Health Committee on June 3rd, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 120 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 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 the black approved earpiece. The former grey earpieces must no longer be used. Please 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 for your co-operation.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

We have a challenge with Dr. Powlowski that we're trying to resolve. We will not hold up the meeting, if at all possible, while that's being done.

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.

I'd like to welcome our panel of witnesses. Appearing as individuals are Dr. Bohdan Nosyk, professor and St. Paul's Hospital CANFAR chair in HIV/AIDS research, Faculty of Health Sciences, Simon Fraser University; Mr. Benjamin Perrin, professor, Peter A. Allard School of Law, University of British Columbia; and Dr. Julian Somers, clinical psychologist and distinguished professor, Faculty of Health Sciences, Simon Fraser University.

Finally, we welcome Catherine Jutras, an overdose prevention consultant. She is representing Arrimage Jeunesse and Mouvement de la relève d'Amos-région.

All of our witnesses today are appearing by video conference. We will ask them to provide opening statements of five minutes in length in the order in which they appear on the notice of meeting.

We will start with Dr. Nosyk.

Welcome to the committee. You have the floor.

[Dr. Bohdan Nosyk, Professor and St. Paul's Hospital CANFAR Chair in HIV/AIDS Research, Faculty of Health Sciences, Simon Fraser University, As an Individual]

Thank you.

Good afternoon.

I'm calling in today from the unceded territories of the Musqueam, Squamish and Tsleil-Waututh nations.

Much of my work has focused on evaluating treatment for opioid use disorders, and I'd like to share some up-to-date evidence and perspectives on this topic, focusing on opioids specifically.

Broadly speaking, there are three options to choose from: outpatient pharmacological treatment, or OAT, short-term detoxification and longer-term residential care. The latter two may also include pharmacological treatment. Only one of these three options is systematically reported and available for independent researchers like me to analyze: OAT. That includes methadone, buprenorphine, slow-release oral morphine and others, prescribed in outpatient clinics and dispensed from community-based pharmacies.

As of March 2024, we had just over 24,000 people accessing some form of OAT in B.C. Unfortunately, retention in treatment has declined over the past 12 years. Although it's a complex story, most fundamentally, we haven't increased our daily dosing to match the elevated tolerance of our clients, who are now using fentanyl as opposed to heroin. More recently, doctors are now having to manage benzodiazepine tapers alongside OAT. Eliminating copayments for treatment and combining prescribed hydromorphone with OAT, as we learned serendipitously through the prescribed safer supply program, have improved OAT retention, although much more needs to be done to improve this form of treatment.

Short-term detoxification treatment in and of itself is not evidence-based care but rather a means of stabilizing and linking individuals to ongoing care after discharge. These data are held by health authorities and are not systematically linked to other provincial datasets. I was involved in a project where we were able to link these data in 2017, and the outcomes for people with OUD were poor. There were high rates of readmission to detox or ED admission, and only about 40% of people with OUD were dispensed OAT after discharge. I believe this is the only published evidence out there on detox outcomes in Canada. I urge you all to verify.

Data on specialized residential treatment facilities in B.C. are also siloed, held either by health authorities or by private for-profit clinics. We know that we have over 3,600 publicly funded treatment beds in B.C., although these are not exclusive to OUD. We know very little about the outcomes of individuals accessing this form of care in B.C. either at the point of discharge or after discharge. Tracking outcomes after discharge is important because what we've found is that transitions back into community are difficult, and it's likely that we need multiple tiers of support, including housing and other social supports, once these individuals are discharged.

What do we know about outcomes for people with OUD served by residential care facilities? Two systematic reviews were published in 2019, one by CADTH and one in the journal Drug and Alcohol Dependence. Though both demonstrated some positive outcomes, few of the component studies focused on people with OUD. The outcomes were mixed for this population, and none included people using fentanyl.

This leaves us with more questions than answers. We need to know the short-term and long-term outcomes for people who received residential care for OUD, including measurable definitions of recovery. We need to build the evidence on who benefits from these services, understand what percentage of that population is accessing services and ensure that this access is equitable, at least on geographic, ethnic and economic strata. We need to know about the staffing requirements and the level of financing needed to reach our target population. Can we hit scale? Finally, we need to continuously evaluate and adapt our approach as the needs of our clients change.

