Evidence of meeting #127 for Health in the 44th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was use.
A recording is available from Parliament.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Eaton.
That concludes our opening statements.
We're now going to begin with rounds of questions, starting with the Conservatives.
We'll go to Ms. Goodridge for six minutes, please.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you, Mr. Chair.
I want to thank all of the witnesses for their testimony, specifically Gregory Sword for sharing about his daughter's circumstance. I really appreciate that.
I'm going to start my questions with Dr. Judson.
In your opening statement, you stated that both Health Canada and the College of Physicians and Surgeons of Ontario have seemingly abdicated all responsibility for oversight.
I was wondering if you could expand on that.
As an Individual
When I first started prescribing methadone, I had to get approval from Health Canada. I had to have a special exemption to be able to prescribe methadone. It was contingent on having taken a course in the prescribing of methadone, which outlined its neurochemistry and the pharmacokinetics of methadone. I had to meet special requirements before the College of Physicians and Surgeons to prove that I was in good standing to be able to prescribe opioids.
Those two authorities, the college and Health Canada, effectively screened me out as being someone who was going to be prescribing methadone for legitimate reasons, and the likelihood of over-prescribing or inappropriate prescribing was minimal.
That doesn't seem to be the case just because the number of patients who are experiencing opioid misuse renders it far too difficult, really impossible, for so many physicians treating that patient population to keep controls over things. It would just consume far too much time, I presume.
I can't say more than that.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
Could you, in your professional opinion, share what the correlation is between the availability of substances and the harms they cause?
As an Individual
If you think not just of opioids, you recognize that all substance misuse that is the problem. It doesn't matter what you use; it's the fact that an individual uses a substance that really defines what addiction is.
As long ago as the early 1970s, soon after I opened up a new practice, I was impressed by a research paper that had been published by a sociologist at the University of Western Ontario. His conclusion was that the more available alcohol is, the more alcohol is consumed. The more alcohol that is consumed, the more problems occur as a result.
That has recently been corroborated by a study conducted actually in Ontario but published in the journal entitled “Addiction”, which is published in the UK, which looked at opioid use. The conclusions were that the more opioids that are prescribed, the more opioids become available to all people for legitimate and illicit reasons, and the more problems occur as a result, including increased health issues and increased visits to emergency rooms.
Those two reports, spanning a 50-year history, indicate the more substances are available, the more problems there are going to be. That's what we're witnessing as a result of these safe supply clinics, which are putting an abundant amount of opioids onto the streets. If these clinics were better regulated, then it would probably rein in the amount of opioids that are finding their way onto the streets.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
Dr. Conrod, I see you shaking your head. Could you perhaps expand and share your thoughts on that subject as well?
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
My understanding of the literature is very similar, so I concur with all of those comments. It also puts people at risk. The more substance use in the adult population, the greater risk for a youth population; the more there are liberal attitudes about substance use, the more young people are likely to use, and at younger ages. There are even studies demonstrating that proximity to alcohol outlets, for example, will influence young people's rates of substance use or alcohol use, for example.
I'll reiterate how concerned I am about the fact that opioid use among young people is rising. What that means is that Canada will continue to have a very significant problem for decades to come.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I appreciate that.
Greg, how easy was it for your daughter to get access to these potent Dilaudid pills?
As an Individual
With one message on either Snapchat or Instagram, she would have someone delivering her whatever she wanted within five minutes. She could get dillies, cocaine, acid and alcohol whenever she wanted. Even after she died, they were still messaging her cellphone.
My friend had access to her Snapchat account and they were still asking if she needed any dillies.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I know Kamilah's friends have said that dillies were widely available at their school.
Can you expand on this? It terrifies me as a parent that highly potent opioids are available in schools.
As an Individual
Most of the kids there would get their supply from someone who could go to Vancouver's Eastside, pick up a bunch of pills and bring them back to the smaller community where I lived. Before my daughter died, there were two other girls in the same area who had died of the same thing, with no mention of it. I only found out from other parents.
It is so easy for these kids to get their hands on it because we don't monitor it in B.C. We just hand out the pills and hope the addicts will take them and not sell them for the drugs they want. They give them to the kids or the gangs, and they come back out to the smaller communities.
Liberal
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you, Mr. Chair.
Thanks to the witnesses for being with us.
Dr. Conrod, in your opening remarks, you talked about the various solutions, which aren't necessarily drug-based solutions, but rather universal prevention programs and more targeted programs.
Your research focuses, among other things, on reinforcing factors that may push a person to use. I wonder if you could talk about those reinforcing and predisposing factors, as well as the preventive approaches you're working on.
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
Yes, absolutely. Do you mind if I give my answer in English?
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
Thank you very much. You've clearly done your research, and I appreciate that.
