Health Committee on Dec. 10th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 145 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.

With us here in the room, from the Canadian Centre on Substance Use and Addiction, we have Dr. Alexander Caudarella, CEO. Online, appearing as an individual, we have Angela Welz. Representing the International Centre for Criminal Law Reform and Criminal Justice Policy, we have Dr. Peter German, president and executive director. Representing Planet Youth, we have Dr. Pall Rikhardsson, chief executive officer.

Thank you all for being with us here today. As I expect you have been advised, you have up to five minutes for your opening statement.

We're going to begin with Ms. Welz.

Welcome to the committee. You have the floor.

[Angela Welz, As an Individual]

Thank you for this opportunity.

My name is Angela Welz. I live in Edmonton, Alberta. Tragically, my youngest daughter Zoe died from an unregulated, poisoned drug supply. Zoe was a beautiful, smart, athletic, creative and determined young woman with a bright future whose life was cut short by the lack of harm reduction options for youth, inadequate on-demand voluntary treatment, restrictive, prohibition-based policies and a toxic drug supply.

Zoe began using substances at the age of 15 after her grandmother's passing and upon learning of her father's terminal cancer diagnosis. Drug use became a way for her to escape her overwhelming anguish and helplessness. After one of her friends died from drug poisoning, she asked for help to get sober, and we quickly investigated securing treatment care for her. We were told that she would have to travel to Calgary and that the wait was going to be at least three months. This wait was too long for Zoe. Ultimately, it failed. After that, she never brought up voluntary treatment again.

I first learned about Alberta's protection of children abusing drugs model, or PChAD, at a parent support group meeting. PChAD allows parents or legal guardians of youth under the age of 18 to ask the court for a protection order for their child. This protection order means that the child will be taken involuntarily to a protective safe house for up to 15 days for detoxification, stabilization and assessment.

In a state of desperation, I moved forward with the PChAD order, although I was apprehensive and felt intimidated by the process. After an emotional disclosure to an AHS counsellor, I was granted the requisition to go to court. I did not expect the open courtroom, which was filled with other family court cases. I had to stand before a judge, swear an oath and recount the circumstances that had led me to this point. I felt judged as a terrible parent, and the experience left me deeply traumatized.

I was granted the court order. Since it's valid for only 50 days from the time it is granted, the clock started to tick immediately. No opportunity presented itself to act on the order until a couple of weeks before it was to expire. Zoe came home feeling unwell. I took her to the hospital. She was given antibiotics. I was to bring her back every four hours for treatment. Given her aggressive infection, I pleaded with the ER doctor to admit her, but he refused. When the antibiotics were completed and while she was sleeping at home, I called the police to enforce the PChAD order. They arrived, woke her and escorted her out in handcuffs to a waiting police car in front of our home, with neighbours watching.

Zoe was furious and felt deeply violated and betrayed by this. At that moment, I realized what this process had done to our relationship and wondered if she would ever be able to trust me or any authority figure again.

While the staff at the safe house were kind, they provided little information, citing privacy reasons. Part of the detox is having family conversations, but that didn't happen because Zoe refused to see me. Near the end of her 10-day stay, she agreed to see me and begged me not to apply for the five-day extension, so I didn't. Zoe was released into my care at the end of her detox, with a follow-up treatment plan she chose not to share with me. I brought her home. Later that night, she ran away and met a friend she had made at the safe house. The next day, both girls were arrested for liquor theft. This was Zoe's first arrest, which brought on new challenges for her. Zoe died on November 7, 2016 from fentanyl poisoning, less than four months after her 18th birthday.

Let me be clear: Zoe didn't die from addiction. She died from a broken system and the unregulated and poisoned drug supply. Since my daughter died, I have learned that care should never be forced or coerced, and treatment should never be housed in a jail, as some provinces propose to do—including Alberta, which plans to move the PChAD detox program to the Young Offender Centre. How much further can we criminalize substance use, and how much longer will we cause more harm than good?

