Health Committee on Oct. 22nd, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 133 of the House of Commons Standing Committee on Health.

Before we begin, I would ask everyone in the room to have a look at the guidelines on this card. The measures are in place to help prevent audio and feedback incidents, and to protect the health and safety of all participants, including the interpreters. Thanks for your co-operation on that.

In accordance with our routine motion, I'm informing the committee that all remote participants have had the required connection tests administered. We're having a challenge with Mr. May, but it's not going to further delay the start of the meeting. I expect that we'll get along just fine. I just want you to know that's done.

Before we begin, I would like to remind members that the clause-by-clause consideration of Bill C-277, on brain injuries, is this Thursday. The deadline to submit amendments is in another 51 minutes. At noon today, the amendment package will be circulated as soon as possible after the deadline passes.

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 with us today Jean-Sébastien Fallu, associate professor, Université de Montréal, appearing online.

We have Masha Krupp in the room. She is a mother who has lost her daughter to a methadone overdose, and whose son has an opioid addiction.

From the City of Toronto, we have Dr. Eileen de Villa, the medical officer of health.

Thank you all for being with us today. As has been explained to you, you will have up to five minutes for your opening statement.

I now give the floor to Jean‑Sébastien Fallu, who is appearing by video conference.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, could I ask the interpreters to speak closer to the mike?

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. Thériault.

I don't think I need to repeat your request. I'm sure the interpreters will do as you asked.

Mr. Jean‑Sébastien Fallu, welcome to the committee.

The floor is yours.

[Jean-Sébastien Fallu, Associate Professor, Université de Montréal, As an Individual]

Thank you very much, Mr. Chair.

Mr. Chair, Vice-Chairs, Members of Parliament, thank you for giving me the opportunity to testify on the study of the opioid epidemic and drug toxicity crisis in Canada, a subject I have been advocating about within organizations for ten years.

As an associate professor at the Université de Montréal for twenty years, I am also editor-in-chief for the journal Drogues, santé et société and a full-time researcher at the Centre de recherche en santé publique at the Institut universitaire sur les dépendance, and the Recherche et intervention sur les substances psychoactives Québec, or RISQ. I also founded the Groupe de recherche et d’intervention psychosociale, or GRIP, which has been operating in harm reduction in festive environments for almost thirty years. Finally, I am someone with lived and ongoing experience with drug use.

It would have been nice to be with you in person, but I am currently in Lisbon for two science events: the Lisbon Addictions 2024 conference and the International Society of Addiction Journal Editors meeting. Yesterday morning, I presented with Carl Hart, a world-renowned neuropharmacologist, who has written several books, including his latest, Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear, which is an essential read.

The drug overdose crisis, or rather the drug poisoning crisis, is above all a crisis of public policy and stigma. My testimony is primarily focused on the stigmatization of people who use drugs as well as policies and their adverse effects. I will pay particular attention to the importance of an informed discussion and highlight the social determinants of health.

The COVID-19 pandemic exacerbated the drug epidemic. The number of deaths has increased from roughly 3,700 in 2019 to more than 7,300 in 2022. Contamination (fentanyl and analogues, nitazenes, benzodiazepines, etc.) also plays a central role in this escalation. It is crucial to understand that criminalizing and punishing people who use drugs is ineffective, stigmatizing and aggravates the situation. Despite the complexity of the situation, one thing remains clear: Stigmatizing people who use drugs impedes their access to care and escalates the crisis.

We need to refocus our analysis on the root causes of this crisis: contamination in an unregulated market due to prohibition policies, failure to prioritize the social determinants of health, and stigma and social exclusion.

Stigma manifests in at least three forms: self-stigma, social stigma, and structural stigma. Stigma is associated with many harmful effects. First, there is dehumanization—which is bad, because we're talking about human beings. There is also shame, loss of self esteem, distress, anxiety, depression, social isolation, and increased substance use—which is the exact opposite effect that very stigmatization is seeking to achieve. There are also decreased requests for assistance, discrimination in access to housing, care and employment. These effects lead to poverty, a deterioration in mental health, incarceration and even suicide. In short—and this is not a slogan—stigma kills.

