Health Committee on June 6th, 2024

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you.

Dr. Goulão, I'm happy to meet you. Thank you for joining us.

Earlier during the meeting, a Conservative MP said wrongly that Canada is legalizing drugs. What would you say to anyone who says that decriminalization and legalization are the same thing or a wordplay?

[Dr. João Goulão]

Thank you, Madam.

Many times, in fact, I tried to explain that those terms do not mean the same thing. Legalization is the regulatory term that means a substance is legal, as we consider alcohol or tobacco. That's different from what we did. Using drugs is no longer a crime, but under our law it is still prohibited and it's punished under the administrative law. Our society continues to give a clear sign of disapproval of drug use, and I think this makes the difference.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Dr. Goulão, what do you think of Alberta's approach of investing heavily in treatment instead of the continuum of care? Under the model, people have a choice between a life of misery, as the minister put it, and mandatory treatment.

[Dr. João Goulão]

Ideally, in the continuum of supplying the responses the person needs, I believe those responses must be built in accordance with the concrete person we have in front of us. Mass policies that offer the same thing to everybody I do not believe are really effective. We must have an individual plan for each person.

This continuum came from all these reasons. We have a new strategic plan here in Portugal and it has three pillars: empower, care and protect. We developed our policies around those three ideas in accordance with the life cycle—with the context of where the person lives and where it evolves. I think an individual plan is key to being effective for each person.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you very much.

Mr. Felicella, your story was quite moving, so thank you for sharing it. I was quite glad to hear you say you didn't need someone to tell you how to live. You needed someone to show you how to live.

In your view, can every drug user go through treatment successfully?

[Guy Felicella]

You have to look at the individual, what they're learning in treatment and their ability to look at life-changing avenues. It's easy to say to people “go to treatment”. It's just very hard to stay sober. Also, treatment or completing treatment doesn't guarantee that you're going to be sober either.

A lot of the time, people need the back-end support after treatment. They need to be shown how to get their ID back. I mean, I needed to know how to pay off past debts, and I had to get my driver's licence. I needed to know how to do a résumé.

You really have to teach. There's so much more that goes on than just getting off the drugs. You really have to create a new life where it's easier not to go back to the substances, and that is easier said than done.

[The Vice-Chair, Conservative, Stephen Ellis]

I'll interrupt you there, Mr. Felicella.

Madame Brière, that's your time. Thank you.

Colleagues, we'll now turn to Mrs. Goodridge.

You have the floor for five minutes.

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

Thank you again.

Minister Williams, as has been put forward, people like to accuse Alberta of not supporting harm reduction, and I know that's nowhere close to the truth.

Can you speak to some of the innovative plans and programs you have in place, specifically the narcotic transition services? People seem to think that the only possible way of dealing with this is to give so-called safe supply and to flood the streets with more narcotics, rather than using a medical model.

Could you explain a little bit what you guys are doing with that?

[Dan Williams]

Thank you for the question.

I'll be honest. I'm disappointed in the national dialogue around language like “harm reduction” and “safe supply”. It's unfortunate that they've effectively become marketing terms meant to convince Canadians of something that they intuitively know doesn't work, when it comes to safe supply, for example.

I don't care about the label anymore. If you have a policy, internationally or anywhere, that wants to get people healthy, then I will adopt that within my program. We have the narcotic transition services, as you mentioned, MP Goodridge. We have the drug consumption sites. We have the digital overdose response app.

We have the virtual opioid dependency program, which provides the world's first and most innovative immediate same-day access to evidence-based opioid therapy for buprenorphine products like Suboxone and Sublocade and products like methadone. Every day 8,000 Albertans get access to that. We have mass distribution of naloxone kits. Some people call all of that harm reduction and some people don't. That's fine.

However, if you call harm reduction mass distributing high-powered pharmaceutical-grade opioids unwitnessed into our communities, when those are diverted and end up on Alberta's high school and college campuses, furthering addiction, starting new addiction and massively introducing thousands of new people into addiction, then I no longer think it's fair to let Canadians believe that's harm reduction. It's clear that's harm production. It's clear that, if you're distributing the drugs, if you're the one purveying them into the community en masse, then that will produce more harm. That is my issue with it.

I am not being idealistic as I come at this beyond wanting to help individuals heal and recover. My big concern is that it's being torqued way out of context for political purposes. I'm not going to allow the marketing terms and the branding to get in the way of actually helping thousands of Albertans who are struggling.

Alberta is defiantly against and will continue to make illegal safe supply for obvious reasons. Applying addictive drugs into a community struggling with addiction will not help the addiction crisis, but I will get them help and meet them where they are. I will meet them and bring them to a spot where they can have an opportunity to recover.

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

Minister Williams, frequently I end up having people reach out to me from all across the country and explain to me how they are contemplating mortgaging their house in order to send their child to addiction treatment or how their child has a two-year wait or their sibling has a six-month wait to get into a treatment service.

The Government of Alberta has removed all user fees for treatment. Why did you do that?

[Dan Williams]

Previously, there was a $1,240 a month fee for someone suffering from addiction if they wanted to access government resources for addiction. Where do you think someone suffering from a fentanyl addiction is going to find $1,200 a month? It's very clear that's not a serious government policy around addiction.

