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. Kennell.
Next we have Ms. Goodridge, please, for five minutes.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
I'm going to start my questions with Dr. Judson.
We've had people come here from London, people who are prescribers of the highly potent opioids. They say that the diversion can sometimes be seen as compassionate. What concerns do you have as someone who lives and works in London, Ontario, when it comes to diversion of these highly potent, government-funded opioids?
As an Individual
Diversion must be minimized, and that has to be a priority. I am not opposed to pharmaceutical-grade opioids being prescribed, but is it appropriate to be prescribing short-acting opioids? No. I've already stated that it is counterproductive. Giving take-home doses prematurely when a patient is not stable in their recovery—they've not engaged in their psychotherapy counselling—is not appropriate. For someone who is actively suffering from addiction to be given these short-acting opioids is just something that will deter them from engaging in lifestyle changes.
There must be some approach that encourages engagement with the patient and the therapist. The purpose of the opioid replacement therapy is to avoid the patient going into withdrawal or suffering from overwhelming cravings. Once those symptoms are eradicated, the patient is stable and more likely to be able to engage in the psychotherapeutic medium that is provided.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you.
Dr. Conrod, what are your concerns when it relates to youth, specifically, and to the very well-documented diversion that is happening of these government-funded, potent opioids that are flooding the streets from coast to coast to coast?
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
All substances that young people use are being diverted in some way. A small portion of them would have been prescribed directly to them by a psychiatrist or by a family physician. The literature suggests that most young people are actually getting them from friends and from family members. They're not getting them directly from government; they're getting them from actors in their communities. These people could be better educated. They could be assisted, as Dr. Judson described, in having access to safer supplies of opioids for whatever reason they are being prescribed, either for pain management or for opioid substitution therapies.
I do want to add one more thing to the discussion. We need to understand that mental health is a very big part of addiction. We're seeing, in the safe supply and opioid substitution clinics across the country, fewer and fewer resources available to deliver the mental health and counselling services that Dr. Judson just described. There are fewer funds and fewer people delivering those. On the evidence for opioid substitution therapies, we know that they're effective in conjunction with mental health services and counselling.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Do you believe that more needs to be done to prevent opioids and a variety of different substances from being accessed by youth?
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
I absolutely agree with your statement. More needs to be done on both sides: on the supply side and on the demand side amongst young people.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Specifically on the demand side, I think that's a great space. Has your organization been able to access federal government funding to help with funding your PreVenture program?
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
There are three ways. One is through research, through CIHR. CIHR has rather consistently been through the clinical trials and the committees supporting research on it. It's been very well reviewed and supported in that way. It's a lot of work, and it's a long timeline to do research in schools.
The second way is through the SUAP. I've partnered with one group in northwest Ontario that had a SUAP grant...or a PHAC grant. I'm sorry. They did an implementation, in their community, of PreVenture to great success. It was very well received.
The third pathway has been through provincial governments. There's a big initiative in Ontario right now, through the health ministry in Ontario, to deliver PreVenture across all schools in the province. We have reached a point where we've trained over 1,000 community-based and school-based professionals in the delivery of the program. There are a number of challenges to this project, but the objective is to deliver this to 30,000 young people over the next two years.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Conrod.
Thank you, Ms. Goodridge.
Next is Ms. Sidhu for five minutes, please.
Sonia Sidhu Liberal Brampton South, ON
Thank you, Mr. Chair.
Thank you to all the witnesses.
Thank you, Mr. Sword, for sharing your pain and your story. My heart goes to Kamilah. I'm a mother of two daughters, and I know how you feel.
Thanks for all the work all the organizations are doing on the ground.
My question is for Dr. Conrod.
Dr. Conrod, you talked about the prevention professionals who are going to be there. We know that youth born after 2010 have social media, technology and screens all around them. We hear more and more experts talking about overexposure to technology and about a clear link to the impact on mental health.
To what degree do you see the impact of suffering from addiction? What are some other factors in the environment of today's youth that impact them? I know there's a question.... What, immediately, is the change you're seeing?
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
The situation is not as unhopeful as we all might think in the sense that alcohol, cocaine and tobacco use amongst young people has consistently declined since the seventies. There's quite a lot that we have managed to do around protecting young people from other substances.
The one substance that is showing an opposite trend is opioids, so we really need to focus on this particular behaviour. Young people's opioid use is increasing despite declining rates of substance use in other forms and it's an extremely dangerous substance for young people to be using. We need to take this very seriously.
All the trends are suggesting that there will be many more deaths of young people in this country from opioids.
Liberal
Sonia Sidhu Liberal Brampton South, ON
My next question is for Dr. Eaton.