Stigma is a social determinant of health. Reducing stigma is an essential goal, despite ideological discourse that suggests otherwise. Reducing stigma includes using people-first language that's accurate, balanced and unbiased; educating the public, and transforming social representations, all with the ultimate goal of transforming laws and policies around drugs.

Substance use has always been an integral part of the human and animal experience. Trying to eradicate these behaviours is like opposing the very nature of human beings and animals or trying to beat air. As a result, prohibition and criminalization not only fail to achieve their goals but aggravate the situation by exacerbating the crisis.

Moreover, our neoliberal policies contribute to misery and poverty. Prohibition policies create a toxic market that escalates the crisis. That is the prohibition paradox. What's more, the social determinants of health are far from optimal. In the face of these toxic markets and the failure to prioritize social determinants, we insist on stigmatizing, excluding and blaming individuals, which only exacerbates the problem.

For decades, our approach to substances has been stigmatizing and disconnected from reality. Rather than asking why, we continue to use the same approach with the hope that we’ll achieve different results.

In closing, I would add that some people say decriminalization in Oregon or British Columbia was a failure, but that is not true. Decriminalization is only a small part of the solution. It does not solve problems of poverty, access to housing, health care, social services and treatment. The same holds true for access to decent jobs. In terms of solutions, several insufficient and irrelevant proposals are often put forward.

However, having read the briefs and testimonies, I can see that the majority of recommendations are in line with mine, which includes: rethinking drug policies in favour of an approach that is geared towards public health and human rights; promoting harm reduction services as well as access to health care and social services for people who use drugs; investing in all social determinants of health, including access to care and stigma reduction; decriminalizing, regulating and legalizing drugs; implementing harm reduction policies; and finally, developing more services and decentralizing them to avoid clustering.

I can define and clarify these recommendations as I answer your questions.

Thank you for your attention to this matter. I’m available to answer your questions.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Fallu.

Next, Ms. Krupp, welcome to the committee. Thank you for being with us. You have the floor.

[Masha Krupp, As an Individual]

Thank you.

I want to thank you all for inviting me to speak today, for giving me the opportunity to share my lived experience with the methadone treatment and safe supply programs.

I'm going to touch very lightly on one issue.

My daughter, Larisa, died in September 2020 from methadone toxicity, 12 days into her methadone treatment. I wanted to bring this to the forefront because there are other ways of dying. This was at the hands of a doctor at Recovery Care here in Ottawa who did not conduct an opiate tolerance test on her prior to starting her on the methadone program. Unfortunately, 12 days into her program, she overdosed because of the dose the doctor gave her two days prior.

I think it's important to know that methadone is a great tool to get a person on the path to recovery, but we also have to look at how it's dispensed and prescribed, and whether the doctors prescribing this know what they're doing and are not skipping any steps.

What I really want to talk about today and focus on is the protracted and lived negative experience with my son, who is in active addiction. He's been under Dr. Charles Breau's care at the Byward Market Recovery Care location on Rideau Street since June 2021, and on safe supply under Dr. Breau's care since the fall of 2022. He's prescribed 28 hydromorphone pills daily, in addition to his current dose of 45 milligrams of methadone. He was on methadone last year, as high as 165 milligrams. He's still using street drugs. Three years later, my son is still using fentanyl, crack cocaine, and methadone, despite being with Dr. Breau and with Recovery Care for over three years.

As soon as he was put on safe supply, he started diverting his safe supply. Most of the patients I see coming out of this clinic on Rideau Street—I see them in front of me—coming out of Dr. Breau's office, coming out of the pharmacy right in front of where I'm parked. I've taken pictures. They're counting out these white pills. Dealers come out of nowhere, and they hand them a little thing wrapped in plastic. I see them move a couple of feet, and they're smoking and injecting right on the street. This is my experience with safe supply, my experience with my son.

