Evidence of meeting #133 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was treatment.
A recording is available from Parliament.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Has he ever to your knowledge received virtual counselling from a counsellor associated with Recovery Care clinic?
As an Individual
I think once. The counsellor's name is Jimmy. My daughter had the same one, even though she was at a different Recovery Care clinic location. Jimmy was the counsellor across all four clinics.
Because this was during COVID, initially during COVID it was all done virtual. My son did agree early on in the program, before the safe supply kicked in, to speak to...because we, as his parents, were giving him ultimatums: if you don't do counselling, we're going to have to.... You know, we were trying to leverage some sort of consequences. He spoke to Jimmy once. For the second appointment, Jimmy dropped it. For the third appointment, my son dropped it. That was it.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
That's incredibly troubling. Thank you so much for sharing.
My next question is for Dr. de Villa, really quickly.
You say that they are witnessed in the City of Toronto. Is that what you were pushing for was all witnessed...? Is that why you moved towards trying to get Toronto to have decriminalization and a legalization of drugs like crack—to have more witnessed programs? Or was this to just have a free-for-all?
Medical Officer of Health, City of Toronto
Through the chair, what we're trying to do is provide evidence-informed advice around how to address a very, very challenging situation on the ground—
Conservative
Medical Officer of Health, City of Toronto
We offer a clinic service that is witnessed, but I recognize that there is a range of different options that are required to meet the different needs of different people.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. de Villa
Thank you, Ms. Goodrich.
Mrs. Brière, you have six minutes.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you to all the witnesses for joining us today.
Thank you, Mrs. Krupp, for sharing your story with us.
Dr. de Villa, you heard the questions asked by members of the Conservative Party and the answers provided by Ms. Krupp.
Under what circumstances should the injection or use of drugs without a witness be permitted?
Are there situations in which that possibility should be excluded?
Medical Officer of Health, City of Toronto
Through the Chair, I thank you for your question.
I think that each encounter with an individual patient, as is the case in any medical encounter, actually rests with an assessment of what the individual's needs are and how best to meet them. I will be very upfront with the committee: I'm a public health physician, so I actually am not actively engaged in individual patient care, but from my training when I did do individual care, it is incredibly important to actually understand what the unique diagnosis is for the person in front of you. What are the circumstances in which they live? How, then, do you provide the best evidence-informed treatment intervention, recognizing what the best medical treatment is. How do you make that medical treatment as successful as possible, given the unique living circumstances of that person?
We know that, whether you're treating high blood pressure or diabetes, each person will require a slightly adjusted version of the treatment. There are general guidelines, but how to apply those guidelines depends on that individual and what actually makes sense.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you.
Mr. Fallu, thank you for participating in this meeting, even though you are currently overseas.
You heard the questions and answers. My question is quite simple: What do you think of them?
Associate Professor, Université de Montréal, As an Individual
I think I'm going to answer in English this time.
First of all, I'm also deeply saddened by any drug deaths, because of the many factors involved. I ask the chair and the members of the committee that we stop politicizing this debate. I said in my testimony that we need a fact-based debate.
Policies have not changed that much. There have been no major policy changes in the last nine years. We're still under criminalization and prohibition, and we're still stigmatizing people, which prevents them from accessing treatment. We're not flooding the streets with drugs; prohibition is flooding the streets with drugs. Of course, there may be diversions, but that's only a tiny part of the major problems we're facing from decades of prohibition that brought this toxic supply. That's the fact. Experts agree on that.
If we don't change our way of thinking, we're just going to continue this crisis and these deaths. People are dying. When I hear that we should adopt a recovery model, I'm sorry, but we've already been in a recovery model for decades. That's where the money is—way more than in prevention or harm reduction. There has been a tiny change in the last years, which was deeply needed, to add other tools to a continuum—a spectrum of services to answer different needs and walks of life.
The Alberta model.... This is a false dilemma. It's a sophism, and it's not prevention or harm reduction or treatment. We need all those things. We need everything. Any serious person I know who will defend harm reduction will also be in agreement with recovery. In fact, in his testimony, Dr. de Villa told you that harm reduction accelerates access to treatment, to recovery, because it's a first contact for people. Even with the Alberta recovery model, I'm sorry, but we just learned that they're under-declaring deaths, so that model is not one to follow.
We need to have more recovery, of course, but we need to change our way to address this problem. That's what I think about it.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you for your answer.
Do you have solutions or recommendations to propose?
Associate Professor, Université de Montréal, As an Individual
The solutions and proposals are the ones I mentioned in my remarks. I could elaborate on those, but, indeed, you will never solve such a problematic issue without doing a number of things. We must invest in all the social determinants of health. We have excellent care in Canada, but it's quite difficult to access. People are struggling to access health care and social services. There is a crisis in access to housing, and the policies in place stigmatize people and exclude them. That creates a toxic market. Let's stop kidding ourselves.
Canada first banned poppy tea and opium, and then morphine, heroin and fentanyl. Every time a substance is banned, other more dangerous and unknown substances emerge. A toxic market exists because of our own policies.
