Health Committee on Nov. 26th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 141 of the House of Commons Standing Committee on Health.

In accordance with our routine motion, I'm 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. We have with us in the room Jennifer and John Hedican and, online, Dr. Marc Vogel, chief physician, division of substance use disorders, University of Basel Psychiatric Clinics. Also by video conference, we have Kim Brière-Charest, project director on psychoactive substances for l'Association pour la Santé Publique du Québec, and Marianne Dessureault, attorney and head of legal affairs for the association. Also with us in the room is Thai Truong, chief of police for the London Police Service.

Thanks to all of you for being with us. We're going to begin with your opening statements of up to five minutes in length.

We're going to start with the Hedicans.

Mr. and Mrs. Hedican, welcome to the committee. You have the floor.

[John Hedican, As an Individual]

Hello. Thank you for the opportunity to speak here today.

We lost our oldest son, Ryan, when he was 26, and our nephew, Justin, when he was 38, to organized crime's toxic supply of drugs. As hard as it is, try to imagine losing your son or daughter, know that over 47,000 Canadians have died the exact same way, from the same cause, as your loved one, and then have to listen to our political parties choose to not acknowledge that these deaths were preventable if they'd implemented different policies.

Ryan, Justin and the vast majority of Canadians who have died to toxic drugs since 2016 would be alive today if they had been alcoholics or alcohol users, as we provide a government-controlled, safe and legalized source for those substance users. Shame on our federal leadership and elected MPs for choosing to ignore this truth and reality. Shame on those elected politicians who continue to politicize a health crisis, one that has killed more than the Second World War.

All political parties choosing to ignore this reality disrespect and minimize the deaths of Ryan and Justin and our families' grief and the 47,000 lives lost and their families' grief. These mass poisonings would not happen to any other demographic. We would not allow 22 people a day to die to the same cause, year after year, and not acknowledge what would save lives.

The prohibition of drugs is the single biggest contributing factor in all toxic drug deaths. It ensures and supports organized crime as the only supplier in every town and city in our country. We have wasted trillions of tax dollars funding a war on drug users—our family members, our friends and our colleagues. For more than 100 years, it has been an absolute failure. Prohibition can't keep drugs from flourishing in our prisons. Prohibition has directly created and supported a powerful multinational black market for organized crime that supplies and poisons innocent substance users.

The prohibition of drugs is a fantasy policy that is wishing it could keep drugs from entering our communities. The reality is that substance use is a normal neurobiological impulse that will always exist in humans. Legalization is the only policy to directly stop our loved ones from dying from toxic drugs and to address reality, just like legalizing alcohol and marijuana has. For political parties to call for only safer communities, more recovery and mental health beds, and forced and voluntary care, and to not choose to acknowledge all these serious and costly issues, will not change a thing until we address the cause: Organized crime is supplying toxic drugs.

Our son, Ryan, had been in recovery twice. The second time it was for eight months at a facility in New Westminster called Last Door. He returned to work as a third-year electrician. Ryan relapsed shortly after returning to work and died during his lunch break at his job site. Relapse is a normal component of the disease of addiction. When this happens, our federal drug policy forces those who fight a disease back to organized crime to get what their body demands. For what other disease would we allow organized crime to fill a prescription?

The major foundation of most recovery facilities is abstinence only rather than harm reduction. Again, that does not address the reality that addiction is not a choice but rather a disease, with a 92% relapse rate for those using opiates. Recovery played a major part in Ryan's death, as his tolerance was low due to his eight months of sobriety when he relapsed.

Recovery needs to be based on more than a faith-based 12-step program that was introduced over 90 years ago. Science and medical intervention need to be funded to address and cure addiction. What other disease do we treat the same as we did 90 years ago?

The politicians who call for recovery as the be-all and end-all are choosing to ignore the truths and realities of recovery. It does not address, and nor will it stop, the deaths of youth, first-time and recreational users, as they are not addicted. It's like these thousands of people somehow don't exist. Recovery will not save all chronic users for many reasons, just as all alcoholics do not enter into recovery. To not acknowledge these lives is morally wrong, a failing of responsibility, and once again showing that all lives are not equal—or matter—to politicians. Votes are valued over lives.

Dr. Bonnie Henry, our B.C. provincial health officer, stated this summer that prohibition is responsible for the death crisis we are in, and that legalization and regulation minimize harms. As an epidemiologist and health professional, her recommendations are based on evidence and science. Political parties base policy and recommendations on the net gain of votes.

Our son Ryan and 47,000 Canadians have died to toxic drugs supplied by organized crime, which is supported by the prohibition of drugs. What else do you need to know to stop this mass poisoning, these preventable deaths?

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Hedican.

Please accept my condolences and those of the committee on the tragic loss of your son.