I have gone in to see Dr. Breau myself, as has his father, over the last two and a half years, asking for a treatment plan, asking for counselling, letting the doctor know that he's using fentanyl, that he's using crack cocaine and we're worried about overdosing.

The doctor really didn't respond to anything. His answer to me was, my son is the one who has to ask for the treatment plan, not me. For the last couple of years I have essentially been monitoring my son. I moved in with him. In fact, three or four weeks ago, I had to call 911 because he overdosed. This is all under the care of Dr. Breau and Recovery Care clinics. We're into three-plus years. Why am I still calling first responders when these clinics, as is my understanding, under SUAP are receiving millions of dollars in funding, $10-million plus to date? Their websites purport to have a treatment plan, individualized for each patient, mental health counselling for each patient. They have one mental health counsellor, to my knowledge, across four clinics, who is only available virtually more often than not.

As someone with lived experience and who has observed what is going on outside of the Recovery Care clinic on Rideau Street for the last three years, for the diversion I'm witnessing, not just with my son but with the people outside the clinic, this is not working. I feel that safe supply has its place and can be helpful, but the dosage has to be witnessed. You can't give addicts 28 pills and say, here you go. They sell for $3 a pop on the streets. You've got drug dealers.... I know this for a fact, through my son. I've seen it. They come to your home 24-7. You can call at 2:00 in the morning. They take your hydromorphone pills. They supply the crack.

Fentanyl is now down to $60 a gram. It used to be $120 or $170. Addicts are like my son, who still wants to get clean through the type of care that he's receiving at Recovery Care specifically, because that's my lived experience.

Dr. Breau, in my opinion, knows what's going on, because I told him that I suspect my son is diverting. I want to know why he's getting so many pills. Where's the treatment plan? Where's the mental health counselling? I need to save his life. Three years in, I should not be calling 911; they're already overextended.

In closing, what I want to say is that I see no evidence of all this SUAP funding—which is taxpayers' dollars, yours and mine—being spent on treatment and recovery at Recovery Care for their patients. I believe that we have to move away from what is a harmful drug legislation model to a hopeful recovery-focused model, where you've got detox treatment, mental health treatment, assistance in acquiring housing and employment skills. I believe that safe supply can work only if it's witnessed and dispensed and there's a treatment plan attached to it.

As I said, I've been trying to keep my son alive for the last three years. He's been in the safe supply program. I have spent hours, weeks and months—his father and I—as we've been looking for a treatment program. We've been looking for something that's based on recovery. At this point, what we see is that all roads point to the Alberta model.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Krupp.

Next, we have, from the City of Toronto, Dr. Eileen de Villa, medical officer of health.

Welcome to the committee, Dr. de Villa. You have the floor.

[Dr. Eileen de Villa, Medical Officer of Health, City of Toronto]

Thank you very much. Good morning. I do appreciate the opportunity to appear before the committee today.

As you have heard, my name is Dr. Eileen de Villa, and I'm the medical officer of health for the City of Toronto.

As I believe this committee is aware, I contributed to a joint brief, along with colleagues from Montreal and Vancouver, that was presented to this committee earlier this year. That brief spoke to the nature of the toxic drug crisis in Canada's largest urban centres, so I'm very pleased to be here today to join you and expand on that information that was already provided and certainly to answer any questions you may have.

Before I go further into my remarks, I do want to note that as I talk about data that are related to the crisis, to the epidemic that we see today, I'd like to note that I do so with respect and with a deep appreciation for what these data mean. As you have just heard from my fellow witness, we're talking about people. We're talking about people who are our loved ones, our friends, our families and our colleagues.

One of the reasons I'm here today is to share with you some stories from our clinic, where I have an incredible team of colleagues who support hundreds of clients every single day.