Absolutely, there are a number of evidence-based prevention programs that should be widely available to all young people. There are only 3,400 high schools in the country, so that's not an enormous task. They are under-resourced and require dedicated resources in order to support these programs, because they are not just a poster in a hallway or a lecture by someone who has had an experience with substance use. These are psychological interventions or multi-year programs that involve building skills in families and in young people that help them manage stress and confidently resist peer pressure to use. Giving young people tools on how to say no really does work.
In terms of counteracting some of the social norms that come from social media...my research has demonstrated that social media is promoting problematic substance use norms, as well as norms that come from other media, families and society generally.
I also want to talk to you about prescription drug misuse, because prescription drug misuse appears to be particularly linked to risk for other mental disorders. What we now know, from decades of research on psychopathology and neurodevelopment, is that there are a number of risk factors for early onset mental health problems.
There are psychological traits that are very good markers of who is likely to develop difficulties with anxiety, depression, impulsivity and ADHD, as Mr. Sword described, and other thrill-seeking behaviours. Young people can report on those traits very easily. How they report on individual differences, such as impulsivity and thrill-seeking, will predict who is likely to misuse a substance, what substance they are most likely to misuse, what prescription substance they're most likely to misuse and what kinds of mental health difficulties they're likely to experience in relation to their substance use.
My work has demonstrated over and over again—and these are large, randomized trials that have been conducted in the U.K., Australia, Canada and Europe, involving thousands of young people—that you can deliver cognitive behavioural mental health interventions early on, in the 7th, 8th and 9th grades. When they're delivered in high fidelity by a trained mental health professional, you can delay the onset of substance use in young people. You can prevent young people from developing a substance use disorder.
I believe we haven't yet demonstrated this scientifically, but that is how you're going to be able to begin to start to address this problem and reduce the burden on the acute substance use and mental health services. You have to help young people delay the onset of use and stop new users from taking up opioid use, which is what is happening right now and has been increasing every year for the past 10 years, almost.
Liberal
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
Yes. Do you want me to talk a little bit about that program?
The PreVenture program, I have to say, is one that I was involved in developing, but there are other researchers—for example, Dr. Sherry Stewart at Dalhousie University—who have collaborated with me on this. This is a program that has just been packaged to be able to train school-based mental health and educational professionals on how to effectively deliver cognitive behavioural interventions preventatively. This program has been demonstrated to be effective when it's disseminated broadly in a community.
In about a month's time, there will be a large publication in the American Journal of Psychiatry, demonstrating a very significant effect on substance use outcomes over a five-year period in a randomized control trial in Montreal involving 31 high schools.
Other trials in Australia have also demonstrated that the PreVenture program is effective in reducing substance use over seven years of a young person's life trajectory. The program has been very widely tested. It's mentioned as an evidence-based program in the Surgeon General's Report published in 2016. I have a lot of experience doing this work in schools in Canada and around the world. Through that experience, I do see that schools have become more and more burdened. They're less well-resourced to do the work.
As my colleague said, they are overwhelmed. Rates of staff turnover and burn-out are very high. Social media, addressing bullying and this need for testing in schools have overwhelmed psychological resources in schools right now. That's why it's absolutely necessary that we add to the available resources in schools across the country. One or two health professionals or prevention professionals across the country, in every school, would dramatically improve young peoples' lives and reduce the risk of further addiction and overdoses, in my opinion.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Conrod.
Thank you, Madame Brière.
I now give the floor to Mr. Thériault for six minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
First of all, Mr. Sword, I offer you my deepest condolences. Your testimony was very touching, shocking even.
Dr. Judson, I would like to take advantage of your experience and thank you for your dedication to the fight against drug addiction: 49 years in the field is a very long time. It could be likened to a calling.
Today the toxic drug crisis is very complex, much more so, I guess, than when you could prescribe methadone to a heroin addict. The drugs of today are made up of a number of substances. Experts have even told us that when you begin to treat someone addicted to synthetic drugs, you can suddenly realize that the individual is becoming very ill because you don't have what it takes to wean him off a certain drug that plays a role in his addiction.
With regard to the crisis we are currently facing, I would like you to tell us what additional challenges we are facing compared to what it was like at the beginning of your career in substance abuse treatment.
Luc Thériault Bloc Montcalm, QC
Of course. You can speak in English; there is an interpretation service. Are you saying you didn't understand the question?
If that is the case, Mr. Chair, the witness should be told how he can hear the interpretation.
Liberal
The Chair Liberal Sean Casey
Dr. Judson, were you able to avail yourself of the simultaneous translation?
Liberal
The Chair Liberal Sean Casey
Okay. On your screen, you should see there that you have the option between hearing the proceedings in English, French, or the language that's being spoken. So you must have yours on floor. Can you adjust it to hear everything in English, please?