Health Committee on Nov. 1st, 2023

[Ya'ara Saks, Liberal, York Centre, ON]

What I will say is that stigma continues to be one of the biggest barriers for individuals who are struggling with substance use in getting help. When, because of stigma, they feel they can't go for help or support, whether it's safe consumption sites, which save lives.... As a matter of fact, 50,000 overdoses were overturned, and 4.1 million individuals who were able to use safe consumption sites are here with us today and able to manage their substance use or to seek treatment.

I will say this: We have to take this step by step. This is an all-of-government approach, which means that we need both provinces and municipalities to be on board in the steps that we take.

B.C. made a bold move in its decriminalization. It asked the federal government for its pilot. We are continuing to evaluate and monitor that to understand what works and what makes sense. I understand you in terms of the urgency, but we also want to make sure that we're moving with an evidence-based approach that really looks at a comprehensive set of tools.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Thank you, Mr. Morrice.

Mr. Thériault, go ahead for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

You know that I have a special interest in this issue. I sit on the Special Joint Committee on Medical Assistance in Dying, which was recently reconstituted.

In its first phase of consideration of mental disorders as the sole underlying medical condition, the committee did not see fit to make a recommendation to the House right away.

We studied the report of the experts on mental disorders, who put in place a number of guidelines, some of which are not present in other cases involving medical assistance in dying. I imagine that you have also studied that report.

Briefly and perhaps as a preamble to a future appearance before the committee, what do you have to tell us this evening about the state of readiness in this regard?

[Ya'ara Saks, Liberal, York Centre, ON]

Thank you.

I'd like to clarify first.

It may be an interpretation issue.

What I'm hearing is “mental health” and not “mental illness”. We are talking about mental illness as the sole determinant in terms of MAID—first and foremost.

A significant—

[Luc Thériault, Bloc, Montcalm, QC]

I am indeed talking about mental disorders. I didn't say “mental health”. It was probably the interpretation services that got it wrong. I did say “mental disorders”. I know very well what I'm talking about.

[Ya'ara Saks, Liberal, York Centre, ON]

I'm just checking.

I just wanted it to be clear. Thank you.

At this point in time what we know is that extensive work was done from the recommendations previously to provide regulatory bodies across the country with strong assessment tools, with the preparation of over 300 medical practitioners so far and a set of guardrails that will ensure that, when evaluations are being done with mental illness as the sole request for MAID, practitioners feel that they are well equipped to understand what is going on.

What we did hear, though, which was why the committee has been struck, was that there needs to be a deeper understanding of those preparatory measures that were put into place to ensure there is a comfort level in moving forward. I would also add that I think this is a very personal issue. For many individuals around the country, for many Canadians, it is difficult to understand and comprehend that it is one's right, with their health practitioner, to have these very important discussions about the choices they make.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Thank you, Mr. Thériault.

Next we have Mr. Johns, please, for two and a half minutes.

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

Minister, the substance use and addictions program has continually been oversubscribed. In 2021 there were applications and proposals of up to $350 million, and the amount funded was $59 million. There is still no funding allocated in the budget for SUAP beyond 2024-25.

Can you provide a breakdown on how many proposals the government received in 2022 and 2023 for SUAP as well as the total funding versus the total amount funded?

[Ya'ara Saks, Liberal, York Centre, ON]

I can tell you the number of projects that we are funding by province and territory, but if—

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

Would it be something that you could table for this committee?

[Ya'ara Saks, Liberal, York Centre, ON]

I believe the officials can table that information.

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

Minister, you can hear the urgency in my voice.

I went to Portugal. There were six deaths per million based on drug-related deaths. Canada is at 180 from the poisoned drug supply. B.C. is at 430. My Island Health is at 503. In my community, for those under the age of 59, it is 2,100 deaths per million. This is from fentanyl and benzos. This is not from a safer supply. This is from a street supply—“tranq”—of mixed drugs.

