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.

On the agenda

MPs speaking

Also speaking

Lorraine Brett  Assistant Editor, The New Westminster Times, As an Individual
Erin Knight  Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Daniel Vigo  Associate Professor, University of British Columbia, As an Individual

The Chair Liberal Sean Casey

I call this meeting to order.

Welcome to meeting number 143 of the House of Commons Standing Committee on Health.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

Pursuant to Standing Order 108(2) and the motion adopted on November 8, 2023, the committee is resuming its study of the opioid epidemic and toxic drug crisis in Canada.

I'd like to welcome our panel of witnesses. Here in person we have Dr. Erin Knight, associate professor in the departments of psychiatry and family medicine at the University of Manitoba. Online we have Lorraine Brett, assistant editor with The New Westminster Times, and Dr. Daniel Vigo, associate professor at the University of British Columbia.

I'd like to thank you all for taking the time to appear today. As I expect you've been informed, you will have up to five minutes for your opening statements.

We'll begin with you, Ms. Brett. Welcome to the committee. You have the floor.

Lorraine Brett Assistant Editor, The New Westminster Times, As an Individual

Thank you very much for this opportunity.

My name is Lorraine Brett. I've lived in New Westminster, B.C., since 1994, where I raised three boys with my husband David. I'm here to address the devastating mental illness, overdose and homelessness crisis facing this country.

For the better part of 20 years, my now 40-year-old son Jordan lived on the streets of New Westminster and Vancouver's Downtown Eastside as a drug-addicted, homeless, mentally ill man. It was 20 years of living hell.

He survived 12 overdoses. He would be rushed to New Westminster's Royal Columbian Hospital, only to be discharged to the streets a short time later.

When addicts face death, there is often a moment of clarity. They want to stop the nightmare. I will never forget the agony of listening to my son outside of RCH emergency, saying through tears, “I don't want to die.”

To get into a recovery bed in B.C., you need to first go through detox, but detox typically has two to three weeks of waiting or more, and clients have to call every day, which is hard to do if you don't have a phone. Jordan overdosed and was revived twice while on that wait-list.

There is an illusion often fostered by misleading government PR campaigns that addiction care is available for those who want it when they want it. Well, this is not true.

I saw calamity erupt on the streets during COVID when the discreet access to safe supply rolled out to homeless addicts like a sick sideshow circus. The endless drug use saw human beings like my son devolve to the level of animals from excess use. Worst of all, COVID reduced the number of recovery beds, detox beds and shelter beds. It was such a horrifying catch-22 for the street-entrenched mentally ill, who are the most vulnerable and are helpless without anyone to champion their dignity and their intention to get off drugs.

Safe supply and the legalization of hard drugs creates an inferno. It's a deeper level of hell. It stalks, traps and incinerates lives.

Our son is doing much better. How could this be?

Here are some things that did not in any way help our son: slick government marketing campaigns about ending stigma, safe supply, decriminalization and social justice activists calling to dismantle systems of oppression.

Here's what worked: involuntary treatment in locked facilities, appropriate antipsychosis medications administered in a controlled environment, psychiatrists willing to use the B.C. Mental Health Act to commit those suffering from psychosis and addiction, and the availability of a bed in an appropriate facility.

In 2006, I helped found the New Westminster Homelessness Coalition Society. I spent five years there, helping to launch a pilot project for services that are still operating today, such as wraparound services for the hardest to house.

Many wonderful people are working on the front lines of this crisis, but I've spent enough time in this system to know the difference between an expensive, professional media relations campaign and actual results.

For example, in B.C., a new recovery and psych facility called Red Fish was opened on the Riverview lands. Those ribbons were cut and the government fuelled media fanfare and trumpeted great press. Unfortunately, the public is mostly unaware that Red Fish was just a replacement for the aging Burnaby mental health and addictions facility, where our son spent three months. No new beds were created.

Where are all the new beds? Thousands more are needed, not a few hundred sprinkled across the country, here and there.

Here's my request of all of you. Stop trying to change the channel by pointlessly boosting expensive anti-stigma campaigns and safe supply rhetoric. Stigma has nothing to do with the overdose crisis. It's just a cynical PR strategy to make the public think they're causing overdose deaths through the way they think and talk about addicts, and that is nonsense.

There is no such thing as safe supply. Stigma does not kill. Drugs do.

The myth is that if it were not for stigma, addicts would be rushing to access the care they need and safe drugs. That's a fabrication. There is not enough care available for those who already actively seek it.

Jordan was an innocent, happy kid a mom could be proud of. He was a football star, a standout, an all around athlete and a hard-working, focused student, and then it all went south.

Alcohol led to pot, which led to crack, which led to meth, which then got mixed with fentanyl. Jordan does not want to be a drug user. He works incredibly hard to stay off drugs. He has just celebrated a year clean.

Here are some concrete recommendations for you.

