Health Committee on May 30th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 119 of the House of Commons Standing Committee on Health.

Before we begin, I'd like to ask all members and other in-person participants to consult the cards on the table for guidelines on how to prevent audio feedback incidents.

Please take note of the following preventative measures in place to protect the health and safety of all participants, including the interpreters. Use only a black, approved earpiece. The former grey earpieces must no longer be used. Keep your earpiece away from all microphones at all times. When you're not using your earpiece, place it face down on the sticker placed on the table for this purpose.

Thank you all for your co-operation.

In accordance with our routine motion, I am informing the committee that all remote participants have completed the required connection tests in advance of the meeting. We still have two people online who have some connection problems, but we're going to proceed with the meeting in any event and hope that this can be resolved by the time they are called upon to speak. We have some challenges with Dr. Powlowski and Ms. Sidhu. As I said, hopefully we will be able to get this resolved so that they can fully participate.

Pursuant to Standing Order 108(2) and the motion adopted on November 8, 2023, the committee is resuming its study of the opioid epidemic and toxic drug crisis in Canada.

Before I welcome our panel of witnesses, I note that you are all participating by video conference. If you haven't already been briefed, simultaneous translation is available. At the bottom of your screen, you can choose floor, English or French to hear what's taking place in the language of your choice.

I'd like to welcome our panel of witnesses.

We have with us appearing as individuals Dr. Paxton Bach, clinical assistant professor, University of British Columbia; and Dr. Bonnie Henry, British Columbia provincial health officer. From Direction régionale de santé publique de Montréal are Dr. Mylène Drouin, regional public health director; and Dr. Carole Morissette, lead physician, harm reduction and overdose prevention. Representing the Oxford House Foundation is Earl Thiessen, executive director.

Thank you to all of our witnesses for being here.

We're going to proceed now with rounds of opening statements in the order listed on the notice of meeting. You will have five minutes.

Dr. Bach, welcome to the committee. You have the floor.

[Dr. Paxton Bach, Clinical Assistant Professor, University of British Columbia, As an Individual]

Thank you, and thanks for having me today. I really appreciate the opportunity to come before the committee today, and I want to thank everyone here for all the time and attention being spent on such a critical issue.

I'm speaking to you today from Vancouver, where I live and work. I work full time in the field of substance use and addiction. I work in a number of different capacities. I'm a physician. I'm an educator with our fellowship program. I'm a researcher. I hold some leadership positions. I'm more than happy to answer questions about any of these areas today for the committee. I can speak about our current activities here in treatment, harm reduction, research, education, etc.

However, what I'd like to lead with and speak about as a clinician working on the front lines of the crisis is the complexity and how the overdose crisis must be conceptualized as a wicked problem. That is, it is a problem composed of innumerable complex and evolving issues. It needs to be approached as such.

I work at St. Paul's Hospital, which is, unfortunately, one of the epicentres of the overdose crisis in North America. My colleagues and I are witness to the scale, complexity and ruthlessness of this problem and how it has evolved over the past number of years. We see people from all corners of the problem, all walks of life and all sectors of society, and we bear witness to the terrible damage being wrought by the current toxic drug supply. We see the uncertainty that touches everyone. We know how quickly it's evolving and how limited we are, and we adapt to this.

In practice, that means I watch harm reduction interventions save lives in real time. I also see people failing to access that and suffering the consequences, or I see them being asked to solve problems they cannot solve. I see our treatment system and help people navigate that treatment system. I see successful outcomes, and I see those who have been unsuccessful in accessing or navigating our treatment programs—who have not found what it is they're seeking from our current treatment systems. Probably most importantly, my colleagues and I are faced all too directly, on a daily basis, with the realities of inequity and how significantly our system as a whole is failing to address many of the root causes of substance use and some of the ultimate drivers of the current crisis.

I'm all too aware that all the prescription pads and treatment programs in the world are not a replacement for things like primary care, appropriate prevention, appropriate care for physical and mental pain, and fundamental needs such as shelter and community.

From those experiences and that reality, it's all too apparent to me and my colleagues—and I think anyone working on the front lines in this sphere—that there is no one approach and no one solution that will address all the highly specific, rapidly evolving needs of every one of these individuals and communities in context. It is not possible to frame our approach in such a simplistic way.

