Health Committee on June 6th, 2024

[The Vice-Chair, Conservative, Stephen Ellis]

I call the meeting to order. Welcome to meeting 121 of the House of Commons Standing Committee on Health.

Before we begin, I 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 order to protect the health and safety of all participants, including the interpreters. Use only the approved, black earpiece. The former grey earpieces must no longer be used. Keep your earpiece away from the 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.

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 welcome our panel of witnesses. We have, as an individual, Guy Felicella, harm reduction and recovery expert, by video conference; Dr. David Tu, medical doctor, Kílala Lelum Health and Wellness Cooperative, by video conference; from the Government of Alberta, Dan Williams, Minister of Mental Health and Addiction; and from the Institute for Addictive Behaviours and Dependencies, Dr. João Goulão, by video conference.

Thank you all for attending.

We start with opening statements. You each have five minutes. Should you wish to look at me, I will hold up a one-minute card when you have a minute left. I like to run the committee on time, given my former military background. We'll try to stick with that.

Given that, Mr. Felicella, you have the floor for five minutes.

[Guy Felicella, Harm Reduction and Recovery Expert, As an Individual]

Thank you.

Good morning, honourable members.

My name is Guy Felicella. I'm here to speak to you today as someone who has struggled with drug use for more than two decades. I lived on the streets. I was a dealer. I went to jail. I survived six overdoses and severe infections before I found recovery. I now have a job helping others, a family and a life that I love.

Before I give my statement, I want to say that I was hesitant to appear at this committee. I've watched several of your meetings since February and have been disappointed by the witness testimony being taken out of context and shared on social media. This is an issue that I care deeply about, so I'm here to share my story and what I know and to ask you to treat this crisis with the integrity it needs.

Here is my key message: The cause of today's crisis is contaminated street drugs provided to Canadians by organized crime, full stop.

Luckily for me, when I started using substances in 1981 to deal with depression and suicidal thoughts at the age of 12, street drugs were not yet contaminated with unknown quantities of fentanyl, benzos and xylazine.

By my twenties, I was addicted to heroin. I was navigating the hierarchies of prison and gangs, seeing death and violence, facing threats to my safety and my life, and dealing with the extreme challenges of living on the street. I was able to survive all this, in part, because even though they were illicit, I knew the drugs I was consuming.

When North America's first supervised consumption site opened in 2003, my life changed immediately for the better. At Insite, I received clean needles, which reduced my risk of overdose and cut my risk of dangerous infections. I got health care and support services. Every time I asked for it, I got help entering detox and treatment programs.

Insite's records show that I used this harm reduction facility more than 4,000 times in 10 years.

I know some of you think I didn't deserve that level of support and that I should have been left to die from my trauma, my addiction and my choices. However, my wife, my three kids, the people I have supported into recovery and many of the youth I've helped redirect would disagree with you. Maybe even the mayor and council of the City of Vancouver would disagree too, since last month they declared a day in my honour for all the work I do to help people.

I experienced multiple overdoses at Insite, including my last two on the same day in 2013. All overdoses were reversed with naloxone. That staff group there saved my life.

It's probably not a coincidence that fentanyl first appeared in B.C. in 2013, but I don't know if it was in the drugs that nearly killed me. That was also the year, after many attempts, that I achieved recovery and it stuck. If I hadn't, I wouldn't be here to talk to you today.

The heroin I was using, which killed 334 people in 2013, has now completely been replaced in the drug supply by an ever-changing toxic mix of fentanyl and other adulterants. This was a massive jump in potency when supply chains were interrupted during the pandemic.

Last year, in 2023, toxic drugs, sadly, killed over 2,500 British Columbians. That's more than seven times the number of deaths, and with that comes an equal increase in related physical and brain injuries; pressure on first responders, health care and recovery programs; and impacts to public safety and to our communities. That's more than seven times the impact in 10 years. That's over 600%. We don't have the resources or people to deal with such a huge increase over such a short period of time.