I want to emphasize here that these are not one-size-fits-all services. Through a Health Canada SUAP-funded grant, we found that perhaps the greatest unmet need was care for pregnant people with OUD. Until St. Paul's opened up a perinatal SUD ward earlier this year, there were only 13 perinatal SUD beds in B.C., and that's not just OUD but all forms of SUD. Twelve of them were in Vancouver, and there were none in the north, where OUD prevalence amongst pregnant women is 2.7 times higher than it is in Vancouver. That's coming out of a paper that's currently under review.

To be clear, no jurisdiction in North America has thus far successfully responded to the introduction of fentanyl into the illicit drug supply. Neither B.C. nor Alberta, the provinces with the highest prevalence of fentanyl in Canada, has done so. I'm a believer in evidence-based decision-making, a learning health system. That means learning from both our successes and our failures.

For the sake of the seven more people who will die of an overdose today just in B.C., I urge you to set aside your ideologies, political beliefs, and aspirations and focus on the true scope of this problem and the needs of these people. One of the constructive actions that this committee can take is to recommend—ideally, mandate—the systematic reporting of outcomes across all forms of SUD treatment, recognizing, of course, the legal complexities of doing so. We need to learn from each other to adequately respond to this persistent and evolving crisis.

I've made available to the committee each of the references used within this statement.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Nosyk.

Next, we have Benjamin Perrin from the University of British Columbia.

Welcome to the committee, Mr. Perrin. You have the floor.

[Professor Benjamin Perrin, Peter A. Allard School of Law, University of British Columbia, As an Individual]

Thank you, Mr. Chair.

Greetings. My name is Benjamin Perrin. I'm a law professor at the University of British Columbia.

A decade ago, I was the lead criminal justice and public safety adviser to Conservative Prime Minister Stephen Harper. I supported the tough on crime agenda and the war on drugs. I've come to realize those views were a toxic blend of ignorance and ideology. My heart was hard. My mind was closed.

What changed? I met with people deeply impacted by this unparalleled, unregulated drug crisis. I met people who use drugs and the family members of those who have lost loved ones. I met groups like Moms Stop the Harm, which have repeatedly asked to meet with people like Pierre Poilievre, the leader of the official opposition, yet he refuses to even listen to those courageous parents. I visited overdose prevention sites and clinics that provide regulated drugs as a substitute for those made by organized crime, places that I understand some members of this committee have refused to even visit. I read the studies and peer-reviewed evidence for myself. I interviewed police, prosecutors, defence lawyers, judges, border officials, indigenous leaders, public health experts, non-profits, peers and addiction medicine physicians.

My faith in Jesus Christ opened my heart to people who are suffering in our society, the marginalized, the downtrodden, the stigmatized and the outcast. I would remind others who share my faith, or profess to, that Jesus came to seek and save the lost, not to condemn and not to punish. He said to let those without sin throw the first stone.

This incredible transformation and journey led to a complete change of heart on these issues. I now have been recommending for many years a compassionate and evidence-based approach. I'll highlight the five urgent needs. There are many mid- and long-term recommendations, as well, but I'll focus on these in the short time I have.

First, naloxone, the temporary antidote to opioid drug poisoning, needs to be widely available and people need to be trained to respond. Naloxone saves lives.

Second, we must ensure every Canadian has access to a safe place to use substances, where they can receive emergency medical support free of fear of criminal prosecution. From January 2017 to January 2024, over 400,000 Canadians used these life-saving supervised consumption services, with staff responding to over 55,000 overdoses. Not a single person died. Over 470,000 referrals were made at these sites to health and social supports. As the Supreme Court of Canada said in a unanimous ruling in 2011, supervised consumption sites save lives, and their benefits have been proven.

All of the sources I'm mentioning have been given to the committee clerk.

Third, regulated substances are needed to replace the toxic, contaminated, unregulated drugs that are killing Canadians. Over 42,000 people died in our country between 2016 and September 2023 during this crisis. Now, misinformation and lies cannot conceal the true reason for these deaths. Illicit fentanyl made by organized crime, including right here in Canada, is the primary cause, detected in 82% of post-mortem toxicology reports. A regulated supply could include prescribed alternatives, compassion clubs or witnessed use for no-cost, regulated alternatives, but with payment required for carries and other options. Those who oppose regulated alternatives condemn Canadians to risk their lives with unregulated drugs made by organized crime. Regulated alternatives save lives.

