Health Committee on Nov. 5th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 137 of the House of Commons Standing Committee on Health.

In accordance with our routine motion, I am informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

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. Appearing as an individual, we have Shaun Wright, retired RCMP superintendent. On behalf of Blood Ties Four Directions Centre, we have Jill Aalhus, executive director. On behalf of Doctors of the World Canada, we have Pénélope Boudreault, nurse and national operations and strategic development director, who is appearing by video conference. Finally, on behalf of Indwell Community Homes, we have Dr. Steven Rolfe, director of health partnerships, who is also appearing by video conference.

Thank you all for taking the time to be with us today. You will have up to five minutes for an opening statement. We're going to begin with Superintendent Wright.

Welcome to the committee. You have the floor.

[Shaun Wright, Superintendent (Retired), As an Individual]

Thank you, committee members, for this opportunity to speak with you today.

I was sworn in as an RCMP officer in 1996. The 28-year career that followed was spent policing in the province of British Columbia.

In August of this year, I retired from the position of officer in charge of the Prince George RCMP detachment, a position I'd held for the previous five years. For committee members who may not be familiar with the geography of northern British Columbia, Prince George is a city with a population of approximately 80,000 people. It is far larger than any other municipality in the northern half of the province and is approximately a six-hour drive from a community of similar size. It is a hub city for goods and services for a large portion of the province. As a result, there is a significant transient population that contributes to social disorder issues.

During my policing career, there were two public policy issues that I observed to have overarching impacts on the area of social disorder in our communities.

The first of those issues was already occurring in the 1990s, when I became a police officer. That was the shift towards treating significant mental health issues in the community rather than in mental health institutions. Unfortunately, the supports provided in the community were either insufficient or inadequate to properly address the complex mental health needs of many individuals. This has contributed to those individuals being involved in criminal activity and incidents of social disorder over the last several decades.

The second issue is the decriminalization of hard drugs introduced in the province of British Columbia in 2023. During the first year of decriminalization, complaints of social disorder in the city increased noticeably. It appears to me that many aspects of this policy mirror the failings of mental health policy, since appropriate resources to facilitate treatment are not in place. There is a significant lack of treatment options available, and the majority of initiatives in this area focus primarily on facilitating the use of drugs, with little focus on prevention or providing assistance to individuals to get out of the cycle of addiction. This is similar to persons with complex mental health needs who are left on their own in society and who are unable to seek out and maintain appropriate care on their own. I have seen very few cases where opioid addicts have made rational decisions to seek treatment to overcome their addiction. There are many services readily available that actively facilitate drug use, but little focus on treatment.

One of the strategies introduced to address opioid addiction is the so-called safe supply of prescribed opioids. The practice of prescribing a quantity of pills for individuals to take away and use at their own discretion is problematic. Many of those prescribed pills are traded in or sold to the illicit drug market by individuals seeking more potent street drugs. This often occurs outside the door of a pharmacy immediately after the prescribed pills are provided to the individual. Those prescribed pills are often seized alongside quantities of street drugs like fentanyl during police investigations.

When I began as a police officer in the 1990s, there was a focus on a four-pillar drug strategy, which consisted of prevention, enforcement, treatment and harm reduction. It is my experience that the only pillar of this strategy now being supported significantly is harm reduction. With decriminalization establishing drug addiction as solely a health care matter, it's my observation that the majority of the resources focus on accepting and facilitating drug addiction and its associated behaviours as a social norm, without a focus on preventing and reducing rates of addiction. As a result, it appears to me that the harms of illicit drugs on society have continued to increase.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Superintendent Wright.

Next, representing the Blood Ties Four Directions Centre, we have Jill Aalhus.

Welcome to the committee. You have the floor.

[Jill Aalhus, Executive Director, Blood Ties Four Directions Centre]

Thank you.

Blood Ties is a small non-profit on the territories of the Kwanlin Dün and Ta'an Kwäch'än Council in Whitehorse, Yukon.

Before our supervised consumption site opened, I was working when I heard a yell. I ran outside and saw the grey skin of the person my co-workers were helping. Their loved ones had brought them to our back alley instead of calling 911 because they were terrified that the RCMP would respond to the call. Our hands cramped from the cold as we filled naloxone vials, did chest compressions and provided rescue breaths in the snow at -20°C in our T-shirts. Thankfully they survived, but this was a regular occurrence. I've had nightmares about this experience and many similar since.

Now that we have a supervised consumption site, this is rare. Overdoses feel more manageable. They are gradual and we catch them early, yet people continue to die in our communities. There's more we need to do. We cannot go backwards.