I have shared my lived experience and the tragic story of Zoe for years now on behalf of Moms Stop the Harm, but the deaths caused by the toxic drug supply continue at a rate that is catastrophic to so many families. As a country, we have regressed significantly, especially in the way harm reduction has been vilified by all political parties. Instead of being recognized as a vital tool in saving lives and supporting people of all ages who use drugs, harm reduction has faced misinformation and political resistance.

It is my hope that we can finally work together to come up with a comprehensive and compassionate plan, beginning with harm reduction services and on-demand voluntary treatment to help end these preventable deaths among youth.

A healthy recovery is possible only if people are alive and well supported. In my experience, involuntary care is not the answer to any hope of that happening.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Welz. Please accept our heartfelt condolences on the loss of your daughter.

Next, representing the Canadian Centre on Substance Use and Addiction, we have Dr. Alexander Caudarella here with us in the room.

Welcome back, Dr. Caudarella. You have the floor.

[Dr. Alexander Caudarella, Chief Executive Officer, Canadian Centre on Substance Use and Addiction]

Chair, vice-chairs and committee members, thank you for inviting the Canadian Centre on Substance Use and Addiction, or CCSA, today.

As you know, the world is rapidly changing. The impact of drugs and alcohol is pervasive. We recently hosted a delegation from the European Union Drugs Agency. We have much in common. We're home to multiple jurisdictions, communities, languages and cultures. There are several differences, but our work together is showing us that we're both facing a rapidly evolving drug landscape.

Drugs are increasingly everywhere and touch everything. This rapid evolution and the threat it poses to people's lives calls for creative, tangible and, perhaps most importantly, reproducible innovations that save lives. There isn't a silver bullet, but I believe our future will be saved by millions of little things and everyone has a role to play. We have much to learn from each other.

However, Canada has earned a reputation as a land of one thousand pilot projects. When it comes to moving beyond these efforts, we have much to learn from each other and from listening to communities and diverse perspectives. Every community deserves to feel safe, and every person deserves access to the services and care they need where and when they need it. Those two concepts can and must coexist.

We’ve had some successes in bringing communities together. For example, CCSA is working with mayors of small cities across the country to create the first municipally led pan-Canadian playbook of evidence-based solutions for the substance use crises so many communities are experiencing. This involves bringing together all facets of a community. We know that people are tired of being lectured by experts and having their real concerns discounted. They want menus of options they can tailor to their communities. Together, we are working towards actionable solutions, adaptable to local realities, community goals, and budgets.

We find ourselves in interesting times. We know what is needed and what works, but we have failed to implement it robustly. Fewer than 10% of people have access to the care they need. Opioid agonist rates in Canada are half of what they are in Europe. There's little accountability. We don't set ourselves goals. We don't set ourselves timelines. We know that there's an increased capacity for need and for future planning, but we continue to just react. We don't live and invest in appropriate community and family prevention, and we don't create the right community environments. Specialists and specialty services won't save us. We need recovery-informed environments and whole health systems, ones that can prevent harm but also help people get well and stay well.

We have an implementation problem. We need innovation. There isn't a one-size-fits-all approach. We can't tell people what works and we can't go about doing blanket bans on things, either. What we need now—what we needed yesterday—is real impact. We're trying to build a future. Please help us arm it with evidence-based tools to make it a reality.

We should start with what we know works. We need coordinated access and treatment options. For example, for alcohol and opioid use disorders, there's an injectable form of naltrexone. It's shown incredible promise in helping people stay on their path to health. It's even shown promise with methamphetamines. It's a monthly injection. It's an innovation in substance use health care. It's more empowering than going to the pharmacy every day. Injectable naltrexone remains unavailable in Canada.

There’s an important discussion currently taking place in Canada around mandatory treatment, and it’s a great example of what requires a holistic approach. The current conversation largely ignores key aspects: What are we trying to achieve, and how will we achieve it? As a physician, I can tell you that I have no problem keeping people in hospital beds to save their lives. As a society, we need to talk about what it would mean to support people forced into treatment.

As a field, we keep making the same mistake over and over. We need to stop closing our eyes to the reality that there is no intervention that won't cause harm. We must weigh the benefits and the risks and make informed decisions. We must also engage in interventions with our eyes wide open and prepare for unintended consequences. The flexibility needed is what makes differences between jurisdictions that succeed and ones that don't. We must elevate the conversation beyond ideology. If we don't, more people will die and more communities will suffer.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Caudarella.

