Evidence of meeting #120 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was perrin.
A recording is available from Parliament.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
You wrote a report in 2022 that was really critical of safe supply. Can you expand on that report for us?
Clinical Psychologist and Distinguished Professor, Faculty of Health Sciences, Simon Fraser University, As an Individual
It was only critical insofar as.... We did this for the Alberta Ministry of Health. We've done systematic reviews, rapid reviews. Rapid reviews are done as they sound, very quickly on a focused question, usually before Parliament or the House.
We were given a series of linked questions. We conducted our analysis. We reported our methods. We reported the questions that we were addressing. We found, as others had found, that there was no evidence directly addressing the practice that we're referring to as safe supply. We highlighted some risks and some alternative interventions that have far greater track records and empirical support in reducing severe addictions. That's what we produced.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Somers.
Thank you, Mrs. Goodridge.
Next is Dr. Hanley for six minutes.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you to all the witnesses for appearing today.
I want to start with Dr. Nosyk.
Thanks for coming. You previously submitted to this committee a presentation that was based on the risk mitigation study. It's quite a long presentation. There are lots of interesting conclusions. Can you briefly recap that study and its findings?
Professor and St. Paul's Hospital CANFAR Chair in HIV/AIDS Research, Faculty of Health Sciences, Simon Fraser University, As an Individual
At a high level, people who received risk mitigation dispensations, particularly opioids, in the week after receipt had a much lower risk of death. We saw a biological gradient in that effect. More dispensations led to a lower risk of death. That was controlling for access to OAT, so it was independent of access to OAT.
We've since come up with a separate study looking at coprescription, because doctors often coprescribe hydromorphone tablets alongside OAT. We actually saw some really positive benefits in terms of improving retention in treatment.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you very much.
Can you see these results applying to other settings? What are the conclusions that we could derive in terms of harm reduction and safe supply being applied to other settings?
Professor and St. Paul's Hospital CANFAR Chair in HIV/AIDS Research, Faculty of Health Sciences, Simon Fraser University, As an Individual
I think this is one tool in our tool box. It's one step and one part of a continuum of care.
As others have mentioned, I don't think this is a debate of harm reduction versus recovery-oriented models. I think we need a full spectrum of different options. In a time when we're dealing with a progressively more toxic and unpredictable drug supply, we need more options to deal with these challenges, not fewer.
Liberal
Brendan Hanley Liberal Yukon, YT
Are you familiar with the research of Dr. Somers and specifically some of the criticism of his research quality by leading addiction experts?
Professor and St. Paul's Hospital CANFAR Chair in HIV/AIDS Research, Faculty of Health Sciences, Simon Fraser University, As an Individual
I am.
Professor and St. Paul's Hospital CANFAR Chair in HIV/AIDS Research, Faculty of Health Sciences, Simon Fraser University, As an Individual
Would you like me to comment on that?
Professor and St. Paul's Hospital CANFAR Chair in HIV/AIDS Research, Faculty of Health Sciences, Simon Fraser University, As an Individual
When the report came out, I hadn't seen it. I had only seen the review and the critique. I reviewed both the report and the critique, and I came to the same conclusions as those who wrote the critique. I thought the conclusions didn't match the underlying data. I think they were premature.
At that time, colleagues across the other institutions I was working with and I were designing the evaluation of the RMG program. It took us time to collect that data and report it out to the public. I was a signatory to that critique.
Liberal
Brendan Hanley Liberal Yukon, YT
Mr. Perrin, thank you for your testimony.
I read your book, Overdose, which you wrote in 2020. I was going to bring it for you to sign, but I realized you were on the video conference today.
Liberal
Brendan Hanley Liberal Yukon, YT
When you wrote that book four years ago, it was during the pandemic.
Has anything changed, apart from things getting worse in most jurisdictions and the contaminated toxic drug supply getting worse and more complicated? In terms of your overall observations, your approach and your recommendations, has anything changed since you wrote that amazing book?
Prof. Benjamin Perrin
The core problem remains the same. It has become worse. Particularly here in B.C., as you alluded to, if you look at the graphs in the B.C. coroner's reports, we see that not only do we continue to have these persistently high levels of illicit fentanyl in these post-mortem toxicology reports, but benzodiazepines have continued to steadily rise and increase.
When we're looking at reasons for why deaths are continuing unabated, relatively speaking, despite some measures being taken, that is something big to contend with.
I think the big thing that has changed, though, since 2020-21 is that we're in the midst of a major backlash against measures that are evidence-based and that we know save lives. Specifically, these are supervised consumption sites, regulated safer supply and treating people who have substance use disorder as people rather than as criminals.
