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.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
What outcomes have you seen? Are you seeing any positive impacts so far?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
So far, it is still relatively new for us. We're still trying to figure out the right way to roll it out and access the people who most need the access to care.
We certainly have had positive experiences in terms of people being able to access care that they wouldn't otherwise have gotten. One way that we're using the Digital Front Door actually is to provide initial contact for people in those remote communities that I spoke about earlier, where otherwise people would have to physically get on a plane, fly to a community and then come in through our walk-in clinics. Making that first connection and being able to provide some of the education and some of the initial assessment to make a plan for that person before they have to leave their community and come into an urban centre has been really helpful.
Liberal
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Yes, I think it is something that can be produced elsewhere. As I mentioned, we actually took it from The Royal here in Ottawa and adapted it to Manitoba, so it's already been taken from one place and replicated elsewhere.
I mentioned this when we were talking about the VODP as well: There are some inherent problems with virtual care alone, because lots of people who require access to care don't have computers, don't have smart phones, and aren't able to come in through those routes, so having the accessibility of low-barrier, in-person service is also really important. We can't do one without the other, but having a broad number of doors that people can get into makes sense.
December 3rd, 2024 / 12:25 p.m.
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
During this committee's study, which has been going on for several meetings, a number of witnesses have told us that the overdose crisis is due in large part to drug toxicity.
In contrast, Alberta's Minister of Mental Health and Addiction said that the crisis stems from an addiction problem, not an increasingly toxic drug supply. He also said that it always ends in one of two ways: pain, misery and death; or treatment.
What are your thoughts on that?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I prefaced my statement today by saying that my recommendations were going to be specifically for impacting people who have a substance use disorder. The reason I prefaced with that is that while a lot of the people who are impacted by the opioid epidemic and toxic drug crisis have substance use disorders, not all of them do. There is a component whereby the toxic drug supply is sometimes killing people who don't have substance use disorders, because it is toxic and because they don't have access to a regulated supply like we do with alcohol or other regulated substances.
The reality is that our liquor stores are a place to access safe and regulated drugs, and our bars and restaurants are supervised consumption spaces.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Knight.
Mr. Thériault, you have the floor for two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
If I understand correctly, the answer to the question I asked earlier is that safe supply has saved lives.
At one point, we had a witness who had a clinic and was caring for people. He told us that we should focus on drug substitutes that are long-acting agents.
I'd like to hear your thoughts on that.
Do such products exist? If so, is there a difference between having to take something daily and taking a substitute drug that's effective for, say, a month?
My questions are for Dr. Knight, but Dr. Vigo can add to the answer if he wishes.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I believe your question is about the difference or the potential benefits around long-acting agents such as an injectable agent versus a daily dispensed medication. Is that correct? Okay.
There is evidence for daily use of OAT medications like buprenorphine and methadone. There is also evidence for long-acting agents like injectable buprenorphine, which is a monthly injectable formulation.
For some people, getting away from taking a medication every day and having that routine as part of their daily experience is beneficial in terms of being able to get away from that idea of continuously taking a medication. They still have access to that medication in their body physiologically, but it's not always front of mind. We have evidence for both, and I think it's important that we have accessibility of a variety of treatment options for people who want to access them, so that we can tailor treatment to the individual in front of us.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
The cost is very dependent on where people live and what the availability of drug coverage is, which is why one of our recommendations is broad coverage of these first-line medications for opioid agonist therapy.
In my province, buprenorphine, naloxone and methadone, as daily options, as well as the injectable buprenorphine, are covered if people are on social assistance or if they have coverage through treaty status. Otherwise, people have to pay for them, and they are relatively similar in terms of cost.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Knight.
Next is Mr. Johns, please, for two and a half minutes.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you, Mr. Chair.
Dr. Vigo talked about the closure of Riverview in British Columbia, and Ms. Brett, you highlighted that as well. We've lost beds, and we see provinces and territories scrambling to scale up to meet the crisis, but the federal government spent less than 1% responding to this crisis.
Ms. Brett, you talked about stigma not being an issue, but it is a stigma that the federal government has spent only 1% of what it spent responding to COVID-19 on this crisis.
How important is it that the federal government scale up detox beds and treatment beds, as you highlighted?
