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.
As an Individual
I just have the audio, video, participants, raise hand.
Liberal
The Chair Liberal Sean Casey
After raise hand, you should see interpretation. Do you see that? On the bottom of your screen.
As an Individual
No... I do. Oh, raise interpretation. I do now. Thank you.
Liberal
The Chair Liberal Sean Casey
Okay.
Mr. Thériault, please resume. You have the floor for six minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Dr. Judson, I'm going to get right to the point. I was complimenting you on your commitment to substance abuse treatment. One could say that this has been your calling, given that you have been working in this field for several decades.
I also said that it was much simpler to treat a heroin addict when you started out than it is today, when we are dealing with people caught up in the current toxic drug crisis. I would like you to tell us about the difference between those two eras.
According to the experts we've heard here in committee, at the beginning of their treatment, people become very ill because opioids are not the only thing contributing to their addiction. There are also other types of drugs in their systems. So people are facing challenges that they didn't face before.
What is your experience in this area? What are your thoughts on the complex crisis we're facing? I imagine that you were working in an institutional environment at the outset and that your work was determined by that setting. Last winter, young Mathis Boivin died after taking a single pill, the first one of his life. Doesn't that makes things more complex?
As an Individual
Thank you for your compliments.
You're correct in saying that it's easier to treat someone with a heroin addiction compared with someone who is using readily available Dilaudid. When we first started treating opioid dependance some 40 years ago, the only available drug at that time was methadone. Methadone is a long-acting opioid agonist that was first developed for the treatment of pain at the end of the Second World War.
The first methadone clinic was established in Vancouver in the very early seventies. At that time, Dr. Cassidy noted that patients who were prescribed methadone for treatment of their pain were quite comfortable and remained on that dose for a long period of time and never required increasing doses.
On the other hand, shorter-acting opioids, such as heroin and Dilaudid.... Because they are so short-acting, the effect is that every two to three hours the patient is going into withdrawal. They respond—combat those feelings of withdrawal—by taking more opiates. When you take more opiates.... You have to understand the neurochemistry of the drugs. To simplify it for the committee, I can only emphasize that opioids, in actual fact, end up destroying nerve endings. When nerve endings are damaged, they do not respond to medication. That's why doses of opioids have to, over time, be increased. It involves those chemicals called cytokines, which some people will have heard of.
When it comes back to treating heroin addicts some 30 or 40 years ago when there weren't any other substances on the street—it was mainly heroin and opium—then the prescription of methadone was very successful. The number of physicians treating this gradually grew, and we were able to keep up with the demand.
It's really since the introduction of these safe supply clinics that [Technical difficulty—Editor] the overabundance of short-acting opioids, which are naturally destroying the neurochemical integrity of the users, that we've seen the demands that those same patients need ever-increasing doses. Safe supply clinics are, in actual fact, doing more harm than good.
I'm not opposed to alternatives to methadone and buprenorphine, which is Suboxone, which I said in my opening statement. The alternatives should be long-acting, akin to methadone and Suboxone, and they need to be monitored so that we don't get this abundance of short-acting drugs, which are diverted. I've witnessed that myself first-hand. I've seen it on the streets outside my own clinic. You don't get the abundance of divertible opioids that end up, unfortunately, in the hands of young people, such as Mr. Sword's daughter.
I hope that's answered your question.
Bloc
Luc Thériault Bloc Montcalm, QC
Yes. We are now dealing with massive doses and much stronger substances than heroin, and that's why the situation is complex.
Dr. Conrod, we talk about this toxic drug crisis and the death rate associated with it. Sometimes a single dose is deadly, which means drugs are something you try for the first and last time. Furthermore, organized crime does not seem to have any qualms or pangs of conscience about what it is peddling.
What are your thoughts on supervised consumption clinics and safe supply? Do you think that we have moved past the stage where we need to save lives and that we can now strictly focus on prevention and treatment, or do we still need to intervene to prevent people from suffering and dying on the street because we are unable to control their consumption?
Are you in favour of safe consumption?
Liberal
The Chair Liberal Sean Casey
Dr. Conrod, Mr. Thériault's time is up, so please provide a brief answer.