I'm sure I am not describing anything to this committee today that they haven't heard already or were not aware of. Really, the need to conceptualize our response to the overdose crisis as a continuum of resources and approaches that speaks to all of these needs concurrently and is adapted to the many different contexts and variations we're finding across such a geographically and culturally diverse country is inarguable and, I don't think, controversial.

In summary, for the committee—as I said, I'm more than happy to talk about any of our activities or research at length today—my testimony for you, and my plea on behalf of the 20 Canadians who will lose their lives to overdoses today in our country, is that we collectively acknowledge this crisis as a wicked problem, with the complexity and sophistication it deserves. It is a problem that is non-partisan and that touches us all.

It is an emergency and one of the defining problems of our time, but it is solvable. We have evidence-based solutions and expert opinions for each of these individual contributors, which we can be talking about and implementing if we all get on the same page about so many of these challenging issues. In order to do that, we really must envision our response as an ambitious, emergent, broad and comprehensive one, and recognize that it needs to be adapted and tailored to so many different settings, to so many different communities and to so many different populations.

In the absence of recognizing this complexity and talking about it with that level of sophistication, we're going to continue to spin our wheels. I'm worried the progress that is attainable will not be there.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Bach.

Next we have Dr. Henry for five minutes.

Welcome to the committee. You have the floor.

[Dr. Bonnie Henry, British Columbia Provincial Health Officer, As an Individual]

Thank you.

Good morning. I'm Dr. Bonnie Henry. I serve as the provincial health officer here in British Columbia.

I also want to acknowledge that I'm speaking to you today from the traditional unceded territories of the lək̓ʷəŋən-speaking people, the Esquimalt and Songhees first nations. I'm very grateful to be able to speak to you today.

I want to start by also remembering and recalling that these are our people, our communities, our brothers, uncles, children, colleagues and neighbours. Poignantly, I have heard from our first nations, Inuit and Métis leaders that too many young people in their communities are being lost to this crisis. Indigenous peoples, we know, are disproportionately affected due to the compounded ongoing effects of colonial racist practices and structures, including residential schools and intergenerational trauma.

We can't lose sight of this, that this trauma, this crisis, is affecting real people in our homes and in our communities. We can't lose sight of that as we debate and discuss in sometimes disconnected settings.

I want to talk a bit about what's reflected in the challenges we're facing right now in this “wicked problem”, as Dr. Bach just described.

We know that the number of deaths increased dramatically in 2020 due to compounded effects for myriad reasons: isolation and anxiety wrought by the pandemic; added stressors that we are facing now in our communities around inflation, food insecurity, visible homelessness and poverty; and major disruptions to the global drug trade that have led to the unrelenting changing toxicity of drugs on the street.

Really, I want to make the point that the proximal cause of this crisis is the increased potent and unpredictable drugs on the street. That is something that is very different from what we faced prior to this crisis. The potency of what is on the street right now is because fentanyl or synthetic opioids have replaced plant-based opioids like heroin—which were causes of problems in the past—because they are cheap and easy to produce.

We do ourselves a disservice when we call what's on the street “fentanyl”, because it is not. It is a hastily manufactured synthetic drug that has fentanyl-like properties but is produced in uncontrolled conditions and mixed with adulterants. Those adulterants are changing dramatically on an almost daily or weekly basis.

We know now that the average concentration in street “down”, or drugs on the street, has increased, and that more potent drugs mean that people are more likely to experience drug poisoning and to die, even if they've tried something for only the first time.

It's also very unpredictable right now. It changes. There are no labels and no quality control, and current adulterants are making these drugs much more toxic: things like benzodiazepine-like substances; xylazine, which is another sedative that's used as a tranquilizer, as we know; and non-fentanyl synthetic opioids, like nitazenes, which are increasingly being found in the drugs.

We also know that stimulants that have been used are now contaminated much more commonly than they had been in the past, and we're seeing that non-fentanyl synthetic opioids are.... Sometimes it's from intentional contamination, and sometimes it's because of a mix-ups where these drugs are being produced. Things like cocaine and MDMA are actually now much more commonly contaminated with these synthetic opioids that are manufactured in uncontrolled conditions. That is the proximal cause of why people are dying right now.