Fourth, we need to address this as a public health emergency. It's not a criminal justice problem. Criminalizing people who use drugs is cruel, ineffective and deadly. Incarcerating someone with opioid use disorder increases their risk of death by 50 times. For many, it's therefore equivalent to a death sentence.

Fifth, Canadians need treatment and recovery options that reflect five key requirements: evidence-based, rapid access, publicly funded, regulated and, finally, trauma-informed and culturally appropriate. Abstinence-based treatment alone is not medically recommended. Studies, including those in the British Medical Journal, show that those who complete a 28-day detox program have an increased risk of death because this is, again, a chronic relapsing condition and their tolerance goes down rapidly during periods of forced or voluntary detox, making a relapse potentially deadly.

This false debate between harm reduction versus treatment is a distraction. We need both. People need to be alive to enter treatment.

In closing, I agree that no jurisdiction in Canada has fully implemented all of these evidence-based recommendations.

I would implore you, if your goal is to get re-elected and secure power, to read the polling data. If your goal is to save lives, I urge you to read the research and listen to those most deeply impacted by this crisis.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Perrin.

Next we have Dr. Somers from the Faculty of Health Sciences at Simon Fraser University.

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

[Dr. Julian M. Somers, Clinical Psychologist and Distinguished Professor, Faculty of Health Sciences, Simon Fraser University, As an Individual]

Thank you.

I am Dr. Julian Somers, a person in long-term recovery, a licensed clinical psychologist and a distinguished full professor at Simon Fraser University. I began my clinical career working at B.C.'s Riverview Hospital in 1987, and was trained in addiction research and clinical practices by Dr. Bruce Alexander and Dr. Alan Marlatt.

I've directed clinical training in departments of psychology and medicine, and led three university-based centres focused on clinical and applied research. My body of research addresses harm reduction and recovery from addictions, often concurrent with additional mental illness among youth and among people who experience homelessness and frequent involvement with our justice system. I have also led primary care and telehealth programs spanning B.C., Alberta and the north.

I'm here today to testify to B.C.'s dangerous and imbalanced approach to addiction policy that prioritizes drug liberalization and legalization and largely ignores addiction prevention and recovery. This approach has been driven by an influential group of current and former health officials whose financial interests overlap with their advocacy.

As has been reported by several journalists, B.C.'s drug policies have been shaped for many years by a network of public servants and university-based researchers who previously focused on pharmaceutical interventions for HIV/AIDS.

The key players include former provincial health officer Dr. Perry Kendall and the Michael Smith foundation's scientific director, Dr. Martin Schechter, who co-created Fair Price Pharma to provide heroin. Former deputy PHO Dr. Mark Tyndall created the MySafe Society, which dispenses opioids from vending machines. Dr. Evan Wood created a pharmaceutical company and directed the B.C. Centre on Substance Use, or BCCSU, which was formed from the HIV/AIDS centre for excellence. The current BCCSU director, Dr. Thomas Kerr, was recently involved in a scheme to disrupt and silence speakers at a conference I spoke at. The BCCSU provides significant annual funding to the Vancouver Area Network of Drug Users, VANDU, and other allied groups. He was also involved in research for the Drug User Liberation Front's activities purchasing, testing and selling illegal drugs. DULF and VANDU have a pending court decision versus the federal government, where they argued for a section 56 exemption to be able to legally buy and distribute drugs, including heroin, cocaine and meth. DULF was raided and shut down by Vancouver police last year. Reports state that Dr. Kendall met with DULF about providing them with heroin. B.C.'s current PHO, Dr. Bonnie Henry, is a protege of Dr. Kendall's and a collaborator in these misguided actions. In her report advocating for decriminalization, she wrote, “As overdoses become more pervasive both domestically and worldwide, jurisdictions are looking to B.C. for leadership and guidance. The stage is set for the province to meet this call.”