This government had an expert task force made up of police chiefs, social workers, experts in drug policy, expert people with lived experience and indigenous leaders. They made clear recommendations that you needed to stop criminalizing people who use substances, provide a safer supply to replace the street drugs and ensure that you invest heavily so that we have “just in time” treatment, recovery, prevention and education. You haven't done that. It hasn't been done at the scale that's needed.

I want us to get to six. We can have hope that we can get to six deaths per million. Every death is too many. When are you going to come up with a plan, and will you reinstate the expert task force so that they can guide your government on recommendations and hold you to account in making sure you have a plan and timelines to implement it?

Will you reinstate that task force to do that?

[Ya'ara Saks, Liberal, York Centre, ON]

What I will say is that at this time we have done a renewed launch of the CDSS to enable us to look not just at what the experts have to offer specifically on the toxic drug supply and those who use substances, but also the other social determinants that feed somewhat into individuals who are struggling.

I've seen some positive news. The Yukon has declared a state of emergency and has provided a comprehensive plan of how they wish to go forward in addressing their toxic drug supply and overdose crisis. B.C. also has a plan that we've been working on with them.

As I said before, the urgency is there. We know the urgency is there, but we also need the provinces working with us on going forward with that. I'm committed to working with every province and territory that comes to us and says, “We need help in getting a plan forward that makes sense for our province and our jurisdiction.”

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

Thank you, Mr. Johns.

Colleagues, we find ourselves in about the exact position that we did on the last panel. We have about four to five minutes left.

I'm going to suggest two minutes for the Conservatives and two minutes for the Liberals, and call on Dr. Ellis for two minutes, please.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

Thank you to the minister for answering questions and being very well prepared this evening. I appreciate that.

I have a very quick question around medical assistance in dying. We talked a bit about mental disorders as the sole underlying medical condition. Many folks out there believe that is simply around depression. Am I to be clear that you would support the frameworks that are now out there, that those who suffer from substance abuse and choose MAID...that you would support that, Minister?

[Ya'ara Saks, Liberal, York Centre, ON]

Just to clarify, anyone who is in a state of crisis, whether it's suicidal ideation or struggling with any kind of disorder in a crisis environment, would not be eligible for MAID.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I understand that, Minister, and certainly that becomes one of the problems: distinguishing between suicidality and someone who wishes to end their life.

My question is very specific, though. Under that provision—MAID for those with a mental disorder as the sole underlying medical condition—would you support the framework that is out there now for those with addictions?

[Ya'ara Saks, Liberal, York Centre, ON]

I think it will be the will of the committee to determine whether the measure that we put in place to assess with regulatory bodies is working and whether we need to do further evaluation on it at this time. It will be the will of the committee.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Through you, Chair, maybe I could word it differently one more way: Would you oppose MAID for those with addictions?

[Ya'ara Saks, Liberal, York Centre, ON]

I don't believe that someone with addictions has an irremediable health condition. I believe that someone with addictions can be helped through harm reduction, treatment and health care supports.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that, Minister, but would those with mental health issues also not have a condition that could be helped? That would not be irremediable either—would it not?

[Ya'ara Saks, Liberal, York Centre, ON]

The sole underlying condition is not a mental health condition. It's a mental illness condition as determined by the DSM-5.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I'm sorry, Minister. Your answers are really not making any sense because.... Do you know what? I was a family doctor for 26 years, and those with mental illnesses, they can be treated for their mental illness.

As you mentioned, with substance abuse you can as well, so which is it? Is it only diseases that the Liberal government chooses, or is it diseases that have potential treatments?

[The Chair, Liberal, Sean Casey]

We're out of time, but take 15 seconds to answer that. Then we'll move to the last questioner.

Go ahead, Minister.

[Ya'ara Saks, Liberal, York Centre, ON]

I'm sure Dr. Ellis, as a clinician, is very well versed in DSM-5 and can answer that question himself.