Health Committee on Oct. 8th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 131 of the House of Commons Standing Committee on Health.

Before we begin, I'll ask everyone in the room to read the guidelines printed on the cards on the table. The measures are in place to help prevent audio and feedback incidents 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 Dr. Sarah Larney, associate professor, University of Montreal, who is online. Sarah MacDonald and Lance Charles are with us in the room. Representing the First Nations Health Authority, we have Dr. Cornelia Wieman, chief medical officer, who is online. Representing the Vancouver Island Construction Association, we have Rory Kulmala, chief executive officer, also by video conference.

Thank you all for taking the time to be with us today. As I'm sure you have been informed, you will have up to five minutes for your opening statements. Then we'll proceed with rounds of questions. We're going to begin with Dr. Larney.

Dr. Larney, welcome to the committee. You have the floor.

[Dr. Sarah Larney, Associate Professor, Université de Montréal, As an Individual]

Thank you, committee members, for this opportunity to speak with you today.

My name is Sarah Larney. I have a Ph.D. in public health, and I'm an associate professor at the Université de Montréal. My research focuses on the health and well-being of people who use and inject drugs.

I have conducted several projects that are relevant to the committee's remit. The most recent of these was an analysis of toxicological findings from people who died of overdose over the past decade in Quebec. These data showed that while Quebec was shielded from the worst of the toxic drug supply and overdose epidemic prior to 2020, this is no longer the case. In recent years, fentanyl is increasingly present in people who died of overdose, alongside a growing variety of highly potent and toxic compounds, including non-medical benzodiazepines, nitazenes and xylazine.

The number of opioid overdose deaths in Quebec increased dramatically in 2020 and has remained high. There were 319 opioid overdose deaths in Quebec in the first six months of the year compared with 236 in the same period last year—a 35% increase. The rate of overdose mortality is low relative to provinces in the west of Canada, but it is probable that the situation will continue to worsen as a result of the toxicity of the drug supply.

We have also studied use of supervised consumption sites in Montreal since 2018. In this work, we found that the proportion of visits to supervised consumption sites requiring an overdose intervention increased markedly in 2020 and has remained high since. However, these overdoses were not fatal because staff were able to quickly respond, providing oxygen, naloxone and further care as necessary. Supervised consumption sites must be a central part of the response to the overdose epidemic. The number of deaths that would occur without them in major cities, regional areas and across the country is unthinkable.

The current overdose epidemic is often dated to 2014 or thereabouts. Recent work in the United States, however, has shown that overdose deaths have in fact followed an exponential growth pattern for nearly 40 years. Using publicly available data from Statistics Canada, we have identified a similar growth pattern in Canada, with an average increase in the overdose mortality rate of 9% per year, every year, since the year 2000. There is no sign of this trend slowing down.

I want to emphasize that exponential growth does not just mean rapid; it means a specific pattern that is underpinned by a process or processes that continually catalyse further growth. While the toxic nature of the drug supply is the immediate cause of the overdose epidemic, these underlying processes contribute to the sustainment and growth of the epidemic. These are most likely socio-economic trends such as increasing housing costs, increasing income inequality and declining income mobility. These trends intersect with and influence each other. It is not a coincidence that overdose deaths have increased in Montreal at the same time that housing costs have increased dramatically and income inequality has also increased.

My point here is that well-funded, low-threshold harm reduction services are essential to manage the acute overdose crisis. These services, however, are hamstrung by a policy environment that permits growth in overdose deaths to continue. Interrupting this growth requires social policy reform, attending to the housing crisis, income stagnation and other issues including overburdened health systems, particularly mental health systems, across the country. Drug policy reform is also essential to address the perverse incentives that drive drug traffickers to produce ever more potent substances.

No single one of these issues that I have mentioned is the sole cause of the overdose epidemic, and no single policy will bring an end to this epidemic. Rather, it is likely that all of these will need to be addressed in some way and the social safety net strengthened if we are to successfully interrupt the epidemic curve.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Larney.

Next, I'm pleased to welcome Sarah MacDonald and Lance Charles, who are here with us in the room.

You have five minutes for your opening statement. I understand that you're going to be sharing the five minutes, if I'm not mistaken.

You have the floor. Welcome.

[Lance Charles, As an Individual]

Thank you for having us.

