Good morning, everyone.
Thank you very much to the members of the committee, particularly MP Luc Thériault from the Bloc Québécois, for inviting me to participate in this meeting.
It's no secret that Canada as a whole is facing an unprecedented toxic drug crisis. That's why leadership by all orders of government is needed to coordinate an effective response at all levels.
Since this crisis is affecting Canada's major cities in particular, I've partnered with my fellow public health officers and public health physicians from Vancouver and Toronto to present a brief today with possible solutions. Some federal levers could admittedly help us, in our provinces and especially in our cities, to deal with this crisis. In my presentation, I chose to focus on the Montreal region, where I live and work.
As we know, since the pandemic, supply networks have changed significantly in Montreal, which was not exactly in the same situation before that. To give you an order of magnitude, currently there are 86 emergency response actions per month at our supervised consumption sites. That's six times more than we had in 2020. We've more than doubled naloxone distribution in three years. We're also seeing a monthly increase in deaths, which is in no way comparable to the number in western Canada, but we still have 17 deaths per month, compared to 12 three years ago and four in 2010.
It's a very concerning trend. I don't think we should hide the fact that there's a crisis underlying this situation. I'm talking about the housing crisis, which adds to the toxic drug crisis and in turn generates a homelessness crisis. The combination of these crises creates a dangerous cocktail in our neighbourhoods.
As the previous witnesses said, we're seeing a phenomenon that's not exclusively related to an overdose crisis. It's also related to a contaminated drug crisis, that is to say, drugs modified when they are being procured. This is not because people are miscalculating the amount to be consumed or because there are more users. It stems from the fact that drugs contain toxic substances, such as fentanyl, nitazene-derived substances or benzodiazepines not currently in commerce.
This obviously affects vulnerable populations, but I think we have to keep in mind that it also affects all sectors of society. Three‑quarters of those who die from overdoses die at home, not on the street. People who die in this way account for half the deaths in Montreal. In addition, there are a lot of casual users. This phenomenon is therefore very broad, and it doesn't only affect marginalized populations, even if more of them die from overdoses.
In Montreal, we've been responding to this problem for decades by working hand in hand with the community sector, the health care sector, the police or public safety and the municipal sector to come up with a continuum of responses from monitoring to prevention and harm reduction, all the way to treatment. As was said earlier, treatment can't be the only option. Obviously, it's this continuum of services and this ability to prevent and stay on top of changes in the modes of use on the ground and the types of drugs that allow us to quickly adapt our action plans and strategies with our partners.
In addition, treatment must be paired with major harm reduction strategies. As we know, we'll never be able to treat all users, because there are a lot of barriers to access and delays. That's why we have people who are not in treatment. Obviously, substance abuse can be seen as a chronic disease. There are periods of relapse, and when someone relapses, they are at an even greater risk of overdose.
Finally, we know that even in pharmacological treatments there are some drugs for which we have few therapeutic options. So we need more research and development to continue to move forward and enhance our capacity to treat.
In terms of the harm reduction arsenal, the evidence is very clear that harm reduction reduces overdoses and the risk of infection. In Montreal, over the past few decades, we've seen the prevalence of HIV and hepatitis C drop among drug users as a result of our strategies.
In addition, our harm reduction services reduce consumption as well as the presence of contaminated equipment on the streets. We have supervised consumption services, and we will need to add consumption by inhalation, because it's become a much more frequent practice in recent years.
We need to expand the distribution of naloxone and injection equipment. We must also expand all drug testing or analysis services. This helps people determine the risk of using a drug and helps us assess the drugs available in the area.
Mobile testing sites are also needed at festivals. We know that young occasional users can be exposed to lethal drugs at festivals.
As I said, we need to bear in mind that only a minority of users currently have access to treatment. We need to look at the possibility of expanding this access.