Health Committee on Sept. 24th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 127 of the House of Commons Standing Committee on Health.

Before we begin, I would like to ask all in-person participants to read the guidelines written on the cards on the table. These measures are in place to help prevent audio feedback incidents and thus to protect the health and safety of all participants, including the interpreters.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

Pursuant to Standing Order 108(2) and the motion adopted on November 8, 2023, the committee is resuming its study of the opioid epidemic and toxic drug crisis in Canada.

I'd like to welcome our panel of witnesses.

We have with us today, appearing as an individual, Dr. Patricia Conrod, clinical psychologist and professor of psychiatry and addiction at the Centre hospitalier universitaire Sainte-Justine at the Université de Montréal.

She's on video conference.

Also appearing as individuals, we have Dr. Martyn Judson, who is appearing virtually, and Gregory Sword, who is with us in the room.

Representing the Canadian Mental Health Association, we have Margaret Eaton, national chief executive officer, who is online, and Sarah Kennell, national director of public policy.

Thank you all for taking the time to be with us today. You will each have up to five minutes for an opening statement.

We're going to begin with Dr. Conrod. Welcome to the committee. You have the floor.

[Dr. Patricia Conrod, Clinical Psychologist and Professor of Psychiatry and Addiction, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, As an Individual]

Thank you very much for inviting me to speak to you today.

As an expert in the field of drug and alcohol prevention, I want to raise a number of concerns. As you know, the—

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, apologies to the witness, but I have a point of order.

With all due respect, I would like to ask the interpreters to speak directly into the microphone. You know very well that the volume is very low in this room. I've set the volume at 85% and I can hardly hear anything. So I would like the people in the interpreters' booth to make a special effort to speak directly into the microphone, not beside it. Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault.

I presume you heard that, Dr. Conrod.

Ms. Kayabaga.

[Arielle Kayabaga, Liberal, London West, ON]

Chair, I would also request that we increase the volume. I can't hear what she's saying.

Thanks.

[The Chair, Liberal, Sean Casey]

Okay.

Mrs. Goodridge.

[Dr. Patricia Conrod]

Yes—

[The Chair, Liberal, Sean Casey]

Give me just one second, Dr. Conrod.

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

I can't hear what's in the room.

[The Chair, Liberal, Sean Casey]

Okay.

Could you say just a couple of sentences? We need to tweak the sound level so that everyone in the room can hear you. I'm going to have you restart your statement once we get all of this figured out.

Go ahead, Dr. Conrod.

[Dr. Patricia Conrod]

You want me to say just a few words without going ahead. Is that it?

[The Chair, Liberal, Sean Casey]

Where are you today?

[Dr. Patricia Conrod]

Can everyone hear me okay? I'll wait for you to give me the word to start again.

[The Chair, Liberal, Sean Casey]

Okay. Is the volume in the room okay now? Can everyone hear me all right?

Welcome to meeting number 127 of the House of Commons Standing Committee on Health.

Does that sound okay in your earpieces, folks?

Is that okay, Ms. Kayabaga?

[Arielle Kayabaga, Liberal, London West, ON]

I can hear you fine. I can't hear her sound.

[The Chair, Liberal, Sean Casey]

Okay.

Why don't you try that, Dr. Conrod?

[Dr. Patricia Conrod]

Are you able to hear me now? I'm speaking up. I can try to speak louder.

[The Chair, Liberal, Sean Casey]

Is it okay in the earpieces? Okay.

Please restart. I'm sorry for the hiccup. Sometimes that happens.

Go ahead, right from the top, Dr. Conrod. Thank you.

[Dr. Patricia Conrod]

No problem.

Thank you for having me speak to the committee today and for your focus on this concerning health crisis, the opioid overdose crisis, that is affecting young people.

I submitted a statement late last night—that I hope you all do read—in relation to how the opioid crisis is affecting young people. More young people have died from opioid-related deaths than alcohol-related deaths, despite the much higher prevalence of alcohol use amongst young people in Canada. The Ontario OSDUHS study recently reported that, compared to all other drugs, opioid use is increasing amongst young people, and now over 20% of high school students are reporting having tried an opioid in the past year.

