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
Dr. Knight, you talked about the B.C. experience and said that decriminalization wasn't enough.
What didn't work? What should have been done before drugs were decriminalized?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
There are two main components that were missing from Vancouver's attempt at decriminalization. One is the scale-up of on-demand treatment. We heard there's this myth that people who want treatment have access to treatment. In reality there are often significant wait-lists, significant barriers for people who actively want substance use treatment to get into treatment. One thing is significant scale-up of the availability of evidence-based treatment prior to the rollout of decriminalization.
The other aspect is an element of dissuasion built into the decriminalization policy. That's what was done in Portugal, where, when somebody has substance use disorder, they are required to go in front of a dissuasion panel that looks at their particular situation and their particular type of substance use and makes recommendations for what type of intervention they are going to get. That was lacking from the rollout in Vancouver, where there wasn't that element of encouraging people to access treatment and trying to direct people with problematic substance use to treatment.
Bloc
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
The question around safe supply is complex. When I talk about safe supply, I want to be clear that there are lots of different definitions that have floated around in terms of that. I'm going to define “safe supply” in your question as prescribed safer supply, which is a prescription for a pharmaceutical opioid typically, although it can be other medications to decrease somebody's reliance on the illicit toxic drug supply.
We know from some of the research and evidence that there are individual benefits from safer supply. We also know that there are significant concerns from the community and from some providers and prescribers around the potential public health harms. The reality is that I don't think we're at a place where we have a strong enough evidence base to say that safer supply is good or bad. It is something that probably does need more evaluation and more research before we talk about whether it's going to be a key component to this.
Liberal
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you.
Dr. Vigo, can you speak about the assertive community treatment teams? I understand that they provide wraparound care and treatment for people living in a community who have complex mental health or concurrent mental health and substance use disorders, who might benefit from a supportive approach to care beyond that of standard services. Is this a model you've looked at?
December 3rd, 2024 / 12:05 p.m.
Associate Professor, University of British Columbia, As an Individual
Well, it's the only evidence-based community treatment for people with the most severe forms of mental and substance use disorders. It has been studied for decades. The continuum of care of assertive community treatment teams and their variation, flexible assertive community treatment teams, has proven to reduce unnecessary in-patient treatment, to reduce ED visits, and to improve the interactions between patients and their families, as well as their housing situation. They are, for sure, an evidence-based approach to this problem.
In fact, I am a psychiatrist in one of those teams in B.C., and I'm the medical lead for the provincial assertive community treatment and advanced practice initiative. We have evaluated this, and we have proven that it reduces by half the days of inpatient treatment compared to the year before admission, and then continues to reduce these up to two-thirds, meaning that we only have one-third of the days of in-patient treatment in five years. The same thing happens with ED visits. The reason for that is that you have a wraparound team that seeks out the patient where they're at and makes a decision in the moment. Do they need to be admitted? Do they need to be discharged? Do they need to be under the Mental Health Act or extended leave, or can they be decertified?
Yes, it is an evidence-based and also cost beneficial approach. We have proven that for every dollar invested in five years, we get $2.20 back. The government saves money through this. There are 34 of those teams in B.C. They are being expanded, and we need to do more; however, that is certainly one of the evidence-based tools we need to rely on.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Do you consider the community treatment teams a best practice that other jurisdictions should also implement?
Associate Professor, University of British Columbia, As an Individual
Absolutely. It is the only practice, basically, for keeping these patients in the community without unnecessary certification, without unnecessary inpatient treatment.
Liberal
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Thank you, Mr. Chair.
Thank you to our witnesses for being here.
Dr. Vigo, in your answer to our colleague, Gord Johns, you stated some statistics and some facts. Are you able to table that information with our committee, please?
Associate Professor, University of British Columbia, As an Individual
Yes.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Thank you.
Ms. Brett, in your opinion, does Canada prioritize recovery for those with substance use issues?
