Evidence of meeting #143 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A recording is available from Parliament.
Bloc
Luc Thériault Bloc Montcalm, QC
Doesn't stigma lead to a loss of self-esteem? If a person doesn't have a positive self-image, that could actually slow the healing or treatment process.
December 3rd, 2024 / 11:40 a.m.
Associate Professor, University of British Columbia, As an Individual
For sure that is a key piece of the treatment and recovery journey of people who are struggling with addiction and mental health issues. That is why it is so important that the treatment of people affected by this is holistic—
Associate Professor, University of British Columbia, As an Individual
—and includes the provision not only of psychopharmacology but also of psychotherapy.
Bloc
Luc Thériault Bloc Montcalm, QC
Stigma is therefore not just a political tool in the hands of those who want more liberalization to fight the toxic drug crisis.
Associate Professor, University of British Columbia, As an Individual
Stigma is a concept and a societal phenomenon. Whether it's used for one thing or another, it's the responsibility of whoever uses it, but it is, in fact, something that, as you outlined, can hinder people in getting care for themselves. It's something that, in certain quarters, can exclude people from care. Certainly, every health system that I know of is trying to make sure (a) that health systems do not stigmatize people who use drugs or have mental illness and (b) that people who have the self-stigma that you indicate can recover through psychotherapy and various forms of interventions that allow for overcoming that.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vigo.
Thank you, Mr. Thériault.
Next is Mr. Johns, please, for six minutes.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you Mr. Chair.
I want to thank the witnesses for their important testimony, especially Ms. Brett for having the courage to share her lived experience as a mother with a child who is struggling with substance use disorder.
I'm going to start with Dr. Knight.
Dr. Knight, can you talk about what the risks and potential harms of involuntary treatment are?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
It's somewhat challenging to talk about the evidence base for involuntary treatment, because the research and the evidence are very poor on all sides. There are some studies that show that involuntary treatment is helpful. There are some that show that it's harmful, and there are some that show that it doesn't really change anything.
It's already been said by some of our other witnesses today that the use of involuntary treatment already exists through our mental health acts and can exist for people who have such severe disorders, both mental health disorders and substance use disorders, that they require care because of the lack of capacity to make decisions for themselves.
However, whenever we remove somebody's autonomy, we have to do so very carefully. Autonomy is a core component of medical care and of medical ethics, so we need to be deliberate about ensuring that, if we remove somebody's autonomy, it is because they require it. Additionally, we need to be cautious that we are not expanding involuntary treatment to the detriment of voluntary treatment for people who want to access service.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Can you speak about involuntary treatment in terms of whether it is culturally safe for indigenous people and patients? As well, are there maybe concerns that involuntary treatment of indigenous patients could compound intergenerational trauma arising from residential schools and colonization?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
That's a great question. I would say that, in my experience.... To sort of clarify my experience, I will tell you that I trained in a family medicine program specific to serving indigenous populations, and my family practice specifically serves urban indigenous populations in Winnipeg. One of the things that I see in my patients is that even voluntary admission to hospital is sometimes perpetuating intergenerational trauma for a variety of reasons. Any institution where people have less power over their decisions has the risk of re-perpetuating trauma. That would only be escalated in the context of involuntary treatment.
I have had patients express to me their concerns about being involuntarily admitted under the Mental Health Act and how that has perpetuated trauma. At the same time, sometimes it's necessary. It is important that when we look at involuntary treatment to any degree, including that sort of course of involuntary assessment that should be part of a decriminalization policy, we do so in a way that is informed by people who use drugs, by people who are indigenous and by minority groups that may be at higher risk of harms related to those policies.
NDP
Gord Johns NDP Courtenay—Alberni, BC
I think there are going to be a lot more questions from that.
Now, in 2023, the Canadian Society of Addiction Medicine published the results of a systemic review of involuntary treatment, which concluded that more research is needed to inform policy in this area.
Again, Dr. Knight, can you speak about how more research can be conducted ethically on the effectiveness of involuntary treatment, given the risks?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I don't think we have time to really talk about the ethics involved and the process involved in developing a research study. Certainly, anything that is research from a health lens, particularly with vulnerable populations, which include people who use drugs and people with substance-use disorders, has high levels of scrutiny for acceptability.
One of the issues that we pointed out in that paper that you reference is that there is such poor description of what was included in involuntary treatment studies that we can't even pull reasonable learnings from most of the studies, because they don't tell us what they did other than putting people in a place where they didn't want to be. Anything that looks at involuntary treatment and attempts to study involuntary treatment in a more robust, evidence-based and scientific way needs to look at the implementation of evidence-based treatment as part of that involuntary treatment, so that we can see whether or not outcomes are favourable.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Johns.
Next we have Mr. Moore, please, for five minutes.
Conservative
Rob Moore Conservative Fundy Royal, NB
Thank you, Mr. Chair.
Thank you to all the witnesses who have appeared.
Ms. Brett, thank you for your personal testimony here today and for sharing the story of your son Jordan. I'm very happy to hear about his one year of sobriety. You certainly have added value to the meeting we're having here today.
Unfortunately, we now have data from a number of years to go back on. We see that the current approach is simply a proven failure. It's not working. In 2016 Canada had about seven overdose deaths per day. That is a terrible stat, except when you compare it with the stat now. We're exceeding 21 per day, more than a tripling of the number of deaths.
