Thanks very much.
As mentioned, I am an associate professor in the departments of psychiatry and family medicine. I am the medical lead of the provincial rapid access to addictions medicine clinics in Manitoba, and I hold several other leadership roles in addition to practising clinical addiction medicine and family medicine.
While I am speaking today as an individual, I am also the president of the Canadian Society of Addiction Medicine. Some of my comments are drawn from CSAM’s submitted brief.
I will note that any response to this complex crisis will need to be multi-faceted and responsive to the needs of all people who use drugs. However, my recommendations will focus on those with substance use disorder.
I will begin with a story that, although fictional, is a compilation of real events. Angela is a single mother. Her partner, Alex, was incarcerated for drug-related charges at a time when they were both using fentanyl. Alex went through severe opioid withdrawal and was denied treatment. Angela sought help and was started on buprenorphine and naloxone. She did well and was excited to move forward with her family. Sadly, Alex died of drug poisoning a few weeks after his release, due to a loss of opioid tolerance while in custody and his untreated opioid use disorder.
Angela has remained stable, but at our last visit told me that she needs to taper off her medication. She feels she can better support her kids while working than she can on social assistance. However, when she starts earning income, she’ll lose her medication coverage, and she can't afford to pay for it. Unfortunately, her chances of long-term success are low, and I am afraid that she will join the over 47,000 Canadians who have already died of drug poisoning since 2016, leaving her kids with both parents lost to the opioid epidemic.
My first recommendation is for the federal government to support national decriminalization of drugs for personal use. While the outcomes from the Oregon and Vancouver pilots have been poor and those pilots have already begun to be scaled back, accompanied by escalating calls for involuntary treatment, it's important that we not discount the idea of decriminalization based on flawed policies.
A key component to successful decriminalization, as evidenced in Portugal, is assessment and direction to treatment for people with problematic substance use. This element of dissuasion has been missing in North American efforts and must be combined with a scale-up of on-demand, evidence-based treatment prior to rollout.
Rather than jumping from decrim without any enticement for change all the way to implementation of involuntary treatment, we should focus on the middle ground, using well-constructed decrim policy to encourage voluntary or minimally coercive use of accessible, evidence-based treatment. Had Alex been offered treatment instead of incarceration, he might still be alive today to see his kids grow.
My second recommendation is for the federal government to establish a task force to develop and enact a national action plan for addressing substance-related harms. There is far too much variability in access to evidence-based care across regions, including between provinces and between urban and rural or remote locations. This is particularly evident in areas where jurisdictional issues between federally and provincially funded services lead to gaps in care, including incarcerated populations and indigenous communities.
Going back to our story, had Alex been incarcerated in Alberta instead of Manitoba, he would likely have been offered treatment because of differences in the provincial correctional policies.
The third and more straightforward recommendation calls for universal coverage of medications to treat opioid use disorder, which will not only save the lives of people like Angela, but also support them to work, with fewer barriers. Specifically, buprenorphine products and methadone, which are the first-line treatments for opioid use disorder, should be prioritized for immediate inclusion on a national pharmacare formulary, with further consideration of alternative agents. Additionally, injectable naltrexone should be prioritized for Health Canada approval and included on the pharmacare formulary once available.
In conclusion, an effective response to the opioid epidemic and toxic drug crisis will be multi-faceted by necessity and must include expanded support for people with substance use disorder as one component. In developing this urgent response, we also need to deliberately combat stigma and divisiveness, recognizing that people who use drugs are our family, our friends and our community members, and they deserve care.
Thank you for your attention. I'm happy to take questions.