It's good to see you once again. Your team in Brampton is doing incredible work on the ground.
My first question is about the youth who struggling with addiction, which is now a crisis situation. Recently, we made a distress line equity fund announcement in Peel to expand the crisis line services provided by CMHA and your partners.
Can you provide some numbers to this committee on the number of young people who are accessing the CMHA distress lines?
National Chief Executive Officer, Canadian Mental Health Association - National
Thank you so much.
I do not have those numbers at hand, but we would be happy to find that information and report back.
We do know, generally and anecdotally, that the numbers are up for youth trying to access services. This is a post-pandemic response even though COVID has ended.
We know that for those youth that developed things like eating disorders and substance use disorders, none of that went away even though the pandemic stopped. I know that kids help phone numbers are up and usage of 988 has been consistently what was expected across the country.
I'd be happy to get back to you with those solid numbers.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Mr. Chair, I want to share the rest of the time with Dr. Powlowski.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. Judson, do you still work at Clinic 528? I believe that's in London and I believe it uses OAT or opioid agonist treatment with either methadone or Suboxone. I take it from your testimony, but I wasn't quite sure.
You were saying that you think the usage of that clinic and OAT has decreased because of the ready availability of safe supply and safe supply of Dilaudid in London.
Do you think that's the case? Is there is there any evidence that this is the case?
Thanks.
As an Individual
Yes, I do still work at Clinic 528.
As I said earlier, we originally had 1400 patients in 2004. Now we're down to about 600 patients. We used to have two or three admissions per day, Monday through Saturday. That has dropped down to one or two per week at the very most.
Most patients who are wanting treatment for their opioid dependence gravitate to safe supply clinics. Why? It's because fewer questions, seemingly, are asked. There is less screening and there is ready availability of take-home doses for the patients before they've been stabilized and established in a comprehensive recovery program.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Judson and Dr. Powlowski.
Mr. Thériault, you now have the floor for two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Dr. Conrod, you talked about the importance of prevention. We have seen prevention efforts, particularly with regard to tobacco use among young people. There is a new phenomenon, however, which is nicotine addiction through vaping and products such as Zonnic nicotine packets, which offer a pure and accessible nicotine product to young people. This creates a serious addiction. What do you intend to do about that?
In addition, could you send us all the literature that you have mentioned? You say that we can intervene preventively, and that is what must be done. We understand very well that it is important to engage in prevention. However, while we are doing that, people are going to die from overdoses because poor-quality drugs are being peddled on the streets. We have to amend the act in addition to working on preventive and long-term measures. It remains, however, that a toxic drug crisis is killing people on the streets. I would like you to send us all the relevant literature, because I absolutely want to read it.
Social media plays two roles in this crisis. The first is providing an avenue for dealers to connect with young people with the intention of selling drugs. The second is contributing to addiction and mental health issues.
Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual
I'm not entirely sure what the exact question is, but I reinforce all of your comments. I agree with all of them.
We absolutely need to direct resources to indicated interventions for young people who have started to experiment with substances. We need to reduce their use of substances and absolutely prioritize interventions that are going to help them not transition to more regular and harmful use of very high-risk substances. We need upstream solutions as well, and we need solutions that will provide people living with substance use disorders and substance dependence with mental health services. They get caught in this revolving door.
I think the committee needs to realize that it's difficult enough to assess someone with a mental health problem. It's also very difficult to assist someone with a substance use disorder, and when you put those two things together it becomes a very complicated mix of symptoms that mutually influence each other. There's this notion called "telescoping". It causes difficulties to rapidly accelerate, and it makes it very difficult to intervene.That is why we advocate for much earlier intervention around the concurrent substance use and mental health problems. What research has shown from large cohort studies is that there are risk factors that will predict who is likely to experience co-occurring mental health and substance use problems. We've even identified some of the common underlying factors that will lead to these problems, and that is where the interventions are targeted.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Conrod.
Next, we have Mr. Johns, please, for two and a half minutes.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you, Mr. Chair.
The only time I can table motions is during this committee time, so I hate to do it, but I have to. Mr. Chair. I move:
That, pursuant to Standing Order 108(2), given the increasing prevalence of privatized health care across the country and the difficulty Canadians face in getting the health care they need, the committee undertake a study of at least four meetings on protecting Canada’s public health care system against for-profit corporations, and that the committee invite the Chief Executive Officer of for-profit health care providers like Loblaw Companies Limited to testify
I'd like to speak to the motion, if I could.
Liberal
The Chair Liberal Sean Casey
Okay, the motion was put on notice more than 48 hours ago, so it is therefore in order.
Dr. Hanley, go ahead.