I simply cannot overstate the heroic efforts of our frontline service delivery partners, some who work directly with me and some who work throughout the system in Toronto. They have seen the epidemic escalate over the past decade, as my fellow witness, Professor Fallu, mentioned. My colleagues have experienced immeasurable grief, as have many communities throughout Canada. My colleagues have saved thousands of lives, and they continue to show up every day to work despite the enormity of the loss that they have experienced and the unrelenting nature of the epidemic we are witnessing.

I do want to tell you about our clinic in the heart of downtown Toronto operated by us at Toronto Public Health. We offer a full range of services and referrals, and we actually see a very high volume of clients every year. In fact, last year, 2023, we supported 18,575 client visits, and over 21,000 client visits to our supervised consumption service at Toronto Public Health in 2022.

As you know, supervised consumption service sites are clinical spaces for people to bring their own drugs to use in the presence of trained health professionals. I know this committee has heard that Canadian and international evidence and our own experience in Toronto show that these sites do save lives and, yes, we do connect people to social services, and we are a pathway for many to treatment.

There are currently 10 of these sites located across Toronto operated by a range of health providers and funded by a variety of sources. The demand—and need—for these services is high.

Across the 10 supervised consumption sites in Toronto, there were just over 96,000 visits in 2022 and just under 95,000 visits in 2023. Amongst these visits, staff at these services responded to almost 2,000 visits in 2022 where overdoses occurred and almost 2,300 in 2023. We saw those many visits with overdoses, and we responded to them.

In addition to providing medical interventions for overdoses, the sites also offer thousands of referrals to health and social services annually, roughly 6,500 in 2022 and almost 10,000 in 2023. In addition to providing direct medical care, we know that the sites serve as an important entry point to a fragmented, although well-intentioned, health care system. We do help link individuals to further sources of care and, of course, to connection, which is an important component of that care.

When people talk about harm reduction, this is what it looks like in our clinical spaces. These harm reduction efforts are meant to work hand in hand with connecting clients to a range of treatment options.

At Toronto Public Health, we operate the only injectable opioid agonist therapy clinic in the city. We currently have funding to provide this treatment option to roughly 35 clients at any given time, although I can tell you that this funding is time limited.

This program offers injectable hydromorphone to medically and socially complex clients who may benefit from this treatment approach, which is delivered on site in our clinic and in an observed fashion. This particular program also includes wraparound services and supports for clients, observed doses and monitoring, a coordinated referral network, case management, and overdose and prevention education.

Eligibility for this program follows national clinical guidelines and focuses on those who are at greatest risk of overdose. I should note that the average length of treatment in this program is a little over 50 days—53 days roughly—although every client will have a different experience. That's the case when we see other health issues and health matters. There may be an average, but there is a slightly different experience, depending on which person we're talking about.

When it comes to this kind of treatment, we have observed and noted that some people will start and stop treatment multiple times. That's why it's incredibly critical that we have a range of options available to meet individuals where they are in their journey.

When we look at our data, we see that since opening the doors, the program has served a wide range of clients, ranging in age from 24 to 62, with 73% of the clients identifying as male.

[The Chair, Liberal, Sean Casey]

I would ask you to wrap up, Dr. de Villa. You have some people anxious to ask you questions.

[Dr. Eileen de Villa]

I will wrap up. Let me just tell you a little bit of a story.

[The Chair, Liberal, Sean Casey]

Be quick, please.

[Dr. Eileen de Villa]

With respect to this service, we have seen really incredible results.

I was just telling my fellow witness here, before the committee began, about an individual client who presented to our service. She was pregnant at the time that she presented to our injectable opioid agonist therapy program. She went on to have a successful pregnancy, a healthy baby, has actually successfully completed the treatment and is now housed. She has actually gained custody of her other children and is living a happy and healthy life.

I think there is lots of opportunity here. There are a range of issues and a range of options that need to be made available. We've heard about the importance of policy, but we need strong approaches as well—prevention, harm reduction and treatment—that take into consideration all the conditions that optimize health and give people the best chance of reaching their full potential.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you.