When we look at what actions have taken place, one action that this government brought in was Bill C-5. It eliminated mandatory jail time for serious criminals who were producing and importing drugs like fentanyl, meth, cocaine and so on, the most serious drugs—schedule I drugs—in Canada. It allows these individuals to import those drugs, export those drugs, or produce those drugs, such as running a meth lab out of their own home, but then, if they are caught by the police, charged and sentenced, to serve their sentence from the comfort of their own home. I think that sends a terrible message to Canadians, because it allows for the revictimization of the most vulnerable.
I want to get your thoughts on that. In your opinion, should those who are bringing deadly drugs like fentanyl and meth into Canadian communities face more serious consequences?
Assistant Editor, The New Westminster Times, As an Individual
Absolutely. It's shocking how vulnerable homeless, mentally ill and addicted people are. My son was a constant victim of violence. He was never safe. The great irony of bafflegab and buzzwords like “harm reduction” is that while he was out on the street, decades' worth of living outside, he was predated on by other addicts and by dealers. He had a knife held to his throat for a two-dollar drug debt. He was routinely threatened. Someone in my presence said to my son, “You know, we'd break your legs for that.” I mean, what...?
We need to support police. We need to give them all the tools we can. Bill C-5 should be repealed. We need drug dealers and drug creators to face the stiffest penalties. Our children are dying, and they're dying under horrific circumstances, being predated upon.
Conservative
Rob Moore Conservative Fundy Royal, NB
Thank you for that.
You said something that I took note of. You said, “Stigma does not kill. Drugs do.” There's certainly no doubt that drugs are taking the lives of so many. It is an epidemic. That's why we're having these meetings. We're looking for solutions.
You've been very critical of the buzzwords. You're saying that we need to focus on things that actually work, on actual results. Can you expand a bit on your statement that it's not the stigma but the drugs that are taking innocent lives?
Assistant Editor, The New Westminster Times, As an Individual
Sure.
My son attempted and actually was in treatment 26 times. He entered 26 different treatment facilities. In almost every case, he was kicked out. He had an undiagnosed mental illness. This was some of the evidence. He also attended about 5,000 AA and NA meetings while he was drunk, while he was high and while he was sober. He has always had an intention to not use drugs, yet we claim that the stigma is so overwhelming that these people need the succour of drug injection sites and safety.
This is a man who knew his mind when it came to drug use. He did not want to be and does not wish to be a user. Safe supply is an expensive PR campaign to promote a false narrative that these are individuals who want and need to sustain their drug use. He wanted off.
He has arrived at that moment. He is a year clean. This is evidence that the combination of involuntary care and clozapine does miracles.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Brett.
Thank you, Mr. Moore.
Dr. Hanley, you have five minutes.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you to all the witnesses.
Dr. Knight, I'll start with you.
You mentioned that you trained in B.C. Now you work in Manitoba. You pointed out differing approaches in different jurisdictions, for example, the availability of treatment while incarcerated in Alberta versus Manitoba.
When you look at these differing approaches across the provinces and, as you mentioned in your testimony, the need or the recommendation to constitute or perhaps reconstitute the expert panel, can you connect those two?
Are you referring to reconstituting the expert panel we had in 2021, or is it some other vision that you have of how we can get some national leadership to help guide best practices from one jurisdiction to another?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
This is a recommendation that I highlighted in our Canadian Society of Addiction Medicine brief about expanding and re-establishing a task force to work on mental health and substance use health, specifically around addressing some of the expert advice and developing a framework that establishes expectations around the availability of evidence-based care.
You can look at it through a provincial lens. The people who live near my rapid access to addiction medicine clinics in Winnipeg have vastly different access to evidence-based treatment than people who live in Red Sucker Lake, Manitoba, or in any of our fly-in, remote communities that have very little access to care.
The same thing is true if you look across different provinces and different jurisdictions. There needs to be some expectation of availability of service for all Canadians, regardless of where they live.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you very much.
Dr. Vigo, you started to describe the difference between criminalizing the act of taking drugs versus criminalizing or making other services illegal. I was quite interested in this. I'm not sure you had time to finish your thoughts earlier.
Can you comment on the current climate in B.C. and where we find the right political environment in order to ensure access to treatment and services for those struggling with addiction?
In other words, how do we get that balance right of what should be in the criminal envelope and what shouldn't be?
Associate Professor, University of British Columbia, As an Individual
Thank you very much, MP Hanley.
I think it is really important to strike a balance there. I think the most accurate depiction of that is a curve developed by the Health Officers Council here in B.C., which was later taken up by, for example, the Canadian Drug Policy Coalition and others. When you criminalize substances, you have a high degree of harms, at both the personal level and the community level, that stem from all sorts of epiphenomena of the black markets and of all of those things, like people getting caught in the criminal system when they are using drugs or have an addiction, etc.
On the other hand, when you completely forgo any regulations and you unleash for-profit criminals to prey on people with an addiction, you have all sorts of high societal harms.
The sweet spot is somewhere in between, which is called a public health regulation approach, where you don't criminalize an illness. Addiction, mental disorders and acquired brain injury are, of course, illnesses that should be treated, but at the same time the societies and the communities in which we live require the laws to be respected by everyone.
There isn't a contradiction between making care available as needed and demanding and enforcing respect for those rules of interaction between individuals. I believe that this is exactly the sweet spot we need to continue aspiring to, where people using drugs are not criminalized, but other actions that are defined as criminal by our Criminal Code are enforced and receive the societal approach that we reserve for them.
Does that answer the question?
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Hanley.
Mr. Thériault, you have the floor for two and a half minutes.