Health Committee on May 30th, 2024

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

Do you plan to support decriminalization in Montreal, as was done in British Columbia? Yes or no?

[Dr. Mylène Drouin]

I have already spoken about this topic. The decriminalization of groups of people plays a role in the continuum of services. However, we need the right conditions for implementation. Obviously, we'll be waiting to see the outcome of the work done in British Columbia. At this time, we find that the conditions aren't right in Quebec and Montreal.

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

Do you think that it's working in British Columbia?

[The Chair, Liberal, Sean Casey]

Ms. Goodridge, your time is up.

Thank you, Dr. Drouin and Ms. Goodridge.

We're going to see if Dr. Powlowski's sound is good enough to ask some questions, and if not, we'll go to Ms. Brière.

Dr. Powlowski, you have the floor if everything's working.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Let's give it a shot.

Dr. Henry, in your report entitled, “A Review of Prescribed Safer Supply Programs Across British Columbia”, on page 27 of the report, you actually admit that diversion is taking place. It says there that it was “reported by PSS program staff and clients as a common occurrence”.

Is my sound okay?

[The Chair, Liberal, Sean Casey]

The jury's out. Keep going.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Okay.

You say in the same report that there is limited data on youth, but it doesn't appear that there's any increased opioid use [Technical difficulty—Editor].

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Mr. Chair, I have a point of order.

The interpreters can no longer do their job.

[The Chair, Liberal, Sean Casey]

Dr. Powlowski, it was a valiant effort.

Madame Brière, you have the floor.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Good morning.

I want to thank all the witnesses for their remarks. Some of them were quite moving at times.

The committee members have just returned from a trip to Vancouver, Calgary, Red Deer and Montreal. We had the opportunity to meet with some of you. I would like to thank you for hosting us. You spoke about your realities and all your great initiatives to help fight the overdose and toxic drug crisis.

Dr. Drouin, I want to continue the discussion started on clearly established scientific evidence. You were speaking about the range of measures needed, an action plan and a strategy to help fight this crisis.

Can you elaborate on this?

[Dr. Mylène Drouin]

I think that Quebec's strategy for preventing overdoses provides a good overview of the evidence and the required components. Obviously, the whole monitoring system is important. We need to work with our partners to understand the situation on the ground. It's a key way to help us adjust our services.

I spoke earlier about harm reduction near consumption sites. We know that these sites have a major impact on overdoses and also on infectious risks. In Montreal, it's worth noting that our supervised consumption sites provide connections with preventive care, treatment and social reintegration services.

I didn't have time to talk about this earlier. If we want to take a broader look at the issue, we also need to address housing, employment and the reintegration of people who have substance abuse problems.

We must also consider the whole preventive aspect. I didn't have time to talk about this earlier either. One of the witnesses spoke about child development from the perspective of childhood trauma. We need to protect young people. We know all about the paths taken by certain young people who, given their background and childhood trauma, face the highest risk of drug abuse or homelessness. These issues often overlap. We must tackle the root causes, so to speak.

In our view, this continuum should be looked at as a whole. We can't focus on one component of the continuum more than another. Of course, this means that a group of partners must work together with the same vision and ambitious resources, because this is a major crisis.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Dr. Bach, I'm happy to see you again.

I was very impressed by the road to recovery initiative at St. Paul's Hospital. You said in your remarks that there was not only one way for the drug user but that we have to suggest or propose a lot of options for them.

Could you speak a little bit more about that initiative and what your goal with it is? I think you would like to open it to all the provinces.

[Dr. Paxton Bach]

Thank you for the question. I'm more than happy to speak about the road to recovery initiative.

To the other part of your question speaking about options, as has been alluded to by all of the speakers, every individual has a different relationship with substances. There are different origins and different needs and those change over time. It's really important that we recognize that diversity and that every individual at any point in time is going to have different different needs and expectations. It's important that we make that easy to access.

The road to recovery initiative is a new, coordinated treatment program that we've launched at St. Paul's Hospital in Vancouver. It is focused on addiction treatment specifically, but really is about making treatment easy to access. It is challenging enough for somebody dealing with a substance use disorder and many of the other factors that come along with that to seek help and navigate the system. It is imperative that we, as those who are working in the system, make them as easy to access and navigate as possible.

Historically, at least in our province—and I think probably most places in North America—that has not been the case. It has not been easy to access or navigate these systems. They have often been quite siloed and challenging to work through.

The road to recovery system is about co-locating all of these various aspects of a treatment system under one roof, such that patients can flow through it seamlessly in a way that they can focus on themselves rather than the navigation. Whether that's accessing an outpatient clinic, a detox facility, short-term treatment or long-term housing and follow-up, it ensures that all these services work together in one cohesive way, so that individuals don't have to spend their time trying to piece those parts together.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Bach.

Thank you, Ms. Brière.

Mr. Lemire, you have the floor for six minutes.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Thank you for your welcome, Mr. Chair.

Ms. Drouin, I want to start by thanking you for your commitment and your remarks. You asked us to look at the big picture and take comprehensive action, particularly with regard to the health determinants.

Can you elaborate on this?

[Dr. Mylène Drouin]

Given the overdose crisis, this means taking proactive preventive action. We need to work on risk factors faced by young people, protective measures starting in childhood and socio‑economic conditions. These are known as the structural determinants of health.

There's also the whole issue of trauma in indigenous communities. The more we work proactively, the more we can build a society that protects our children and young people.

