Health Committee on Nov. 5th, 2024

[Jill Aalhus]

We really need our responses to be evidence-based and community-led. They will look different in every community. As I said in my opening remarks, we need to continue to uphold the dignity of people who use substances. We cannot police our way out of this. We cannot rely on a one-size-fits-all approach. Not everyone we lose has an opioid dependency, and each person's path to wellness looks different. We need a range of options to meet people where they are.

One thing that makes this work feel unsustainable is the politicization of our efforts. The lack of support only heaps on top of the sometimes traumatic toll of the work. We need more support, less criticism and more long-term commitments of funding to support work in harm reduction, including in rural and remote contexts and in the north.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Aalhus.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Ms. Boudreault, we are facing an overdose and toxic drug crisis. It's a very complex problem. It's not as simple as what Portugal experienced at one time, when they only had heroin and a substitute for heroin. We have drugs today that are killing people. One capsule kills. So we had to intervene based on the overdoses and the resulting mortality.

In terms of the four pillars of the drug strategy, do you believe that harm reduction, including safe supply, is more effective in an overdose crisis than enforcement and prohibition?

[Pénélope Boudreault]

Thank you very much for the question.

I believe so.

I think that risk and harm reduction has a proven track record in Montreal. A recent newspaper article reported that there were no fatal overdoses at the supervised consumption site featured in the story. I've been working on the ground in the streets of Montreal for nearly 20 years. In the past, we didn't have access to naloxone. Today, more and more people, including the general public, are obtaining naloxone because they feel it's important to be able to save lives. It does save lives. People administer naloxone in the event of an unfortunate overdose or drug poisoning.

As you say, it's not always people who use opiates who are poisoned. Some drugs are contaminated, hence the need for safe supply programs where people who use drugs at least have access to clean or less dangerous drugs.

When I worked in detox, I saw the results of the repressive approach, such as forcing someone to stop using. People would avoid jail time by coming to detox. They would do their time, and then they would go back to using.

The detox approach works very well when people are ready to stop using, when they've made the decision to do so, when they've reached that point. They will probably go through difficult times and relapses, hence the importance of intervention groups being close to these individuals to support and guide them without judgment.

[Luc Thériault, Bloc, Montcalm, QC]

One of the four pillars of the strategy is enforcement. Don't you think that, given the current crisis, that pillar is the least effective?

[Pénélope Boudreault]

Yes, I'm afraid so. When laws are repressive, it forces people to hide. Drug use has always existed, and it probably won't go away. Again, there are reasons why people use. Some do it for pleasure, and we can't judge them.

As most of the witnesses have said, there are multiple types of drugs and users, and there are multiple reasons to use. However, preventing people from using or telling them that it's wrong is certainly not the approach that works. Imposing prison sentences or forcing people into detox treatment doesn't work.

People who use drugs still have judgment, and they're able to make decisions with full knowledge of the facts. It's just that they get to a point where they run out of options. If groups and peers with experiential knowledge are there to listen to them and recognize that they are worth helping, these individuals will be able to benefit from an environment that will enable them to make smarter choices, choices that will be better for their health and well-being.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Wright, in your 28 years with the RCMP and in the last few years, how many organized crime illicit drug rings have you been able to dismantle?

[Shaun Wright]

Particularly over the last couple of years, the officers under my command were quite successful in many enforcement efforts against drug suppliers. We don't target individual users.

[Luc Thériault, Bloc, Montcalm, QC]

Why is it that we're grappling with such a massive toxic drug crisis and mortality rate?

Is that due to the ineffectiveness of the enforcement pillar or to safe supply and harm reduction, as you claim?

[Shaun Wright]

There is a lack of resources on the enforcement side, and that could certainly be addressed. I would say the greatest key factor in lethality, as I think you stated, sir, is that we're dealing with fentanyl now, not simply the heroin of decades ago, and it's much more potent.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thériault.

Next up is Mr. Johns, please, for six minutes.

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

First, I want to thank all the witnesses for their testimony. I'd especially like to congratulate Superintendent Wright on his retirement. Thank you for your service to Canada.

I'll start with my questions.