My name is Lance Charles. This is my wife Sarah MacDonald. She is the mother of Brianna MacDonald. Brianna passed away on August 23 from an overdose. She struggled with mental health. It dragged her down a dark path. She was an amazing little girl. She had a laugh like no other child. She was there for you when you needed her.

Around the time I came into Brianna's life, she started to experience issues with her mental health. She started experimenting with drugs, as well. Her drug of choice was Molly, but she would try anything she could get her hands on. Brianna had over 20 recorded suicide attempts. She tried to overdose on prescription drugs she would steal. Over time, you could see she was going down a very dark path.

We, as parents, started to discuss what we could do and tried to get her help. We looked into treatment centres, mental health centres, doctors and counsellors. None of it helped. The treatment centres told us she was too young. The doctors told us she had behavioural issues. Others told us she's too young to diagnose. Brianna's father and I begged doctors to keep her in hospital. The doctors overlooked what we said and released her, sending us home with Narcan kits. This was starting to get very alarming. It seemed we spent every other week with Brianna at the hospital. She was prescribed many different medications. Some worked for a bit, while others didn't work at all.

We noticed things were getting darker. She became a ball of rage. She was up all night sneaking around and doing drugs. She started to come and go as she pleased. Sarah and I would often get woken up by the police bringing her home because she was found extremely intoxicated. Police would also be needed when she had her violent episodes and threatened to kill herself. An officer asked me once what I would like him to do. I told the officer, “She's threatening to harm herself. Please invoke the Mental Health Act and force her into a hospital.” The officer told me he couldn't because it's against her will.

This is when I discovered the Infants Act. This little girl had more rights to her medical decisions than her own parents. She could tell doctors anything they wanted to hear, and they would release her. Back in February this year, Brianna was found in the kitchen overdosing. Sarah called 911. An ambulance came a short time later to take her to Abbotsford general. Sarah got very mad when she was at the hospital. She stood up to the doctors, who were just going to pump Brianna's stomach and send her on home. Sarah directly told the doctors that we were tired of this. Brianna needed help with her mental health.

This time they sent her to the children's hospital in Vancouver. Brianna didn't do well there. She was lashing out at staff, and screaming. They really couldn't handle her. They weren't fit to handle her. They transferred her to a place called CAPSU. It's at Surrey Memorial. They held her for about 10 days. While there, she had her good days and she had her bad days. Sarah had a meeting with the doctors. They told her Brianna was clear to be released when, realistically, she wasn't. She had just finished putting a pencil through her hand. Once again, Sarah fought to keep her there. Of course, all they did was send us home with a Narcan kit.

This is when we started to see the real dark side of Brianna. We noticed she started using drugs like Molly on a regular basis. We were astounded that she could actually get these drugs. One evening, a car randomly pulled up in front of our house. I went outside after asking my wife who this person was showing up in front of our house. It turns out that we didn't have a clue. I went out to check and make sure. I asked what this person's business was in front of our place. These were two 16-year-old children who were there to sell our daughter Molly. We took pictures of the licence plate and reported it to the police. The police never did anything. They didn't even report back to us.

Now I was really getting worried. It was shortly after this that Sarah started wondering what else was she up to, so she started following Brianna around.

Brianna would actually go to a harm reduction site. She would acquire these zip-lock bags full of needles, cooking kits and pamphlets on how to cook the drugs and safely use them. We were astounded by the fact that these were available to a child. How can a 12-year-old, as she was at that time, acquire these? She can't buy marijuana at a dispensary and she can't buy booze at a liquor store, but she's able to pick up these kits from a harm reduction site to use drugs—a site that is meant for people who are not children. It didn't make any sense

Now we have reached the darkest times, just before she passed. Around the end of July 2024, Brianna became so violent towards her mom and I. This was a direct result of not just the drugs, but her mental health, which had gone so far down a deep path.

Sarah was destroyed seeing her daughter do this. We talked about it every night, trying to figure out what to do. Days later, Brianna became so violent with us that she caused some serious damage to her mom, who ended up in hospital with a severe concussion and some serious brain trauma. I ended up with a black eye and a cracked orbital socket.

Now her mental health was in a really dark spot and we didn't feel safe having her at our house when we have other children. The police removed her from our house and advised that it was not safe for her to be around our other children because she had become so violent. They ended up taking her to a place called Cyrus house. Cyrus house tried to hold her and keep her there. She stayed one night. The next night she didn't return.

When she didn't return, Cyrus Centre put out a missing persons report. This is when we found out she now wanted to be at a homeless camp. The police found her there. They didn't directly tell us that she was at a homeless camp. We found that out days later, by ourselves.