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
Briefly, we need a comprehensive drug strategy that includes safe options for people with opioid dependence, one that includes a much stronger focus on programs and interventions that are going to stop young people from using any drug. A young intoxicated person is much more likely to try other substances, for example. What is circulating currently on the streets and on the Internet is extremely dangerous for young people.
The last thing I would say is that it's not just safe supply clinics that have contributed to circulating opioids. It is also day surgeries and the prescription of short-acting pain relief medication for pain management. That was the beginning of the opioid crisis. It then caused people to transition to other, more potent forms because they were underdiagnosed for their dependence on opioids, then undertreated.
This has been a 30-year problem that has evolved and morphed into a very complex situation that requires a comprehensive approach to its treatment.
Liberal
NDP
Gord Johns NDP Courtenay—Alberni, BC
First, thank you to all the witnesses for their important testimony, especially Mr. Sword for his courage to be here and share. It's such a difficult issue for everybody trying to find solutions here.
I want to thank you for sharing so we can talk about them.
Dr. Conrod, we heard from Mr. Sword about the fact that his daughter was able to access the Internet. In minutes, she could get fentanyl, cocaine, meth, hydromorphone, or marijuana. It was just a click away. You also highlighted, in your speech, the impact of the Internet. You mentioned the need to improve online safety for youth.
Can you answer and share your thoughts on a couple of questions? What role is social media playing in the youth mental health crisis? Do you have specific recommendations on how we can make the Internet safer for youth?
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
Thank you for this question.
I have conducted quite a bit of research on the topic. The work I have done has demonstrated that social media, more than other forms of media, is contributing to young people's poor mental health. The work we published was attributed to having inspired some of the work done by Meta on young people and the impact of their products on mental health.
Canadian research is informing and changing policies in other countries right now around online safety for young people. I really like some of the solutions that have been proposed and passed in the U.K. and Europe. There's even a report I could make available to everyone on some changes that industry has had to implement in relation to some new regulatory policies in Europe. They result in safer practices for young people on social media platforms.
What I can say is this: The more a young person uses social media the more they are likely to experience depression and anxiety symptoms. The more they learn that underage drinking is normal the more they're influenced to drink at an earlier age. We find the same effect for cannabis. We have also shown that using social media impacts cognitive development and makes a young person more disinhibited and impulsive, and it contributes to ADHD symptoms. We know that all three of those behavioural and symptom profiles place a young person at much higher risk for early-onset substance misuse.
Therefore, social media is directly and indirectly increasing young people's risk for addiction, in my opinion. It's through access to substances, but it's also impacting young people's cognitive development and the development of self-control, as well as influencing their attitudes about substance use. There are three separate effects.
What is a solution for Canada with respect to online safety for young people? Hold industry responsible for the harms. We're not doing that in Canada, to my understanding. I don't think we should only be focusing on hate speech. There are other harmful effects of social media on young people, and there are solutions to this. I don't know how much time I have left. The idea is to make sure products are safer for young people. We can talk about this, perhaps, at another time.
Hold industry responsible for making their products safer for young people—recognizing that young people are using their products.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you so much, Dr. Conrod.
We could ask you questions all day, I'm sure. Youth prevention is so important. We just don't talk enough about prevention. We look forward to you sending that information to us.
Ms. Eaton, you talked about a recommendation that was made to the committee at a previous meeting to take a good look at the Canada Health Act because it doesn't cover or support interdisciplinary care for people with chronic, complex illnesses.
Do you think that the constraints of the Canada Health Act are hampering our response to the mental health and toxic drug crisis that we're facing right now?
National Chief Executive Officer, Canadian Mental Health Association - National
Thanks so much for that question.
I'm going to turn to Sarah Kennell, who is in the room and is our Canada Health Act expert, to answer that question.
Sarah Kennell National Director, Public Policy, Canadian Mental Health Association - National
Thank you very much, Mr. Johns, for the question and good morning, committee members.
The fact is that the Canada Health Act only covers services delivered in hospitals and by physicians, which means that services like counselling and psychotherapy—those upstream interventions that Dr. Conrod spoke to such as addictions treatment services—all fall out of scope. That means that people who are looking for life-saving addictions treatment services and counselling services that can prevent the worsening of symptoms have to either go without or pay out of pocket.