Next, from the International Centre for Criminal Law Reform and Criminal Justice Policy, we have Dr. Peter German.

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

[Dr. Peter German, President and Executive Director, International Centre for Criminal Law Reform and Criminal Justice Policy]

Thank you, Mr. Chair.

Thank you for the invitation to appear before the committee. I regret that I'm not able to join you in person.

Allow me to introduce myself. I was a member of the RCMP for 31 years, rising from constable to deputy commissioner. I also served as deputy commissioner of Correctional Service Canada.

Since retiring from government, I have authored various reports on money laundering and, more recently, on port policing. I teach at a law school, provide expert opinion evidence and am the author of a text respecting Canada's proceeds of crime legislation.

As president and executive director of the International Centre for Criminal Law Reform and Criminal Justice Policy, I have the privilege of guiding our institute as its associates undertake projects within Canada and abroad.

I applaud this committee for examining the drug crisis on our streets. As a long-time resident of Metro Vancouver, I can state without hesitation that the situation today in the Downtown Eastside is worse than I have ever seen before. It has become a wasteland stretching for many city blocks. People are dying at a greater rate than we saw dying of COVID. Small decreases in the number of weekly deaths do not take away from the fact that this part of Vancouver resembles what has been described as an open-air hospice. There are thousands of human beings bent over and struggling to survive.

The housing crisis exacerbated existing issues: the depopulation of our mental institutions, drug addiction and the outflow of indigenous people from traditional territories.

There was a time when you could walk the streets of the Downtown Eastside in peace; not anymore. Many who live on the streets are carrying weapons for self-protection.

The crisis also extends farther afield to the suburbs of Vancouver and the interior of B.C., exemplified by the 2022 murder of an RCMP constable by a homeless person in Burnaby.

I do not pretend to have a cure for this crisis, and many smarter than I have proposed solutions. I believe it is safe to say that all solutions to date have failed. The number of people on the streets far outstrips the services available to them. Prevention, including education, is vital; so is treatment. My heart goes out to our first witness, Ms. Welz, for what she has gone through.

The one word I do not hear, however, is “enforcement”, yet it is through enforcement that we get drugs off of the streets. With the necessary amendments to our criminal sentencing guidelines, it can also allow us to provide individuals with a treatment option.

Canada has been referred to as a high-value, low-risk country for transnational organized crime. It provides a platform for criminals to undertake their activities.

All of those things that make Canada a desirable place to live also make it desirable to organized crime. Combine these benefits with a criminal justice system that does not provide swift justice or certain sentences, and we as a country become an easy target for organized crime.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

No.

[The Chair, Liberal, Sean Casey]

Please mute your mic, Mrs. Goodridge.

Go ahead, Dr. German. I can assure you that that was inadvertent.

[Dr. Peter German]

Thank you.

For decades, Canada was a prolific exporter of marijuana. Organized crime has moved into the production of much more serious drugs, including fentanyl and methamphetamine. The discovery of super labs in B.C. is emblematic of this evolution. Canada now has the unenviable reputation of being an exporter of deadly drugs, primarily to Asia and Australia.

Unfortunately, it is difficult for police and prosecutors to maintain complex prosecutions. Well-intentioned judicial decisions have all but tied the hands of police and prosecutors through onerous disclosure requirements, which run up against restrictive time limits for prosecutions. For example, in British Columbia, there are virtually no prosecutions occurring for money laundering. There is a plethora of reasons why criminal investigations and prosecutions are much more difficult to undertake in Canada than in the United States.

Closely allied to the foregoing is the security of our borders, which literally define Canada. We need a secure border strategy to put criminals and others on notice that we are no longer easy prey.

Securing Canada's border starts with our leaky ports. We have no dedicated police in our ports. The Ports Canada police was abolished in 1997, replaced by fences, cameras and security guards. Inadequate resourcing of the RCMP has resulted in a dramatic decrease in its ability to undertake controlled deliveries of illegal substances.

