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.
Associate Professor, University of British Columbia, As an Individual
Psychosis is a syndrome that affects cognition. It entails, for example, delusions and hallucinations, and is very frequent in certain mental disorders, such as schizophrenia or bipolar disorder type 1, so it is a syndrome as part of a disease.
What is holistic psychiatry? Was that the second question?
Associate Professor, University of British Columbia, As an Individual
That refers to the B.C. Mental Health Act, which indicates that when someone requires detention under section 22 of the Mental Health Act, then that person can receive treatment under section 31. That treatment needs to be psychiatric treatment.
Now, for a while there has been a lot of confusion and back-and-forth as to what psychiatric treatment means and what can be provided under section 31 of the Mental Health Act.
What I was indicating is that once someone meets criteria for the Mental Health Act, meaning they have a mental impairment that results in their inability to take care of themselves—with physical and mental deterioration, risk to self and others—and there is a treatment that could help them, but the person is unable to comply or engage with it, then you can provide the treatment as a psychiatrist under section 31. That treatment needs to be psychiatric treatment, meaning that you cannot, for example, say that this person has a psychotic syndrome because they have a brain tumour, so you're going to indicate brain surgery under section 31. No, you need to provide things that are under the specialty of psychiatry, which means any psychopharmacological approach, including, for example, a combination of antipsychotic medication and buprenorphine.
The distinction here is on buprenorphine or any other psychopharmacological approach that is within psychiatry and its subspecialty, such as addiction psychiatry. The distinction is important, because many of our patients with severe mental illness and substance use disorder do require a combination of these two, and other medications and other psychotherapeutic approaches. That is what I call holistic psychiatric treatment—something that can be provided voluntarily 99% of the time and involuntarily when needed, and can address the person as a whole.
Does that make sense?
Liberal
The Chair Liberal Sean Casey
That's your time. Thank you, Ms. Sidhu.
Next is Dr. Ellis, please, for five minutes.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Thank you very much, Chair, and thank you to the witnesses.
Dr. Knight, I have a couple of questions for you, if I might. You talked about evidence-based treatment with respect to opioid use disorder, substance use disorder, etc. Can you tell us exactly where the so-called safe supply fits in that? What is the evidence?
If you have some evidence, I think it important that you table that with the committee.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
There are some reasons I deliberately didn't talk about prescribed safer supply in my recommendations, and that is partly because I feel, in reading the evidence that exists to date, that we don't have a clear picture of the role of prescribed safer supply.
I do want to highlight that it really is an intervention that is trying to decrease people's reliance on the illicit toxic drug supply, and that there are other mechanisms to do that as well that could be considered, including what Dr. Vigo talked about in terms of the regulation of drug supply.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
This is your area of specialization, Dr. Knight. This is what you do. If I hear you correctly, realistically, the use of, as you call it, “prescribed safe supply”.... From some of the testimony we've heard, I'm not entirely sure how much prescribing is going on, simply because there doesn't always appear to be a significant doctor-patient therapeutic relationship that exists. That being said, what I heard you say just now is that the scientific evidence related to that is minimal.
Let us consider that what we're seeing with this so-called safe supply is an experiment with a terribly vulnerable population. Is that what you see it as?
Yes, I agree that perhaps the intent was to save lives, but there's no evidence, and of course you mentioned in one of your statements that it's important that we use the best evidence there is.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I'd like to clarify that my position is not that there is no evidence for prescribed safer supply. My position is that there is conflicting evidence. We know that there are some benefits for people who access prescribed safer supply, and we know that there are some potential harms. What is not clear is where that balances out in terms of risks and harms. Any time we do any intervention, that's the question; is the balance of benefits higher than the balance of harms?
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
I'll just interrupt you there, Dr. Knight.
When you look at this—again, you talked about the evidence—I think it important that the evidence you cite be tabled with the committee. Would you undertake to do that, please?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
Yes, I can send some evidence to the committee, absolutely.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
As we've heard, not just today but multiple times from many witnesses, this is an extremely vulnerable population. Would you agree with that?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I would agree that lots of people with substance use disorders have aspects of vulnerability. There are lots of people who have substance use disorders who are highly functioning people in our society as well. I go back to the idea that, really, people—
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
I'm sorry, Dr. Knight, I just have limited time.
Does it make sense, then, without their consent, to do experiments on vulnerable populations who may or may not be impaired by substance use...or on anybody?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I said this earlier, in one of my comments. When we're doing scientific research, there are checks and balances in terms of the ethics and in terms of—
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Dr. Knight, there were no checks and balances with so-called “safe supply”.
Do you think that folks who were receiving so-called “safe supply” consented to it being an experiment?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
I can't speak to the individual conversations between the prescribers and the people who received safer supply, but it would be general medical practice to discuss the risks and benefits of any treatment with individuals.
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
I think, Dr. Knight, we've established already that many folks who received so-called safe supply didn't even have a doctor-patient relationship with their prescriber, so how could you possibly think that they gave any consent to be part of an experiment?
Please. I mean, you're a scientist. I think this is basic science, is it not?
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
This brings us back to the need for recommendations on a national level in terms of what the requirements are for a provision of—
Conservative
Stephen Ellis Conservative Cumberland—Colchester, NS
Dr. Knight, this is about a basic science experiment gone wrong.
December 3rd, 2024 / 12:25 p.m.
Liberal
Liberal
Élisabeth Brière Liberal Sherbrooke, QC
Thank you to all the witnesses for being with us today.
Dr. Knight, I want to give you an opportunity to tell us a bit more about Digital Front Door and the Rapid Access to Addictions Medicine Clinic.
Associate Professor, Departments of Psychiatry and Family Medicine, University of Manitoba, As an Individual
The Digital Front Door is something that we've rolled out in Manitoba relatively recently based on the experience out of Ottawa on increasing the accessibility of different avenues for getting connected with addiction medicine treatment, particularly for people who live in areas where they may not have physical access to an addiction clinic or who have other barriers to accessing service. It's really an alternative door, through either a computer or a smart phone, to be able to essentially get the same rapid access to addiction medicine services as if you physically walked through our door.