Prioritize those simultaneously suffering from addiction and psychosis. Dramatically expand the use of mental health laws to incarcerate and treat dual-diagnosis persons. Dramatically accelerate the opening of thousands of beds in secure facilities. It's an emergency. Take it on as an emergency. Find those facilities. Procure the land. Make the construction happen.

For those who are addicted and not psychotic, but who present with such psychotic symptoms as paranoia, remand them to care involuntarily. If the psychotic behaviour disappears, well, then, let them transfer into voluntary treatment facilities.

Now, for sure, expand tenfold the number of detox beds and expand tenfold the number of treatment beds in Canada.

Thank you very much for listening to me today.

The Chair Liberal Sean Casey

Thank you, Ms. Brett.

Next we have Dr. Erin Knight, who's with us here in the room. She's an associate professor in the departments of psychiatry and family medicine at the University of Manitoba.

Welcome to the committee, Dr. Knight. You have the floor.

Dr. Erin Knight Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual

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.

The Chair Liberal Sean Casey

Thank you, Dr. Knight.

Finally, Dr. Daniel Vigo from the University of British Columbia is coming to us via video conference.

Welcome to the committee, Dr. Vigo. You have the floor.

Dr. Daniel Vigo Associate Professor, University of British Columbia, As an Individual

Thank you, Mr. Chair.

The situation in which we find ourselves in Canada and B.C. has been described by Ms. Brett and the previous speaker. The question is why. How can we move forward in improving those outcomes?

In 2013 the chief of police and the Vancouver mayor called a press conference declaring a mental health crisis. There were about 300 people with severe mental illness, polysubstance use disorders and acquired brain injury who were displaying some of the situations that have now overwhelmed our communities. The chief of police and the mayor asked the health system to please take care of it: “We are unable to do it. We are police officers.”

Why is it that in the past 10 years in Vancouver, we went from 300 to 10 times that, and to 100 times that for those at risk of suffering those severe illnesses?

There were three main causes for that. The first one was the 2012 closure of Riverview Hospital without a replacement. The replacement should have been sufficient community services and sufficient inpatient beds to provide treatment, mostly voluntary treatment but at times involuntary treatment, as needed.

The second reason was the technological revolution that happened. As with every technological revolution, it took society by surprise. That technological revolution was the backyard production of cheap synthetic opiates at scale, with precursors that are impossible to stop and cheap to obtain. They allow anyone with entrepreneurial instincts and no ethical boundaries to transform $1,000 into $1,000,000 by creating the tragedy we're seeing.

It has happened in many areas of human experience that technological revolutions have had an impact like this. Moore's Law for microchips predicted that every two years the potency of the computational power of chips would double. Well, morphine in the hands of these entrepreneurs has led to a hundred times more powerful fentanyl and to ten thousand times more powerful carfentanil. When that happens, nature is transformed by these molecules. Our brains are transformed. The ability of these drugs to produce addiction while at the same time damaging the brain and preventing people from recovering and engaging voluntarily in treatment has been overwhelming.

The third cause for this situation was that, as was highlighted by the previous speakers, a group of patients was particularly vulnerable—patients with severe mental illness who were exposed systematically to these synthetic drugs. By the way, it's not only opiates; it's also the synthetic stimulants, the crystal meths of the world and the new combinations of every drug that now contaminates the illicit drug supply. For people with severe mental illness, the systematic exposure to these drugs generates acquired brain injury. That acquired brain injury has generated a new clinical triad that is now the norm in our cities. We were unprepared for it, because it didn't exist to the scale, severity and complexity that we're seeing.

I'm a psychiatrist in an assertive community treatment team. We are interdisciplinary teams who treat these patients in the community—finding them where they are; finding the homeless housing; finding them an adequate inpatient bed when they need it, and ED visits just for the time they need it; giving them involuntary care when they are unable to seek it out themselves; and pulling them out of involuntary care the minute they are able to regain their ability to engage and the mental impairment is treated by the adequate combination of psychiatric medication and ACT.

These three things have created a blind spot in most of our societies, in most of our communities.

How do we fix this? Since June of this year, I've been the chief scientific adviser for psychiatry, toxic drugs and concurrent disorders, and, based on a decision to develop and implement evidence-based policy, we have access to all the provincial data. We know the number of beds, FTEs, psychiatrists, GPs, nurses and social workers that are needed, and our recommendations have to do with many of the things that have been said by the two speakers before. There's a thread of agreement in our three testimonies that I would like to highlight.

We need streamlined access to life-saving pharmaceuticals, including the ones that were mentioned right before me, like depot naltrexone and naloxone, but we also need to simplify the use of clozapine, which is a life-saving drug for these patients, and there's a lot of red tape around its use.

The Chair Liberal Sean Casey

Dr. Vigo, can I ask you to wind up? You'll have lots of opportunity to expand on your thoughts in the question and answer period. If you could just bring it to a conclusion, that would be appreciated. Thank you.

11:20 a.m.

