Health Committee on Oct. 22nd, 2024

[Jean-Sébastien Fallu]

I agree that anything that isn't based on fact and confuses concepts and people is indeed toxic. Statements like that don't make any sense at all.

Many experts around the world are studying drug policy. There are many policy options, including diversion, decriminalization, de facto decriminalization, de jure decriminalization and legalization. There are many models, and they're not the same at all.

Models like decriminalization don't address some of the issues. For example, is Portugal safe from fentanyl? The answer is no, because, when you have decriminalization, which is sometimes called diversion, you don't have quality control. That means fentanyl can show up there. It's probably already there, but it's not nearly as problematic.

I think we need to have an informed debate, talk about the facts, be informed by people who spend their lives studying these phenomena in depth. There are lots of different schools of thought in the sciences, but people do reach a consensus.

We obviously don't all agree. Some people think decriminalization is enough. I, for one, disagree, because decriminalization does not address the fundamental issues of the overdose crisis, such quality control, stigmatization, corruption and the ensuing violence.

[The Chair, Liberal, Sean Casey]

Thank you.

[Jean-Sébastien Fallu]

I would just like to clarify, with respect to legalization, that no one here is talking about giving free drugs to kids.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Fallu.

Next is Mr. Johns, please, for two and a half minutes.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Dr. de Villa, the Conservative Doug Ford Ontario provincial government recently announced plans to close certain supervised consumption sites and prevent new sites from opening. This flies in the face of what we heard in earlier testimony from the deputy commissioner of the RCMP and the president of the B.C. Chiefs of Police, from my home province, who both said that we need more safe consumption sites, not less.

Can you please share your thoughts about the potential impact of these closures on people who use drugs in Toronto and on public safety? For example, do you believe that closures could lead to increased deaths and/or public drug use?

[Dr. Eileen de Villa]

Through the chair, very briefly, I do believe there is real danger associated with eliminating supervised consumption services.

As I mentioned in an earlier answer, we see that supervised consumption services have actually prevented fatal overdoses. They also happen to be a method by which people are able to connect to important social services, and they serve as pathways to treatment. I think the loss of supervised consumption services will mean the loss of those pathways, whether it's to improve social service or to treatment services.

I think, as well, when we look at what this means, we are seeing thousands of people across supervised consumption service sites making use of those services in Toronto. If those services are no longer available, I think what that means is you'll have more and more people, particularly in the face of an affordable housing crisis, actually using in public and creating the kinds of challenges that we've heard many people around this table speak of, to say nothing of the fact that you will have more overdoses happening in the public realm. That will be a draw, I would say, on paramedics resources, on law enforcement resources and on emergency room visits.

There are some real challenges that I foresee associated with this, given our experience with supervised consumption services, but as I've said already to this committee and to all other parties who ask me about this, we need multiple points of intervention. We need multiple approaches. We absolutely need more prevention. Yes, we need harm reduction, and yes, we need treatment, and we need a better policy environment that actually supports people towards better health, whether they use drugs or they don't.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. de Villa.

Thank you, Mr. Johns.

Next is Mrs. Goodridge, please, for five minutes.

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

Thank you, Mr. Chair.

Dr. de Villa, as part of the application that you guys put in to make it legal for people to possess a number of different drugs, including crack, heroin and meth, you didn't have an age delimitation, so children could legally carry and use drugs as part of the model you put forward. Do you think it is responsible to have a program for children to have a legal method of using drugs in a recreational model?

[Dr. Eileen de Villa]

Through the chair, the application that was put forward by us at Toronto Public Health was for decriminalization, which, as we've heard, is different from legalization. I do want to make the distinction, and I've said already to this committee and I will say it again, the notion is not to promote or encourage widespread unregulated drug use. It's to recognize that drug use is happening, and it is actually causing harm to people in our community, including those who are young.

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

Okay—

[Dr. Eileen de Villa]

The notion is to try and reduce the stigmatization associated with that.

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

I appreciate that. We have very limited time.

In British Columbia, they developed guidelines to allow fentanyl to be prescribed in a recreational model to children under 18. Do you support that?

[Dr. Eileen de Villa]

Through the chair, again, I'm not familiar with the model in B.C., so it's difficult for me to comment on that.

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

Okay. Do you support so-called safe supply being prescribed to children under 18, yes or no?

[Dr. Eileen de Villa]

Through the chair, what I support is an assessment of individual patients or people who are under care and using evidence-informed treatment to support that.

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

If the evidence—

[Dr. Eileen de Villa]

I cannot speak towards any specific situation without actually conducting a proper assessment.

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

Okay. Would you want your children to be prescribed highly potent opioids, if they were under 18, without you being aware of that?

[Dr. Eileen de Villa]

Through the chair, I would want the medical system to provide appropriate care to my children for what situation they have in front of them.

Clearly, as parents, we want to be involved in the care—I get that—and we have particular legislation in respect of consent to treatment. I think that's important as well.

To my mind, what we need to do is create an environment that actually allows for good medical care to be provided to individuals, regardless of their age, and we need all of the approaches to be available.

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

You want it to be regardless of their age. You believe that children under 18 should be allowed to be given recreational fentanyl and hydromorphone without their parents' consent, without their parents' consideration, because that's just a good idea.

[Dr. Eileen de Villa]

That is not what I said. What I said is that we have existing consent-to-treatment legislation. I think we need to observe the laws of the country.

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

That's fair enough.

My last piece.... I'm just gonna go on a little rant here to Dr. Fallu.

I appreciate that you are a tenured professor. You get to basically say whatever you want because that is your right as a tenured professor. One in five Canadians struggles with addiction. That means that four out of five can use substances and perhaps don't fall into the ugly struggle of addiction. However, one in five does not have that luxury. One in five tries a substance and can't stop. I think it is highly irresponsible for you to be in a position of leadership and to be bragging to your students about how drugs have made you a better person. I don't think that sends the right message to students. I don't think that sends the right message to Canadians. I don't think that is appropriate in any way, shape or form.

I would just urge you to understand that addiction is a real, serious issue. The one in five Canadians who struggles with addiction does not have the luxury to experiment with drugs. They don't have the luxury to walk into a liquor store. They understand that the one drink they pick up might be the last time that they go home to their family.

Frankly, sir, we have an epidemic of addiction in universities, and students in those places require support and assistance. I would urge you to consider your words.

[Jean-Sébastien Fallu]

Thank you for explaining what addiction is. Let me explain that stigmatizing people and creating misery with neo-liberal economic policies are both core factors of why one out of every five Canadians is addicted. The fact is that with any approach we might have in terms of criminalization, people are still having addictions. It's a human behaviour. It will not disappear. We have to do what science and lived experience tells us is best to help people and reduce this problem, and this is not by stigmatizing and criminalizing them.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Fallu.

The last round of questions is going to be by Madame Brière for five minutes.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Mr. Chair.

For the record, we just wasted almost five minutes of our time on a refused request.

Dr. de Villa, if my understanding is right, provinces decide on the training of physicians, what they can prescribe and when, and what is getting reimbursed. They also oversee professional boards conducting inquiries on banned prescribing. Is it accurate to say that provinces have a role to play here?