This deadly trend is repeating in every province across Canada and every community in North America, regardless of drug policies, which brings me back to my key message. This is a toxic drug crisis. It's not a policy crisis. It's not an addictions crisis. It's not because of wacky people or wacky ideas. It's not caused by harm reduction, safer supply or decriminalization, and every single one of you knows this.

You've heard from over 50 witnesses, and you've received 20 briefs. This must be clear acknowledgement that toxic, illicit drugs are the cause of this public health emergency, and the public must be informed and warned about where the real risks lie. You are hurting people when you say otherwise.

Different experts have different ideas and solutions, but if there is no agreement on the cause of the crisis, then your work here at this committee is absolutely pointless. Only from shared understanding can real solutions, rather than campaign slogans, be developed, debated and decided.

Thanks for your time, and thanks for listening.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Mr. Felicella.

Now we'll turn to Dr. Tu.

You have the floor for five minutes, sir.

[Dr. David Tu, Medical Doctor, Kilala Lelum Health and Wellness Cooperative, As an Individual]

Thank you, Guy.

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

Thank you, honourable members, for this opportunity to speak with you.

Allow me to begin by situating myself in the work that I do. My name is David Tu. I am a non-indigenous family physician. For the past 24 years, I have worked as a family doctor in Vancouver's Downtown Eastside with a dominantly indigenous practice. I am grateful for the last four years to have been the recipient of a Health Canada SUAP grant, which has allowed me to explore the impacts of partnering indigenous elders with primary care providers to deliver services to indigenous people living with opioid use disorder in an urban setting in a meaningful way. I currently work at the Kílala Lelum health centre in the Downtown Eastside.

As Guy just said, we are eight years deep into a public health emergency in British Columbia, resulting in the deaths of seven individuals per day due to an increasingly toxic and unregulated drug supply. Indigenous people living in the Downtown Eastside are at the epicentre of this crisis. To illustrate this, I want to share a story that highlights some of the complexities of the situation.

Ms. M is 38-year-old indigenous woman of Métis and first nations ancestry. I've known her and she's been a part of my family practice for the past 14 years. She's the mother of a three-year-old son. She's incredibly witty and a fiercely loyal human being. She's also endured extreme levels of trauma in her life, and she lives with a long-term, severe substance use, opioid and stimulant use disorder.

For the two years after her infant son was taken from her and removed to care, Ms. M expressed no interest in controlling her substance use. Despite the support of her family and a dedicated care team, there was minimal engagement in opioid agonist treatments and only sporadic engagement with prescription alternatives.

During this two-year period, she experienced multiple overdose events. She could easily have died and been just a statistic in the sheer volume of indigenous people dying each day in B.C., yet with an increased sense of hope for reclaiming her role as mother to her son, I am pleased to say that Ms. M is now engaging in care and is on a fentanyl patch-based OAT program that has allowed her to significantly reduce her illicit opiate and stimulant use.

She is currently motivated to attend an indigenous family-centred residential treatment program with both of her parents, her sister, her partner and their son. Sadly, the only two indigenous-specific treatment centres in B.C. that accept families will likely reject this family, one, because they exclude people who are receiving OAT and, two, because they do not allow children under age eight.

We are hoping for an exception, but both centres have a six- to 12-month wait-list, and this is a harsh reality for this family. Eight days ago, Ms. M was discovered unconscious in a bathroom in her mother's apartment building. Thankfully, she was resuscitated, and she recovered in the emergency room.

Let me make a statement of fact. The unregulated drug supply is killing people, and first nations people are at six times the risk of death compared with non-indigenous people in B.C. To paraphrase elder Bruce Robinson of the Nisga'a people—you can't help people if they are dead.

Many individuals with a substance use disorder are not ready to address their addiction for a variety of reasons. This means that oftentimes treatment services are unlikely to bring about a recovery for them, similar to Ms. M in the two years following the removal of her child.

