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.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Really quickly, you mentioned one thing that I think is a failure of Health Canada, the lack of listing injectable naltrexone. I have advocated to the Minister of Health and the Minister of Mental Health and Addictions on this particular issue, and it's fallen on deaf ears.
You now have a platform. Why do you think this is important?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
It's important to expand the availability of evidence-based treatment options. Right now we have accessible our first-line treatment options. We have, also, in certain areas—
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Yes, particularly naltrexone, because this is something that is not available currently.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
It's something that is not available currently, and we, as addiction physicians, have been advocating for its availability for many years. There are some barriers that have been put in place through Health Canada, and we are asking for the support of the federal government in reducing those barriers so that we can have this option for treatment.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Knight.
Thank you, Ms. Goodridge.
Next is Dr. Powlowski, please, for six minutes.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
I'm pleased to see you all here, but my questions are for Dr. Vigo. I think some of them were your remarks. I'm not sure if they're only your remarks, but I understand you're the chief scientific adviser for psychiatry and toxic drugs in B.C. and, certainly, within the popular press the message came out that British Columbia was contemplating more involuntary treatment of patients. I wonder whether you could explain your ideas about involuntary treatment. My understanding is, and this is for a population of...you already talked about the triad, people who have substance abuse disorder, mental health issues and acquired brain injury altogether. Certainly, my understanding is that, under present psychiatric law, there is the ability to involuntarily admit and treat people who require long-term antipsychotics. Is that what you were contemplating using more in B.C.?
The other component of that is I think there was something about clarifying the issue of being able to use OAT, like sublocade, for people who were also receiving long-term antipsychotics. Maybe you could just clarify for us the whole issue of involuntary treatment, who should get it and whether that should be expanded.
Associate Professor, University of British Columbia, As an Individual
For any physician, the need to provide involuntary treatment is something we encounter with relative frequency, not only in the areas of mental health—
Liberal
The Chair Liberal Sean Casey
Dr. Vigo, we're having trouble hearing you. Is it possible that you moved your mic since your last intervention?
Associate Professor, University of British Columbia, As an Individual
Can you hear me now?
Liberal
The Chair Liberal Sean Casey
I think that's better. Can you raise the mic up between your nose and upper lip, please?
Thank you.
Associate Professor, University of British Columbia, As an Individual
Thank you very much.
We encounter people we need to provide involuntary care to in several situations. I was an ED physician for a couple of years, and if we had someone who had suffered a concussion with loss of consciousness, and we were assessing them and saw that they were confused and said, “No, I'm going to go home and sleep it off,” we could not allow that to happen. That can happen through a different act than the Mental Health Act, but it is the same type of situation.
If we stay closer to home and you have a patient with a manic episode who tells you they want to go get on a plane to Vegas and so on, and you see they are in an episode of psychosis and agitation, again, you cannot let them go as they will. You need to treat them, because there is treatment for that.
Very similarly, we know that in this clinical triad, the effect of synthetic opioids on the brain decreases the volume of the brain. The more the brain is damaged, the higher the risk of overdose, so there's a vicious circle there that eventually leads you near cognitive disorder, not unlike the one we see due to vascular disease or other forms of dementia.
The Mental Health Act that we have in B.C. allows us, and even requires us, to treat people when they have a state of mental impairment meeting certain stringent criteria. That state of mental impairment is something we find very frequently with people who are acutely affected by the combination of a severe mental illness with either a substance-use disorder or a neurocognitive disorder that is the product of acquired brain injury.
Does that mean we want to expand the use of involuntary care? No. We want to increase the options for voluntary care, which have not been sufficiently expanded so far, and as we expand options for voluntary care, we will be able to use involuntary care more precisely for the people who really need it.
In order to do that, we need to create some services that don't exist. Among them, again under the Mental Health Act, we are able to create things called “approved homes”. Approved homes are secure houses in the community where people at the most severe end of the spectrum, who require services under the Mental Health Act for long periods of time, can be housed in a safe, humane environment with one-on-one rehabilitation.
Similarly to what was said by Professor Knight, we are also creating units in correctional centres—on remand in Surrey, for example, where our patients frequently wind up because of their disturbed behaviour due to this clinical triad. Because of the Mental Health Act, they cannot receive involuntary care while they are being incarcerated, so what happens is they are put in seclusion until a bed frees up in a forensic hospital. We have now created a mental health unit in corrections where they can receive treatment the moment they need it. It will take a few months to create it, but it has been decided.
These are the types of things we're trying to do. We're trying to allow for the treatment of people who absolutely need involuntary care and create services that can provide both voluntary and involuntary care as needed, so that the overall use of the Mental Health Act will decrease, but the number of folks who need it and don't receive care will also decrease because they will receive it the moment they need it.
You pointed out the important thing about the use of buprenorphine and other psychopharmacology under the Mental Health Act. There's no restriction under the Mental Health Act of B.C. as to what a psychiatrist needs to decide is the appropriate combination of pharmacology for a person who needs it. We need to provide holistic psychiatric care, and that very frequently includes, in these types of patients, a depot antipsychotic or clonazepam and depot buprenorphine, because of the repercussions that psychosis has on behaviour if it's treated only with antipsychotics.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vigo.
Thank you, Dr. Powlowski.
Mr. Thériault, you have the floor for six minutes.
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Thank you to the witnesses.
This crisis is complex. Most of the committee's witnesses talked to us about multiple solutions.
Dr. Knight, you started by saying we need multi-faceted responses. Can you talk to us about the role stigma plays in the addiction process and in treatment? There's a social aspect to it, but there's also a mental health aspect. Ms. Brett didn't talk about the mental health aspect.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I think stigma does play a role in accessibility to treatment and people's willingness to address treatment. I think it plays a role in the way that we talk about substance use in the community. It also plays a role within our health care setting.
The reality is that addiction medicine is a relatively new specialty, and incorporating substance use disorder treatment within the health care setting is relatively new. Even among health care providers, nurses, doctors and other providers within both the hospital settings and the communities, there's a need for increased education and increased competency to work with people who use drugs.
As we build that competency and continue to work on the issues of stigma through appropriate use of language and through appropriate and person-centred approaches to people who use drugs, we can increase their comfort level with seeking care when they're ready to do that.
Assistant Editor, The New Westminster Times, As an Individual
I'm sorry to interrupt.
Is there any chance that someone could assist me? My translation is not working.
Liberal
The Chair Liberal Sean Casey
Do you see on the bottom of your screen where you have three options of English, French or floor audio? It's like a little globe.
If you set that to English, then that's what you'll hear in your headset.
I'm speaking French right now. Can you hear the English interpretation?
Yes? Okay.
Associate Professor, University of British Columbia, As an Individual
I also don't have that option, or I don't see it.
Liberal
Associate Professor, University of British Columbia, As an Individual
I do. Thank you very much.
Liberal
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Dr. Vigo, in your experience, how does stigma hinder the healing process when the patient internalizes the other's gaze? Does internalizing that stigma interfere with the healing process?
Associate Professor, University of British Columbia, As an Individual
Thank you.
I think the issue of stigma is important. As you pointed out, there is self-stigma; there's structural stigma and there's stigma in societies.
I believe we are all tending to a more inclusive approach that seeks to make sure that stigma doesn't play a role in preventing people from getting care, so it's an important part of that.
I also think that, as was said before by other witnesses, the urgent issue is the effect of toxic drugs on brains, so most of our attention and funding should be directed to expanding available services.