Health Committee on June 6th, 2024

[Dr. David Tu]

To be honest, there's a lot more complexity than giving a simple answer that it is just this one thing, but it is fundamentally about connection. It's about relationships, and one of those relationships is to the land. Conceptually, from the teachers I've had, from indigenous elders and providers, the solution to addictions focuses around relationships more than substituting other therapies or modalities, and the relationship to the land is a really important relationship for many indigenous peoples and cultures.

Establishing those reconnections, along with the reconnections to who you are as an indigenous person, to your family and to your ancestors.... These are the connections that actually draw people into a positive state of identity as a human being. People who acquire that state—a good relationship with themselves, a positive outlook—tend to make affirming, positive choices for themselves. It's those relationships that support them to make choices such as decreasing the use of harmful substances on their bodies.

I've seen it play out as people going on a canoe journey or, actually, people just taking daily walks to the beach in our neighbourhood to connect with the ocean. There are many ways to re-establish those relationships, and there are many very sophisticated indigenous modalities, from indigenous medicine providers, to actually bring about those reconnections to the land and that meaning. I don't want to belittle the sophistication of indigenous medicine practice because it is sophisticated, but there's a lot of evidence that this is a pathway for many to change their substance use.

To your question, yes, I definitely, wholeheartedly endorse greater investment both in developing the protocols and in developing the resources.

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

Mr. Williams, perhaps you might comment on it too. Would it be your recommendation to put more resources into land-based treatment?

[Dan Williams]

Thank you for the question.

I think that land-based treatment, especially through an indigenous lens, is a central pillar to how we look at recovery as an opportunity. We believe every single Albertan who suffers from addiction deserves an opportunity at recovery. We see really great outcomes. When you look at therapeutic living communities or recovery centres, which land-based treatment would be specifically within, when that's paired with opioid agonist therapy, the data is clear on that in terms of research. Also, our outcomes point to that as well. I understand you had Dr. Day present as well to this committee, our head of addiction medicine.

We partnered with five indigenous communities, four on reserve, where it really is not an imposition of, “This is what you're doing,” but a proposition: “How do we partner together for nation-to-nation conversation around...?” Every single first nation chief I speak to, every time I go on to a reserve, they're asking for recovery treatment capacity. They are asking for that. They are saying please. They understand that there are marketing terms around safe supply, etc., but they see past that because they see the carnage in their communities. They are saying, “Please help us with this,” so the Province of Alberta said that, even if it is federal jurisdiction, this is a community problem that we need to step into to work on with them.

We invested approximately $35 million in each of these recovery centres, plus the operation costs, where it will be owned and run on reserve by first nations, culturally integrated. We think it's a central piece in how we look at addressing the crisis.

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

Thank you.

Dr. Goulão, you talked about the commission that people have to appear before if they're caught with drugs. What happens with the problematic users who don't agree to any sort of treatment, who don't agree to use opioid agonist treatment or to attend some sort of therapy? What's the next step, or is there a next step?

[Dr. João Goulão]

The attempt is to motivate people with problematic use to attend or to join a treatment program, but they are free to refuse. Then, in the first contact with users, the only recommendation given is, “Please do not come here for the same reason in the next”—let's say—“six months because otherwise we'll have some kind of penalties.”

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

Okay, so there are penalties. What are those penalties?

[The Vice-Chair, Conservative, Stephen Ellis]

Dr. Powlowski, maybe you'll hold that question.

I'm sorry, Dr. Goulão. The time for this round is over, but we have lots more time left. Thank you for that.

Witnesses, before we go on, if you struggle with Canada's other official language, French, there is a button on your computer screen. If you weren't made aware, it looks like a world, and you can pick the language you wish to hear this in.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Goulão, thank you for accepting our invitation. Many praise your model or refer to it. Everyone, whether on the right or the left, draws from it, and I want to highlight the key elements.

Some claim that there needs to be criminal consequences to encourage people to go through treatment, and that decriminalizing drugs lets people off the hook and leads straight to chaos. How do you see it?

[Dr. João Goulão]

Thank you for the question. In fact, I do not agree. We are much more effective in reaching and helping people in this framework of decriminalization than before.

I must tell you that we lived for a long time under a dictatorship here in Portugal, during which people did not even approach treatment facilities because they were afraid to be referred to the police. In fact, decriminalization facilitated and made everything much smoother, with more dignity and a drop in stigma towards people who use drugs, so I consider that it was a very good step forward.

[Luc Thériault, Bloc, Montcalm, QC]

Before decriminalizing drugs, should we not make sure that we have well‑coordinated wraparound services? Earlier you mentioned a continuum of care, and I'd like to hear more about that.

Also, the Minister of Health tells us that people have a choice between misery and treatment. The province is building treatment centres and putting people in them. Is there another way, aside from this binary approach? Are there people who go on taking drugs for 20 years without putting their lives at risk and while continuing to function?

[Dr. João Goulão]

I believe that the first thing to do is to assess and get an understanding of the needs of the person we have in front of us, and the motivations of their drug-related problems. I also believe that we need to provide to people who use drugs the minimum level of dignity before we can demand that they struggle for a change in their lifestyle.

Does this person have a house? Does this person have access to health care? In general, does this person have their basic needs fulfilled? Only then can we work on motivation to change. That's why I'm talking about a continuum, and the continuum from harm reduction policies that are not an incentive to continue using substances but a way to contribute to a better and longer life in any circumstance.

[Luc Thériault, Bloc, Montcalm, QC]

Some think that harm reduction puts in place conditions that can lead to disorder and indulgence on the part of police and stakeholders, allowing people to wallow in misery. How important is harm reduction in your continuum of care to achieve betterment?

