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.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Mr. Chair.
Thank you to all of the witnesses for being here with us.
Before I start my questions, Mr. Thiessen, I want to recognize you for your bravery and strength. Thank you for sharing your story with the committee today.
Dr. Henry, my first question is for you.
You're known to most Canadians for your response to the pandemic in B.C. Could you talk to this committee about the impact this pandemic had on mental health, especially that of British Columbians?
British Columbia Provincial Health Officer, As an Individual
Thank you for that.
I think that is one of the challenges that we face that is most critical. I'm particularly concerned and have been for some time. The data has shown that the issues of mental health and anxiety in young people in particular have gone up dramatically throughout the period of the pandemic. While we have seen some recovery, there are still higher rates of anxiety and mental health issues for young people. We know that when those issues increase, many people turn to substance use to help support them in their world. We've seen an increase in substance use.
Substance use disorders in young people remain low, thankfully. We have not seen an increase in that over the past number of years. What we have seen is increased occasional use and challenges for people who have problems accessing mental health and substance use support.
Those are the issues that we really need to focus on right now. It's a broad spectrum of how to support young people to recover from the traumas that they've been through over these last few years.
Liberal
Sonia Sidhu Liberal Brampton South, ON
From a public health perspective, do you think forced treatment is a good idea?
British Columbia Provincial Health Officer, As an Individual
Data has shown over the years that if you force treatment, or a treatment is done when people aren't ready, that can leave them more at risk when they have relapses or when they leave treatment. As well, doing that undermines the relationship of trust they may have, particularly with their health care providers.
We say all the time that the opposite of addiction is connection. Having a trusting relationship with their health care provider is what people tell me they crave, they want and they need to help them on their road to recovery.
Liberal
Sonia Sidhu Liberal Brampton South, ON
My next question is for Dr. Bach or Mr. Thiessen. It's about stigma. What recommendation or examples of successful policies can you give to this committee to address stigma in British Columbia or across Canada?
Clinical Assistant Professor, University of British Columbia, As an Individual
I can speak to that more just in the sense of how much I see as a physician, as somebody working on the front lines, how stigma does impact the way we provide care for people who use substances and accordingly their willingness to access care. It is very rare that I see a patient who hasn't experienced stigma related to their substance use, whether it's from friends or family, in the workplace or in the health care system. We can't ignore how significant an impact that has on people's willingness to be forthcoming about their substance use, to seek help and to have trust in that help.
As far as specific policies that have been successful in addressing stigma go, that's something I'd have to give some thought to. I can't really speak to that, but I think that unfortunately it goes much deeper than any one specific policy. This is about a cultural shift in the way we think about substances and substance use disorders. This is a process and something that I think really must inform every discussion we have and every intervention we're talking about, because if we don't address that as one of those fundamental upstream drivers, we are going to continue to struggle.
Liberal
Executive Director, Oxford House Foundation
That's a very good question, and that is a huge driver right now in society in general.
To me, stigma and shame go hand in hand. It plays both sides. Right now there's a huge stigma towards recovery. When I was addicted, I had a lot of people stigmatize me and everything. The way I see it now and the way I speak to people who are on the cusp of entering recovery and everything is that looking at yourself through other people's opinions is really a rotten way to live your life. It should be based on your opinion about yourself, and I think there has to be a societal shift and change with respect to how every aspect of a recovery-oriented system of care is viewed. It shouldn't be stigmatized. It's hurting more than anything right now. Shame is a huge feeder of addiction, and those coincide with each other.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Thiessen.
Mr. Lemire, you have the floor for two and a half minutes.
Bloc
Sébastien Lemire Bloc Abitibi—Témiscamingue, QC
Thank you, Mr. Chair.
Ms. Drouin, what regulatory barriers could the federal government remove to simplify the process; to ensure that health authorities and community agencies can apply for and receive exemptions; and to provide supervised consumption, overdose prevention and drug analysis services? Above all, why should these barriers be removed?
Regional Public Health Director, Direction régionale de santé publique de Montréal
I'll let Dr. Morissette, who manages all this paperwork, tell you about it.
Lead Physician, Harm Reduction and Overdose Prevention, Direction régionale de santé publique de Montréal
We really want to point out that, as you know, to set up supervised injection or inhalation services, we must obtain an exemption from the Controlled Drugs and Substances Act.
