Health Committee on Dec. 10th, 2024

[Arielle Kayabaga, Liberal, London West, ON]

Thank you, Chair.

I would like to extend my condolences, as well, to Ms. Welz. Thank you for your continued work and advocacy, and for keeping your daughter's memory alive.

I also extend a welcome to all of our witnesses.

Perhaps I can start with you, Ms. Welz.

Could you share a bit about the continued stigma around those who are struggling with addiction? What are your thoughts, and what suggestions would you make to see that evolve?

[Angela Welz]

Thank you.

I've been working, for over eight years now, to try to mitigate stigma. It's a very uphill battle. The narrative has to change among so many of us, and we just aren't there yet. We use stigmatizing language. We put people down, particularly people who use drugs. People use drugs for a variety of reasons. My daughter started using drugs to cope with the loss of her grandmother and the potential loss of her dad. He died 18 months after she did. It's been very difficult, and it's a cause very dear to my heart.

I don't know what the answer is to that, but it has to start pretty much at the upper levels. Words like “addict” are very derogatory. Using words like “clean” doesn't do anything. It implies that people using drugs are dirty. We need to move forward and change some of the narrative, and some of the derogatory and stigmatizing words we use. There has to be a national educational piece to try to change that. It's very difficult, because it's been ingrained in so many of us for so many years. The war on drugs created that. It's upward of 50 years now that we've been dealing with some of this stigma.

Unfortunately, I don't really see that changing any time soon, unless we, as people, make those changes ourselves.

[Arielle Kayabaga, Liberal, London West, ON]

You talked about the harms and dangers that the laws for protecting children abusing drugs in Alberta created for your daughter.

Can you expand on that? What would you suggest be done differently?

[Angela Welz]

As I mentioned, when parents end up going to the PChAD program in Alberta, it's out of desperation. We have nothing else left in our pocket or tool box. I tried every which way to get Zoe into voluntary treatment. She felt completely blindsided by her substance use and by how it affected her so badly. She didn't want to be a burden on the family because we were dealing with her dad's cancer. She didn't want to cause more harm in that way. We tried several times to get her into voluntary treatment. However, as I said in my testimony, three months is a long time to ask anybody to wait, particularly a youth of 15 or 16 years old. It also means they have to stay abstinent because, for most of these treatments, you need to be abstinent. Asking anybody at the age of 15 or 16, let alone an older person, to be abstinent for that period of time is very complicated.

I applaud Planet Youth. I think that's a very good way to start to have a conversation around youth.

Involuntary care, as I mentioned in my testimony, was horrifying not just for her but also for the rest of the family. I knew when I enacted the court order that I had made a huge mistake, and there was no way I could turn that back. Unfortunately, I saw the ramifications of that. It did much more harm than good.

[Arielle Kayabaga, Liberal, London West, ON]

Thank you so much for sharing that.

Just to tie it in a little bit with that, Dr. Caudarella, you talked about accountability, and I wondered what that looks like for you. In your comments about prevention, you talked about making sure that the families and the environments are right.

What are you suggesting that we could do to have better environments and communities that are preventing children from growing up to become part of this disease that has grabbed our communities?

[Dr. Alexander Caudarella]

On the second one first, look, the good part is that we know that supporting families and social environments, as our colleague from Iceland spoke about, works really, really well.

What we also know is that those kinds of environments not only help people not develop substance use issues, but then, also, what's going to happen to them when they leave treatment, right? You're talking about people who have 10, 20 and 30 years of life after that. They need to stay well. These kinds of environments are really, really key.

One of the things that's most in common across all these things, and it is dramatic, the differences.... For example—

[Arielle Kayabaga, Liberal, London West, ON]

I apologize, but what did they look like, just so we can take those notes?

[Dr. Alexander Caudarella]

What did they look like?

[Arielle Kayabaga, Liberal, London West, ON]

I think we're running out of time.

[The Chair, Liberal, Sean Casey]

That's your time.

We'll have a brief answer, please, Dr. Caudarella.

