Evidence of meeting #141 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was community.
A recording is available from Parliament.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Given that, today you're talking about safer supply of substances and the concerns around that. We've seen Alaska. Their death rate went up 45% last year. Baltimore's is about five times the death rate of what's going on in London, Ontario. The price of fentanyl has crashed. It's so cheap in those places.
Why can't they stop substance use and the death rate going up in those places? How can you compare that to what's going on in London?
Chief of Police, London Police Service
That's a good question. I can't comment about those jurisdictions. I'm not aware of the criminality and the issues that are happening in those jurisdictions.
NDP
Gord Johns NDP Courtenay—Alberni, BC
We know that the war on drugs is a North American-wide issue, and that it's failed drug policy. That's clearly evident.
We heard from the B.C. Chiefs of Police. We heard from the deputy commissioner of the RCMP. They said that there is diversion of pharmaceuticals, that hydromorphone and safer supply is just a fraction of what they're finding on the street compared to fentanyl. They cited that toxic drugs are killing people. They advocated for more safe consumption sites, more safe supply, and, of course, scaling up treatment, recovery, prevention and education.
Do you not agree with their analysis?
Chief of Police, London Police Service
As I've already stated, I am in full support of scaling up prevention, in full support of scaling up treatment and in full support of scaling up harm reduction. I'm also in full support of scaling up enforcement efforts.
This is a complex issue, as you know, sir. With respect to what is happening, I am focusing not specifically on the safe supply program. I am focusing on the criminality as a result of the diversion that is occurring, and it is impacting our community here in London.
Liberal
The Chair Liberal Sean Casey
Thank you, Chief.
Next is Mr. Doherty.
Go ahead for five minutes, please.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Thank you, Chair.
I first want to thank our witnesses for being here.
Mr. and Mrs. Hedican, I know our condolences are little comfort to you, but please know that they come from.... I share your anger. I share your frustration as someone who has witnessed my brother on the street for far too long gripped in this crisis. I lost a brother-in-law to overdose.
While we may differ in our views, I can tell you that my frustration lies with the billions of dollars that have been spent, yet we still continue to lose people like my brother-in-law, your son and nephew. I just want you to know that I share your anger and frustration. I think that we should be doing this in a better way.
I will direct my questions to Chief Truong.
Chief Truong, British Columbia has walked back their decriminalization experiment. We had retired RCMP superintendent Wright here a couple of weeks ago. He said that the decriminalization experiment was the worst public policy decision in B.C.'s history when it comes to crime and disorder. Would you agree with that?
Would you agree that if London were to go forward with decriminalization, it would increase crime and disorder in your community?
Chief of Police, London Police Service
Chair, through you, as the police chief of London, Ontario, I am not in support of the decriminalization of drugs in our community. I am in support of the discretion of our officers to have the ability to intervene when appropriate. I'm in support of working together with health professionals and social service agencies to address the root causes of crime, specifically, the consumption of drugs and opiates.
I will also tell you that, when we are talking about the proliferation of public consumption of dangerous drugs in the community, there's a balance that needs to be considered as a whole to the community and not just to that individual. You have to look at every individual case by itself through the lens of the social determinants of what is happening.
We cannot take away tools and the ability for police to intervene when appropriate. There are times when it is appropriate to address situations of open drug use that impact the safety and well-being of the collective community.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Thank you, Chief, for that answer.
In your view, in London and perhaps working with your colleagues across our country, would you say that we are powerless to stop illicit drugs from flowing through our borders and into our communities?
Chief of Police, London Police Service
Sir, I missed that last word you used.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Are we powerless to stop illicit and deadly drugs such as fentanyl from flowing into our communities and our country?
Chief of Police, London Police Service
Chair, through you, I don't think we are powerless. I think more needs to be done.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Would you say that police forces have the resources needed to make an impact?
Chief of Police, London Police Service
I would say that, from an enforcement perspective, police services, particularly those that are experiencing a prevalence of organized crime occurring in their communities, require full support and more resources to address organized crime and the crime that is occurring in their communities.
It is not just enforcement. Police have to involve prevention as part of the response. Again, the pillars are prevention, treatment, harm reduction and enforcement. I'm in support of all of that.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
In your opinion, for crime and disorder and what have you, in your community in London, which is what you're aware of, would safe supply be helping fuel fentanyl use, deaths and crime?
Chief of Police, London Police Service
That is not a question where one single answer can be stated. As I've stated before, there's one issue of safe supply that is impacting the community that I am responsible for, and that is the diversion of safe supply.
