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
Associate Professor, Université de Montréal, As an Individual
[Inaudible—Editor] was a success.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
I appreciate your answer.
Forty-seven thousand Canadians have lost their lives since 2016. I struggle to see how that is a success in Canada overall.
I'll go to Ms. Krupp again regarding her comment about safe supply.
We heard from the parents of Brianna MacDonald a couple of weeks ago. She was a 13-year-old who died by overdose alone and in a homeless encampment. Their powerful testimony included how the words “safe” and “drugs” don't belong “in the same sentence”.
Would you agree with that?
Conservative
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Do you believe that the federal government has fooled people into believing that opioids and other drugs are safe based on the marketing of harm reduction programs?
As an Individual
I believe that there needs to be education for sure. I had to educate myself on safe supply, methadone, things like the half-life of methadone and the recommended doses when you're starting a program.
In my daughter's case, the doctor started her off on a 30 dosage, yet the literature I reviewed across Canada and the United States, including all the medical associations, recommend a 10 to 20 dosage. He started her at 30, and he didn't do an opiate tolerance test. There are all kinds of things that parents need to be aware of.
In terms of Brianna, the tragedy there is beyond me. This is a 13-year-old, and the fact that the parents couldn't get her the help that they desperately tried to get her.... Their hands are tied by policies, by legislation and by the ignorance of the general.... You have to be living it daily.
Let me tell you how I spent my Sunday.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Please wait just one second. I just want to get this online.
Have you witnessed safe supply being diverted into the hands of children?
As an Individual
I haven't with regard to children, but I have with regard to adolescents.
As an Individual
They knocked on our car window. My son had just gotten in from his Friday visit. The boy looked to be about 19, and he tapped on the window. I said to my son to lower it, and the boy asked for hydromorphone. He begged for two pills. He said, “I'll give you 20 bucks.” I said, “I'm really sorry. You can go to the clinic,” and we drove off.
That's right; it was just blocks away from here.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Krupp.
Thank you, Mr. Doherty.
Dr. Powlowski, you have five minutes, please.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Interestingly, I think we perhaps see a little bit of convergence of opinion. I'm not a fan of safe supply for reasons that—can I call you Ms. Krupp?
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
—Masha has talked about and concerns about diversion, and for a lot of people on harder stuff, Dilaudid doesn't cut it anyhow, because they go on to use harder stuff. I'm also, for the record, not a big fan of decriminalization. I think the police need to have the legal means to control people who are publicly using and selling drugs.
What you have said, though, Masha, is that you think it's a totally different thing when you're actually witnessing safe supply, where someone gets the drugs there and don't bring it home, but possibly sell it. That is certainly what Dr. de Villa has talked about in this one clinic.
We've heard a lot about the evidence of safe supply. In fact, from my reading of the literature, a lot of the evidence comes from places like Europe, where they've done a lot of heroin-assisted treatment, which is exactly that: witnessed treatment. And this is a Swiss model, where people can come in two to three times per day and get a witnessed dose of intravenous drugs. For the most part, they don't go home with drugs. Someone described our safe supply and getting a whole bunch of Dilaudid as the poor man's version of that because it's more expensive to have a witness program. You, I think, have already said something, but again, for the record, if you had the option of bringing your son to the clinic that Toronto Public Health has where he would get witnessed doses of intravenous medications, would you think that that would be better than the treatment you currently receive?
As an Individual
Yes, and I think I mentioned that to you before we started: If I could take him to a clinic here in Ottawa where he would get an injection, whether it's two or three times a day, most definitely I would.
I also want to clarify that I'm not in support of decriminalizing [Inaudible—Editor]...this is just another path. I'm not a supporter of that either. The police do need to have a means.... I have seen the proliferation on Rideau Street and in the Byward market, of all these people, because there's a safe injection site right next to Recovery Care. It's not working; you cannot normalize drug use.
I was there on Friday and I had to go to the drugstore to get something. I'm not a fearful person and I get to know all these people who are diverting and using right in front of the clinic, in front of all the tourists and parents walking by with kids. This guy, he's always got a big stick and he's higher than a kite—you can see that and he's twirling it and sometimes he gets angry. I'm gauging the situation: do I walk around him? Do I wait? Do I go somewhere? Why am I supposed to be dealing with this? Is this safe supply? Is this what decriminalization will do? Safe injection, I support but why are they doing everything out in the open if safe injection and safe supply are working?
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. de Villa, in that clinic you have, which actually provides intravenous Dilaudid, my understanding is that you only have 35 patients on that drug. I know with the Swiss model with heroin-assisted treatment, they put thousands of people...and these are hard-core drug users; these are not teenage kids. These are not people who have been using it for a few months and maybe spiralling down. These are people who have been using it for years, often people who have repeatedly gone to jail, and they kind of accept it and they failed everything else. Literally thousands of them have been put on it. You have just 35 in Toronto.
Should we be considering expanding that access to the clinics? For example, for Masha's son, that was available for the real hard-core cases, the ones that you can't get off anything else. Should we be opening more clinics like the one you have? I think you told me you were actually going to lose the funding for that clinic.
Medical Officer of Health, City of Toronto
Through the chair, very briefly, yes, of course we should be expanding treatment options like the one we have in Toronto and many other treatment options. We should also be expanding prevention options. We should be expanding harm reduction options and we should be modernizing our existing drug policy. It's the notion of decriminalization as a policy support to more access to better services, real access to services, plus addressing the social conditions within which these health challenges take place. The notion here is not to endorse widespread unregulated use, but as Professor Fallu says, the reality is that this is human behaviour. It's incredibly complex, and it requires a nuanced and complex discussion, and nuanced, complex solutions.
To think that one simple change, or one avenue, or one approach will actually change this is just not reasonable. In fact, it's not evidence informed. What I've sought to do across the board, whether it's with decision-makers here at the federal level or at the provincial level, or certainly at the local level, is to put in front of you the best available evidence on the challenges we see that are impacting the health of our citizens.