[Dr. Alexander Caudarella]

Briefly, they look like teaching parents how to be parents. Many people didn't have parents who taught them what parenting looks like. It means going to places where maybe alcohol and drugs are not a necessity to participate in social things. It means having access to prosocial sports and different things.

Very quickly, I'll say for the accountability that it means tracking things. It means evaluating, but it also means setting ourselves targets. We have to talk about more than just death. Death is one measure that's really hard to control. We have to talk about it and set ourselves goals about what is an ideal percentage of people on OAT. What's an ideal percentage of people in wait times to treatment, for example?

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Caudarella.

Mr. Thériault, over to you for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Ms. Welz, I want to start by saying that my thoughts are with you. Your participation in this study and what you're doing honours the memory of your daughter.

The witnesses here today are coming at the problem from different angles, and that's a good thing. Some talk about prevention, some talk about treatment, some talk about harm reduction and some talk about enforcement. We need all of that to try to solve this complex problem.

I'm going to start with Dr. Caudarella.

In your presentation, you said that we know what needs to be done and we know what works, but we haven't been able to put it into practice in a meaningful way. Why is that?

[Dr. Alexander Caudarella]

I think there have been issues with co-operation. The crisis has caused a lot of heartbreak. In response to that, the federal and provincial governments created a thousand different regimes, each proposing a different solution, and I think that ultimately didn't help the situation.

We don't spend a lot of time talking to the communities themselves to find out what they need. We think we know what needs to be done. As you said, people know the drug component or the prevention methods, for example, but it's not a matter of choosing one or the other. All aspects are important, and we have to find a way to integrate them all.

Right now, we're pitting one community against the other, even when we're talking about forced treatment. We're not discussing anything tangible.

I would say that the problem is really one of communication.

[Luc Thériault, Bloc, Montcalm, QC]

You say that we need to raise the debate above ideological issues. I don't want to ask an ideological question by highlighting that, but what are you referring to?

[Dr. Alexander Caudarella]

If it were any other area of public health, people would naturally accept the idea that there needs to be a spectrum of interventions and that each area of intervention has a role to play.

Let's take the example of Czechoslovakia, which decriminalized drugs. When it did not get the hoped-for result, it criminalized them again. Then it decriminalized them a second time, but in a different way. It's a learning process. It's not that some things are fantastic and some things are terrible. Each thing is terrible and fantastic at the same time.

[Luc Thériault, Bloc, Montcalm, QC]

You say there's an injectable form of naltrexone. I'm not an expert, but I know that there's a molecule called buprenorphine, which, according to your presentation, seems to have the same effect, and it's available in Canada.

These substances would make treatment much easier, since they're injected once a month and completely change the way the person's brain works. We know that a drug addict's world revolves around their daily use, so if they have everything they need to avoid experiencing adverse effects for a month and are even protected from overdoses, that changes the situation.

Why not focus heavily on that solution?

[Dr. Alexander Caudarella]

You're right, but I would like to clarify something. Buprenorphine and methadone are agonists. So they're opiates. Nealtrexone, on the other hand, is an antagonist, meaning that it blocks the effect of opiates.

Now, I would really like to know why you can have a family doctor in this country, but you can't be prescribed buprenorphine, for example. It was possible in France during the heroin crisis in the 1990s.

Naltrexone is an antagonist, which means it's the opposite of buprenorphine, but it's one of the only drugs available that can be used to treat methamphetamine and opiate addiction in Europe and the U.S. Some people can't or don't want to take buprenorphine, so naltrexone is another very effective option for people who don't want to take an opiate for several years. It's been prescribed in the U.S. for over 20 years.

[Luc Thériault, Bloc, Montcalm, QC]

Before we even think about mandatory treatments, we need to know why it's so difficult to access voluntary treatments. Why do you think that is? Ms. Welz's testimony is quite eloquent in that regard.

[Dr. Alexander Caudarella]

There are many reasons for this.