Liberal
The Chair Liberal Sean Casey
Thank you, Chief Truong.
Thank you, Mr. Doherty.
Next is Dr. Powlowski.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. Vogel, I'm so glad you're here. I've been wanting to have somebody come and talk about the Swiss model for a long time.
I think what we're observing in this room today is a microcosm of the debate about safe supply, where we have the Hedicans passionately advocating for safe supply because it's a toxic drug supply that's killing people, and on the other hand, we have Chief Truong talking about diversion and the concern that diversion creates this very cheap supply of narcotics that may be the entry-level narcotics.
I've certainly heard this, for example, from B.C. psychiatrists who deal with the population on the streets. I asked them why kids start on Dilaudid, and they said, “Well, they're cheap.” The price went from $20 at one time, and after safe supply came in, it was one dollar, whereas a joint is five dollars on the street. What are you going to get, the joint or the Dilaudid?
You start on Dilaudid. No, Dilaudid doesn't kill you, but the problem with narcotics is you get used to them and you have to go to something stronger. That's what's happening, and the concern is people are selling the Dilaudid and then using fentanyl, and it's the fentanyl that kills people.
What's the answer to balance these? I think, in large part, it's what the Swiss do.
Dr. Vogel, do you agree that the whole basis of the Swiss model is observed treatment? For the vast majority of people who are on stronger drugs like heroin, they're not going to be okay with oral pills anyhow, so you give them an injectable, but they have to come in and take it there. The vast majority of the HAT program is observed treatment. Is that correct?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
Yes and no.
Most people who enter heroin-assisted treatment will receive an injectable, which is a treatment under supervision, meaning they will have to come in two to five times a day to inject the pharmaceutical heroin. There is no take home at the beginning of the treatment, but this can actually change if the patient stabilizes enough in treatment after a certain period of time. We have relaxed regulations in the past years, so there is now take home for up to a week. We offer pharmaceutical heroin for injectable purposes but also as tablets.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
I think, when we talked about this previously, you're quite careful, though, when you do it, because you are concerned about the possibility of diversion and you have to have a therapeutic relationship.
How long does the doctor have to be in a relationship with the patient before they start doing this?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
The federal regulations for heroin-assisted treatment state that it has to be six months, but for oral opioids such as methadone or buprenorphine, there's no such period, so it's up to the discretion of the prescribing physician.
You're absolutely right. There's time to build up a relationship between nurses and doctors and the patients, and then, when the patient is sufficiently stable, we provide them with take home. At the start of treatment, it's always supervised.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Can you talk a bit about what happened as a result of starting heroin-assisted treatment in Switzerland? My understanding is that before this there were drug parks in—I don't know; was it Geneva or Bern? There was a big problem with the open consumption of drugs and needles in the park, the same kind of thing we're actually witnessing here.
My understanding is with the Swiss model you basically eliminated the drug parks and you greatly decreased the public consumption and use of drugs. Am I right?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
You are completely right. There are no open drug scenes anymore. Last year, they really opened up because of crack cocaine, but this is a different issue.
In terms of heroin and opioids, we do not have an open drug scene. We have no public use, so this is not a problem. I think this is attributable to heroin-assisted treatment and the massive scale of heroin-assisted treatment that I hinted at in my opening statement.
The other thing is we also introduced other services such as supervised consumption services, housing and things like that. There are several measures, but I want to point out that with all of these measures, it's a complex issue. We heard that today and we have to come together.
One major part of it, as a physician, I think, is treatment.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vogel.
Thank you, Dr. Powlowski.
Next we have Dr. Ellis, please, for five minutes.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks very much, Chair.
I'd like to continue on the route that Dr. Powlowski was on. I think it's important to correct some misconceptions that we've heard here in this committee.
For instance, opioid agonist therapy and witness dosing, as Dr. Powlowski talked about, obviously is not the same thing as not having a therapeutic relationship with an individual who uses drugs and simply sending them home with 30 tablets of eight-milligram Dilaudid.
Dr. Vogel, I'll start with you, sir, if I may.
During your time in participation in the Swiss model, was that type of safe supply ever trialed in Switzerland, just giving patients eight-milligram tablets of Dilaudid in significant quantities?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
No. As I pointed out, we have the possibility of treatment and we have the possibility of doing take home to patients that we, as physicians, deem stable enough, but I also have to point out that these take homes are actually what the majority of patients receive in Switzerland now. I want to also make clear that it's part of a treatment. It's part of regular and scheduled contacts with a physician, and it's not outside of treatment.