Thank you.
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.
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
The Chair Liberal Sean Casey
Thank you, Ms. Brett.
Thank you, Dr. Ellis.
Next is Dr. Hanley, please, for five minutes.
Liberal
Brendan Hanley Liberal Yukon, YT
Dr. Knight, among the many misconceptions that are being promulgated by my Conservative colleagues are that this government or respected health care leaders like Dr. Bonnie Henry are pushing for “legalization of hard drugs”. What I'm hearing from many experts such as you is advocacy for a safe, regulated supply of drugs, such as we see with the post-prohibition approach to alcohol.
I wonder if you can help us distinguish between so-called “legalization” of hard drugs, which I've never seen in this country, versus access to a safe, regulated supply as an alternative to the rampant access to a toxic supply of drugs that is basically being supplied through organized crime networks?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Maybe one of the easiest ways to talk about that is by giving an example, because we have access to a safe supply of alcohol through regulation. There are communities in Canada where alcohol is not allowed, and often in those communities an unsafe supply of alcohol becomes what people are using, in terms of homebrew and in terms of superjuice, things that have much higher risks of harms related to them because they're part of an unregulated supply of a generally regulated substance.
Dr. Bonnie Henry was talking about regulation, and Dr. Vigo has talked about this as well: that curve, where the lowest amount of harm is from a regulated public health approach to the supply of addictive substances.
Liberal
Brendan Hanley Liberal Yukon, YT
Very briefly, because I have a couple more questions for Dr. Vigo, what would that actually look like in practice? Could you give me an example of how that would be applied?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
It's hard to be brief about this. The complexities of it are why I didn't actually address it in my notes. If we were to look at creating a regulated supply of addictive substances more broadly, we would need to look at it with a strong lens of prevention as well, in terms of ensuring we're not having too loose regulations that increase the risk of early use and increase availability.
However, being able to supplant the illicit toxic drug supply with a regulated and more predictable supply would likely decrease harms related to the existing toxic drug supply.
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
Dr. Vigo, I have a couple of questions for you while I have the remaining time.
One is that you mentioned the role of clozapine, and I think you implied that it is underused or perhaps is not as available as it should be. This was also reflected in Ms. Brett's comments about how this helped her son.
I wonder if you could talk briefly on that drug and what we need to do to elevate access to it.
Associate Professor, University of British Columbia, As an Individual
In our organizations, our institutions, our practices are usually that the risk-benefit analysis in the use of certain drugs leads to very stringent prescription protocols. Clozapine is one of those drugs that requires, for example, weekly venipuncture blood tests in order to check the white blood cells, because there's a very infrequent side effect, which is neutropenia, the decrease of white blood cells. If that goes undetected, some people can die.
Now, of these folks we're talking about, no one's going to die of neutropenia. No one's going to die of an undetected infection because of neutropenia. They're going to die of an overdose. For this subpopulation, the risk-benefit equation needs to change.
We are restricting accessibility by demanding those venipunctures that they cannot comply with, simply, so what we did here is that we developed a protocol by which we forgo the venipuncture and we do the dips, the point-of-care testing that can be done very easily by the ACT teams as needed.
Therefore, we can expand the availability of clozapine, but that needs a willing bureaucracy, and I say bureaucracy in a positive sense, not in a negative sense. I mean in the old sense of the way we organize our rules and our administration. A willing bureaucracy can accept this adjusted risk-benefit equation. The College of Physicians and Surgeons of BC has accepted this, and it is now approved and being rolled out.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vigo and Dr. Hanley.
Mr. Thériault, you have the floor for two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Thank you, Mr. Chair.
Dr. Vogel and Dr. Knight, here's what Ms. Brière‑Charest of the Association pour la santé publique du Québec told us last week:
...existing solutions are no longer an adequate response to the scale of the needs and cannot attenuate the crisis. We need to do more to prevent premature, avoidable deaths, expand access to voluntary treatment, enhance prevention, ensure a regulated supply and reduce the burden on the judicial system.
Do you agree with that?
Associate Professor, University of British Columbia, As an Individual
Those were a number of different statements. I agree with most of them.
I would say, though, that for some substances, the proper level of availability could be none. Carfentanil is 10,000 times more powerful than morphine. It has no use anywhere in any regulatory framework that I can foresee. Nitazenes and fentanyl are drugs that it would be very difficult to find a suitable availability for that is outside the medical system for the purposes of treatment, surgery, etc.
That's the only one of those statements that I would qualify in the sense that, for sure, we need to find a sweet spot of regulation, and, for some substances, that may be none.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Essentially, I agree with those statements.
I do agree with Dr. Vigo's qualification of finding the right regulation for a regulated supply of substances. I absolutely agree with increased access and prevention and reducing the legal burden associated with substance use.
Liberal
The Chair Liberal Sean Casey
Mr. Johns will have the last round of questions for this panel. It's two and a half minutes.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Dr. Vigo, what can the federal government do to support provinces and territories that are trying to scale up mental health and substance use supports?
Do you think the government should set a target for spending on mental health and substance use health that reflects the disease burden?
We know many OECD countries spend significantly more than Canada on their health care budgets—double, in fact.
Maybe you could speak to that.
Associate Professor, University of British Columbia, As an Individual
I definitely think that in a country such as Canada, where the funding for health care is public funding and it's a combination of meeting federal regulations and targets and provincial decision-making, the federal government could help by—
Liberal
Associate Professor, University of British Columbia, As an Individual
I was saying that for sure the federal government would have a role in developing incentives for provinces to prioritize evidence-based interventions that expand treatment. There will be innovations that need to be developed, in the same way that in the U.K. there were innovations to suddenly scale up thousands of beds.
Where the capital funding and operating funds will come from will require important changes in the way we do things.
The other thing, with the utmost respect, is bureaucracies. We sometimes find that to create 20 beds with one secure room, we have a timeline of nine months. That cannot happen. We need to streamline our expectations with building permits, community consultations and things like that, so that we can actually expand the number of those beds.
NDP
Gord Johns NDP Courtenay—Alberni, BC
I have one last, quick question.
What can be done to reduce the risk of relapse following involuntary treatment?
What wraparound supports are necessary after treatment?
Associate Professor, University of British Columbia, As an Individual
That is an interesting thing, because it's only if the involuntary treatment is inappropriate that someone would have an increased risk of overdose or death afterwards. Involuntary care, under section 31, for someone who has a substance use disorder or an opioid use disorder, would never withhold opioid agonist therapy. On the contrary, it would provide it in the form of, for example, depot buprenorphine, which would ensure that the person does not have an overdose that would kill them.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Vigo and Mr. Johns.
Thanks to all of our witnesses.
Ms. Brett, your testimony was extremely personal and powerful. We wish you and Jordan every success on your journey to recovery.
To Dr. Vigo and Dr. Knight, your presentations showed great patience, professionalism and expertise, and we are grateful for that.
Thank you all for being with us.
Is it the will of the committee to adjourn the meeting?