All they said to us was that is safe and that she's with another adult—who was nobody to us. We didn't know her; we didn't even know her name. Since when is it okay for a 13-year-old to be at a homeless camp? Why didn't the police bring her back to Cyrus Centre? Why was she just left there with another adult who doesn't associate with us?

We did keep in contact with Brianna every day. We brought her food and we brought her clothes, but she didn't want to return home. We tried to inflict rules and tried give her more stability; we told her that if she comes home, she needs to follow these. She said, “Why? I can do whatever I want out here”. It didn't make any sense. If she needed clothes or if she needed anything, she could always reach out to us and we were there for her.

Now we come to August 22 and August 23, 2024.

I went to work on August 22, thinking this wasn't going to be a change in my life. I was at work. I work night shifts at Seaspan international. I received a phone call from my wife, who never calls me at three in the morning. It was the one that a parent dreads.

She started the conversation off with, “I love you very much”. This is when she proceeded to tell me that our daughter had passed. This is every parent's nightmare.

This is when we realized that the system we have in place had failed her massively. The people she could go to for help failed her.

My question is, and always will be, why are harm reduction places considered safe? Why are children allowed...I shouldn't say “allowed”. Why are there no programs, really, in place for our children and their mental health? These drug addictions would have never become what they were had she been able to, honestly, get the mental help.

She used to tell us she would have demons and voices in her head, and the only way she could drown them out was through the drug use. I don't know about you guys here, but when you stand back and think about that, it is very alarming that a child is using drugs to drown out voices in her head. The mental health problems were there, but anybody we reached out to weren't. They would send us home with Narcan kits. They would tell us, “We can't force her into anything against her will.”

On September 19, Brianna's friend Chayton, a very lovely little boy...they were best friends.... They started experimenting with drugs because they both struggled with mental health. He had a very hard time dealing with the fact that Brianna was gone, to the point where he made a suicide attempt shortly before Brianna's funeral and, days later, after her funeral, succeeded. He is no longer with us. These were two 13-year-olds who have passed now, not only because of drugs but struggles with mental health. We need things to change because our children are dying, and we can't afford to lose any more children.

I thank you for bringing us here to speak. I hope Brianna's story, as well as Chayton's story, can bring awareness to the struggles that our children are having and awareness to the parents who are struggling with children who are struggling.

It hurts every day thinking about this situation, because I think that, if Brianna had access to the proper mental help, she'd still be here today and able to tell you this herself. Instead we have to speak on her behalf because she's no longer with us. It breaks my heart, having to speak about a child who's no longer here. We do need change, and it needs to be now. Our children are dying, and no other parents should be going through this pain. I hope that, today, we can bring some answers and enlightenment to this subject.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Charles. Please accept my condolences, and those of my colleagues, for the passing of your dear Brianna, and also our respect for your courage to tell such a personal story in a public forum.

Next we go to the First Nations Health Authority, and Dr. Cornelia Wieman. For the next five minutes, Dr. Wieman, you have the floor.

[Dr. Cornelia Wieman, Chief Medical Officer, First Nations Health Authority]

Thank you.

Good morning, boozhoo, aniin.

I'm Dr. Nel Wieman. I'm originally from Mishi-baawitigong First Nation in Treaty 5 territory, which is part of the Anishinabe Nation. I serve as the chief medical officer at the First Nations Health Authority here in British Columbia.

I want to acknowledge that I'm speaking today from the traditional, ancestral and unceded territories of the Musqueam, the Squamish and the Tsleil-Waututh nations.

The FNHA is the first organization of its kind in Canada, created by and for first nations people in B.C. to support their health and wellness. Since before the toxic drug crisis was declared a public health emergency in 2016, we have been on the front lines, addressing the disproportionate impacts on first nations individuals and communities who have worsened historical and systemic inequities and intergenerational trauma.

Our role is to engage with communities, and we continue to expand our public health response to this emergency in collaboration with our health governance partners.

Our data for B.C. first nations people is alarming. In 2023, we lost 448 first nations people to toxic drug poisonings. This was a 10.3% increase from 2022. First nations people died at 6.1 times the rate of other B.C. residents. Women and young people are particularly overrepresented. Since 2016, we have lost 2,356 lives. These data are not just numbers. They represent our family members, our aunties, our youth, our elders. They are loved and missed. This is only the tip of the iceberg. There are vast numbers of other substance use-related harms, such as acquired brain injury, disconnection, and mental, emotional and spiritual distress.

