Health Committee on June 6th, 2024

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

I started to ask you this before, and you didn't get to answer. If there is no penalty and you appear before the commission, they're not going to force you if you don't want treatment. However, if it's repetitive, then you can and you will fine people.

How much is that fine? If you go for treatment, does that mean you don't get fined? How does that work?

[Dr. João Goulão]

I must say that for people who are addicted, who are really problematic users and who have a drug use disorder, fines are never applied. There's a long list of penalties that may be applied, such as being forbidden to attend certain places or to join certain people, or the obligation to attend, for instance, the health centre.

For instance, if I have someone who is HIV-positive and they are missing the consultations, the commission may impose that the person attend the consultations and bring a piece of paper showing that they have been there and they are complying with their treatment for HIV.

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

The commission can require people to get treatment then, you said, if they're chronic users.

[Dr. João Goulão]

Yes...to follow the obligations.

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

This is my last question. In many cities in Canada, like the Downtown Eastside in Vancouver, you see a lot of people with what's termed “the nod”. They are basically stoned in a public place. Do you see that in Portugal?

[Dr. João Goulão]

Yes, we see it. We tend to have fewer of these situations, but of course, it occurs.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Dr. Powlowski.

Colleagues, we have two rounds of questions left of five minutes each.

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

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

Thank you again.

I really appreciate all the witnesses for being here. Each time we have one of these meetings, I think we get further into this, which then necessitates a space where I believe we should continue studying, have more questions and have more witnesses come, because this is clearly something that is much larger than I think we initially grasped when we looked at this.

My question is for Minister Williams. Are you aware of any jurisdictions in the world that have had success when they focused on recovery? If so, can you provide details on them?

[Dan Williams]

Obviously, Canada is a unique country with its own jurisdictional and cultural context and milieu, so whatever we do, it's going to have to be unique to us. Even the province of Alberta has a principle of subsidiarity in the Constitution, with provinces responsible for health care for a reason. The Alberta solution might look different from others, and we see two different policies happening in B.C. and Alberta that contrast. We're happy to see that we're going to have a policy outcome for both that we can use for analysis.

We have looked at Australia. We have looked at Massachusetts. We have looked at Portugal. Happily, as Dr. Goulão mentioned, we were there recently, spending time understanding their system in-depth. Recovery is a terrific opportunity. Most recovery, when it comes to therapeutic living communities, for example, as a model, isn't instigated just by governments.

Look at the world's largest. San Patrignano in Italy started in 1978. I believe it's a 1,200-person community. It has great outcomes. I think the last study I saw from the University of Bologna had a 72% rate of success, and recidivism was relatively low there, measuring longitudinally, multiple years out.

There's a lot of good information around therapeutic living communities and around recovery as a model. Recovery capital with Dr. Best, out of Scotland, is incredibly informative, along with a number of researchers like Dr. Humphreys, whom I know you heard from here at the committee. There's a lot of good evidence internationally, both locally and increasingly more at a government state level.

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

What could the federal government be doing differently to help Alberta, and Canadians more generally, with addictions?

[Dan Williams]

I'll speak for the Alberta context, not for other provinces. As you well know, and as I've made it abundantly clear, safe supply is illegal in Alberta. Unfortunately, we still have the policy consequences of safe supply coming into our province from reckless, unwitnessed safe supply programs in British Columbia, for example. It is the world's most radical drug policy. No other jurisdiction does it, and it is deeply devastating to the next generation of new addicts coming online.

However, beyond stopping that, or at the very least, if you refuse to stop it federally, employing the chemical tracer so we know the diversion....

I'd say the Government of Alberta has stepped forward in a very big way by partnering with indigenous communities. Importantly and constitutionally, this is the responsibility of the federal Crown. I believe we've stepped into a space that has been left open and abandoned by the federal government. I would like to see it come to help us with what the first nations are asking for, which is treatment capacity in a land-based, culturally sensitive, integrated continuum of care, from shelter systems all the way through to post-recovery housing and everything in between, with the corollary investment to follow. This is because, right now, it's falling on us.

Happily, we are partnering, because we believe we need to. We'd like to see the feds also fulfill their responsibility.

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

Thank you.

My next question is for Dr. Goulão. What recommendations would you give to the Government of Canada to improve its addiction policy to have more people find recovery from addiction?

