with community services that help with housing and social reintegration. Everything must be connected.
We have also developed expertise in our monitoring team. We have anthropologists who get involved on the ground and who meet with people in order to understand the changing consumption habits, the practices, the needs, the cultural issues, the new consumers or the various circumstances. This helps us give our teams the right tools.
12:40 p.m.
Bloc
Sébastien Lemire Bloc Abitibi—Témiscamingue, QC
On that note, I want to recognize the work of a local worker in this field, in Abitibi‑Témiscamingue. In 2023, she published an essay based on a qualitative survey. The essay is entitled “Drug use, a ‘stupefying’ world: drugs: a glimpse into a little‑known reality.” This is part of the project entitled “A look at the reality of psychoactive substance use in the MRCs of Abitibi and Rouyn‑Noranda.”
The committee could find some useful data.
Thank you.
12:40 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Lemire.
Next is Mr. Johns, please, for two and a half minutes.
12:40 p.m.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Mr. Chair, before I get started on my time, I believe I have unanimous support to move a procedural motion. I move:
That, pursuant to Standing Order 81(5), the committee invite the Minister of Health and the Minister of Mental Health and Addictions to appear for no less than one hour each regarding the Supplementary Estimates (A), 2024-25; and that this meeting take place as soon as possible, but no later than June 20, 2024.
12:40 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Johns.
The motion has not been provided with adequate notice, so it would normally be ruled out of order, but we can do anything by unanimous consent.
Is there unanimous consent for Mr. Johns to present the motion and for the commttee to adopt the motion?
12:40 p.m.
Some hon. members
Agreed.
12:45 p.m.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you, Mr. Chair.
Dr. Henry, we saw in 2014, as I said earlier, 7.9 deaths per 100,000, which is horrific, go to 30.3 deaths per 100,000 under the former B.C. Liberal-Conservative Christy Clark government. That was the largest spike in British Columbia's history—383% over four years. We saw a similar spike in 2019 to present day under the United Conservative government in Alberta of 275%.
Can you speak about maybe why this happened under those governments? Certainly, we've seen a spike under the NDP, but the spike has been far less. Can you talk about what trends you're seeing?
12:45 p.m.
British Columbia Provincial Health Officer, As an Individual
Just to clarify, I don't have any comments around what government is in power around these issues. What I've seen is that it is very much dependent on what is on the street. That is what is leading to deaths.
In British Columbia, we have tried to take an approach that is nuanced and that looks at all of the various aspects that we need to have in place to support people and to keep them alive, whether they are somebody who has a substance use disorder or whether it's somebody who is using drugs on an occasional basis. We know that people are dying in both of those situations.
12:45 p.m.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you. I appreciate the qualified response. I do.
Dr. Henry, the Minister of Mental Health and Addictions keeps saying that they're “meeting the moment”. This is a health emergency. Do you believe the federal government is meeting the moment? What could the federal government do?
We saw how they responded to COVID-19. We were able to work through jurisdictions and respond rapidly. What is the difference you're seeing in terms of this crisis? Is it just the stigma that is the barrier? We're seeing that, I believe, from the federal government in the inaction and the incremental approach.
May 30th, 2024 / 12:45 p.m.
British Columbia Provincial Health Officer, As an Individual
I do believe that the issue of people who use drugs is cloaked in stigma and shame. That keeps people from talking about this. We know from data that everybody in our communities across this country has been affected by this crisis in many ways. It is something on which I think we need to have a coordinated approach across the country. There is absolutely room for people doing different things in different communities to support their communities, but I would like to see a coordinated cross-governmental approach that supports people in communities across this country, because all of us are being affected.
12:45 p.m.
Liberal
12:45 p.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you, Mr. Chair.
I guess I will start with you, Dr. Henry. Does diversion scare you? Are you concerned by diversion?
12:45 p.m.
British Columbia Provincial Health Officer, As an Individual
I think diversion, as I've said many times, is a symptom of unmet needs. In the case of the unmet needs that we are seeing, it is very concerning to me. It means that we need to take different approaches.
I also want to recognize that diversion is not new. We've seen that in many parts of this country. In B.C. the toxic drugs on the street have been the proximal cause of what we've been dealing with, but in other provinces, prescription drugs are—
12:45 p.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I have very limited time.
Do you think having more drugs on the street will solve an addiction crisis?