Associate Professor, University of British Columbia, As an Individual

Dr. Daniel Vigo

The conclusion is that, in order to improve outcomes for this crisis, we need to expand community services and inpatient services that are able to provide both voluntary and involuntary services as needed, and we need to transform the existing services so that they are able to provide treatment for severe mental illness, substance use disorders and acquired brain injury.

The Chair Liberal Sean Casey

Thank you, Dr. Vigo.

We will now begin with rounds of questions, starting with the Conservatives and Ms. Goodridge for six minutes.

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

Thank you.

I'm going to start with you, Dr. Vigo.

Police buy-in was a key aspect of the government's justification for launching the decriminalization pilot that made hard drugs legal in British Columbia. Last week, both the BC Association of Chiefs of Police and the Canadian Association of Chiefs of Police pulled their support. They cited a continued high rate of overdose deaths, public drug use and drug-related crimes since the pilot started.

Have you or will you advise the government to end the failed experiment?

11:25 a.m.

Associate Professor, University of British Columbia, As an Individual

Dr. Daniel Vigo

The recommendations that I have provided are aligned with what we are doing now in B.C., which is that the use of drugs, the use of drugs itself, should never be criminalized; however, in our societies, we have rules and regulations that should be respected by every citizen, and, in that context, the current situation is that drugs are not criminalized but the rest of the rules that regulate our interactions are enforced.

11:25 a.m.

Conservative

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

You will not give a recommendation to roll back this irresponsible pilot project.

11:25 a.m.

Associate Professor, University of British Columbia, As an Individual

Dr. Daniel Vigo

Coming back to my expertise, which is psychiatry, mental health and public health, what I can say is that drug users should not be criminalized and that the laws that regulate the public space—

11:25 a.m.

Conservative

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

All right, thank you. I have very limited time. I'm going to switch courses.

11:25 a.m.

Associate Professor, University of British Columbia, As an Individual

Dr. Daniel Vigo

You have limited time, but I am a witness—

11:25 a.m.

Conservative

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

I gave you the same amount of time as it took me to ask the question, which is the procedure here in this committee.

To Ms. Brett, thank you so much for coming here and sharing your son's journey and your experience as a mother. Do you think that the NDP and Liberals have normalized drug use in this country?

11:25 a.m.

Assistant Editor, The New Westminster Times, As an Individual

Lorraine Brett

Yes, I do.

11:25 a.m.

Conservative

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

We had a mother from Ottawa come and testify at this committee that the government is acting like a drug lord. Do you agree?

11:25 a.m.

Assistant Editor, The New Westminster Times, As an Individual

Lorraine Brett

In essence, it's true. I saw her testimony. Yes, it's coming from the top down. The federal government has arranged laws to support safe supply, which has been delivered to clients who divert, and young children are dying as a result. It's drug trafficking.

11:25 a.m.

Conservative

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

In your opinion, do you think that this dangerous pilot project that was inflicted on British Columbia should continue?

11:25 a.m.

Assistant Editor, The New Westminster Times, As an Individual

Lorraine Brett

Absolutely not, and the moment that one child was impacted in any negative way, this should have been stopped. A lot of the folks who came to this panel used the words “dignity” and “respect”, but I claim that there is a moral and ethical obligation on the part of the government to respect human life and that of innocents. The children who find themselves intersecting with diverted drugs.... It's the beginning of the end. It must come to an end.

11:25 a.m.

Conservative

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

I really appreciate this. I think this is the scary part: The government keeps hearing evidence it doesn't like, so it decides that it is not actually evidence and that it's going to continue on its path because, clearly, “We just haven't done it properly.”

Dr. Knight, I found it really interesting that you said the outcomes are poor in Oregon and British Columbia, but you think that we should continue trying to do what has been a failed experiment. Then, further in your statement, you actually stated that Alberta, which is doing a dramatically different recovery-oriented system of care changes...that the Alberta model would potentially be a better outcome for the person you fabricated in your story. How can both things be true? I'm very confused.

11:25 a.m.

Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual

Dr. Erin Knight

I think that, intentionally or unintentionally, you've taken my comments out of context. The thing that I compared between Alberta and Manitoba is a difference in provincial correctional policy related to opioid agonist therapy. I did not speak specifically about Alberta's model of care.

11:25 a.m.

Conservative

Laila Goodridge Conservative Fort McMurray—Cold Lake, AB

Okay. Thanks.

You support Alberta's use of opiate agonist therapies. I'm sure you're aware that Alberta has a very innovative program—the virtual opioid dependency program—that allows 24-7 access to opiate agonist therapies. Is that something that you think we should be rolling out across the country?

11:30 a.m.

Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual

Dr. Erin Knight

I think there are elements of the VODP that are very successful, and there are also elements that don't reach at-risk populations. It is one thing, as part of a multi-faceted expansion of service, that we could look at. I do have concerns that it is entirely virtual, and there is some need to see people in person and to develop relationships with people.