The CBSA has a minuscule capacity to examine the millions of containers entering our ports, many of which are then transshipped by rail or truck to the United States. The merger of CP Rail and Kansas City Southern now makes it easier for cargo to transit from Mexico to Canada and back. While the United States has a dedicated border patrol, Canada relies on the RCMP to provide border coverage as an adjunct to other pressing policing duties.

Members of the committee, the status quo is untenable. Simply throwing more money and resources at the problem is like adding furniture to a sinking ship. We can do better. This will require political and bureaucratic will, but most of all, a national strategy to deal with the crisis on our streets. We must no longer be a patsy for organized crime, allowing it to traffic drugs and launder the proceeds. That strategy must involve the federal and provincial governments and include a strong enforcement component.

Thank you. I'm most pleased to answer any questions that you may have.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. German.

Finally, I believe from Iceland, representing Planet Youth, we have Dr. Pall Rikhardsson, chief executive officer.

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

[Dr. Pall Rikhardsson, Chief Executive Officer, Planet Youth]

Thank you very much, Mr. Chairman. It's an honour to be here.

My name is Pall Rikhardsson. I'm the chief executive officer of an organization called Planet Youth. We are dedicated to exporting and adapting the Icelandic prevention model to different contexts around the world.

I want to explain what that particular methodology is.

The Icelandic model is a system of prevention focused on demand reduction when it comes to alcohol, tobacco and other drugs. It originated in Iceland. It was developed back in 1995 or 1996, when drug and alcohol use was running rampant among Icelandic youth. If you asked a random teenager back then whether he or she had consumed alcohol and been drunk in the past 30 days, the answer was yes, at 42% or 43%. If you ask a random teenager today in 2024, 6% will answer yes to that question.

The methodology was developed over time. We at Planet Youth have systematized how this model is implemented and adapted to different contexts. We are currently in 22 countries, operating with 53 partners—15 in Canada are focusing on adapting the model. The model itself is based on sociological theories dating far back about the importance of the social environment for kids. In every kid's life, there are four factors that are very important in the social environment, and very important for how they develop and behave: family, peer group of friends, leisure time and school, since that's where they spend most of the time. The tenets of the Icelandic prevention model focus on changing the social environment and these factors so that kids, as they're growing up and becoming teenagers, will make different decisions, which impacts the risk of them becoming substance users.

The model itself is based on different principles and focuses on the social environment, not on individuals. It doesn't focus on telling kids to just say no. It focuses on changing the social environment around them, so they will behave differently when they grow up. It emphasizes community. Community action is at the root of this prevention system, so we engage and empower that community through data and the ability to define actions based on that data. It also acknowledges that this is a challenge that just takes time. It is not a magic solution or silver bullet. This is something that needs time to work.

The method itself is based on 10 steps. The first two are preparation. The next three are collecting data from the children and giving them a voice so they can tell us how they are feeling and about relationships within the four domains I described earlier. After that, the data is put to work. We define actions and dissemination strategies. Then we implement those over time. Now, the data element is critical. All of our partners base decisions about what to do on data. In the model and in our work, getting data back to the partners within eight weeks, regardless of how many students are surveyed, is critical, so they're basing decisions about the kids on fresh data—right here, right now.

The guidance program we run is divided into five-year processes or programs. The first year is when we establish a baseline. There's a knowledge transfer. Then we define what to do, implement that and measure again in the third year—not the same kids but rather the kids subjected to the interventions. Basically, we're measuring the impact of interventions, not individual kids. The fourth year is an implementation year, and the fifth year is a measurement year again. The whole idea is that communities become self-sufficient and continue this process without the help of us or other agencies after that.

We are very much focused on the impact of this. Like I said, we're in 22 countries with 53 partners, and we are running evaluation studies of the interventions being carried out in those contexts. To reiterate, we are not exporting what was done in Iceland. The model does not include interventions. We're exporting and adapting the process by which these results were achieved in Iceland. The interventions and actions always have to be contextual, as we are seeing in the Canadian projects.

The evaluation studies do support that this is having an effect, both on the processes that are being carried out and the impact of the protective factors on the outcomes.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Rikhardsson.