Assistant Editor, The New Westminster Times, As an Individual
No, not at all. My son has gone through hell, as have I and my family. He's essentially been victimized by the lack of appropriate care. We've pounded on every door, yet, in the end, his behaviour became.... I mean, he turned into an animal. I found him bent over, eyes closed, unaware that he had his eyes closed when speaking to me.
There was just never any supportive help, not what we needed when we needed it. It's chaos. It's malevolence to leave people to die on the street. It's a form of evil. It's inhumanity. It's man's inhumanity to man, and we need to do everything we can to change this. We are in an emergency. There is no doubt. We must act as if this is a crisis of immense, horrific proportions.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
You said in your opening statement that you've been in New West since 1994. I'm sure that over the course of those years, you've seen changes to our community and to the New West community due to the drug crisis.
Assistant Editor, The New Westminster Times, As an Individual
Yes. There was chaos on the streets. It was reported by everyone. There have been violent acts. We had a taxijacking, which resulted in multiple car crashes. In Vancouver, of course, we had someone who cut off the hand of an innocent bystander. The chaos has just continued to mount, and deaths continue to mount. We cannot, in good conscience, any one of us, continue with the status quo. It cannot remain thus.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Would mandatory treatment have helped your son get clean? Has it helped get him clean? He's a year sober.
Assistant Editor, The New Westminster Times, As an Individual
Yes, he is a year sober. He has been under the Mental Health Act, involuntarily. This is the end of year four. It's been a process.
He did use occasionally in that window, prior to this last year, but there has been such an amazing focus of care. Limitation of movement and locked facilities were the ticket to begin with and continue to be so, where needed and when needed. He is a miracle of the benefits of mental health care, the best psychotic drugs, like clozapine, and great therapeutic services provided by the psychiatrists there.
We couldn't be happier. This is a godsend. It's a miracle. We need more, and we need it now.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
Ms. Brett, if you could speak directly right now to Prime Minister Trudeau, Minister of Health Mark Holland and the Minister of Mental Health and Addictions, Ya’ara Saks, what message would you give them?
Assistant Editor, The New Westminster Times, As an Individual
Oh, dear God, do not prevent the opportunity for our children to have this care. They need it so desperately. They're dying every day, every minute. We need the floodgates to open. We need help. We can't live this way.
Conservative
Todd Doherty Conservative Cariboo—Prince George, BC
I truly appreciate your heartfelt testimony.
As you probably have heard, my brother is on the street as well, and has been since the early 1990s. He started on the streets in Surrey and in New Westminster, and so very likely was probably in the same circles as your son, so my heart goes out to you. I wish you and your family nothing but the best.
Thank you for your testimony.
Liberal
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Mr. Chair.
Thank you to all the witnesses.
My first question is for Dr. Knight.
Dr. Knight, you talked about fewer resources and the difficulties of providing addiction medication to those who are living in rural and remote areas. You also recommended universal coverage for first-line medications for substance use disorders, including naloxone.
What needs to be done so they can have access to the medication, especially in remote areas and rural areas?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
It's a very complex situation, and it really depends on the degree of rurality and remoteness we're talking about.
There are a large number of “fly-in only” communities in my province, and often, almost exclusively, they are communities that don't have pharmacies and don't have the ability to dispense medications within the communities. That is a major barrier to the use of medications that have to be witnessed and dispensed by either a pharmacist or a health care provider.
The advent of long-acting injectable buprenorphine has enhanced the ability to provide treatment for opioid use disorder in those communities, because it doesn't require daily use of medication. That is another area where the availability of long-acting injectable naltrexone, which I mentioned, would be useful in terms of providing another treatment option for people who either don't want to or can't go to the pharmacy regularly for medication options.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you.
My next question is for Dr. Vigo.
Dr. Vigo, can you speak about the difference between a mental disorder and psychosis? Also, can you explain holistic psychiatric care?