I also want to focus my short remarks on some of the concerns we have seen with what has become a very polarized and, sadly, political process.

First, I think it's very important to recognize that harm reduction and recovery and treatment are not in competition. It is not either-or. They are both essential and necessary parts of a continuum from prevention and from understanding what's on the street to harm reduction, to treatment and to recovery, and it includes everything from naloxone and access to drug checking to overdose prevention services and prescription medications for people to get them away from the toxic street drugs, with alternatives and medical assisted treatment, or OAT, as we know.

I want to refer the committee to the report I released in February of this year reviewing our prescribed alternatives or safer supply program here in B.C. It has been submitted to the clerk, but not in time to be translated. It is also publicly available. There's a lot of nuance in there that I think is important for us to understand some of the problems we are faced with.

Also in there is an ethical review of what we're faced with right now and why these programs are so important.

I also want to acknowledge that recovery is a spectrum. I accept that many in the recovery community and many clinicians equate recovery to abstinence. Many recovery homes won't accept, for example, people who are even on medically assisted therapy.

I believe this is a false dichotomy as well. We talk to people who have used drugs. The term “recovery” is not a medical term. It's not about abstinence; it's a process. It's a process through which people improve their health.

[The Chair, Liberal, Sean Casey]

Dr. Henry, it pains me to do this, but I would ask you to wrap up. You'll have lots of opportunity to elaborate on your opening remarks in response to questions.

Could you bring it to a conclusion, please?

[Dr. Bonnie Henry]

I will conclude then by saying that this is real people. This crisis continues to ravage our communities, taking the lives of our young people. We need to work together on this. I believe we all have the same goal, which is vibrant, thriving and safe communities.

I'm committed and my colleagues are committed to working together to find these solutions, and not giving in to the discourse that we have seen. The very lives of our families, our friends, our neighbours and our children depend on it.

[The Chair, Liberal, Sean Casey]

Thank you.

We will now go to the representatives of the Direction régionale de santé publique de Montréal.

Ladies, you have the floor for five minutes. You may split up your time as you see fit.

[Dr. Mylène Drouin, Regional Public Health Director, Direction régionale de santé publique de Montréal]

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.

[The Chair, Liberal, Sean Casey]

Dr. Drouin, please wrap up your presentation. You have gone over your time. You'll have the chance to say more during the question period.

[Dr. Mylène Drouin]

That's fine.

We submitted some recommendations to the committee. In particular, we want more flexibility and easier access to exemptions. We also want to break down administrative barriers.

Of course, as I said earlier, we recommend increased funding for research in certain areas of treatment and also for the development of new pharmaceutical solutions and harm reduction strategies.

The overall message is that we need a proportionate response to the current crisis. We can't afford to become divided. We must do the opposite. We're losing lives in our community right now. We must stand together.

This crisis requires a number of sectors of society to work together. This includes the health care system, of course. Scientific evidence helps us identify the solutions that will have the greatest impact. We can't afford to fail in this crisis.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Drouin.

Finally, we will hear from the Oxford House Foundation, represented by their executive director, Earl Thiessen.

Mr. Thiessen, welcome to the committee. You have the floor.

[Earl Thiessen, Executive Director, Oxford House Foundation]

Thank you, and thank you, all, for the previous comments. It's an honour to be here.

I bring a different perspective, the lived experience. I am an indigenous man in long-term recovery for 16 years. I'm the creator of pre-treatment housing and peer and culturally supportive indigenous recovery homes. We have long-term, peer-supported transitional homes with no end date.

I'm here to provide my lived experience, along with professionals, with battling homelessness and addiction, which for many of us, including me, means healing. I'm here to provide my thoughts on solving the addiction crisis.

My unresolved childhood trauma eventually led me to the streets, to being homeless for seven years and to my unwillingness to face my demons and my use of alcohol and drugs, including pharmaceutical opioids. This was an emotional response to my childhood trauma, which was so powerful. The shame of being sexually abused is so intense that many men and women lose their lives to addiction or suicide, refusing to speak about it.