Assistant Editor, The New Westminster Times, As an Individual
I'm thrilled to be able to say over and over again to all of you in significant positions of power, and to the Prime Minister himself, that we absolutely need to shift our approach to crisis emergency management. In this case—and my son is a witness—there is evidence now that this involuntary care will work.
Dr. Vigo has articulated a way forward, but without more beds and without more effort to create spaces, we can't treat these people; we can't take them off the dangerous streets, and we can't save them.
Absolutely, we need the Prime Minister to move on this. We need the federal government to move now and quickly. Lives depend on it every single day. There's always someone else, and there are many who die. We need to act like every life matters.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Thank you so much, Ms. Brett. The B.C. Liberals closed that facility.
We know, Dr. Vigo, that involuntary treatment is not an ideal approach but one that is seen as a last resort. What do you think can be done upstream to potentially avoid getting to the point where caregivers or medical professionals are pursuing involuntary options to keep people safe? Are there early prevention initiatives that are effective and need to be scaled up?
Associate Professor, University of British Columbia, As an Individual
For sure, we need to implement the scale-up of voluntary options that would allow us to use involuntary as a last resort, as you said. We also need, as Professor Knight indicated, broad access to available drugs, such as buprenorphine and others, and simplified ways of prescribing that.
That's another important thing. Some of the drugs we use to treat these very difficult disorders have all sorts adverse events and unintended effects. Buprenorphine has a very benign profile of side effects and there are immense benefits, at least for people who also have mental disorders, to the depot formulations.
I guess what I'm saying is that we should simplify the way physicians can prescribe buprenorphine and other alternatives, for sure, across the board.
Second, if we could make, as a result of these conversations, depot naltrexone available across Canada, that would be phenomenal. It's not there just because of a combination of bureaucracy and poor business decision-making that is fixable in the context of a health emergency.
Liberal
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you, Mr. Chair.
Dr. Vigo, I appreciate that you've also now shared your concerns about the fact that Health Canada's bureaucracy has stood in the way of access to an evidence-based drug, which is injectable naltrexone.
Can you describe why it is important that Health Canada finally act to make this drug available?
Associate Professor, University of British Columbia, As an Individual
We have a lot of safeguards that our institutions create to make sure we have thorough evaluation and assessment of the different options. In a public health emergency, we need to do a reassessment of those risk and benefit equations.
In the case of depot naltrexone, this is a molecule that would block opioid receptors. It would allow us to treat, for example, as we were discussing before, people who have not developed an opioid use disorder but are in the initial stages of that. They are being exposed systematically to overdoses, either by seeking them out or through the contamination of the supply. They would benefit from blocking those receptors, because, let's say, they are young and their brains are developing.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you. I appreciate that.
Earlier at this committee, we had British Columbia's public health officer, Dr. Bonnie Henry, call for the legalization of hard drugs. She actually produced a report a bit later on that recommended that the government consider running, or have privately run, retail stores to sell drugs like heroin, cocaine and meth.
Do you believe that this is something British Columbia should embark on?
Associate Professor, University of British Columbia, As an Individual
The premier has been very clear that the current approach of the government is that there will be no expansion of those initiatives that make drugs available. The expansions are going to be for services that are within the context of treatment. Access to opioids in the form of agonists, partial agonists and antagonists will be through treatment centres and recovery-oriented practices.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
We've also recently been seeing quite a number of drug busts of super labs. The most recent one was found in your province of British Columbia.
Are you seeing issues in regard to the increased availability of drugs as a result of the pilot project that made the possession of hard drugs like cocaine, meth and fentanyl legal?
Associate Professor, University of British Columbia, As an Individual
The question is whether I have seen an increase.... Can you repeat that question?
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Have you seen an increase in the availability of drugs on the streets in British Columbia as a direct result of the pilot project that made it legal for people to have fentanyl and use fentanyl in British Columbia?
Associate Professor, University of British Columbia, As an Individual
The increasing availability of synthetic drugs is due to how easy it is to obtain those precursors. Those precursors came initially from China and now come from Mexico. They allow for the backyard production of those products at scale. That is the cause.
Of course, the responsibility falls upon the authorities to prevent the circulation of those precursors and to bust those labs, as you just said.