[Dr. João Goulão]

This is the first step to approaching people who are the most disorganized and to gaining their confidence in the health personnel, so that we can establish a relationship because this is the basis for the therapeutic work. I think harm reduction is in fact key to approaching people we otherwise do not manage to reach.

[Luc Thériault, Bloc, Montcalm, QC]

Did you experience cohabitation problems, and if so, how did you manage them?

[Dr. João Goulão]

I do not understand the meaning of “cohabitation”.

[Luc Thériault, Bloc, Montcalm, QC]

In Canada, harm reduction strategies include supervised consumption sites, as well as supportive housing, which can give rise to problems between those sharing spaces in a community.

Did you experience those problems in Portugal, and if so, how did you overcome them?

[Dr. João Goulão]

On the contrary, I think this is the continuum I was talking about. We try to establish continuity in the levels of care that we can provide in any circumstances, and we do not give up on people in any circumstances.

I am not able, as a medical doctor, to motivate someone to step into a treatment centre. However, in a therapeutic community, at least I can contribute to that person having the conditions to use with lower risk and to continue working on other areas of his life.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Monsieur Thériault.

Dr. Goulão, thank you.

Dr. Johns, you.... I've promoted you to a doctor, Gord. I hope you welcome that promotion.

That being said, Mr. Johns, you have the floor for six minutes.

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

Thank you, Mr. Chair.

Thank you to all the important witnesses for your incredible testimony and all of your work.

Minister Williams, your government has had a significant growth in toxic drug deaths per capita, from 800 in 2019 to over 2,000 last year, the worst year on record, and now has a per capita rate that's almost on par with British Columbia.

Paul Wells just wrote in Substack the other day that the scale of the crisis in Edmonton and across Alberta makes it hard to be sure of success. He cited Deputy Chief Driechel. He has been in the Edmonton Police Service for 27 years, and he said, “It's worse than I've ever seen it.”

We've also seen your government close safe consumption sites. You've opened one new one since you formed government. You've cancelled five. You've closed two, and you plan to close three. The previous government had opened eight new ones and planned for two.

Do you support safe consumption sites and recognize the importance they have to save lives?

[Dan Williams]

Thank you so much for the question.

Alberta's government continues to fund drug consumption sites, but our position is fundamentally that without an off-ramp out of addiction and treatment capacity being built, which is seriously and chronically underfunded and under-built across the country, how do you expect somebody to ever get healthy?

The purpose of a health care system should be about getting people care, treatment and into recovery and healthy, so we fund them. However, I don't think a drug consumption site on every corner is going to solve this problem. We need a serious adult conversation as a country about what that off-ramp looks like. Alberta is putting a policy option forward that has largely been ignored by the rest of the country for the last 25 years.

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

Nobody is saying that we don't need more treatment and recovery, Minister. I think all of us agree that we need to scale that up. That is something we're all unified on.

Regarding the importance of safe consumption sites, I'm going to ask Guy Felicella to perhaps comment about those.

Mr. Felicella, you advocate for both harm reduction and recovery. Can you talk about why that is so important?

[Guy Felicella]

Yes, most definitely.

I mean, obviously, dead people don't recover. You also have a lot of people who use substances who don't struggle with an addiction. With the risk of the contaminated drug supply that's on our streets today, first-time substance users, intermittent substance users, casual substance users and people who struggle with addiction—people from all walks of life who use substances—are at severe risk of death.

The unfortunate part is that it's like we wait for people to have this addiction before we actually help them. Treatment and recovery won't help people who just use these substances. Harm reduction services will, and a lot of them build the connections and services to build out other health care services.

Look at the 20-year impact of Insite in the Downtown Eastside of Vancouver, which has referred 71,000 people to offsite services. Many of those could be detox, treatment, recovery, health or hospitalization. Harm reduction is really a big connection piece, similar to what Dr. Goulão was speaking to, to build support, build the trust, build the non-judgmental, compassionate relationship that's needed when somebody does make the leap. If you look at Insite, on the second floor, it has a detox floor. On the third floor, it has a transition floor.

I will say this. It wasn't recovery services that came to the Downtown Eastside to get me out of there. It was harm reduction services that were giving me bus tickets and cab fares to treatment facilities, and every time I left treatment—because it's a chronic relapsing condition—harm reduction welcomed me back. I wouldn't be alive today without it, so I'm a fierce advocate for understanding that we need a full pathway, a full continuum of care in this country that supports both harm reduction and recovery. Gone are the days where it's either-or. It has to be both. This drug supply is killing people.

Again, as I said, not everybody who uses substances struggles with an addiction.

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

I'm just going to add to that. You said not everybody has an addiction. Can you speak about that?

Minister Williams talked about it being an addictions crisis. Do you want to comment on what you heard there?

[Guy Felicella]

Yes, if it were an addictions crisis, you could look back to decades past where alcohol consumption had the highest rate of addiction in the country forever. It was the number one drug, so if that was an addictions crisis, why didn't we call it an addictions crisis 20 years ago?

It's really a toxic drug crisis because the drug supply has just shifted and changed. Yes, sure, there are people who are struggling with addiction who are using substances. I'm not denying that, but let's get real. What's killing people is the contaminated toxic drug supply. Some people, yes, may struggle with an addiction, but again, it being a chronic relapsing condition.... I went to treatment over a dozen times, and the majority of people who go into treatment don't walk in the front door and out the back door and their lives change. This is a process. Recovery is a long journey for a lot of us, for the majority of us.

I think one of the things we have to look at and be real with is how we treat death and prevent people from dying, and how we support people and treat addiction. You can't treat addiction if people are dead.

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

Thank you.

How much time do I have left, Mr. Chair?