The BCCSU has substantial influence on public policies that focus in a dangerous and imbalanced way on pharmaceuticals. Drugs are a relatively small component of policies and services that reduce harms associated with addiction. Furthermore, the BCCSU appears to be focused on advancing drug legalization. Dr. Kendall served as co-executive director of the BCCSU after retiring as PHO. Despite public reporting of apparent conflicts of interest, I'm not aware of any actions to investigate how our current policies may be related to incentives among those involved.

My efforts to advance relevant evidence have garnered a severe backlash in my home province of B.C. In 2022 I co-authored a rapid review on safe supply that highlighted the weak status of evidence, the likely risks, including drug diversion, and the alternative interventions that are well supported by evidence. The BCCSU responded by holding press conferences and producing an open letter accusing us of conducting low-quality research, which was a grossly inaccurate statement. They also attacked my character and have sponsored plans to disrupt events that I am speaking at and have me removed as speaker. These are the methods of activists, not scientists.

In March 2021, I briefed B.C. deputy ministers on evidence related to addiction. One week after the briefing, I received a letter ordering the immediate destruction of our entire database spanning over 20 years of research and involving hundreds of thousands of British Columbians. Remarkably, the B.C. government subsequently lied about these actions.

I continue to speak out because I have a responsibility. The suffering in some parts of our country is exacerbated rather than ameliorated by public programs. We need to redirect our actions to address addiction prevention and recovery.

I’m grateful for the opportunity to appear.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Somers.

We will now turn to the representative from Arrimage Jeunesse and Mouvement de la relève d'Amos-région.

Please go ahead, Ms. Jutras.

[Catherine Jutras, Consultant, Overdose Prevention, Arrimage Jeunesse and Mouvement de la relève d'Amos-région]

Hello, everyone.

First of all, thank you for inviting me to appear before you. I am not used to having this kind of platform. I have been working on the front lines for about 20 years and I was a street worker for 12 years, working every day with people experiencing the kinds of problems we are talking about today. I am not used to making this kind of presentation and I am a bit nervous, but I will do my best.

I was invited here today because I conducted research for a year and a half. I began the research at the end of 2021 and finished it in 2023. During that research, I was on the front lines documenting the real-life experiences of people who use drugs in an effort to highlight the human element behind this problem. People often refer to data and facts, but the human element often seems to be overlooked. This whole problem is extremely complex. I wanted to highlight that fact. Since I had the opportunity to work with people in order to bring attention to this problem, I had access to their personal histories and was able to develop trusting relationships with them.

In the studies that are conducted, it really seems to me that we will never get the real numbers as long as there are so many taboos in this area. These taboos and stigmatization are major factors that obscure the real things that we see, do not see, or experience at the same time.

I have forwarded my study findings to the clerk so you can review them. I say a study and research, but it was really very simple. I did my research in the community, not with a university.

What led me to conduct my study? I started my study by reaching out to people on the front line. I took part in 29 directed discussions, not really interviews, with people who use drugs. I met all kinds of people, both homeless people and ordinary people who use drugs. I talked to a municipal councillor, to single-parent families and to people working in the mines. People from all walks of life use drugs. Someone said something that struck me, and that was how I began my study. That person said they did not want to become a statistic, the number you become if you die of an overdose. That was really the comment that sparked my study.

What were the findings of my study? I met directly with 29 individuals. I spoke with 14 workers from 11 different services in Abitibi—Témiscamingue, the region I am from. I also reached more than a hundred people through various surveys. What this study shows is the real complexity of the problem.

I would like to ask you to consider the problem from another point of view. Drug use can be seen as problematic in itself. In many cases, however, we see a lot of people who use those drugs to deal with another problem. When I say the complexity of the problem, I mean we have to look at the problem as a whole. Rather than focusing on the fact that a drug causes a specific problem, we have to ask and try to understand why people use those drugs. They are the ones who could tell us why they use them. We cannot generalize because every person has their own reason for using them.

The problem has to be addressed proactively. In my opinion, there are two aspects: prevention, which people talk about a lot, and harm reduction. They have to be considered together because they do not have the same objective. That said, the vision and goals are ultimately the same, but we need to work on both aspects at the same time.