I would like to share some context for our work as a frontline service organization in the north. The Yukon's land mass is roughly twice the size of the United Kingdom, but this vast territory is home to only 47,000 people, with 30,000 of those in Whitehorse. Eleven of the 14 first nations are self-governing, and four have declared states of emergency due to the toxic drug crisis. Most of our work is in Whitehorse. Since our short-term SUAP project funding ended, we have little funding for rural harm reduction, but we patch together resources to provide outreach and education across Yukon's rural communities.

Last year, we lost 23 people from our small population. This represents a rate of 50.4 per 100,000, which is even higher than B.C.'s already devastating 45.5 per 100,000. One-quarter of people in the Yukon are indigenous, yet they account for up to three-quarters of overdose deaths. In the Yukon's close-knit towns and villages, every loss impacts entire communities. In Yukon first nations, each life is precious not only individually but also for the cultures fighting to survive the ongoing impacts of colonization. Elders tell me of the pain they feel from losing their youth, who are their nations' future and survival. Community care is so strong here, and people look out for each other, but they need better support.

Blood Ties offers programs to meet a range of needs, including youth education, harm reduction, drug checking, supervised consumption, and housing and wellness supports across the spectrum of substance use. We operate one of the only inhalation rooms in the country, which has seen more than 25,000 visits this year alone.

As the Yukon's only harm reduction organization, we are constantly stretched thin. It's not sustainable. High living costs, housing shortages and an emotionally taxing workload make it difficult to recruit and retain staff. We are under-resourced with short-term funding that doesn't allow for long-term planning, but what really wears us down is the politicization and misinformation heaped on our efforts.

In this context, we know what won't work. We can't police our way out of this. Criminalization only drives more harm. Neither can we 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. I think of my friend Maya, who was proudly indigenous, proudly in recovery and a fierce advocate for harm reduction. Her healing journey included residential treatment, yet ultimately her life could only have been saved by a safer drug supply, decriminalization, peer-led supports and a compassionate approach that recognizes each person's inherent worth.

Communities and people with lived experience across the Yukon have told us what they need: a continuum of care that includes harm reduction, recovery, land-based healing, access to regulated non-profit treatment and dignity—policies that see all people as worth saving regardless of where they are on their journey. We need core long-term investments that build on our communities' inherent strengths.

In honour of Maya and all of the loved ones we've lost, I envision a Yukon where everyone, whether they use substances or not, can be well, where community-led, culturally rooted solutions thrive and where each person's dignity is honoured. We have the tools and knowledge to create this future; now we need the commitment and political courage to do so.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Aalhus.

Next, from Doctors of the World Canada, we have Pénélope Boudreault. Ms. Boudreault is with us online.

Welcome to the committee. You have the floor.

[Pénélope Boudreault, Nurse and National Operations and Strategic Development Director, Doctors of the World Canada]

Thank you, Mr. Chair.

Honourable members, thank you for inviting me to participate in your work.

As national operations director at Doctors of the World, I am honoured to bear witness to the realities on the ground experienced by our teams in Canada.

As a nurse by profession, I walked the streets of Montreal in 2006 to provide frontline care to marginalized people and people experiencing or at risk of homelessness. I now accompany a team of nearly 20 health professionals who provide care and community support.

Doctors of the World is an international health organization with a presence in more than 70 countries. It has been here in Canada since 1996. Our mission is to ensure and defend access to health care for people in exclusion, insecurity or crisis situations.

In Montreal, for nearly 30 years, the teams at our mobile clinic and in our mental health program have been working with people who are homeless or at risk of becoming homeless, including urban indigenous populations and people who use licit or illicit psychoactive substances.

Our teams witness growing precariousness on a daily basis, alarming deterioration in living conditions and the harmful consequences of prohibitionist policies on these individuals and communities.

As a health organization, we advocate for a risk and harm reduction approach based on public health considerations and respect for human rights. When it comes to this health and social crisis, our observation is clear: Whether in legislation, policies, care protocols or the practice of health care and social services professionals, we must seek to support these individuals, not punish them, coerce them or further exclude them.

Our teams are concerned that they are seeing more and more people using alone, putting them at increased risk in the event of an overdose or drug poisoning. It is essential to support and design measures that promote safe consumption and, in particular, to provide support where people are not afraid of being judged or repressed. This means maintaining and expanding supervised consumption sites, providing access to naloxone and ensuring safe supply. Every day, our teams witness the positive impact of these interventions on people's health and safety. Beyond these services, we need to provide comprehensive support for people at risk of overdose and drug poisoning, particularly those the traditional system cannot reach.