Alongside other harm reduction initiatives, prescribed alternatives and opioid agonist treatments can help reduce the risk of overdose; however, it is widely agreed among medical professionals like me that we can't prescribe our way out of this public health emergency. There are several things that we collectively need to do to change course.

The first is a fully functional continuum of care from harm reduction to recovery-oriented treatments.

The second is a pathway we can all be on to a regulated drug supply. We must also acknowledge that culture saves lives. For indigenous people specifically, whose route to addiction was often paved by the trauma resultant from colonialism, traditional medicines and cultural practices offer a meaningful means for many to gain control over their substance use and address the underlying causes of their addiction.

The third need is for more investment in programming focused on culture, traditional medicines and land-based healing. To be clear, we need investment in treatment programs. For indigenous individuals such as Ms. M, who are prepared to address their substance use, there is a need for increased access to culturally appropriate residential and community treatment.

Lastly and importantly, we must put an end to false dichotomies and divisive politics. I couldn't say it better than Guy did. We are a country of abundant resources, and the COVID-19 pandemic revealed our capacity to mobilize resources in response to public health needs. We need harm reduction services, including prescribed alternatives to keep people alive when they are not prepared to—

[The Vice-Chair, Conservative, Stephen Ellis]

Dr. Tu, I have to interrupt you. You'll have lots of time to expand on your ideas as people ask you questions, but your five minutes are over, sir. Thank you.

Next we turn to Mr. Williams.

You have the floor, sir, for five minutes.

[Dan Williams, Minister of Mental Health and Addiction, Government of Alberta]

Thank you.

Thank you for your warm welcome here, in Ottawa.

My name is Dan Williams. I am the Minister of Mental Health and Addiction for the Province of Alberta. I'm a policy-maker. I don't have lived experience. I haven't worked on the front lines. I am someone who gets to decide, with my cabinet and my colleagues in Alberta, how to respond to what is an addiction crisis that is ravaging Alberta, in our families and communities—and across the entire country, we see the same direction happening.

For you, as the opioid epidemic and drug crisis committee appointed to investigate this, I think it's important that we frame it in the appropriate way. The reason we have overdoses as we do and see this tragedy unfolding with our families and on our streets is that there is a disease. It's the deadly disease of addiction. It doesn't discriminate based on who you are, and it could affect anyone.

The reality is that addiction has one of two paths, only one of two ends—and anyone who tells you otherwise is lying to you and they could be lying to themselves. There are only two ends to addiction. As a policy-maker, as a province and as a country we need to accept this reality. It either ends in pain, misery and, tragically, given enough time, death, or it ends in treatment, recovery and a second lease on life.

That is why Alberta cares so passionately and believes we have this obligation to care for those who are in a vulnerable position, those who are suffering from this disease of addiction, which could end deadly or in hope and renewal, so that they can be family members again—brothers, sisters, fathers and mothers—and allow us to have a vibrant community with these individuals recovered and fully contributing again to those wonderful parts of our community that we love so much.

Therefore, Alberta has invested a huge number of resources to build this out. We understand that we have a choice as a province, just as we do as a country, between continuing down the path that we've seen for, let's say, the last 25 years in Canada in terms of a policy setting that is not producing the results that we need.... Our communities are increasingly unsafe. Individuals who are suffering from addiction do not get the dignity and care that every one of them deserves with the opportunity for recovery.

I think we, all of us—and especially you in this committee and those responsible for making the federal policy—have and share that same moral obligation that I have, as a minister in the Province of Alberta, and that each citizen of our country has, in wanting to see our communities improve and the dignity of everyone respected and cared for.

To give you some idea of the work we've done, we'll have invested, by the end of it, probably close to a billion dollars in capital. We're working towards that end when it comes to building the infrastructure. Alberta, along with the rest of the country, for many years did not built out the treatment capacity needed. We need to have an off-ramp out of addiction. If we see an increase in addiction happening, whether we talk about the oxycodone crisis—which propagated much of the opioid pandemic that we saw and still are in the midst of—or about meth, cocaine or any other substance, even alcohol, we need to have a path for people to leave addiction and end up not dead but in recovery.