In our situation, we need to increase and diversify the services. We want lighter administrative processes so that we can provide more services and, in particular, inhalation rooms.
This means less reporting. We know that it's a demanding process. All the partners work hard to meet the requirements of an exemption application. However, I think that making the process easier and reducing the time required to obtain exemptions would be a major step forward.
Bloc
Sébastien Lemire Bloc Abitibi—Témiscamingue, QC
Street drug analysis is a key measure in the toxic drug crisis.
Can you tell us more about the effectiveness of this measure and how to make it even more effective?
Regional Public Health Director, Direction régionale de santé publique de Montréal
I can start answering your questions, and Dr. Morissette can chime in.
Drug analysis has a number of objectives. The first is to give users in different places the opportunity to find out about the risks involved and the content of the drug that they're about to take. These drug sample tests help us understand the drugs currently going around and adjust our harm reduction strategies accordingly. This concerns both our public health organization and our partners.
Obviously, we carry out these tests in supervised consumption centres. However, we're conducting the tests in an increasingly wide variety of places. We even go to major festivals—Montreal is known as a festival city—where young people, including our children, often have the opportunity to use drugs. These drugs can be contaminated and fatal. We also use the tests to prevent overdoses in these places, especially since the people are occasional users.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Drouin.
Next, we have Mr. Johns for two and a half minutes.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you.
I'm going to ask Dr. Bach to talk about the road to recovery model and care at St. Paul's. I know some of the committee members have been there. I've been there to meet with you and your team. I had a visit to better understand the work you're doing.
Can you talk about the status quo versus the alternative model you're delivering?
Also, can you talk about gaps and opportunities in the medical education landscape in Canada, and how addressing these may help build a workforce of physicians who can respond to this crisis with quality addiction care?
You have about two minutes. I'll give you the rest of my time in this round.
Clinical Assistant Professor, University of British Columbia, As an Individual
Certainly. Those are two excellent questions.
I already briefly discussed the road to recovery model at St. Paul's, and we were very happy to host some of the members there. Once again, we're talking about a coordinated model of care where, essentially....
There's already a question here about forced or coerced treatment. We have not traditionally done a particularly good job in Canada of making treatment easy to access, participate in and navigate—making it patient-centred, flexible and coordinated. Before starting more conversations about forcing people into treatment, I would suggest we start by trying to make it appealing and attractive while speaking to people's individual needs, goals and situations. Just make treatment easy.
Again, the road to recovery program is about coordinating a whole host of services under one umbrella so patients can enter at different points and move through it in ways that speak to their particular needs and trajectories, which are seldom linear, as we know. Then—
NDP
Gord Johns NDP Courtenay—Alberni, BC
Dr. Bach, I'm sorry to interrupt.
Do you think it's almost premature to even have a conversation about mandatory treatment, when people who want help can't even get it anywhere in Canada?
Clinical Assistant Professor, University of British Columbia, As an Individual
Yes. I would suggest that we need to be focusing on making treatment available and easy for those who are asking for it. That's the bare minimum in terms of where we can start.
Moving to your second question—which I think is a very critical one, and one we don't talk about enough—one of my roles is director of our fellowship program here, which I'm very privileged to sit in. We train 10 fellows per year, approximately, at St. Paul's. That's 10 addiction medicine experts per year. Unfortunately, about a third of the capacity for the entire country is coming out of our centre. We simply do not offer a lot of training opportunities for people who are seeking, in the medical field, to work in this space. Therefore, when we talk about increasing access to all these services, we really need to be mindful of our workforce and look at ways of incorporating opportunities for education for any number of different health professionals—making that education available.
In the current climate, anyone seeking further training or education in this space must be able to access it. That is, if somebody is actively wanting to do this work, the least we can do is try to facilitate that exposure or training—whatever level that might be—in order to build that workforce. I am—
Liberal
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Dr. Henry, I was wondering if you could tell us how many publicly funded treatment beds there are in British Columbia.
British Columbia Provincial Health Officer, As an Individual
I don't have that data, but I can get it to you.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
The answer is 3,663.
Do you know how many people are prescribed safe supply in British Columbia?
British Columbia Provincial Health Officer, As an Individual
Last we checked, the prescribed alternatives program had about 4,000 individuals.