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.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
You did mention buprenorphine, or Suboxone, in passing in answering previous questions. I wonder if you could elaborate a little bit on where Suboxone is in your treatment regimen in the Swiss context.
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
Buprenorphine is available here. It's available not in combination with naloxone, because that was never prescribed and never used. It was taken from the market. We use it in approximately 10% of patients. The reason for this is that patients can choose from a variety of different substances. They will more often than not opt for a substance other than buprenorphine. Buprenorphine is a so-called partial agonist. It does not have the full effect. Most patients are not looking for this effect in their treatment.
They are not treated adequately, in my personal experience, with buprenorphine. If you look at the evidence, the randomized controlled trials say different, but this is not real-world evidence, I think.
Liberal
Brendan Hanley Liberal Yukon, YT
Thanks. That's very helpful.
Very briefly, with regard to inhalable heroin, you mentioned oral and injectable. Is there an inhalable agent that's available in Switzerland?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
We're currently investigating nasal pharmaceutical heroin, which is atomized into the nose. We're doing that because we have people who do not inject but are severely addicted. We also want to offer a reduced-risk option for receiving pharmaceutical heroin.
There is inhalable heroin, so-called smokable heroin, in the Netherlands. It works fine. It's another option. As I said, you need to have a range of substances, but you also need to have a range of routes of administration in order for treatment to reach maximum efficacy.
Liberal
Brendan Hanley Liberal Yukon, YT
I have only a minute left, but to the Hedicans, I want to add my condolences for the loss of not just your son, Ryan, but also your nephew, Justin. I'd love to learn more about their lives and what their losses among thousands of others have meant for our families and our communities.
I'm not sure if you've seen some of the testimony from previous meetings where other parents with equally tragic losses have come with completely different views. When you hear aggrieved parents who share your anger, but who direct their testimony to a completely different place, how do you think we should treat this testimony as committee members?
As an Individual
We're not talking about the people who aren't addicted who are dying. I don't understand that. How do we save the people who aren't addicted, the first-time users? Nobody is asking that question, and I don't understand that. There hasn't been one question on that.
The only way to do it is to address the toxic supply of drugs. Shame on all of you for not asking that question. Kids, first-time recreational users, are dying, and you're not asking how we save them. You're talking about a small percentage of chronic users. Honestly, I'm disgusted. It's.... Sorry.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Hedican.
Next we have Dr. Ellis, please, for five minutes.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks very much, Chair.
I'd like to talk to you, Dr. Vogel, about what Mr. Hedican is maybe referring to. I think there may be another way to look at those so-called first-time users. Realistically, we haven't discussed prevention much in this committee.
In your experience in Switzerland, or perhaps in Europe in general, have you had any opportunity to look at that specifically?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
Well, I'm not an expert on prevention. I'm an expert on treatment.
In Switzerland, we have very few young people initiating opioid use. We think part of it, and I tried to explain that before, is that the scale-up of treatment has made it very clear that it's quite dangerous to use opioids. There's a high risk you'll overdose, and you'll get addicted. There is also a high risk that you will end up in treatment.
I'm not sure whether that can be said for Canada with the treatment option I'm aware of, but in Switzerland, it's very clear. If you have an opioid addiction, you have to go into treatment. This is very unattractive. We are sure that this is part of what has been preventive. What has also been preventive is that, obviously, less opioids are being sold on the streets, because we provide more effective treatment than is done in other places.
I also think that most adolescents are aware of the dangers. They could probably get codeine, things like that, but it's harder to get, for example, pharmaceutical heroin on the streets. That's clear.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
I realize it's not your area of expertise, but are precursor drugs for the creation of things like fentanyl, etc., legal or illegal in Switzerland?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
Most precursor drugs are illegalized once they pop up. That's the way. Once the system recognizes the substances, they are scheduled.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Do you have any idea how long it takes to make precursor drugs illegal?
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
I do not.
November 26th, 2024 / 12:55 p.m.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thanks very much for that.
One of the interesting things, of course, is, as we talk a bit about the fact that in Switzerland, fentanyl is really not a so-called drug of choice, it does make the Canadian environment a little bit different. I think that bears repeating.
The other things that are incredibly important are that the scientific studies that have been done with respect to treatment are all really based on witness dosing, or at the minimum, opioid agonist therapy. Certainly, your idea that there are requirements for a multitude of different substances will help tailor treatment uniquely to the individual. Here in Canada, certainly methadone has fallen out of favour, although it's been used in treatment for a very long time.