I want to highlight the role of peers and community-based intervention in preventing and adapting services and approaches to people who use drugs. People with experiential knowledge have a unique ability to build trust with people experiencing substance use problems. They have invaluable life experience to help them identify and prevent crisis situations, such as overdoses and relapses. By adapting to the realities of the people they meet, they share vital information on risk and harm reduction, help people better understand and access essential health services, and guide them through their journey.

Community organizations, on the other hand, play an invaluable role by providing a support and solidarity framework for people in precarious situations. These organizations are often the first points of contact for people in crisis. They provide basic services, such as meals, shelter and clothing, but above all they provide a safe and non-judgmental space where people can get support.

Finally, a diversity of tailored approaches and services is critical. Substance use involves individuals of all backgrounds and gender identities, as well as all ages and socio-economic status. Every life course and every consumption experience is unique, which requires a great deal of flexibility and tailoring of interventions to be effective. A rigid or one-sided approach will not meet the complex needs of these individuals.

For example, our work with urban indigenous communities has shown us that standard services do not always suit their reality. We are working closely with the Indigenous Community Network in Montreal, because the solutions to this crisis must be determined, designed and put in place by those who are living and experiencing the direct impact of repressive policies.

In summary, we need to prioritize risk and harm reduction measures, because they save lives. Collaboration among peers, community organizations and health systems must be funded and encouraged to reach those who traditional services cannot reach.

We advocate for a diverse strategy that promotes dignity, respect and support. It's important to support these individuals, not punish them.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Boudreault.

Finally, representing Indwell Community Homes, we have Dr. Steven Rolfe appearing online.

Welcome to the committee, Dr. Rolfe. You have the floor.

[Steven Rolfe, Director of Health Partnerships, Indwell Community Homes]

Thank you, Mr. Chair. As a point of correction, I'm not a doctor yet. I'm still a mister. I apologize for the error on that form, but I am a Ph.D. student.

Thank you for this opportunity to speak.

My name is Steven Rolfe. I am the director of health partnerships at Indwell. We are a supportive housing charity in southwest Ontario specializing in creating deeply affordable housing, combined with access to mental health and addiction services. We currently provide services to over 1,200 people.

Our tenants all come to Indwell programs with two core needs. These are the need for stable and deeply affordable housing, and the desire to access supports that foster health, wellness and belonging. While everyone's journey toward health is varied in the complexity and time to achieve goals, there is a commonality: Our tenants have experienced lives of precarity and instability, they seek space to heal and they have no interest in returning to lives of instability.

Our tenants come to us from hospitals, shelters and states of homelessness with a range of complex needs. In some of our programs, the rates of concurrent or primary substance use disorder challenges are eight out of every 10 tenants. Each comes to us with the hope for change that comes with finding a place of safety to live.

My professional background is in nursing. I have spent 37 years focusing my practice on the care of people experiencing profound health and social challenges arising from mental health and addiction. I am confident that I cannot recall a period where the availability and lethality of chemicals has had such an impact on the people I am privileged to serve. Vulnerable people beset with a multitude of challenges arising out of chronic disease, disadvantage and poverty are subject to the offer of inexpensive drugs amid hopelessness.

Today I want to share two key thoughts in relation to opioids and the toxic drug supply. The first is to state that the proliferation of opioids and toxic drugs, including methamphetamine, fentanyl and derivatives, has exacted a terrible toll of death and disease in our communities over the last six years.

The second is to highlight the value of meaningful responses to loneliness, illness and houselessness through safe housing, care and connection that restore hope and build health and wellness. Tangible responses of supportive housing that people choose to live in are the foundation of recovery and can mitigate the impact of toxic drugs.

Few Indwell communities have been spared the loss of a neighbour to overdose or drug poisoning within the last six years. In 2022, from my recollection, we had an average of one memorial service a week. This is across eight or nine different sites.

The years of the COVID-19 pandemic and associated public health measures seemed to accelerate the proliferation of drugs in our communities, with an increase in the number of overdose occurrences and, sadly, deaths related to drug use. Evaluation of this period provides us with some insights into correlates of toxic drugs and community impact. One is the loss of physical connection and contact with positive community events, the loss of communal meals and social events, and the reduction of human contact to virtual or distant and short contacts, which creates loneliness. Another is limited access to mental health and addiction programming in hospitals and community mental health agencies. Another is the loss of community cohesion, which allows for an increased presence of people taking advantage of vulnerable tenants by offering drugs.