We have increased capacity by over 10,000 beds from 2019 to now. We're building 11 recovery treatment centres, four of them on reserve in indigenous communities, for up to one year of treatment, very serious treatment. We do all this to reduce all possible barriers to getting people into treatment, understanding that addiction ends in one of two ways—with either pain, misery and, tragically, untimely death or treatment, recovery and a second lease on life. There's no third option.

How could we not, as a society, invest in treatment? I'm not saying not to do everything else. Of course we need to have a full continuum of care, and I agree with every presenter's comments on that today. With compassion in our hearts, it's deeply un-Canadian to just let people be palliated in their addiction without making them a serious offer for recovery. We need to expand treatment capacity. We need to reduce barriers, eliminate costs and blow it wide open.

People who oppose me say, yes, that's fine, but we need to build treatment and recovery. Who's doing that other than Alberta? We're putting our money where our mouth is.

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

Thank you. I appreciate that.

Dr. Goulão, in the province of British Columbia, they've developed protocols to allow for the prescription of recreational fentanyl to youth under 18 years old who are struggling with addiction.

Is that something that Portugal would move towards or would support?

[Dr. João Goulão]

No, ma'am, I don't believe so. Hopefully, we are not dealing with the same kind of reality that you have, but I don't believe this would be a step Portugal would take.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Mrs. Goodridge. That's your time.

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

[Brendan Hanley, Liberal, Yukon, YT]

I want to thank all the witnesses for some incredible testimony today.

Minister Williams, thanks for coming in person, and thank you again for hosting us on our communities tour. I'll try to be brief with you, because I want to move to other witnesses, but my colleague did bring up some of the alarming increases recently in overdose death rates in Alberta, and I'm not sure you had a chance to specifically respond to that.

Can you briefly tell me your thoughts on how you're addressing that?

[Dan Williams]

Yes. Thank you. I'll try to be brief. I understand you have others you want to address.

Alberta has an integrated illegal drug market with British Columbia. We suffer, obviously, from the mass distribution of all sorts of drugs, including fentanyl, etc., and illegally diverted hydromorphone. We have a similar starting position. Happily, Alberta has continued to stay below B.C. on per capita and total overdose rates—an important metric for us.

If we look at last year, we were 14% lower than B.C. on a per capita rate for overdoses and, of course, 25% lower in the first two months. If you look at just February in Alberta versus B.C., year over year, we're at 33% fewer overdoses than B.C.

We're cautiously optimistic that the recovery model and its culture are having a positive impact. We've seen, since April last year, a continuous decline in overdose rates. The pandemic was brutal on every jurisdiction when it comes to this. Alberta, we believe, is starting to see some of the fruits of this, with only two out of 11 of our recovery communities coming online.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

I was incredibly impressed by the recovery centre in Red Deer, and by your help in hosting us there. At the same time, afterward, when we visited a harm reduction and health promotion site in the same city, it seemed a bit opposite. We saw an organization very strapped for resources and feeling that their daily work with the street-involved and drug-using community was at risk. They were even hesitating to talk about harm reduction. I have to say that the contrast was rather striking.

Putting safe supply and diversion aside, can you clarify? I think you just did, but I want to have, on the record, your position on harm reduction as one of the pillars of care and part of the continuum of care. How are you supporting that in Alberta?

[Dan Williams]

Sure. There are many different programs. Obviously, there is naloxone distribution, and that program in Red Deer distributes much of it. We have a drug consumption site for now, in Red Deer. The municipality has recently asked us to review what that looks like, so we're going to take a serious look at partnering with them on that. Of course, we have narcotic transition services.

Any one of those items could very easily be described as harm reduction. I have no problem with that. I need to meet people where they're at, but I need an off-ramp out of addiction, as well—not just for society but also for these individuals. Where do they go? I can't have them in hospital waiting rooms, enduring this tragic cycle or turnstile of in and out and not getting the care.

I need to build that recovery model. I need the Alberta model to be an example that shows everyone that there is hope. You're not destined to die.

[Brendan Hanley, Liberal, Yukon, YT]

Minister, I'm going to stop you there, if I can. Thank you very much for that.

Dr. Goulão, I'll echo what Mr. Johns said about how important the visit to Portugal was that we were able to have and was hosted by you last year. I have so many questions for you.

I'll focus on how you think the system you've established in Portugal over the last 20 years would address a toxic drug crisis such as we have here—not just fentanyl but also a contaminated drug supply. You must be watching us and watching to see if fentanyl arrives in Portugal.

Do you have a system in place to address what could be a change in drug supply in Portugal?

[Dr. João Goulão]

Thank you, sir, for your question.

We try to track what kind of supply happens in our market. One of the key responses is pill testing—testing the substances that circulate and are used by the users. I think it's very important to have that in place in order to identify early what is circulating.

Apart from that, we are working on the education of people, on the availability of naloxone and on preparing people for something we expect will come to the European market with the same kind of availability you notice in your country.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you, Dr. Hanley.

Mr. Thériault, you have two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Minister, how many overdose deaths were there in Alberta in 2022 and 2023?

[Dan Williams]

We have ASUS, which is the Alberta mechanism we use for publicizing. It's the most integrated and transparent that I know of in the country. I have the 2023—

[Luc Thériault, Bloc, Montcalm, QC]

All I have is two and a half minutes. Can you give me the numbers?

[Dan Williams]

I understand. Thank you for your question.

I have the 2023 and 2024 numbers in front of me. I don't want to misquote. I am happy to get you the resources for the 2022 numbers.