That is why we invested in 11 recovery communities across the province, five of which are partnered with indigenous communities. Four are on the reserve of the indigenous community, knowing that they're disproportionately affected by this deadly crisis of addiction. We need to step into that space, not waiting but rushing in to support them in how they see.... As we heard previously, culture is an important part of that land-based healing, so it's culturally appropriate healing that goes along with the indigenous communities in Alberta.

We obviously invested not just in those 11 recovery communities for a full continuum of care, but we meet people where they're at. Our system funds millions of dollars for drug consumption sites and naloxone kits. We have therapeutic living units in our corrections facilities. We have access to treatment, which I know many of you got to see when you generously came to Alberta to see our program.

When it comes to the path forward for Alberta and for Canada, my request to each of you is to take, as we heard from earlier testimony, very seriously this crisis. We cannot continue with experimentation like decriminalization, which, happily, we saw walked back in Alberta. We in Alberta are opposed fundamentally to a policy, like safe supply, which hands out drugs to drug addicts in an attempt to deal with an addiction crisis.

We believe in hope and opportunity. We care about the compassion you need to care for those individuals who are struggling. We ask as well, as a federal body responsible for first nations, that you come to the table, do not avoid your obligations with first nations and partner with us and the first nations to provide hopeful solutions.

Thank you for your time, and I look forward to answering your questions.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Minister.

Now we will hear from Dr. Goulão.

Dr. Goulão, you have the floor for five minutes.

[Dr. João Goulão, Institute on Addictive Behaviours and Dependencies]

Thank you, Chair. It is an honour to join you and this committee

I will use my five minutes, first of all, to try to destroy some myths around the so-called Portuguese model. I'm aware that the way Portugal used to address the heroin epidemic in the eighties and nineties is quite often described as mere decriminalization or, more than that, a liberalization of drug use. However, it is far more than that.

On one side, we did not liberalize the use of substances in Portugal. Drug use is still prohibited. It is not a crime. People do not undergo imprisonment penalties, but there is a set of administrative sanctions that are used to deter people from using drugs.

On the other side, decriminalization is only one part of the system, which constitutes a continuum from prevention to treatment that includes harm reduction policies and reintegration. Even if I consider decriminalization to be a very important part of that, it is mostly a way to get in touch with people who otherwise do not approach the health system or search for any kind of support to change their lifestyles.

With the complete set of policies that we have put in place—and I was happy to have the opportunity to share what we do here with Minister Dan Williams and his staff a couple of weeks ago—we managed to stop an epidemic that I compare to the one you are living through in North America related to fentanyl. It cuts across all layers of society and affects all families. I believe that it's almost impossible to find a Canadian or American family that has not been affected by this epidemic.

I think the way to completely change how we address those problems is to consider drug-related disease, or drug use disorder, as a disease with the same dignity as other diseases, and think of the people who suffer from it as having the same dignity as patients who suffer from other kinds of diseases. I think it's key to consider and to approach those problems from the health and social side, rather than prosecution or any kind of coercion of people who have these kinds of problems.

I'm very happy to address this, and I'm completely at your disposal to reply to questions you may have about the Portuguese way to address these problems. Thank you for having me here.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Dr. Goulão.

We will now turn to rounds of questions. We will start with the Conservatives.

Mrs. Goodridge, you have the floor for six minutes.

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

Thank you, Mr Chair.

To start out, I want to thank you, Mr. Felicella, for being here and sharing your story so bravely. I'm glad that you are here to tell your story, and I'm glad that you are alive. It proves that recovery is in fact possible.