In 2016 in British Columbia, a public health emergency was declared due to the significant increase in drug-related overdoses and deaths. We know that fentanyl and synthetic opioids have been the driving force in the crisis. In fact, the B.C. coroner says that 79% of deaths related to toxic overdoses are caused by fentanyl—fentanyl is found in them.

Retired Superintendent Wright, there was the recent bust of a superlab up in your neighbourhood in Prince George that prevented 95 million hits of fentanyl from hitting the streets, which is significant. Can you speak about why you think law enforcement has been unable to stop the flow of fentanyl and the harm it has caused to communities despite the significant investment in resources? Why can't police really stop fentanyl superlabs? How many do you think there are out there?

[Shaun Wright]

I'm not in a position to comment. I don't have information on how many superlabs there may be.

With regard to my personal experience and opinion as to the persistence of fentanyl trafficking and the continued flow of it, I would say the simplest explanation is that there is a market for it. There is an appetite for it. Someone will always find a way to feed that appetite, just as there's a drive to accommodate any sort of illicit product. I think that's why there has been a heavy focus on fentanyl in the last, probably, five or so years. It's small and very profitable.

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

The Northern Health authority has the highest death rate per capita in the province of British Columbia. It has the lowest uptake of safer supply. Overall in British Columbia, we've seen the number of deaths per capita drop since the decriminalization pilot was brought in. These are just facts, according to the chief coroner of British Columbia.

We had Superintendent Dwayne McDonald here, and he called for more safe consumption sites, as did the president of the B.C. Association of Chiefs of Police, Fiona Wilson. Do you agree that we need more safe consumption sites?

[Shaun Wright]

It's my opinion that we need to focus on reducing the demand rather than facilitating the usage.

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

I think we need to do both, for sure—

[Shaun Wright]

Yes, for sure.

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

—but do you recognize the importance of safe consumption sites for saving lives and limiting public drug use?

[Shaun Wright]

I agree there is a place for that. As I expressed previously, I believe that the four-pillar approach, which would include some harm reduction initiatives, is appropriate.

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

We saw the toxic drug deaths in Alaska go up 45% year over year. Last year, their drug death rate was worse than British Columbia's. In Lethbridge, it's triple that of British Columbia. They have no safe consumption site. Regina has no safe consumption site and has a death rate 50% greater than British Columbia's. Baltimore's death rate is over four times, 400%, greater than British Columbia's. You can go to Philadelphia or Tennessee, and there's open drug use. It has skyrocketed over the last eight years, which you talked about. In all of those places, there's no decriminalization and no safe supply.

Maybe you can tell us why it's skyrocketing across North America in places where there aren't policies like decriminalization and safer supply.

[Shaun Wright]

I wouldn't be enough of an authority to speak in those general terms outside of jurisdictions where I've worked. What I can say is that, in my opinion, correlation does not necessarily equal cause. With regard to safe consumption sites, or overdose prevention sites, we have one in the community of Prince George. As pointed out, there's been no overdose deaths there since it's been open, similar to most overdose prevention sites. However, we have had overdose deaths on the sidewalk out front where lots of people gather around.

I think it may be one piece of the puzzle, but I don't think it's the silver bullet to fixing everything.

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

I agree with you.

We've heard from the chiefs of police, from the First Nations Health Authority, from the chief coroner of B.C. and from the chief medical health officers right across the province that we need to scale up treatment, recovery, prevention and education, and of course replace toxic street drugs with safer supply and stop criminalizing people who use substances. That's what we've heard straight up from those organizations.

Fiona Wilson, the president of the B.C. Association of Chiefs of Police, talked about the diversion of safe supply. She said that the diversion of pharmaceuticals—toxic street drugs and street drugs in general—is nominal at best. She said that hydromorphone made up a fraction of them, that it was fentanyl that was killing people and that organized crime was replicating hydromorphone and pushing it out on the street—that was a lot of the hydromorphone they were finding—along with other pharmaceuticals.

Would you agree that it's fentanyl that's killing people on the street?

[Shaun Wright]

I would agree that, as stated from the coroner's report, fentanyl is definitely present in the vast majority of overdose deaths, yes.

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

Do you believe substance use disorders should be treated as a health issue? Do you agree with public health leaders that there are significant harms associated with criminalizing people who use drugs?