Between 2015 and 2021, life expectancy for first nations people in B.C. fell by 7.1 years, driven both by the COVID-19 pandemic and the toxic drug public health emergency. This reveals the long-term losses and harms to our communities, and the urgent need for critical action. FNHA's response, to date, has been rooted in cultural safety, community engagement and innovative initiatives derived from shared learnings across our five regions. Our approach is community-driven and nation-based and supports a continuum of care that meets people where they are in their wellness journey. We have developed and funded culturally safe community-based programming grounded in harm reduction, which includes expanded OAT availability, establishing peer support groups and outreach teams, funding first nations-lead overdose prevention sites, and increasing access to harm reduction supplies in communities. We have also supported public education and awareness through our Not Just Naloxone training program and communications campaigns; expanded cultural programming, including through land-based healing initiatives, and funded rapid access to treatment and healing centres that incorporate culturally safe practices.

While progress has been made, we continue to face significant barriers. These include the inaccessibility of substance use services in communities, particularly in rural and remote areas, and the lack of long-term, sustained and flexible funding, including for cultural programming. We cannot ignore the role racism and discrimination play, and the lack of recognition of the intergenerational impacts of colonialism resulting in culturally unsafe health care. This is further compounded by the stigma surrounding substance use, which prevents people from accessing care.

In closing, the toxic drug crisis of 2024 is more deadly than it was nine years ago. The major driver of deaths is the increasingly unpredictable, dangerous and potentially lethal unregulated drug supply. The politicization of this emergency threatens progress, especially the backlash against proven evidence-based harm reduction measures that can save lives, and hits first nations people the hardest, deepening existing inequalities.

Every loss is felt deeply by families and communities, and we call upon our system partners to implement timely solutions that are first nations-led, culturally safe, trauma-informed and appropriately funded.

I thank you for your attention today.

Thank you, meegwetch.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Wieman.

Next, from the Vancouver Island Construction Association, we have Rory Kulmala.

Mr. Kulmala, welcome to the committee. You have the floor.

[Rory Kulmala, Chief Executive Officer, Vancouver Island Construction Association]

Thank you, Mr. Chair.

I'm Rory Kulmala, CEO of the Vancouver Island Construction Association, where I have the privilege to work and live in the traditional territories of the Lekwungen peoples and on the historical lands that we have a relationship with through the Songhees, Esquimalt and Saanich peoples to this day.

The year 2024 marks the eight-year anniversary of the state of emergency declared by the B.C. government in 2016 in response to a dramatic increase in overdose deaths that year. Toxic drug poisoning from illicit drugs remains the most prominent cause of unnatural death in British Columbia, greatly surpassing those of suicide, motor vehicle accidents, homicide and prescription drug overdose.

In 2022, the BC coroner's office released the report “BC Coroners Service Death Review Panel: A Review of Illicit Drug Toxicity Deaths”, which outlined some important demographic trends among a representative sample of British Columbians lost to toxic drug poisoning. An important finding of this report was a trend in employment by sector: Of those employed at their time of their death, 52% were working in construction, trades, transport and equipment operation. The high number of drug poisoning deaths represented in the construction industry has been, in part, attributed to substance use and consequences of strenuous work environments, with long shifts and pain. Stigma is pervasive in the construction industry, as is the real barrier to accessing treatment, resources and harm reduction supports, including those for mental health.

The Tailgate Toolkit project, which we have developed, was initially funded by Island Health. It was born out of an increased need for supports and services specifically created for the construction industry. The work of VICA's harm reduction team in creating a curriculum and dialogue for the industry was recognized by the B.C. government, and funding for the project was picked up in January 2022 to deliver this training throughout the province.

The project targets anyone working in construction and trades who uses substances and employers who wish to increase harm reduction awareness in their workplaces. The goal of this project is to bring awareness and increase access to harm reduction services and provide ideas to those who work in the construction industry. This project is the first of its kind in the construction industry. It's innovative, in that the project partners with indigenous knowledge keepers; lawyers; an organization that supports people living with chronic pain; people with lived and living experience; health authorities; managers; supervisors; and owners of construction and trades companies to break down stigma and provide training and education to meet the needs of our industry. It aims to reduce the number of toxic drug deaths in the province of British Columbia.