Next, we'll have Dr. Marc Vogel, chief physician, division of substance use disorder, University of Basel.

Welcome to the committee, Dr. Vogel. The floor is yours.

[Dr. Marc Vogel, Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual]

Thank you very much for the opportunity to appear before the standing committee. It's a particular honour for me because I have a long-standing connection to Canada ever since I spent a high school year in Alberta in the early 1990s.

As an active clinician and researcher, I specialize in opioid and cocaine use and dependence, as well as the treatment of concurrent psychiatric disorders. I currently serve as head physician of the addiction department at the University of Basel Psychiatric Clinics.

Our department provides opioid-assisted treatment to approximately 500 patients. In addition, we offer in-patient treatment, as well as outreach treatment, and we provide medical services at Basel's two supervised consumption sites.

Canada is currently grappling with a severe opioid overdose crisis that is devastating communities across the country. In 2015, I had the opportunity to spend several months as a research fellow at the University of British Columbia, and I was struck by how deeply the opioid crisis is affecting individuals and society as a whole.

Switzerland, too, faced a public health crisis related to opioids in the 1980s and 1990s. Intravenous heroin use was the key driver of the HIV epidemic, which hit Switzerland harder than any other European country. Open drug scenes were visible in all major Swiss cities, and per-capita overdose deaths reached the highest levels in the world.

Switzerland's political system is based on compromise between linguistic regions, urban and rural areas and political parties across the spectrum that have to share governmental responsibilities. Laws are often subject to political referendums. Overall, our political decision-making processes are slow.

However, in the early 1990s, the urgency of the situation was so great that politicians, law enforcement, the treatment system and individuals who use drugs, along with their families, came together to completely overhaul Switzerland's drug policy. The result was the introduction of harm reduction as a fourth pillar of Swiss drug policy alongside prevention, therapy and law enforcement. Harm reduction measures, such as supervised consumption services, needle and syringe dispensing, and low-threshold social initiatives like supported housing, employment and free meals, were implemented on a broad scale. Importantly, this was accompanied by the introduction of patient-centred, low-threshold treatment for opioid dependence. Opioid agonist therapy with methadone became easily accessible, covered by mandatory health insurance and available nationwide, primarily in general practitioners' offices but also in specialized institutions like ours.

Patients have always been involved in decisions regarding their treatment, and most unnecessary regulations and restrictions were abolished. For the majority of patients, take-home methadone was introduced. Despite these measures, it became clear that a portion of the opioid-dependent patients still did not benefit from treatment. This is why Switzerland introduced heroin-assisted treatment in 1994, providing pharmaceutical heroin under medical supervision, embedded in a therapeutic environment that includes addiction and psychiatric care, as well as social support. Heroin is prescribed for injection, as well as in the form of tablets. Currently, we are also investigating the prescription of nasal heroin in a national multicentre study.

It's important to emphasize that heroin-assisted treatment is much more than just dispensing heroin. It's a comprehensive, interdisciplinary and cost-effective treatment approach that also addresses psychiatric comorbidities, such as psychosis, depression or trauma, which often contribute to addiction in the first place. Up to 80% of patients in opioid agonist therapy in Switzerland have such concurrent psychiatric problems. I firmly believe that opioid agonist therapy can only achieve its full potential when these co-occurring issues are also addressed.

All of these measures were implemented on a large scale and were made available across the nation. Switzerland, while smaller than Nova Scotia and with much of it mountainous, now has 16 supervised consumption services and more than 1,800 patients in 24 heroin-assisted treatment centres. Why is this important? We know that only patients receiving treatment can benefit from it. In Switzerland, around 80% of opioid-dependent people are engaged in opioid agonist therapy with a range of medications that they can choose from on any given day.

In Canada, this proportion is much lower. In our outpatient clinic in Basel alone, we treat over 200 patients with pharmaceutical heroin. If we were to translate this number to Toronto, that would imply approximately 3,000 patients in heroin-assisted treatment. However, when I prepared for this meeting, I reviewed Dr. de Villa's recent statement to the committee. She noted that the only injectable opioid agonist treatment program in Toronto has 35 patients.

The opioid-dependent population in Switzerland is now an aging cohort and new solutions are needed to care for elderly patients.

The number of new opioid users has declined steeply since the 1990s. The provision of heroin-assisted treatment has been confirmed in five popular referendums, and problematic opioid use is viewed as a medical issue, leading to a reduction in stigma around this treatment. We're convinced that this is the result of the broad introduction of harm reduction measures and low-threshold opioid agonist therapy, including injectable options and treatment of concurrent disorders.

Thank you for your attention. I'm happy to answer any questions.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Vogel.