We gain knowledge when teaching through words and actions. We heal the same way. The first time I talked about my sexual abuse was while in treatment and doing my steps with a female elder. I cried for two and a half hours telling her about my childhood trauma. I walked out of her room a different man. I had held that childhood trauma for 25 years, and that's what kept feeding my addiction. That kept bringing me back to the same vicious cycle that progressed into what we're dealing with today.

After starting my recovery journey and healing from my childhood trauma, I reconnected with my heritage. It played and plays still a significant part in my healing journey.

I'm going give you a brief, lived experience. I want to tell you a story about a young boy who suffered numerous challenges and trauma in his life, a young boy who grew into a youth who was taught not to show his true emotions, a boy who grew into a young man who had endured so much trauma that he thought he was alone and chose to live a lot of his life just like that—alone.

This young man was a victim of sexual abuse, physical abuse and mental and emotional trauma as well as spiritual trauma. This coping mechanism took the next 20 years of his life. It took his family away. His friends did not want to be around him due to his alcoholism and deceptive tendencies. Eventually, he burned all his bridges and hurt his family so much that everyone gave up on him. He ended up being dropped off at a homeless shelter because nobody could trust him.

This terrified man-child had finally found a place where he was accepted without judgment, without prejudice, and he thought that this was where he belonged, with no self-esteem and no self-worth. This man accepted that this was his destiny.

Living seven years as a homeless, alcoholic addict was what his unresolved trauma led him to, a life with no meaning or purpose, no aspirations or goals, and no love for himself or others. After one of the largest losses in his life at the time, his partner of two and a half years being murdered, he reached a point where he had lost all he was willing to lose due to his addiction and unresolved trauma.

On November 13, 2007, he was arrested for being drunk and disorderly in downtown Calgary. The arresting officers brutally beat him in the back alley. His foot was broken, his eye was swollen shut, and he suffered numerous bruises all over his body. They found that he had 11 warrants for his arrest, so he went to the drunk tank to face the justice of the peace. He had an opportunity to speak with the justice of the peace that morning. He was honest for the first time in his addicted days. He explained that he wanted help, help to deal with his trauma and his addiction issues and help to deal with the murder of his partner.

The justice of the peace asked her name. He responded, Jackie Crazybull. The justice of the peace stated that he had heard about the murder and offered his condolences. He then proceeded to speak with the devastated and defeated man. He said, “I'm going to release you on your own recognizance. I want you to go get the help you so desperately want, and I want you to clean up all these criminal charges.”

That morning, upon his release, this man limped up to medical detox to start his journey towards healing. After almost a full year of treatment and reconnecting to self, culture and community, he made small goals that turned into huge accomplishments. Today, that little boy who suffered all that trauma, that young man who turned to drugs and alcohol as a coping mechanism, that young man who ended up homeless for seven years, turned his life around and is now the executive director of the very same organization that helped save his life.

My name is Earl Thiessen, and I am a wounded healer.

Now I'll move on to the professional part.

As an indigenous leader in Alberta, when it comes to recovery, recovery housing and supporting the continuum of care, I see first-hand the damages of opioid use. In fact, I'm raising my sister-in-law's daughter due to her mom's passing from an overdose.

In my opinion, the way decriminalization and safe supply are being presented is not the path forward. They're making problems worse. They're prolonging trauma and keeping people in a perpetual state of drug use. In my opinion, safe supply is akin to pharmaceutical colonization.

There are other methods, but for the people I serve, the path forward is a recovery-focused path. The biggest thing I can see is that we need more medical detox. Withdrawals are horrible. I experienced them, hit the ground, chewed through my tongue, had two grand mal seizures, then treatment and then recovery. To accomplish long-term recovery, people need all of these, starting with detox and treatment. That's where the pre-treatment housing model came into play due to the wait-list. They need peer support, employment and recovery-focused housing.

There is only one sure way to 100% avoid overdose, and that is not to use. That being said, I fully understand there is a process to go through to get to this point. Saying that one must understand.... Want and need are light years apart. Every person who has an addiction needs to seek help, but it's those who want to seek help who actually can and will recover.

For those who do not want to recover, we need to provide positive reinforcement and show them, through lived experience, success stories that recovery is possible and that they can find recovery. We pray for them. This is all I could do for my sister-in-law. She lost her life.