There are three components to the tool kit. Toolbox Talks is approximately 30 to 45 minutes in length and is delivered live on-site, and we can do it via Zoom, with VICA's harm reduction team. The talks highlight stats about the drug poisoning crisis; why it's an issue in the construction sector; why it's an issue for men particularly; the connection between mental health and substance use; physical and mental health resources; harm reduction and recovery resources; and any other available resources and supports that an employer may require.

The talks can also serve as an operation for the distribution of naloxone kits and training on those kits.

The second component of the tool kit is a training course directed at those in supervisory and frontline positions. They're delivered over two full days or four half days. The training covers statistics about the drug poisoning crisis; an introduction to harm reduction as an approach; construction industry discussions; substance use and mental health; components of stigma; recognizing substance use and impairment; mental health first aid; mental health and substance use literacy, with a focus on having effective and supportive conversations; naloxone injection training; indigenous perspectives; active listening; compassion; resiliency; chronic versus acute pain; pain management stigma; and more through the summary of services available.

In consultation with local health authorities, the third component of the tool kit is digital and print resources for both employees and employers that highlight the harm reduction and recovery services that are available to workers within and beyond their benefits packages. These resources are a mix of province-wide and regional-specific resources that will contain identity-specific supports, including indigenous-led organizations and an industry-specific support group.

VICA's current harm reduction team includes trained regional facilitators who are positioned throughout the province in construction association offices. We call them RCAs. They're all trained social workers working in collaboration with the provincial health authorities. Facilitators gather information on the programs and services available in their area and the province along with information about specific needs of individuals working and living in those regions.

Currently our B.C. construction association has reached over 12,300 construction-related companies. Facilitators offer training either virtually or in person, allowing our project to reach even more communities where travel could be a barrier.

In partnership with the Umbrella Society, which is a local substance support centre here in Victoria, B.C., the final component of VICA's project provides weekly meetings for folks in construction struggling with substance use. They are facilitated by two Umbrella Society staff who have lived experience of both substance use and working in the construction industry.

From January 2023 to the end of September 2024, VICA's harm reduction staff have had the opportunity to provide 230 talks, over 5,500 people working in the construction industry—

[The Chair, Liberal, Sean Casey]

Mr. Kulmala, could I get you to wrap up? You'll have lots of time to expand on your presentation in the questions and answers that follow.

[Rory Kulmala]

Sure. That summarizes our components, and I'll leave it there.

[The Chair, Liberal, Sean Casey]

Thank you, sir.

We are now going to begin rounds of questions starting with the Conservatives.

We'll go to Mr. Doherty for six minutes, please.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you, Mr. Chair.

I will start off by thanking you, Mr. Chair, for allowing our witnesses the time hey deserve to tell their story.

I'm going to focus my questions on Mr. Charles and Ms. MacDonald.

I want to thank you guys for your strength. I don't know if I would have had the same strength that you have, so I thank you for that.

If you could send one message to Justin Trudeau about the failed drug policies, what would it be?

[Lance Charles]

How can you put “safe” and “drugs” in the same sentence? It doesn't make any sense. Those two contradict each other deeply.

On the policy, you should just look at those two words, and they should tell you and give you an answer right there. “Safe” and “drugs” don't mix.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

The system failed Brianna. We just needed one adult to stand up in the room to fight for you.

You begged doctors and those people who should have been there to do no harm and to help your daughter. What was the message you received?

[Lance Charles]

The help wasn't there. The doctors kept sending us away, and it kind of sent a message that really....

[Sarah MacDonald, As an Individual]

It didn't matter.

[Lance Charles]

—it didn't matter at all, that she didn't matter and that her mental health didn't matter.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

I think I read somewhere that you were essentially told that, if she wanted to kill herself, that's her choice. Is that true?

[Sarah MacDonald]

Yes.

[Lance Charles]

It's very true.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Do you believe that Brianna would be alive today if she got the help that she needed, the mental health help?

[Lance Charles]

I believe that not only would she be here today, but she'd be able to speak out on her own situation and what she'd gone through. I believe that, if the help were there and available, her beautiful smile would still be here.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Just to be clear, Brianna had just turned 13, correct?

[Sarah MacDonald]

Yes—just in July, on July 15.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

So she was just a month into her 13th year.

July 15, did you say? It's the same day as my son's birthday. I should note that she passed away on my daughter's birthday.

What does Brianna's story say about the state of mental health care in Canada?