We'll begin our rounds of questions with the Conservatives for six minutes.

Ms. Goodridge, go ahead, please.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Mr. Chair.

I want to thank all of the witnesses for their testimony here today.

Ms. Welz, I'm deeply sorry about the loss of your daughter.

Mr. German, I apologize for interrupting you. I have a sick little guy at home, and I was explaining to him in the background why he couldn't get Alexa to play stuff.

Just to get started, you co-authored a report in 2023 entitled “Policing Our Ports”. What core issues did you identify? What were your key recommendations from that?

[Dr. Peter German]

Thank you, Ms. Goodridge. I have two grandchildren. I understand exactly what you're dealing with.

Essentially, the report highlights the fact that there are no port police in Canada. How do illegal drugs and human cargo, for example, and other commodities that organized crime traffic in get into our country? They have to come in through the border. That means by plane. It means by vehicle. It means by railway. It means by ports.

Vancouver, for example, is our largest port in Canada. Millions of containers come into this port all the time. There is a lot of contraband coming in. There are seizures. We know that contraband arrives, and yet we have no dedicated port police. That was the number one issue. Our port police, as I mentioned in my opening statement, were abolished in 1997. They have not been replaced. Then there's the federal component. The RCMP simply doesn't have the resources to do what they used to do in the ports.

That would be essentially what we highlighted.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

From my understanding of the Vancouver Fraser Port Authority's terminal, approximately three million containers a year go through that port. Is that correct?

[Dr. Peter German]

At least, yes; there is an expansion under way at Roberts Bank terminal, correct.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

How many of these containers are searched for drugs versus how many are not searched?

[Dr. Peter German]

I don't believe CBSA releases that number, but we know that it is a very, very small percentage. They would not release that information to us. We also know that even fewer are searched outgoing. As I mentioned, Canada, being a producer nation of drugs, is exporting drugs. Those drugs will oftentimes go by way of ships.

It's a very small percentage. About 30% of what comes in is transshipped into the United States. It actually falls to the United States to do our job for us if we can't do it.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Does this make Canada especially attractive to organized crime?

[Dr. Peter German]

Yes. As I indicated, a number of factors make Canada attractive. I mean, all the good things about Canada make it attractive. We have good transportation, good communications, good governance and all of those things. It means a very stable environment.

We also have a criminal justice system where we don't lock people up and throw the key away. Even getting there is difficult. It is very difficult for police and prosecutors to maintain complex cases. You see money-laundering cases falling by the wayside time and time again. You see police throwing their hands up in frustration trying to make financial crime cases, conspiracy cases and so forth. It's just very difficult to obtain a conviction.

If you're transnational organized crime, what better place to hang out?

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Does this lead to the fentanyl epidemic we're seeing here in Canada, as our ports are so leaky?

[Dr. Peter German]

Well, it's certainly one avenue for access to Canada. Fentanyl, as we know, is an extremely dangerous drug. Organized crime traffics in fentanyl, just as they do in methamphetamine. If it's not produced here, then it has to come here somehow. It either crosses the U.S. border or comes in through the ports or airplanes. We actually do a pretty good job of interdicting drugs coming in by air, if they're on the person. Air cargo is a little bit different.

By far and away, though, most cargo entering our country comes via the ports. That is why ports are so important.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you. I find that, actually....

Is there a difference between how we treat our ports in Canada and how the port is looked at in Seattle?

[Dr. Peter German]

We highlighted that in our report. We looked at the American model. The American model is about having, generally speaking, port police. The port police are sometimes a transportation police. For example, in Seattle, our nearest city to Vancouver, they have a well-established port police force that looks after the Sea-Tac airport—the international airport—as well as the seaport.

We also talked to port authorities in Seattle and elsewhere. They can't say enough good things about their port police, because they provide a form of community policing. They know everybody. They know management. They know the unions. They know the terminal operators. They can resolve a lot of issues that our municipal police department simply can't, because they are not in the ports.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge. That's your time.

Next we have Ms. Kayabaga.

Go ahead, please, for six minutes.