We're now going to begin with rounds of questions, starting with the Conservatives for six minutes.

Mrs. Goodridge, go ahead, please.

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

Thank you to all of the witnesses for being here today.

I'm going to start out.

Masha, I'm so sorry for the loss of your daughter. You are wonderful for the support you're giving to your son in helping him find recovery.

After nine years of very marked change in addiction policy where this Prime Minister, Justin Trudeau, has decided to flood the streets with dangerous opioids and create....

Mr. Chair, thank you. The mic of the witness was not on mute.

Can I have my time back?

[The Chair, Liberal, Sean Casey]

Yes, go ahead.

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

Thank you.

After nine years of marked changes in Liberal addiction that's flooding the streets with dangerous opioids, legalizing drugs like crack and heroin in British Columbia, and normalizing drug use for a whole new generation, do you believe that has played a role in making it harder for your son to find recovery from addiction?

[Masha Krupp]

I certainly believe that the safe supply, as it's been administered to him in the last two and a half years, has definitely played a role because he's.... The word is “diverting”, but let's use the real word: it's called "trafficking".

I've had the police over to talk to him about what he's doing. He fears law enforcement enough that he's not wanting to go to jail. He doesn't have a criminal record.

Yes, in my view and my lived experience, with the safe supply in my son's case there's no treatment attached to it. It's just the doctor giving him all of these pills. He diverts them, gets the drugs he needs and he's still an addict.

In my view, if he didn't have these pills and was receiving methadone, or if he was receiving his hydromorphone under witness dosage and there was a treatment plan attached to it, I believe it would be successful.

As it stands now, to me it's not successful. It needs to be overhauled. There has to be regulatory oversight.

You're flooding the market, using taxpayers' dollars, with lethal opiates that are making their way into high schools. Adolescents are paying up to $10 a pill for hydromorphone.

How could this be helping us?

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

Well, I think that actually leads into my next question. Do you think that the government calling this “safe supply” and using that term and making it seem like these are somehow safe is a responsible word?

[Masha Krupp]

It's an unsafe supply in my view, as a mother with a lived experience in observing how Recovery Care dispenses their safe supply. It's not safe. It's only safe if it's witnessed or, like the doctor here, in their clinic, where it's a witnessed or injectable dosage.

Then I'm all for it, but you need oversight. You need to be audited. You can't dispense these kinds of drugs to addicts and expect them to take them as they're prescribed—like, come on....

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

It's interesting. Do you believe that the government has effectively become the drug dealer in cases like your son's?

[Masha Krupp]

Well, let's see. The doctor is dispensing the hydromorphone pills by legislation—federal government legislated. You've got the federal government. You've got the doctors involved. You've got the pharmacies. Then you've got the street drug dealers. I would have to say that at a higher level, yes, our Liberal government right now is acting like a drug lord maybe: here's your hydromorphone, the doctor gives it here, here's my son and there are the street dealers. It's a chain, so yes.

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

It is terribly concerning.

In one of the things you said in your opening statement, you talked about how your son goes to this Recovery Care clinic. You have to take him every single week, but all he gets is a scrip, and he does a drug test. He doesn't actually get any counselling.

I went onto the Recovery Care website. They talk about mental health, and they seem to talk about the fact that this exists, but you're saying that in the two years that your son has been part of this program, he hasn't received mental health support. Is that correct?

[Masha Krupp]

No, the only thing is that when I have faxed letters to Dr. Breau, or the few times my son allowed me to go to talk to him, he would come home with a sheet of photocopied anything anybody could access, you know: Narcotics Anonymous, the mental health crisis line, the suicide line.

It's almost an affront to me as a taxpayer and a mother of an addict, because I know they're getting this funding. Are you telling me that with your $10 million-plus you can't have an extra counsellor in your clinic on site?

None of the things they claim in their website, in my experience over three years, has ever been realized with my son.

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

To your knowledge, has he actually received counselling from a counsellor at Recovery Care clinic?

[Masha Krupp]

No.