As we look at, and as Mr. Hedican talked about, the NDP-Liberal government is failing at its job here having presented safe supply without any supports to go with it. It's a travesty. As we begin to potentially look to form the next government, we really need to look at other things in terms of prevention, resilience, continued disruption and quality rehab. Those kinds of things, coupled obviously with housing, are what Canadians need to wrap their minds around in looking at how we can make the system better in Canada.
Dr. Vogel, do you have any final words on how we might improve things here in Canada? If you're not familiar enough with the system here to comment on that, that's fine.
Chief physician, Division of Substance Use Disorder, University of Basel Psychiatric Clinics, As an Individual
I heard a lot about witness dosing, and yes, witness dosing has its place. However, I also want to point out that it's very hard to keep up a life, manage a family and keep a job if you have to appear at the treatment centre two to five times a day, 6,000 times a year. I want to point out that take homes are very important. The majority of patients here receive take homes. It's actually quite a liberal treatment.
I would advise Canada to abolish unnecessary rules and regulations, and put more responsibilities in the hands of physicians and people who use.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vogel.
We'll go to the Liberals next.
Ms. Kayabaga, go ahead, please.
Liberal
Arielle Kayabaga Liberal London West, ON
Thank you, Chair.
I'm going to go straight to the chief.
This is based on some of the questions that you've received in our committee, as well as the comment that you made around not being able to arrest our way through the crisis, and the context of our community, the city of London, which has experienced many of these overdoses over the last decade, even in places like the jails.
I'm curious to know, if we were to remove the current crisis of toxic drug use from the streets today, do you think there would be other drugs that would pop up on the streets?
Chief of Police, London Police Service
Thank you for that question.
Chair, through you, yes, I do. With organized crime, it's about profit. It's about exploiting individuals for gain and profit. There's no question that there would be additional drugs and that the war on drugs would continue.
Liberal
Arielle Kayabaga Liberal London West, ON
I heard you say that you are willing to continue to collaborate with the services that are available in London.
Chief of Police, London Police Service
That is correct. They're very important.
Liberal
Arielle Kayabaga Liberal London West, ON
Chair, I just want to put this on the record as well. Someone mentioned earlier that the beds are a federal responsibility. They're not. I just want to make sure people know that it's a provincial responsibility.
I'll give my time to Mr. Powlowski.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Appropriately, given Mr. Hedican's remarks, I'm going to go where he wants to go, which is the casual user. We haven't been addressing that. Yes, we're talking about long-term addicts, but how about the very many people—which sounds like your son—who use on and off? You also hear stories about one pill and a kid or someone like a hockey player. There's one pill and they die.
I think that's really hard to deal with and to find a solution for. I think it has to be one of our reports, but....
What you're seemingly suggesting, Mr. Hedican, is legalizing safe supply. You go and buy your booze and you buy some narcotics there, too, but it would have to be cheap enough. With marijuana, there's still a black market for marijuana because it's cheaper on the street than it is in the marijuana stores. Similarly, with narcotics, there would be a black market, so you'd have to make it cheap. Then wouldn't you run the risk of people, like my kids, who are going to buy beer, so maybe they'll buy some narcotics, then they get addicted to the narcotics and it's created a bigger social problem with this large population of addicted people?
I don't know. I mean, if you have suggestions, this is a really important topic, so I give you the floor and probably the last few minutes.
As an Individual
One hundred per cent that's reality. We don't have a choice whether we want drugs in our community. The only choice we have is who controls it, government or organized crime.
Yes, someone may try another substance because it's for sale next door to the liquor store. It's the gateway drug that we put on every corner. People are always going to try drugs and the vast majority is after they've drank. That's just reality and we're not addressing reality.
The reality is that as long as we have alcohol—and people use substances and alcohol for different reasons—people are going to try drugs. I'm repeating myself. It's either organized crime or government.
We can see today—we have over 80 years of evidence—how it's working out with organized crime. It's never going to change.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
I agree with you. I have sons. They go to parties and there's alcohol. I always tell them that if there's drinking and people have drugs, just leave, because after a few drinks, you're going to be tempted to do it.
Do you have any other suggestions with that combination?
Yes, I think a lot of times people first try it when they're drinking. They say, “Everyone is taking it, so I'm going to take it.” The next thing you know, they're overdosing.