There are a number of solutions to addressing addiction. They don't just involve acute treatment and pharmacological interventions. They also involve indicated prevention programs, universal prevention programs, and selective or targeted prevention programs, and that's what I want to speak to you today about.

In my brief, I have highlighted a number of systematic reviews. One was reported by the Surgeon General in 2016 in the U.S. and provides a very thorough overview of the evidence-based prevention programs that are currently available and can provide solutions to the current opioid crisis in Canada. There is also a report by the United Nations Office of Drugs and Crime, as well as a joint report by WHO, UNESCO and UNODC. In all three of these reports, there are programs that have been developed in Canada and tested in Canada, but they are not being widely distributed and made available to young people in this country right now.

I chaired a committee, a working group, focused on the emerging health crisis to find solutions for at-risk and young users of opioids. We reported a systematic review that was published in The Canadian Journal of Psychiatry a few years ago. In this report, we identified two programs—only two programs—that have been shown to prevent the uptake of prescription drug misuse amongst young people. One is the Prosper delivery system that has been widely evaluated in the United States. The second is the personality-targeted prevention program, which was developed in Canada and widely tested in Canada.

With regard to a significant evidence gap with respect to solutions for young people who are using opioids and at very high risk of overdose deaths or transitioning to lifelong experiences of addiction and dependence, we conducted a number of focus groups with at-risk users across the country. A number of recommendations are reported, and I refer you to a number of publications that were published in The Canadian Journal of Addiction. The overwhelming message that came from these qualitative interviews with at-risk users was the need for more youth-oriented programs and the desire for more school-based programs, workshops, face-to-face interactions and discussions related to risk for prescription drug misuse, including addressing underlying mental health challenges, peer pressures and concerns about other people's use.

I would be very happy to go over the evidence in relation to prevention programs that are currently available in Canada and that could be widely implemented. I just want to finish with a number of recommendations to the committee on how we could better address young people's risk for opioid overdoses in this country.

First, communities need help reviewing and making sense of very complex literature on drug and alcohol prevention. I recommend that Health Canada maintain a review process and a registry for evidence-based drug and alcohol prevention programs, similar to what has been made available through SAMHSA in the United States and other state registries for evidence-based prevention programs.

We need more federal funding for drug prevention in this country. As you know, alcohol and drug misuse represent enormous costs to society, but less than 1% of those costs are dedicated to implementing prevention programs in the country. Communities need additional resources to help them in adapting evidence-based programs and evaluating their implementation in new contexts where there are evidence gaps.

In light of the growing health threat to young people brought about by the opioid crisis in North America, Health Canada and the Canadian government should explore ways to incentivize provinces and territories in setting statutory orders and minimum standards for drug prevention so that every child in the country is exposed to an evidence-based program immediately.

We need a more coordinated implementation resource and evaluation tool. This could be easily attached to CIHR's CRISM network, but we need more resources dedicated to research and evaluation of prevention and not just a focus on opioid substitution therapy treatments, which has been mostly what the research has been focused on to date.

Health Canada should also stop investing in drug prevention strategies for which there is limited scientific evidence. I can talk more about that.

Finally, we need better online safety for children and young people. The illicit drug market has transitioned to social media, and that is where kids are being groomed for lifelong substance use and misuse. It's extremely important that we begin to look at new ways of protecting young people online.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Conrod.

Next is Dr. Martyn Judson.

Welcome to the committee, Dr. Judson. You have the floor.

[Dr. Martyn Judson, As an Individual]

Thank you, Chairman, for this invitation to speak before the House of Commons Standing Committee on Health.

I am a physician licensed to practise in the Province of Ontario, which I have done for 49 years. Initially, I engaged in general practice and then specialized full-time in addiction medicine, commencing in 1990. I'm certified by the International Society of Addiction Medicine and, in the management of substance misuse, by the Royal College of General Practitioners, U.K. I was the first physician to prescribe methadone for the management of opioid dependence—which is the same as addiction—west of Toronto, and that was in 1991.