Many people and organizations focus on the biopsychosocial aspect of trauma and recovery—

[The Chair, Liberal, Sean Casey]

Mr. Thiessen, I'm very sorry. This is powerful testimony. You had five minutes and we're now into the eighth minute. As much as it pains me to ask you, could you please wrap it up? There will be lots of opportunity to respond to questions and elaborate on your story.

[Earl Thiessen]

It's no problem.

We need to extend that focus further into biopsychosocial, spiritual and cultural aspects of recovery. We need to look at and evaluate all aspects of recovery and have like-minded individuals living in the same environment.

In closing, I would like to read Truth and Reconciliation Commission call to action 21:

We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, all.

We're going to begin with rounds of questions, starting with the Conservatives.

We'll go to Mrs. Goodridge for six minutes, please.

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

Wow. Thank you, Earl, for sharing your truth with us. Thank you for putting a face to trauma and a face to recovery and the power of recovery. I was having to wipe away my tears, so thank you.

In your statement, you said something that really struck me. You said that, in your opinion, “safe supply is akin to pharmaceutical colonization.” Could you elaborate on that?

[Earl Thiessen]

Yes. This is my opinion. My people have experienced colonization before, and this, to me, is exploitation of a vulnerable population. It's not getting better.

There needs to be a path forward to healing. Of the 95% of people who are using, it's due to childhood trauma. To me and to the people I serve, this isn't the proper approach. It's corralling people. I don't think that's the way our country should be operating. We did that once, and it's a black eye on our country.

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

Yesterday, the Minister of Mental Health and Addiction said she thought that decriminalization was a success in British Columbia. Do you agree with her?

[Earl Thiessen]

No. On the approach out there, decriminalization wasn't that approach. Decriminalization for me is to give the person the option to either seek treatment or to accept a charge for the illegal activity that's taking place. The Portuguese model is being altered, I guess you could say. In my opinion, it's just not the way to go.

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

Thank you.

Dr. Drouin, recent news reports about the Maison Benoît Labre described how young parents and their children needed to get around drug users in front of the entrance to the organization.

The residents of the neighbourhood are worried. What do you have to say to them? Do you think that this situation is acceptable?

[Dr. Mylène Drouin]

The parents are indeed worried.

We're part of the good neighbours committee, which is looking for solutions. As I said earlier, the Maison Benoît Labre is primarily a shelter and day centre for homeless people.

The organization has added two rooms for supervised inhalation and consumption, which serve a minority of users. About ten users a day access the room, while hundreds of people visit the centre each day.

The homelessness issue is multi‑faceted. One matter that certainly warrants consideration concerns the mitigation measures needed for the locations chosen for these centres. We must look at how to ensure that young people and the school receive the support needed to reduce these harms or, at least, overcome the challenges of cohabitation.

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

Thank you.

Do you think that supervised injection and inhalation sites should be located right next to a school?

[Dr. Mylène Drouin]

There aren't any standards or regulations in this area.

Let me draw a parallel with the legalization of cannabis. When discussing this issue, we often wondered where the sale sites should be located.

If a supervised injection centre must be located about 200 or 500 metres away from day cares or schools, an issue arises. Day care centres and schools are all over Montreal. Supervised consumption sites would end up in fields or along rail lines, for example. However, to reach the clients and make a harm reduction strategy work, the sites must be in the right places.

That said, I completely agree with the need to think ahead when deciding to open this type of site. It isn't just about day cares and schools. It's also about the neighbourhood.

We must think about how to implement mitigation measures to ensure that the cohabitation goes smoothly. We must also think about having a number of sites to avoid crowding.

There currently aren't enough resources to accommodate the number of people who need homelessness services. As a result, these people congregate in the same places.

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

Would you like to see hard drugs legalized, as was done in British Columbia?

[Dr. Mylène Drouin]

Of course, we know the challenges posed by stigmatizing groups of people and using the courts to solve problems. We also understand the potential impact on people who want to find housing or employment and reintegrate into society.

In Montreal, we're working on this issue. However, at this time, we find that the conditions aren't right in terms of services to call for decriminalization rather than legalization. I think that we must pay attention to the terms that we use.