They go without because they simply can't afford that treatment as an option. That means that the symptoms worsen over time to the point where they are dealing with highly complex issues resulting in criminal activity and repeated hospitalization, which ultimately cost our system more and is harder to treat.
We also see the increasing prevalence of the delivery of addictions treatment services by private providers, which means that there is no accountability, no standards, no regulatory oversight and people have to pay tens of thousands of dollars to get into these programs. I've heard of stories where families have to take out second or third mortgages in order to pay for their family members to have access to this treatment.
It's just not considered part of our public universal health system.
The solution that is on the table right now is to create an amendment to the act that would explicitly include a reference to “community-delivered”, just like the services that Mr. Sword was so sorely looking for, for his daughter and other community members. This would create an inclusion in provincial and territorial health insurance plans, so that people can get the care they need when they need it.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Kennell.
Next we have Mr. Moore.
Congratulations on your promotion to the health committee. You have the floor.
Conservative
Rob Moore Conservative Fundy Royal, NB
Thank you, Mr. Chair.
This question is for Dr. Judson.
You mentioned in your comments the difference between someone being prescribed a controlled substance and how that medication is closely monitored by their doctor and their pharmacy.
Can you explain to those who are watching how this differs from what is now referred to as the so-called safe supply that we're seeing in our communities?
As an Individual
Certainly. I'd first like to say that I concur and endorse the comments offered by Dr. Conrod. We share the same opinions.
First off, I would say that it's a misnomer. The very fact that these clinics are called ”safe supply” is an attempt at misinformation in implying that anybody who takes these drugs will be perfectly safe to use them. All they are are pharmaceutical-grade opioid prescriptions, so the recipient knows that the drug has come directly from a pharmaceutical company and it's not being made in a clandestine street laboratory.
However, the use of such medications is still dangerous. Using the short-acting opioids is just an alternative to patients using street opioids.
I want to emphasize that the taking of the medication, whether it be methadone or Dilaudid prescriptions, is just a small part of the treatment for addiction. I always emphasize that when prescribing methadone or Suboxone to a patient, that was an attempt to engage with the patient, establish rapport and get them steered in the right direction of going to address their psychosocial needs.
The perpetuation of a supply of opioids is in actual fact just perpetuating the addiction. It's not doing anything to change the lifestyle of the individual. That's where most of the resources need to go. If we're spending a lot of time and money prescribing short-acting opioids, we're in actual fact not really effecting any change.
Conservative
Rob Moore Conservative Fundy Royal, NB
Thank you, Doctor.
This is ripped out of the headlines, but I want to get your comments on it. This was just yesterday. “A police raid at a heavily used harm reduction site in Nanaimo resulted in several criminal charges against two people.” In summary, one individual was charged with “14 counts of possession for the purpose of trafficking and eight weapons offences”, and another was charged with “six possession for the purpose of trafficking counts and five weapons offences”.
Doctor, based on your extensive experience, does that news surprise you?
As an Individual
No, because crime and addiction are somewhat inextricably linked. However, I want to emphasize that it's not the patients—the users, those who suffer with substance misuse disorders—who should be targeted. It's the dealers and the suppliers who need to be reined in. That's why I feel sufficiently strongly that many of the doctors who are prescribing short-acting opioids...I question whether they really understand the harm they're perpetrating. They're not regulated. If they have inadequate education on the subject, that is just going to contribute to the problem.
I want to emphasize, too, that I refer to substance misuse as the “four-two-one” condition. Most medical students spend four years in their institutions. If they are lucky, they will get two hours of teaching on what is the number one cause of morbidity.
If you're graduating doctors who really don't understand addiction, you can see how easy it is for them to over-prescribe and inappropriately prescribe, and the same applies to pharmacists. They don't have the training and education necessary to prevent excessive amounts of opioids ending up on the street. Most of those opioids that seemingly come from safe supply end up in the hands of the traffickers, the accounts of which you just described. They're accumulating these supplies because their business is to promote drug use.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Moore.
We'll go to Dr. Hanley, please, for five minutes.