Health Committee on Oct. 1st, 2024

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

Therefore, you—

[Dr. Rakesh Patel]

If you have that, you're going to see what you call “chaos”.

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

Dr. Patel, are you an advocate of having fentanyl available in a so-called safe supply program?

[Dr. Rakesh Patel]

I am an advocate of doing that, because it will save lives.

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

My next question is this: I saw yesterday, in fact, that you guys got an extension to your clinic for an additional three years, per Health Canada.

What consultation and communication did you have with the surrounding community regarding the clinic's operation?

[Dr. Rakesh Patel]

I'm not understanding the question. Forgive me.

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

Oftentimes, there's communication with your neighbours when you're operating something. There are tons of reports of increased crime.

Have you had any conversations? Was there any requirement from Health Canada to have community consultation in order to make sure public safety is being maintained?

[Dr. Rakesh Patel]

There's no requirement from Health Canada, but we fundamentally, as an operating infrastructure, consult with all of our community partners in Lowertown and the different shelters we have across the city.

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

Okay. Health Canada does not require you to have any consultation with community or to take into account the larger public safety risks when operating.

[Dr. Rakesh Patel]

It doesn't. On a formal basis, I and my CEO are not required to do any particular reporting back to Health Canada.

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

It's incredibly troubling—as we see so much crime happening in the very few blocks around your clinic—to know that Health Canada gave you another rubber stamp to continue operating for another three years, without putting any additional measures in place to ensure diversion isn't happening and that public safety is being put front and centre so kids aren't being put at risk. I really do not understand how Health Canada is doing its job and not doing those kinds of things.

My last question is for Dr. Ghosh.

Are you familiar with recovery-oriented housing solutions like Oxford House?

[Dr. Sumantra Monty Ghosh]

I am, yes.

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

Do you believe that recovery-oriented housing solutions similar to Oxford House are good models to get people housed and break the cycle of addiction?

[Dr. Sumantra Monty Ghosh]

I do.

Oxford House is, essentially, high-level supportive housing. It is an equity-based supportive housing facility as well, meaning that it is public and paid for by the Government of Alberta. One of the points I wanted to make earlier was that the Government of Alberta has provided access to these services for free.

The key to Oxford House is that it helps build community. They are long-term treatment facilities in the sense that it's not just three weeks that people spend there. It's not just six weeks that people spend there. They can spend a long time in these facilities. We know that the longer they spend in these treatment facilities the better their overall outcomes will be post-discharge from these services.

The other benefit of Oxford House is that they also provide transition services back to the community, which, as you know, is another key, evidence-based idea. It provides increased support for clients and has better outcomes as well in terms of recovery, cessation of substance use and decreased relapse.

Oxford House is a—

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ghosh.

Next, we have Madame Brière for five minutes, please.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Mr. Chair.

I would also like to thank the two witnesses for their testimony, which has been very useful and very interesting.

Dr. Patel, based on their questions, it's easy to see where our colleagues across the way stand. Would you please reiterate your observations about the importance of an approach that takes into account the four internationally recognized components: prevention, law enforcement, risk reduction and treatment?

Also, Dr. Ghosh, this is related to the question you were just asked, so I'd like you to answer it after Dr. Patel comments. We obviously need services to house people, but that's not the only option.

[Dr. Rakesh Patel]

Thank you for the question.

I hope I've understood your question. I will try to answer it.

I think the approach to the social determinants, as I think you're alluding to, is going to be the most important way out of this crisis. I'm not convinced that we're never going to have a drug crisis. The reason is as I said: At the very beginning, humans have desires, and we're risk-takers, so a supply-side approach is never going to work. We've demonstrated that for the last 60 years. Unless we get rid of our fundamental biases in this, we're not going to overcome the situation.

Why housing is really important, as I've alluded to, is that it gives you personhood, and without that, there is no motivation for you to change. I can't change somebody. I can only help them try to change, but if they don't want to change or cannot find it in them to change with everything around them, I can't change that. That's a fundamental truth that I have to accept. As a physician, I can't fix everything. I can do my best, but I can't fix everything.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you.

[Dr. Rakesh Patel]

I don't know if I've answered your question appropriately.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Dr. Ghosh, do you have something to add?

[Dr. Sumantra Monty Ghosh]

Thank you so much.

I do agree with Dr. Patel that housing is probably one of the key ways that we can get out of this crisis, especially around public consumption of substances, but it has to be in conjunction with other services as well.

Yes, for me, again, housing is crucial. I think it is the key piece that we don't have enough of in the system, and it's something that we need to be focused on. It's not just housing as well. It's supportive housing at a level of intensity that is congruent with the concerns of the individual. Some of these clients have severe mental health concerns. Some of them have severe brain trauma, brain injury or cognitive concerns. We need to have adequate support at a level similar to what their needs are. This includes addiction supports as well.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Dr. Ghosh.

Dr. Patel, you also worked as a pharmacist.

Is that correct?

[Dr. Rakesh Patel]

I did, in inner-city Detroit, in emerg and in the ICU there. Yes.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Okay, so I'd like to ask you a question about traceability.

Whether one is for or against the principle, how would that work in practice? Wouldn't we need two production lines and two distribution chains?

Also, wouldn't organized crime be able to copy the product very quickly?

[Dr. Rakesh Patel]

The question is fundamentally around traceability, and you're right. From a compounding perspective, I don't see how a manufacturer would agree to that.

The medications we get from a safe supply program are from manufacturers. They're not compounded by us and they're not compounded by a community health centre. They come directly from the manufacturer. If you wanted to trace those, you would have to add a second step in order to trace them. That tracer would have to be detected. It would have to be easily detected and it would have to be detected consistently to demonstrate that it came from a particular batch from a manufacturer that led to a concern over diversion.

Anybody in organized crime who makes a tremendous amount of money could easily copy that, because they're far more inventive than traditional manufacturers are. They are far more inventive not because they're smarter, but because they don't play by the rules. There are no rules. They can do whatever they want. All they have to do is get a traced fentanyl analog, a Dilaudid analog or a crystal meth analog, find the tracer and use exactly the same tracer. Then they're off in the clear.

There's no regulatory burden on your average drug dealer. There's a huge regulatory burden on a pharmaceutical manufacturer: again, harm reduction.