I'm going to start my questions to Dr. Goulão. In your opening statement, you said that in Portugal, under the Portuguese model, you didn't liberalize drug use, and that decriminalization was just one aspect. In Portugal, if someone were to be smoking crack on a beach, what would happen to them if a police officer were to come around?

[Dr. João Goulão]

Thank you for the question. I don't know if I must reply immediately, Mr. Chair?

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

Yes.

[The Vice-Chair, Conservative, Stephen Ellis]

Yes, please, sir. We do a back and forth here, and the total amount of time for each party at this time is six minutes.

[Dr. João Goulão]

Okay.

If someone is using an illicit substance in a public place, the police authorities may intervene, might take this person to the police station, apprehend the substance or substances that he or she has and weigh it. If the amount of the illicit drug that the person has with him is more than what's considered adequate for personal use for 10 days, there's the presumption that this person is smuggling drugs, trafficking drugs, so he or she will be sent into the criminal system as before.

If the person has less than that amount, adequate for personal use for 10 days, they are just sent to present before an administrative body called the Commissions for the Dissuasion of Drug Addiction, which is a body under the Ministry of Health that has the power to apply administrative sanctions, similar to those that are used for traffic problems such as not using a safety belt or things like that.

The main task of that commission, which is composed of health personnel, is to assess what kinds of needs this person has related to drug use. If he or she is an addicted person, they are invited to join the treatment facility and the commission has the possibility to facilitate the affair and to make it very simple.

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

In British Columbia, they embarked on a very radical drug legalization project where they effectively removed all tools from the police to be able to do anything with public drug use. They've recently rolled some of that back because it was an abject failure, leading to skyrocketing addictions.

I noted that in a 2018 Vancouver Sun article, you said, “Decriminalization is not a silver bullet,” and “If you decriminalize and do nothing else, the problem will get worse.” That's exactly what we saw happen in British Columbia.

You talked about the dissuasion committee. How exactly does that work?

[Dr. João Goulão]

When the person comes to that commission, there's a technical staff with psychologists and social workers, who collect a history for the person, trying to identify the needs and to understand if the person is in fact addicted to substances or is a mere recreational, occasional user. In any case, if the person has an addictive disorder, they are invited to join a treatment facility, but it's not compulsory. There's some work of motivation to address people to treatment.

Most of the people who are present at those commissions are not addicted, in fact. Most of them are users who are not really problematic, but the aim is to intervene before they become problematic, so to act on any factor in their lives that may lead to a more problematic way, to more problematic use, later on.

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

In Canada, they have a program that's called a so-called safe supply program, and they give out sometimes upwards of 30 hydromorphone pills per day to people who are struggling with addiction. Is this something that is happening in the Portuguese model?

[Dr. João Goulão]

No, madam.

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

Do you think that it is a smart idea?

[Dr. João Goulão]

I don't dare to.... Our realities are quite different, but in any case, we use plenty of substitution opioid treatment with methadone and buprenorphine. However, we do not have this kind of safe supply policy that you are experimenting with there.

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

What is the breakdown—

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Mrs. Goodridge. That's the end of your round.

Thank you, Dr. Goulão.

Next we turn to Dr. Powlowski.

Dr. Powlowski, you have the floor for six minutes.

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

Dr. Tu, you mentioned land-based treatment in your testimony. One purpose of what we do is to eventually come up with a report and recommendations to the government, so I want to hear more about land-based treatment. Are you using it? How successful is it? What evidence is there that it's successful, and do you think we need to put more resources into it?

Certainly my impression is that, for indigenous people, this holds a lot more promise than a lot of other forms of treatment.

[Dr. David Tu]

Thank you very much for that question.

I acknowledge that I am partnered with and work alongside many experts in indigenous medicine practice, cultural practice and land-based therapies, but I myself am not an expert in those modalities and therapies. However, I have witnessed their impact. In terms of evidence....

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

Dr. Tu, can you tell us what exactly it is? If somebody goes into land-based treatment—I think I know—do you go out to the land for a couple of days or weeks, or how does it work?