[Dr. João Goulão]

I believe you have a lot to offer people who want to change their lifestyle. I also believe it's probably possible to improve coordination among several responses and the so-called continuum of care, from harm reduction to treatment facilities and the way we can cultivate people to step in.

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

In the Canadian context, we have three northern territories. There isn't a single treatment centre in any of those territories. We have so many first nations communities from coast to coast to coast that do not have any access to treatment.

[The Vice-Chair, Conservative, Stephen Ellis]

Be very brief, Mrs. Goodridge, please.

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

My question to Mr. Goulão is this: Do you believe Canada should be investing in creating more treatment space?

[Dr. João Goulão]

First of all, it's necessary to make a diagnosis of what is needed in each region. Calculate a ratio for the responses—the number of available beds in therapeutic communities—then build them accordingly. You need the diagnosis.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much.

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

I have a point of order, Mr. Chair.

Given that we started 10 minutes late and this round will finish at five minutes past, can I ask if it's the will of the committee to give the NDP and the Bloc an extra two and a half minutes each, in order to complete the full two hours?

[The Vice-Chair, Conservative, Stephen Ellis]

If it's the will of the committee, I'm here at your service. I'm looking around the room. That would require unanimous consent, I believe.

Are there objections?

Very well. It's a tad unusual. Usually, we end rounds of questioning with the Conservatives and then the Liberals. Again, if it's the will of the room, I'm happy to do that.

I don't see any objection, so we'll do that.

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

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Mr. Felicella, I know you do a lot of work with youth. We may not have time to go too in depth on that, but I know you have an interest in reorienting youth at risk.

I wonder if you could briefly describe this, and perhaps submit more details to the committee about your work with youth.

[Guy Felicella]

Yes, most definitely.

I've spoken in over 100 schools. I talk to youth and share my story of overcoming immense challenges throughout my life, and the variety of services that helped me get to where I am today. You know, as a person who understands and talks about the struggles I had as a youth, as well.... It's very relatable to youth. I've had many testimonies from mayors, towns, school principals, liaisons, counsellors and police. It's been very overwhelming.

Recently, I did a talk at Hugh Boyd Secondary School. Youth come up to me after every talk. They're usually in tears. A few of them are really struggling. They feel so much stigma and shame because they don't have the ability or capacity to reach out. They feel judged for how they're living their life. The next day, the principal emailed me saying the whole counsellor's office was packed with students reaching out and saying that Guy Felicella has a way of making reaching out sound cool. I just try to inspire youth not to go down the same path I did. However, if they do, I want them to know there are people like me and others who are in the community. There are services. We care and want to support them.

I think it's very important for us to continue to give youth the realities of the current crisis we're dealing with today, so they can move forward with their lives.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks, Guy.

I'm going to give you a very rapid perspective.

In this committee, we've looked at Alberta a lot. We've looked at B.C. a lot. We've done a lot of comparing and sometimes finger pointing. I would like to see the best of Alberta and the best of B.C. put together.

Do you have a brief perspective on that?

[Guy Felicella]

I am concerned about the way Alberta has scaled back harm reduction, but I do like its approach to recovery, getting people stabilized on OAT. Unfortunately, we are seeing the results of the model through their data. Last year, B.C.'s increase in overdose deaths from 2022 was 6.9%. Alberta had a 16.6% increase, and Saskatchewan actually had a 23% increase. The lesson here from all of it across the country is that we have to do both: harm reduction and recovery together.

It's a relay race, like a baton passing back and forth as many times as possible to meet the needs of the individuals who are struggling. If you're going to meet somebody where they're at, then meet them where they're at. It's one thing to say it, but people aren't dying from safer supply. They're dying from toxic drugs. If that's a pathway to get people to move forward with OAT and into treatment and recovery, I don't see why anybody would be against that because, sadly, people are dying from toxic drugs.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks, Guy. Thank you so much. That's very helpful.

Dr. Goulão, I wonder if you can briefly talk about how you built treatment capacity in the system in preparation for decriminalizing drug use and setting up the dissuasion panels—which was some 25 years ago now—and how important that was. However, I also want you to reflect on the spectrum of treatment from in-patient to out-patient to psychotherapy. If you can give a brief résumé of that in about a minute....

Thank you.