When I wrote Overdose, to be quite honest, I actually thought I was wasting my time on a few chapters in the book in which I was arguing why we need to have supervised consumption sites and why we need to have alternatives to toxic drugs. At the time I wrote it, I thought it was so self-evident and that was where things were going. Now we see it going in completely the opposite way.
The biggest concern I have right now is the misinformation and the lies that are blocking life-saving interventions.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
Can you give an example of a lie or two that are being propagated and preventing evidence-based policy from being implemented?
Prof. Benjamin Perrin
Yes. Here's one that I called out: This is from Conservative MP Glen Motz. Some of you will have seen this. It is a tweet he put out on X on April 30 of this year. He wrote, “Trudeau decriminalized public use of crack, heroin & other hard drugs, resulting in a 380% increase in BC deaths”. That's a lie. I responded to him directly in my own post, citing BC Coroners Service data. I wrote, “This is a lie you are spreading. There has been no such increase”. In fact, the most recent data at that point was from February 2024, comparing February 2023 to February 2024. In those months, there was actually an 11% decrease in people who had died.
Those are the kinds of lies and misinformation we're talking about.
A second example I would give you is the lie that it's safer supply that is killing Canadians. That's a lie that has been perpetuated by the current leader of the Conservative Party Mr. Poilievre.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Perrin.
We will continue with the Bloc Québécois.
Mr. Thériault, you have the floor for six minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Ms. Jutras, no need to blush or apologize for being shy. It is important for us to get the facts from the front lines, in addition to the expert testimony we have heard, beyond the toxic mixture of ignorance and ideology that Mr. Perrin referred to. That truth is subjective of course, but it is important for us, through your voice and your work, to listen and hear what these human beings have to say to us so we can learn lessons and adjust our approach to their suffering.
Mr. Chair, if Ms. Jutras would be so kind, I would like her to submit her qualitative study to the committee so we may refer to it. If she agrees, I would like it to serve as a reference document for the committee.
Consultant, Overdose Prevention, Arrimage Jeunesse and Mouvement de la relève d'Amos-région
Yes, of course.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you.
So you had access to a sample of 29 individuals who opened their hearts and agreed to trust you and tell you their story.
Stigmatization is one of the greatest dangers faced by people with an addiction. We heard about that when we visited major Canadian cities. I would like you to tell us more about that. What harm does stigmatization cause? What do those people say about it?
Consultant, Overdose Prevention, Arrimage Jeunesse and Mouvement de la relève d'Amos-région
I can give you quite a striking example. When I was looking for people to tell me about their experiences, I met a parent whom I didn't know who said that it made no sense and they had to talk about it. It was a single parent of two children, one of whom needed a lot of attention. That parent was incredibly afraid. I say “that parent” for a reason, because they passed their fear on to me. I can't say whether it was a mother or a father, because I am too afraid of identifying them. I respect their anonymity. That parent might however be representative of a lot of parents in the same situation.
That parent has responders and police officers in their family. No one in their family or circle knows they use drugs and take 8 to 10 amphetamine tablets every day to be a good parent. But that person can't manage, isn't able, doesn't have the energy, and cannot do it under the incredible social pressure to be the best parent possible, pressure that you must be familiar with as well. That person who takes 8 to 10 amphetamine tablets every day does not seek help. That person told me that if their children were taken away, that would be the end for them. So they have an incredible fear of seeking help and are afraid to talk. I could hear the person's voice trembling when they spoke to me, a person who deprives themselves of all kinds of services out of fear.
There is also stigmatization, which is even worse than self-stigmatization. People eventually internalize those messages. I am thinking of another person who was very involved in the community, a responder who had helped many people, but whose life had changed dramatically. Now that person is injecting drugs and has been treated as human garbage on the street. They had helped the community so much, but internalized those messages: When doors are opened for them and they are invited in, they answer that they don't deserve it.
There was also another person who asked for help at a certain point. In my study, I say that there is no wrong door to knock on to ask for help. That person knew about a rehabilitation centre, but did not know about the red tape involved. One evening when they were using, they decided they couldn't go on and had to stop because it made no sense. So they went to the centre because they had friends who had gone there. They were turned away and told they would have to go through the usual process and go to the local community services centre. This person didn't criticize the system. They said instead that they didn't even deserve to be helped by an addictions organization and were worthless. Then they went and used drugs. That's an example of the internalization of stigmatization messages.
Liberal