Evidence of meeting #129 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A video is available from Parliament.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you very much, and thanks for the incredible testimony from both of you.
Dr. Patel, I would like to pick up on some of those themes from my colleague. Primum non nocere, or first, do no harm, do you think that would be an appropriate module for politicians as well?
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
First of all, I have two follow-up questions for you, but—
Liberal
The Chair Liberal Sean Casey
Dr. Hanley, I'm sorry to interrupt.
I see Dr. Ghosh pointing to his headset. I think that means he has a technical problem, and we just lost him. He does, indeed, have a technical problem.
Liberal
The Chair Liberal Sean Casey
Hold on one second, and we'll see. If he's not back within a minute, we'll need to call him, so just stand down for the moment, please.
Dr. Ghosh, can you hear us?
Assistant Professor, As an Individual
I sure can. You have my apologies for that. I had to log out and log back in.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you, Mr. Chair.
Dr. Patel, I have two, hopefully, fairly brief questions, because I also have a couple of questions for Dr. Ghosh.
You talked about the conundrum of supervised consumption really being designed around longer-acting drugs, principally heroin. You mentioned that people often don't even have time to get into the facility, because of the use of short-acting drugs.
Can you talk a bit about that mismatch, and what we need to do? Should we be actually putting more resources into safe consumption to make it that much more accessible, or is there a bit of a mismatch between the short-acting drugs and supervised consumption facilities?
Ottawa Inner City Health
That's an excellent question, given that the actual drugs on the street are no longer the classic French Connection heroin.
First of all, I would argue that we need either extended hours for safe consumption sites or more, so that we can get people off the street to where they can use safely and where we can have eyes on them to tend to all the other health care problems they actually need....
Also, it's the way people are using drugs now on the street. As people who use drugs age, they have fewer and fewer veins in which to inject, so they're doing different things with the drugs they have. They either take them orally, which doesn't give them the same high, so they have to take more, or they're smoking or inhaling them, which makes them extremely rapid in onset. That avoids going into a safe consumption site to find a vein to inject.
As people are growing older in their lives and using drugs because of all the other things that are influencing them, they're losing veins, so they're changing the way they actually use drugs. That is actually problematic because they're smoking their fentanyl, their crystal meth and their crack on the street. I can't bring them into a safe consumption site because of the law around where you can and can't smoke, particularly indoors. It's just like smokers at a bar. You can't smoke at a bar in a restaurant, so you go outside. Well, that's exactly what's happening.
Liberal
Brendan Hanley Liberal Yukon, YT
Will closing supervised consumption sites actually lead to higher visibility of drug use and more encounters on the street?
Ottawa Inner City Health
My short answer is yes because of the types of drugs and the ways people are using them now.
Liberal
Brendan Hanley Liberal Yukon, YT
Dr. Ghosh, I'll move to you.
I'm encouraged, perhaps, or curious that you, as an Alberta-based physician, actually mentioned decriminalization. I wonder where you think we can, perhaps, take up that conversation, given the whole politicization of that discourse at the moment. What do you see as the next step in approaching decriminalization? What are your thoughts?
Assistant Professor, As an Individual
Thank you so much for this opportunity, Mr. Hanley.
I see us moving forward towards the Portugal model of decriminalization. The Portugal model of decriminalization has accountability as its cornerstone. It was established by a conservative government in Portugal back in 2006. While there isn't published evidence on this, there's plenty of program-based evidence around this and years of data around the outcomes of this particular program.
Essentially what happens is that, if anybody is caught with less than two-weeks' worth of substance on their body, they are given a citation and they're taking that citation over to a dissuasion commission that—
Liberal
Brendan Hanley Liberal Yukon, YT
Dr. Ghosh, I'm going to interrupt you because I think the committee is familiar with the Portugal model. I'm glad to see you endorsing that, but can you briefly reflect on how that model would apply when fentanyl analogs are the primary drugs of use?
Assistant Professor, As an Individual
I think it gives an opportunity for individuals to access care, and it moves the conversation away from criminalization, which we don't do for any other health diagnosis, orienting them towards a health system. What I mean by that is that we don't criminalize diabetes or hypertension if someone goes and grabs a Slurpee. If they have poor blood glucose, we don't throw them in jail.
The Portugal model, I think, benefits us in that sense because it really does orient the person who is using the substance towards the health care side of things as opposed to the corrections and justice side of things, and it does—
Liberal
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you, Mr. Chair.
Dr. Patel, you don't have studies that prove that there isn't diversion, but you're saying that diversion isn't a problem. How can both statements be true at the same time?
Ottawa Inner City Health
Fundamentally, it goes down to why people divert. People will divert predominantly because they don't have a place to stay. If they need a place to stay, they'll divert their drugs. They don't have food; they don't have shelter; they don't have hygiene—those are fundamental reasons for diversion. The people I look after are not going to Lisgar high school and Rideau high school and selling drugs to high school kids. That's not of value to them.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
That's not the only diversion. This is one of the big pieces we've been hearing. There are countless articles that have been written on Ottawa proper and the Ottawa inner-city health of those blocks surrounding the so-called safe supply programs, where drug dealers go. They exchange fentanyl for these drugs. Then those drug dealers take them to the high school students, flooding the streets with dillies. Allowing people to have these to take home is creating chaos.
Sandy Hill is not a safe place to walk. I'm very curious about how you can say that your clinic and diversion have nothing to do with the lack of safety in that community.
Ottawa Inner City Health
I fundamentally disagree with your inference that safe supply is the primary driver of “chaos”, as you call it, on the street. The fundamental drivers of chaos on the street are the types of drugs available on the street. Treating a fentanyl and crystal meth problem with Dilaudid is like treating my arm that's been chopped off in a car accident with pediatric Tylenol. It's a fundamental mismatch.
If we want to improve what we're doing, there are different ways to do it. Providing fentanyl to the kinds of people I see would be one alternative.