However, in the case of the overdose crisis, we must work a bit less on health determinants and a bit more on harm reduction, up to and including treatment. We must try to reduce the negative impact of drug use on individuals. This means implementing a range of services to reduce deaths and overdoses. We must bear in mind that, even though overdoses fortunately don't always kill people, they do lead to complications. We must also take into account treatment and everything that affects people's skills.

This means implementing a continuum of services. In terms of the health determinants that require proactive steps, we must opt for a preventive approach to help us identify the risk factors and protective factors surrounding consumption and harm reduction.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

You just touched on the issue of harm reduction. I would like us to explore it further.

Can you explain how harm reduction fits in with a treatment approach that supports innovative treatment and rehabilitation measures?

[Dr. Mylène Drouin]

Obviously, treatment can't be the only solution. People have a wide range of needs and different substance use journeys. They may face delays or barriers in accessing services, or they may not be ready. Meanwhile, harm reduction strategies are needed to protect them; provide a safe environment; and reduce the risk of death, infection or various complications.

Addiction should be likened to a chronic disease. It sometimes takes several attempts at rehabilitation and treatment, as well as several relapses, before a person can recover. During these relapses, harm reduction strategies are needed.

Moreover, in terms of treatment, no substance or pharmacological option can replace all the drugs currently on the market.

Under these conditions, it can be much harder for some people to access treatment or stop using. They have few alternatives, so we need to protect them.

One public health mandate is to protect the health of the entire population. As a result, these people must also be protected. We can't expect all drug users to seek treatment at the same time.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

In Montreal, your approach integrates the various levels of intervention. These include the regional public health department; the Centre hospitalier de l'Université de Montréal, or CHUM; frontline care facilities; and resources on the ground. The result is greater synergy among workers and better results.

In your opinion, how would this crisis unfold without the pillar of harm reduction and the integration of different services, which you're advocating for in Montreal?

[Dr. Mylène Drouin]

Integration is key. It's what makes our work possible.

I could give the floor to Dr. Morissette. She developed the strategy in Montreal over decades. This strategy helps us and all the partners monitor and understand the situation, so that we can develop and adapt our services.

Above all, we must be able to set up new services, such as the services currently available for substance inhalation. If research provides new evidence, facilities such as CHUM must be able to address it. We can't be caught off guard by new trends.

Dr. Morissette, do you have anything to add?

[Dr. Carole Morissette, Lead Physician, Harm Reduction and Overdose Prevention, Direction régionale de santé publique de Montréal]

I think that, without harm reduction and the implementation of our supervised consumption services, we would likely have seen many more deaths than we're seeing now. We know that it prevents deaths.

To address the severity of the current crisis, we must implement more services. Harm reduction services must be considered a solution rather than a problem. This means increasing and diversifying the services.

We also need to provide access to housing. I'll come back to the dual crisis of overdoses and homelessness. For a person on their journey, having a place to live is one factor that may lead them to take the first step towards reducing or even stopping drug use.

Again, harm reduction and treatment aren't mutually exclusive. They're part of a continuum. All these strategies are needed to achieve success.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Thank you so much.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Drouin and Dr. Morissette.

Thank you, Mr. Lemire.

Next, we have Mr. Johns for six minutes, please.

[Gord Johns, NDP, Courtenay—Alberni, BC]

First, I want to thank all of the witnesses for their important testimony and the important work that they all do.

We heard from the chief coroner of British Columbia. Dr. Bonnie Henry, you're also the chief medical officer of British Columbia.

The B.C. chiefs of police and the Canadian Association of Chiefs of Police, the First Nations Health Authority in British Columbia, the B.C. First Nations Justice Council, as well as the Health Canada expert task force are all saying that this is a complex issue that requires a comprehensive response. Every single organization and individual I listed were clear that we need to replace the toxic street supply with a safer supply of substances, stop criminalizing people who use substances and create a system with treatment on demand, investing heavily in recovery, prevention and education.

Dr. Henry, we just had the decriminalization model in British Columbia come into effect in January 2023. In the month prior, the death rate per 100,000 per day was 7.5. In the last two months, the death rate dropped to 6.1 and 6.2.

Do you believe that the decriminalization trial in British Columbia is working and has been working?

[Dr. Bonnie Henry]

Thank you for that question.

You're absolutely right that we need to focus on what this is. It's one of a suite that we have heard is necessary. The decriminalization of people—that's the important thing—is about removing criminal penalties for possession of small amounts of controlled substances. It is not legalization, and it is not a free pass to violent or threatening behaviour. It is not the full solution. It's one important tool to help, for a couple of reasons.

One reason is that we see the people who are visible to police, and that is what a lot of the focus is on. It's uncomfortable for us to see homeless people on the street who don't have a safe place to go to use their drugs or to connect with people. It also is important for those who are not visible, who are also dying, and we've heard that this morning. It could be young people, who may be experimenting or are occasional users. It could be the young man who's working in the trades, whose family I hear from all the time and who didn't know that he was using drugs again or had relapsed, because of the shame, stigma and fear of a criminal record. This keeps people from talking about their drug use and reaching out for help.

In that sense, yes, the decriminalization of people here in British Columbia has levelled the playing field across the province so that it's not discretionary about who gets their drugs seized or who gets a criminal record. We've seen that in the statistics on drug seizures and on charges for people who use drugs.