Next, we'll go to the Association pour la santé publique du Québec, represented by Kim Brière‑Charest and Marianne Dessureault, who are with us via video conference.

Welcome to the committee.

You have the floor for five minutes.

[Kim Brière-Charest, Project Director on Psychoactive Substances, Association pour la santé publique du Québec]

Thank you, Mr. Chair.

Ladies and gentlemen of the Standing Committee on Health, thank you for including us in this consultation.

Canada is in the midst of a massive public health crisis causes in large part by contaminated unregulated drugs on the illegal market. More than 47,000 people have died in our communities since January 2016. That's more than the number of Canadian soldiers killed during the Second World War. The scale of the problem indicates the need for an urgent, adapted, nationwide response.

Members of the Global Commission on Drug Policy identified Canada as a country that stands out thanks to its bold pursuit of policies infused with a human rights and public health approach. However, existing solutions are no longer an adequate response to the scale of the needs and cannot attenuate the crisis. We need to do more to prevent premature, avoidable deaths, expand access to voluntary treatment, enhance prevention, ensure a regulated supply and reduce the burden on the judicial system.

The overdose crisis has been less severe in Quebec than in other provinces, but it is present nonetheless. Many indicators suggest it is getting worse. The province's approach to addiction is a continuum involving prevention, research, harm reduction and treatment. The social safety net has certainly contributed to reducing the prevalence of overdose and avoiding additional pressure on the health and social services system. Acting on the social determinants of this crisis is crucial. The lack of social housing and resources in certain sectors exacerbates health and social coexistence problems.

In addition to tackling aggravating factors, the toxic drug supply and the immediate on-the-ground response, we need to enhance upstream prevention. We need to stop the bleeding and manage emergencies.

Criminalization aggravates stigmatization, which leads to hidden consumption and delays access to resources and treatment. It increases pressure on the judicial system without truly tackling drug toxicity. In 2020, criminal justice costs related to the use of drugs other than alcohol, tobacco and cannabis exceeded $10 billion.

The Association pour la santé publique du Québec believes that recent political debates across the country threaten the continuity of harm reduction resources. Sometimes, these resources are a person's last link to care and treatment, a pivotal role for people with no access to health care resources. Sometimes, there's no other way to reach those people.

Brain lesions due to oxygen deprivation during overdose can aggravate mental health and addiction problems and make people less likely to access supervised consumption services. Not only will that increase the death toll, but it may also result in more permanent health complications.

Supervised consumption services are crucial to making a safe, clean, legal structure available. Detox and therapy are essential, but they have to be part of a continuum of resources. There is no evidence that forced treatment is effective, and it exposes people to a higher risk of overdose. We need to start by making treatment accessible, free, adapted and universally available to ensure geographic equality for all.

Prescribing regulated substances significantly reduces the risk of accidental death. However, given the potency of substances on the illegal market, available medications are no longer able to ease withdrawal symptoms. Access to regulated substances is crucial to reducing the effects of drug toxicity. Let's not forget that overdose is typically caused by contaminated drugs, not prescribed drugs.

Addressing overdose is complex. There are no simple solutions. According to a report by the UN High Commissioner for Human Rights, the war on drugs is having a disproportionate impact on the poor and on vulnerable groups. This public health crisis calls for a cross-party approach based on scientific evidence so people don't play politics with problems related to overdose.

I'll let my colleague, Marianne Dessureault, finish our presentation.

[Marianne Dessureault, Attorney and Head of Legal Affairs, Association pour la santé publique du Québec]

I'll wrap up with a few words about the legal aspect.

The Canadian Constitution is based on a legal foundation that informs how we approach the opioid crisis. Drug laws and policies must be consistent with the Canadian Charter of Rights and Freedoms, but also with provincial legislation, such as the Quebec Charter of Human Rights and Freedoms. The right to life, safety, integrity and freedom, which consent to care derives from, is a fundamental principle enshrined in our framework. All policies and legislation must take these founding principles into account and align with them.

[The Chair, Liberal, Sean Casey]

Thank you.

Last but not least, from the London Police Service, we have Chief Thai Truong.

Welcome to the committee, Chief Truong. You have the floor.

[Chief Thai Truong, Chief of Police, London Police Service]

Good morning, Mr. Chair and members of the Standing Committee on Health. Thank you for the opportunity to appear before you today to discuss the opioid epidemic and the challenges we face in London, Ontario, with respect to the safe supply program and its unintended consequences.