I co-authored the first edition of methadone treatment guidelines, published by the College of Physicians and Surgeons of Ontario. Subsequently, I became the medical director of Clinic 528, which at one time retained 22 physicians managing the disorder of opioid dependence for over 1,400 patients.

In the mid-1990s, methadone prescribing was closely regulated by Health Canada and the CPSO, otherwise referred to as “the College”, in order to minimize mismanagement of patients, drug diversion and overdoses. The protocols necessary to achieve these goals were followed strictly, and patient safety and improved health were noted.

Initially, the Clinic 528 operation met significant resistance from local businesses, but after anxieties were allayed, the clinic became a respected part of the community. Anecdotal information from the London Police department indicated that heavy crime decreased.

Since the introduction of what is called “safe supply clinics” in London, the number of patients enrolled at Clinic 528 started to decrease, and many of the patients who have remained have continued to exhibit instability in their recovery from the disease of addiction.

I accept that opioid replacement therapy in the form of methadone and Suboxone does not meet every patient need, and alternative opioid prescribing is acceptable, necessary and indicated, but this should involve long-acting opioids. The use of short-acting opioid preparations such as Dilaudid, which are not monitored nor regulated, significantly increases the risk for patient destabilization, overdoses, diversion, homelessness and crime.

The political situation in London has not helped to mitigate these risks. Both Health Canada and the College of Physicians and Surgeons of Ontario have seemingly abdicated all responsibility for oversight, resulting in many physicians and pharmacists engaging in the practice of prescribing short-acting opioids, which aggravate addiction.

It is important to recognize that those who suffer with addiction can be considered to be suffering with a disease, but the use of opioids is also a choice, a means of coping and a reflection of the decay in society. The remedy is not to prescribe abundant amounts of opioids. Instead, introduce controls and support systems, which will help not just patients, but also prescribers, dispensers and the local communities. Once patient stability is established, health, responsibility, pride and integrity can develop.

Safe supply, for the most part, does not induce such progress.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Judson. Next we have Mr. Gregory Sword.

Mr. Sword, welcome to the committee. You have five minutes for your opening statement. Go ahead, sir.

[Gregory Sword, As an Individual]

Thank you for having me. I lost my daughter two years ago to this opioid crisis. I fought for the last two years to save her life, and I failed. She was able to get safe supply with just one click on Snapchat, and she would be able to get any drug she wanted within five minutes.

She was in and out of the hospital for the last two years of her life. Her first overdose was with fentanyl. The mental health team was called in to give a report, said she was okay, and within five minutes she was released from the hospital. My daughter was suffering from ADHD. When we did the lockdown for COVID, it took her out of her regular routine and she had no escape. She wasn't used to being confined for the entire day, so she started to go online more and more. At that point, she started to dabble. She started with marijuana, and then went to bars, which was the street Xanax, and then finally she was introduced to dillies. Being a naive father, when she would talk about going out for a dilly bar, I thought that was ice cream, so it never raised any concern for me. She would hang out at Dairy Queen with all of her friends. It progressed from there to the point where she had another overdose, almost a year to the day before she died. We had one year to save her, and we failed. Every time a youth counsellor would come in, they'd give me the same thing. She had to ask verbally for help. My daughter was stubborn. She would never ask anyone for help. As a father, I had to sit there and watch my daughter commit suicide for a year and I wasn't able to help her.

We would have drug counsellors come in to talk to her, and they would tell her that it was okay for her to continue to use marijuana. They took me right out of the picture. I could not control any substance my daughter took. In her mind, that gave her the right to keep on smoking marijuana, which put me in the hardest position of my life. Would I let her go onto the streets to get her marijuana, or would I become a drug dealer for my own daughter? I took the latter approach and started to sell, to give my daughter the marijuana she needed to make sure she was getting a safe amount.

But that wasn't good enough for her. She liked the pills. The ease with which she was able to get the pills was unbelievable. She would go to the local park, and she would have what they call safe supply within five minutes. She was embarrassed about doing it. She and her friends, after the second overdose, decided that they needed to stop, but they would not ask for professional help. She got to the point where she was embarrassed and she was an addict, so she started to hide it. She would wait until I went to sleep and then she would take her pill in her bed. I would be gone to work the next morning, so I would never see the effect of it, until I got that fateful phone call that she was found dead in her bedroom.