We refuse to recognize that substance use is part of human nature. I've said it before: It will never go away. We must find a way to regulate the market. It exists, and it will always exist. We must choose whether to allow organized crime to control the market, leave it in the hands of multinationals, or entrust the government with the responsibility. There are risks, of course, because there will never be a perfect policy. There are certainly drawbacks to each of them, but we have to find the best one. The best policy is not to back down on prohibition; it is to provide a framework for the policy.
Liberal
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Ms. Bruyère already asked the questions I had for you, Mr. Fallu. I will now try to clarify a few points.
Could you explain what you are referring to when you talk about structural stigma?
Associate Professor, Université de Montréal, As an Individual
Structural stigma comes from policies and regulations, whether they're general laws or rules from within organizations. Fundamentally, our laws will dictate what we do in relation to drugs.
At its core, stigmatization is a process by which individuals are labelled as non-mainstream and immoral. As long as legislation is designed to punish and prohibit de facto substance use, there will certainly be stigmatization.
My presentation yesterday was about the importance of reducing the stigma of drug use rather than reducing drug use itself. People, and even ideologues who claim to be experts in the field, have spoken out on this issue. This is the case, for example, of Mr. Keith Humphreys, who wrote an article in The Atlantic containing many false arguments and many red herrings. Such people are relying on botched logic.
Structural stigma is caused by our laws. By prohibiting normal human behaviour that has existed since the dawn of time—and always will—we stigmatize, exclude and kill people. As I said, stigmatization has so many negative effects that, in the end, it kills people.
Bloc
Luc Thériault Bloc Montcalm, QC
Earlier, you touched on the fact that Alberta was under-reporting mortality rates. You said you'd learned that the number of deaths reported by Alberta was lower than the true number.
How did you find out about this?
Associate Professor, Université de Montréal, As an Individual
That observation was made by an independent author. I could track down the source of this document, which was published just two days ago.
Bloc
Luc Thériault Bloc Montcalm, QC
That information would indeed be quite useful to the committee in drafting its final report.
You said that drugs should be decriminalized, regulated and legalized. However, the debate is becoming polarized. On the one hand, Oregon is backtracking, as is British Columbia. On the other hand, Alberta claims that detoxification is voluntary and that it is the gold standard.
What failed to work in Oregon and what failed to work in British Columbia?
Why do you say it's not a failure? Under what conditions could it have worked?
Associate Professor, Université de Montréal, As an Individual
I could speak about a number of things, but I'll try to be brief.
If we just decriminalize drugs, as some states or provinces have done, without addressing access to care and treatment or without improving access to housing and decent jobs, nothing will change. I'm talking about social determinants. No one ever claimed that decriminalization would solve the overdose crisis.
Decriminalization does ensure that people do not end up with a criminal record. It also allows for destigmatization, but that's not enough. As everyone said, it is a half measure and, since it won't have the desired effects, people will call it a failure and we'll backtrack. That's exactly what was predicted, and I was at the forefront in saying so.
Decriminalization is not going to solve the problems that were born of capitalism or poverty. There are people living on the street who are unemployed, who are homeless and who have mental health issues. Policies need a much broader scope. It's just one small step. We have to go further and regulate the market. Obviously, that is simply one tool in the arsenal.
According to experts, the number of deaths or people with substance use problems is similar, with or without decriminalization. In that case, why do we continue to criminalize people? Why violate human rights and continue to criminalize people if it has no effect?
I will now address mandatory treatment. Scientific data has its limits, as always. Some experts say that mandatory treatment is about as effective as voluntary treatment. Based on my reading of the scientific literature, mandatory treatment is less effective. Most importantly, we need to know how to manage the risk of death or trauma. However, that's not part of the conversation.
As we know, people with addictions often have trauma. How do we determine the threshold for imposing treatment? Shouldn't we begin by looking at the root causes of addiction, such as the social determinants of health and poverty, as well as trauma, for example? Should we not ensure access to care rather than impose mandatory treatment?
In closing, I have one final question. Could voluntary treatment be made available before making it mandatory? It's not even accessible, and there's still a stigma attached to it. In other words, this is not a service that the public and politicians see as a priority when allocating public resources.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you, Mr. Chair.
First, Ms. Krupp, I also want to send my condolences to you for the loss of your daughter. I also want to thank and commend you for your courage in supporting your son and for your advocacy. It's all of our jobs to help support your son. The goal of this committee and of this study is to provide recommendations to keep him alive and to find a pathway to a better life.
You talked about drug replacement therapy having its place. Can you speak about the place that you would like to see it play?
As an Individual
Do you mean the safe supply and how the hydromorphone is being dispensed?
As an Individual
From my lived experience, I'm hearing all these answers to questions and all this long-windedness, and I can appreciate it, but I want to know how many people in here, in this committee, have lived what I have lived through. You can talk about references. I point to the Alberta model only because we're desperate as parents to find something that will save his life. There, they are monitored. We need something monitored.
We can't be dispensing drugs that are making their way to the streets. It's a currency for drug addicts and for people like my son. This hydromorphone is a currency unless it's strictly regulated, perhaps in a pharmacy setting or perhaps in a setting like the doctor here talked about, but it cannot be given to them 28 pills at a time, every day, for them to go and trade them for street drugs. You're defeating the purpose of safe supply.