[The Chair, Liberal, Sean Casey]

Ms. Jutras, I would invite you to finish your opening remarks. The committee members are eager to ask you some questions, and you will have the opportunity to comment further in answering them.

[Catherine Jutras]

Time flies, Mr. Chair. I will conclude my remarks, but I will be pleased to provide additional details in answering questions from members.

My message is to ask you to consider the complexity of the issue and to respect each individual's journey. It often seems that people want to solve a problem by giving individuals a predetermined timeframe, but it is very important to respect each person's path to rehabilitation. We have to remember that not everyone who uses drugs has problems.

It is fairly simple to work towards harm reduction by facilitating access to substance analysis. In my view, the problem is that people don't know what they are taking, and they experience the effects of toxicity and contamination, which increase the risk of overdose. Facilitating access to substance analysis could be a step in the right direction.

I will stop here, but I look forward to the members' questions.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Jutras.

We will now begin with rounds of questions starting with the Conservatives.

Mrs. Goodridge, you have six minutes, please.

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

Thank you Mr. Chair.

Thank you to all the witnesses for testifying here today.

My questions are going to be primarily directed to Dr. Somers.

Dr. Somers, you mentioned Dr. Perry Kendall. What was his role when he was a public servant with the Government of British Columbia?

[Dr. Julian M. Somers]

Perry served as our inaugural provincial health officer, our head medical health person advising the provincial government.

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

What about Dr. Mark Tyndall?

[Dr. Julian M. Somers]

Mark served as Perry's deputy and overlapped in that role with Dr. Bonnie Henry, also serving as deputy provincial health officer.

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

What about Martin Schechter?

[Dr. Julian M. Somers]

Marty—I'm sorry; before our most recent disagreements, I was on a first-name basis with all these individuals.

Marty worked in HIV/AIDS in the centre.

They all had very important roles and worked collaboratively in truly groundbreaking HIV/AIDS-related work. Marty, most recently, is the scientific director of the Michael Smith foundation, which is B.C.'s largest health research funder. He also has a role at the University of British Columbia.

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

In your opening statement, you made reference to the fact that some of them are now working for pharmaceutical companies. I think that's quite concerning. I was wondering if you could lay that out a little bit. I know that you have a lot of experience when it comes to this, so I was wondering if you could share with us where they are now.

[Dr. Julian M. Somers]

I've observed that they turned attention from HIV/AIDS to addiction as a group. They appear to have preserved the same focus on pharmaceutical interventions that made a lot of sense in relation to reducing infectious diseases, but it's not a good fit for addiction. As I said in my remarks, pharmaceuticals play a relatively limited role.

It's clear now that they worked together in advancing a larger agenda to prioritize the role of pharmaceuticals. They each laid claim to various corporate methods of following through on their advocacy. Unfortunately, they also took the step of stymying criticism and had a strong influence on shaping an overall narrative that, in some cases, was really inaccurate—an example being, as was said with respect to HIV, that everyone is at risk. They tried to promote that same narrative with respect to addiction, where it is simply not true.

Looking at B.C. to give some fairly stark examples—

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

Sorry, we have very limited time, so I just want to summarize.

You said that top public health officials, who made decisions about whether safe supply would go forward in British Columbia, then went on to found pharmaceutical companies that would stand to benefit financially by supplying safe supply in British Columbia.

[Dr. Julian M. Somers]

Yes, and elsewhere.

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

In your opinion, is this a conflict of interest?

[Dr. Julian M. Somers]

I wouldn't be the first to say there is the appearance of conflict. I believe there is that.

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

It's generally accepted that the appearance of conflict is in and of itself a conflict.

You just said that they wanted to benefit from safe supply elsewhere. Could you expand on that a bit? Where else were they trying to expand their grasp?

[Dr. Julian M. Somers]

For instance, it would be through the so-called compassion club model, which also harkens back to HIV/AIDS. Essentially groups and networks of people would procure drugs and make them available to others. Those are now across the country. The vending machines that are part of Dr. Tyndall's company are in multiple provinces.

The effort to advance so-called safe supply also had national aspirations and is of course implemented in provinces other than B.C. The origin of this is with this group. They had their sights on having both a national and international impact, as Dr. Henry noted in her report on decriminalization.