Health Committee on Nov. 26th, 2024

[Dr. Marc Vogel]

When we implemented our policies, there was illegal heroin sold on the streets, which was our toxic drug supply. We didn't have medication opioid toxic drug supplies like we do now, but it was in principle the same illegal heroin being sold.

There were young people getting addicted, having an overdose and dying, like Mr. Hedican rightly pointed out. We had that, and with the treatment and all of these harm reduction pillars that we offered, I think we had a medicalization of the problem as well. It was very well known also with Swiss kids and adolescents that if you start taking heroin, you'll end up in treatment. You'll have to go to the doctor, and it's very unattractive to go to the doctor.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Vogel.

Next is Mrs. Goodridge, please, for five minutes.

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

Thank you, Mr. Chair.

Chief Truong, you said what you've seen in London is that the so-called safe supply created a currency for people who were addicted so that they could sell it to get the drugs they were actually after. Would your job be easier if this so-called safe supply flooding the streets with potent opioids wasn't on the streets in London?

[Chief Thai Truong]

Again, I will state through the chair that I rely on the medical professionals and experts to provide their commentary on the efficacy of safe supply. What we are working toward with our community partners in London is making sure there is mitigation of diverted hydromorphone.

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

If fewer drugs were being diverted onto the streets in London, would it be easier or harder for you to do your job?

[Chief Thai Truong]

That's what we are aiming for, that there is no diversion of hydromorphone into the community.

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

You talked about there being a de facto decriminalization, because you guys were not engaging with people who were using drugs in open spaces. Has the London police now started to engage with people using drugs in open spaces?

[Chief Thai Truong]

Our police service is looking at a comprehensive strategy with community, with health professionals, with social services to look at a stronger initiative and strategy to deal with open drug use in the community.

In previous years, officers were looking and understanding that drug consumption is a health issue and a health concern. They were using their discretion accordingly. We have seen the results of that. We have seen and heard from the community, and we're seeing impacts on the community as a whole. We're looking at a different strategy to engage when appropriate.

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

I went to London—I was about seven months pregnant—back in April 2023. I was shocked by the amount of open drug use that was so visible in downtown London. In fact, I watched a drug deal happen in front of the CBC headquarters, which then told me that perhaps I wasn't in a safe part of London, just to find out that it probably had been safe nine years ago.

What have you guys changed from a policing standpoint or what barriers are in the way from a policing standpoint for you to deal with the open drug use in London?

[Chief Thai Truong]

Some of the challenges are that we understand drug addiction is a health problem and a health concern, and there are determinants that are creating this environment for people to be in this space—

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

Are you allowed to charge for simple possession of drugs?

[Chief Thai Truong]

Absolutely, we are.

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

Do you charge for simple possession of drugs?

[Chief Thai Truong]

This is what I've been saying. In the last few years, ma'am, our officers have dramatically reduced their enforcement efforts with possession, because we understand that it is a health problem. We are listening to the community. We are also abiding by the principles of the Controlled Drugs and Substances Act, making sure that, if we arrest, it is because there's a public risk.

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

I fully agree. It is a public health concern and needs to be dealt with as such.

Have you seen any increase in the amount of detox available in the city of London?

[Chief Thai Truong]

I have not.

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

Have you seen an increase in the amount of addiction treatment available in the city of London?

The government decided to roll out a dramatic new program, and you haven't seen any increase in detox. Have you at least seen some increase in treatment?

[Chief Thai Truong]

London, like many other municipalities, requires support and funding for treatment options.

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

Do you think the federal government failed in rolling out a radical new program and not providing any support for the medical side?

[Chief Thai Truong]

Again, I'm not going to answer that question.

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

That's fair enough.

There's no new detox, and there's no new treatment. If you were to arrest someone with simple possession for open drug use, what would happen?

[Chief Thai Truong]

Right now, if we were to arrest based on the circumstances, our officers have the availability to arrest, seize the drugs and release unconditionally.

The second option our officers have is to arrest and charge when appropriate, seize those drugs according to evidence and put those individuals or that individual before the courts.

We recognize that we only want to put them before the court when it is appropriate and, in some circumstances, it is necessary to put them before the courts. In some cases, putting them before the courts is an opportunity for them to receive care in that capacity. A lot of the times when our officers are engaging—we are looking at this right now—are there other options for community to be involved and engaged and to support that individual?

There are circumstances where our officers have to engage for public safety purposes, and circumstances will dictate either court or other avenues of care.

[The Chair, Liberal, Sean Casey]

Thank you, Chief Truong.

Next we have Dr. Hanley, please, for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

I want to thank all the witnesses today for some really important testimony.

Dr. Vogel, I would like to start with you. I would guess that you're familiar with the 2008 NAOMI trial, which attempted to assess who would be the best candidates for heroin-assisted treatment in the Canadian context. Briefly, that study quoted that “long-term, chronic opioid injectors with severe health and social problems, and several previous addiction treatment attempts” would be among those candidates. It also pointed out that the participants are largely “polydrug users with cocaine being the second most popular drug of choice, after heroin.”

That was in 2008, so times have changed, but I would venture that this remains, as I think you suggested, an underused treatment in Canada. It's a struggle to get funding and general support for this treatment as well as local production, as in the case of Fair Price Pharma in the Downtown Eastside.

Does this patient description match who is accessing treatment in Switzerland? What do you think we are missing in our approach, apart from perhaps a massive scale-up in this treatment?

[Dr. Marc Vogel]

That's pretty much the same kind of clients or patients we have here. The reason for this is that the Swiss did a trial on this. The inclusion criteria of the trial we did 30 years ago was basically replicated in every other trial and every other setting without ever asking whether or not this made sense.

There was one trial that looked at patients who did not fulfill the criteria—they had not failed previous treatments and they had not had methadone before—and it worked equally well. That was a German trial. So that works equally well.

There's no evidence for what I'm saying, but I'm absolutely sure that every patient with an opioid dependence has the possibility to benefit from heroin-assisted treatment, regardless of whether or not they failed treatments before.