London has garnered significant attention in recent months regarding the safe supply program. While the program is well intentioned, we are seeing concerning outcomes related to the diversion of safe supply medications. The diversion of regulated medications, including hydromorphone, is a growing concern. These diverted drugs are being resold within our community, trafficked to other jurisdictions and even used as currency to obtain fentanyl, perpetuating the illegal drug trade. Specifically, we are seeing significant increases in the availability of diverted Dilaudid eight-milligram tablets, which are often prescribed as part of safe supply initiatives. Vulnerable individuals are being targeted by criminals who exchange these prescriptions for fentanyl, exacerbating addiction and community harm. This issue is not isolated to individuals experiencing substance use challenges. It also impacts the safety and well-being of our entire community.

The human cost of the opioid crisis is devastating. In 2019, 73 individuals in London lost their lives due to drug overdoses. That number spiked to 123 in 2020 and reached 142 in 2021. While fatalities have slightly declined since then to 123 in 2023, we remain far above prepandemic levels. Tragically, over 80% of opioid-related overdose deaths in London are linked to fentanyl.

Our enforcement data emphasizes the growing issue of diverted medications. Hydromorphone seizures have increased substantially over the past five years. In 2019, we seized 847 pills, 75 of which were eight-milligram Dilaudid. By 2023, seizures ballooned to over 30,000 pills, with nearly 50% being eight-milligram Dilaudid. These increases cannot be attributed to pharmacy thefts, as London has had only one pharmacy robbery since 2019. Our police service is working diligently to disrupt the trafficking of fentanyl and diverted safe supply medications. We are targeting individuals and organized crime groups that exploit vulnerable populations and fuel the drug trade.

However, enforcement alone is not sufficient. We are collaborating with community health partners to address the systemic issues contributing to diversion. These efforts must be holistic, integrating prevention, harm reduction and treatment. I'm not here to criticize the safe supply program but to address the serious challenges associated with its diversion. We need innovation to mitigate risks. We need robust enforcement to hold traffickers accountable. We need continued collaboration among health, social service and public safety sectors to effectively respond to this crisis. This is a complex issue requiring collective action. I want to acknowledge the challenging efforts of health and social service partners working on the front lines of prevention, harm reduction and treatment in response to this opioid crisis. However, it will require strong collaboration and strong enforcement to face this crisis.

Thank you for your time. I welcome your questions.

[The Chair, Liberal, Sean Casey]

We will now begin with rounds of questions starting with the Conservatives for six minutes.

Mrs. Goodridge, you have the floor.

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

Thank you.

I want to thank all the witnesses for coming here today.

To the Hedicans, I'm sorry for the loss of your children.

Chief Truong, you said that there were clearly unintended consequences from this radical new policy of safe supply that was brought in and piloted in your community of London.

When you put out your press conference and talked about safe supply, how confident were you that the drugs that you were seizing were from these safe supply programs?

[Chief Thai Truong]

We had direct evidence linking the seizures of eight-milligram Dilaudid specifically to the safe supply program.

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

Is enough being done to prevent the diversion of these pills?

[Chief Thai Truong]

There needs to be more. Obviously, we are seeing the diversion of safe supply in London. That's why it's very important that we work together in the community with our partners to ensure that regulations are in place and that we do our part with enforcement.

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

We had one doctor here from London, Ontario, Dr. Sereda. When we asked her about diversion, she talked about the fact that there were some compassionate reasons behind it, indicating that it wasn't just all bad. She works for London InterCommunity Health Centre, which puts into question whether they have enough protocols in place to prevent diversion from happening in their clinic.

Do you believe that all the clinics in London that allow safe supply to continue have enough protocols in place?

[Chief Thai Truong]

We've been working very closely with the executive director, Mr. Courtice, of London InterCommunity Health Centre. A strong relationship with them is very important. They've recognized that working together with us and tightening up their standard operating procedures are things that we need to look at.

We're working very closely not only with London InterCommunity Health Centre, but also with other partners and stakeholders within the community to see how we can mitigate this diversion.

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

Would it not be easier if this program were to end? Not only is it clearly creating harms in the community of London, but there are ripple effects all across southern Ontario.

[Chief Thai Truong]

Decisions regarding medical efficacy and public impacts of safe supply or harm reduction strategies are best left with medical experts and medical professionals.

My role as the chief of police is specifically law enforcement and the efficacy of addressing the criminal aspects that coincide with diversion.

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

What is the street price of diverted safe supply in London?

[Chief Thai Truong]

In London, the prices fluctuate. Obviously, it's unregulated. Our last intelligence information and evidence of Dilaudid eight milligram is that they're being being sold for between two dollars and five dollars per tablet.

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

That's a substantial decrease from what it initially had been. Is that correct?

[Chief Thai Truong]

In other areas of the province and across the country, including communities in remote areas, that price is significantly higher, the street value.

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

To what extent is organized crime involved in the trafficking of these government-fuelled opioids?

[Chief Thai Truong]

Organized crime is involved.

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

You said that the safe supply is being distributed into other communities. Which communities are they?