First, these treatments aren't accessible. No triage system is in place to ensure that people receive the most suitable treatment.

Second, why do family doctors know exactly where to send a person with diabetes, but have no idea where to send people who ask about addiction treatment?

We can talk about involuntary treatments. However, before that, there are various rather coercive forms of treatment.

For example, the CRAFT approach focuses solely on the interaction between the person and their family, rather than on a professional interaction with the individual. This approach increases the chances of the person receiving treatment by 700%.

We also know that, for some doctors, the success rate in treatment is 90%. We tell them that they must enter treatment or lose their right to practice medicine.

There are many different models.

Moreover, less than 8% of employers in the country have a policy on the treatment of addiction. This means that 90% of workers—most of them—have no course of action if they ever face an addiction problem. This is an issue.

That's why the treatments aren't accessible.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Caudarella and Mr. Thériault.

Next we'll go to Mr. Johns, please, for six minutes.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Thank you.

First, I want to thank all of the witnesses. I agree with Mr. Thériault that this is an excellent panel with regard to a wide spectrum of harm reduction, treatment, prevention, education and enforcement. It's critical that we have a comprehensive response.

Dr. Caudarella, you talked about the lack of a plan, the lack of a timeline, with the CDSS. They talk about an integrated, coordinated model, but there is no timeline, no plan and no resources to implement it.

I tabled a bill, Bill C-216, which was defeated two and a half years ago. That bill was to put forward, within a year, a plan. I know that some of my colleagues supported it. They wanted to see a two-year window to come back with a plan to respond.

Can you talk about the importance of actually having a plan, what other countries have done—like, say, Portugal—and how they've responded to health emergencies when it comes to substance use?

[Dr. Alexander Caudarella]

Thank you.

You'll recall that in my last testimony, I spoke a lot about the need for a whole-of-government approach. It cannot be the departments of mental health or mental health and addictions. It has to be everybody, like we heard before: law enforcement, public safety and health, but also the social services. Everyone has to come to the table.

Yes, there's no federal plan, but I don't know that there's a province that has a good plan with timelines very specifically set out. Again, if this were diabetes, heart disease or cancer, we'd say that we want our treatment rates to get to x by x date. Why are we so afraid to set those timelines and dates?

On the last part, I'd say this. This is going to sound funny coming from a national organization, but we need to have a laser focus on individual communities. They have spoken loudly: They do not want to be told what to do. For example, in the spring, in Lethbridge, Alberta, we're going to be hosting not just a big meeting but the next kind of plan for our small towns. We want to present the evidence to mayors, to decision-makers, and let them decide.

They need a menu of options. They don't need to be told what to do. We need objectives at a national level, but we need to facilitate local players to make the decisions that are right for them. I think that's critical, and that is what jurisdictions have done really, really well.

The last thing I'll say very quickly is that when we talk about risk reduction, that changes now too. It's not just risk to self. We need to start talking about the risk of violence and the risk to society and what we need to do more broadly.

[Gord Johns, NDP, Courtenay—Alberni, BC]

I'm just going to build on that really quickly.

You were actually at the Timmins summit, I believe, and we—the New Democrats—have been calling for a national summit. We had a national summit on auto theft, but this toxic drug crisis has killed more people than COVID, I believe, at this point. Can you talk about the importance of that happening?

Also, you're working with the mayors, I think, the small and big city mayors, in terms of localizing the response. Can you speak about the importance of that, and in a short response, if you could?

[Dr. Alexander Caudarella]

We've had a number of national events. We think that biting off a little bit that you can chew.... We did one with family doctors. We did one with families about how to approach prevention. Now we're doing one with small-town mayors; they have the same problems as big cities, with less money and less resources. They want to get stuff done.

I will tell you that we had people with “Drug Free” in the name of their organization, and we had provincial harm reduction coordinators, and they got along in those meetings. They want to work together. They want to find solutions that work for them. When you put people together in a room and ask them to take something tangible and walk out with solutions, they get along and they work, because at the end of the day everyone wants a healthier Canada.