Since then, I've reached out and tried to figure out what went wrong. I've talked to MLAs. I've talked to the police. The police keep telling me they're handcuffed. I've talked to counsellors; they don't have enough resources. After my daughter died, one of her best friends overdosed two more times. Another best friend has overdosed three more times since her death. We finally got one of them into rehab after she finally reached out and asked for help. It took her a month and a half to find a bed.

For teenagers, a month and a half is a lifetime, especially when they're struggling with addiction. We could have lost that girl very quickly, because we do not have the funding to help these children overcome their addictions.

That's everything I have to say right now.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Sword.

Next, we have Ms. Eaton from the Canadian Mental Health Association.

[Margaret Eaton, National Chief Executive Officer, Canadian Mental Health Association - National]

Thank you so much, and good afternoon. Thank you for this invitation to appear before the committee to support this timely study.

I very much want to thank Greg Sword for his powerful words, and for the courage that I know it took for him to come and share his story. I offer my condolences to him and the families across this country who have lost loved ones because of this toxic crisis.

The Canadian Mental Health Association delivers free front line community mental health substance youth health services in more than 330 communities across every province and Yukon, in rural, northern, and urban settings.

Community mental health and addictions care is a critical complement to physician and hospital-based care. Our services can range from mental health literacy and integrated youth hubs, case management and navigation, clinical counselling, addiction withdrawal management and treatment, stabilization units, supportive housing and mobile crisis teams, and help lines, including participating in the national 988 suicide distress line.

However, it is a constant struggle to meet the growing needs of Canadians, with long waiting lists for services across the country. Front line community health organizations sit outside the primary care system, a reality that is baked into the 40-year-old Canada Health Act, which only guarantees access for those struggling with mental health and addiction issues to emergency rooms, psychiatrists, and family doctors. It does not provide access to essential mental health and substance use health care provided by community organizations.

This means that most community-based mental health and substance use health services are not covered under provincial and territorial health insurance plans. As a result, we are underfunded and left to piece together short-term project funding and fundraising off the goodwill of Canadians who have the capacity to give. Further, community health organizations are often left out of crucial health care conversations with decision-makers.

There are also severe wage inequities for our staff, compared to hospitals and other health care centres. This, coupled with the long waiting lists, leads to high levels of burnout, low retention, and high turnover. Our workforce is exhausted, and grappling with moral distress, trying to respond with compassion and energy to a crisis that is worsening.

I've heard from frontline staff about the challenges they are facing in response to the toxic drug crisis. Across the country, they tell us about how their clients are ready to be in treatment, but they sit on a wait list for four months, because there are no publicly funded treatment options available. They tell me about their clients who are in recovery, but they relapse, because they don't have housing, let alone housing with wraparound supports. They tell me about the pain of losing multiple clients to opioid poisonings in just one week.

I believe that everyone in this room shares a common vision to ensure that our communities are safe places, where our families and friends can thrive. It is a vision that ensures there are supports for those who are struggling with mental illnesses and substance use disorders, so that they can get the help they need when they need it.

Of course, we want to respect jurisdictional areas of responsibility, but there are specific programs, policies, and legislation that you as federal decision-makers have the power to act on, so here are three.

Number one, most importantly, amend the Canada Health Act to explicitly include community-based mental health addictions and substance use health care services. Number two, earmark funding under the national housing strategy, specifically for transitional and supportive housing units. Individuals can receive the best possible addictions treatment, but if they don't have a place to call home, we are neglecting a foundation to their recovery. Number three, task Health Canada with coordinating a federal plan to address the crisis.

Our system can't rely on jails and hospitals. Our communities deserve better. Federal leadership is needed to coordinate a compassionate and integrated approach. The opportunity of this study is to bring mental health and addictions health care on par with physical health care. I urge you as federal legislators to act.

I'm joined by my colleague, Sarah Kennell, national director of public policy, who is in the room with you today. She is there to answer any questions that you might have.

Thank you so much for this time.