Indwell's response to this built on the strengths of the supportive housing model to restore housing as a place of safety and healing. This response included tenant-led development of guest management policies that included the implementation of overnight security. The lifting of public health measures led to the swift reimplementation of social gatherings, understanding that healthy community connection is the building block of resilience. Finally, there was the implementation of a blend of life-saving measures—which would include the issuance of harm reduction supplies and the presence of naloxone, both staff- and tenant-led—with a sharp focus on accessing addiction treatment.

As an example, in 2022, we opened a new, 15-unit supportive housing program in St. Thomas, Ontario, where we offered people who were living in encampments the choice to live in housing with access to supports. Every person who accepted the offer had significant challenges with substance use, including opioids and other toxic drugs. For these individuals, supportive housing became a catalyst for their respective journeys toward wellness.

Some common touchstones of their experiences included a desire for personal security and freedom from people offering drugs, interest in developing mutually beneficial guest management policies that facilitate a reduction in the availability of substances, engagement with staff and a reduction in the necessity for emergency overdose intervention. This was a program where daily overdose occurrences were happening. As we began introducing addiction medicine into the facility and bringing in primary care doctors and addiction medicine doctors, we watched the number of overdose occurrences go from daily to zero in six months.

In general, it's about a shift in attitude from survival to a focus on health and wellness. When you provide basic necessities, people are better able to focus on the things that are going to keep them well.

[The Chair, Liberal, Sean Casey]

Thank you. I'll get you to wrap up, Mr. Rolfe. You'll have lots of chances to expand on those points during the question and answer session.

[Steven Rolfe]

I'm on my last paragraph, sir.

[The Chair, Liberal, Sean Casey]

Thank you.

[Steven Rolfe]

If I have one message to offer today, it is that out of the solutions for addressing the terrible costs of addiction arising from the unprecedented proliferation of toxic drugs, offering practical solutions based on choice and accepting a person's basic needs for care are among the most effective. When people have access to things that bring a true sense of security, health and stability, they're better able to leave what is unhealthy behind. Supportive housing, access to health care from places of stability and the presence of a positive community are hope-instilling and resilience-building responses.

Thank you for your time.

[The Chair, Liberal, Sean Casey]

Thank you.

We'll now proceed to rounds of questions, beginning with the Conservatives.

Mr. Doherty, you have six minutes.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you, Mr. Chair.

I want to start by thanking our witnesses for being here. In particular, I want to thank our friend from Prince George, retired superintendent Shaun Wright, who served our community and province.

Mr. Wright, earlier this year, you called B.C.'s drug decriminalization experiment “one of the biggest public policy disasters” in our province's history. Can you expand on that a bit?

[Shaun Wright]

Basically, my experience was that it led to a marked increase in incidents of public disorder within the community I was policing at the time. It had significant negative effects in that regard, resulting in a lot of complaints from the community—both community residents and business owners—and it made it very difficult for the police to intervene in behaviours of open drug use and disorder.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

How have our communities changed over the last, say, eight years?

[Shaun Wright]

I would say there's been what I would describe as a dark turn with regard to disorder on the streets. As a case in point, approximately eight years ago, when I arrived in Prince George, a lot more of the public disorder was fuelled by alcohol consumption. While that's still not great, things definitely have taken a darker turn over the last couple of years, as the primary agitator causing a lot of public disorder incidents is now illicit drug use, opioids in particular. It's much more pervasive and has a darker and more threatening tone.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Can those who are struggling with addiction make informed decisions?

[Shaun Wright]

It's been my experience that no, they can't. In general, they make poor decisions. Many of them are homeless, living in very poor conditions, and it's evident that they are not capable of making informed decisions for their own best benefit.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

There's been a lot of talk in our province about this. Premier Eby, John Rustad and our leader have talked about providing those who are addicted with two streams...involuntary care. In your opinion, would that work?

[Shaun Wright]

I believe that's definitely an additional tool that would be very useful, as previously discussed. I think a lot of people under the influence of opioids and other drugs are not in a position to determine which path they truly want to go down.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

We've had witnesses, even here tonight, who have talked about criminalization and perpetuating stigma. Is that your opinion as well?

[Shaun Wright]

I'm sorry; could you rephrase that?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Do you believe involuntary care and walking back decriminalization would contribute to the stigma of those who are struggling with addiction?

[Shaun Wright]

To be honest, even prior to the introduction of decriminalization, among a large proportion of the population, it was my experience that there wasn't a tremendous amount of stigma.