Health Committee on Dec. 4th, 2023

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 93 of the House of Commons Standing Committee on Health.

Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders. I understand that we have one witness and one member participating virtually, so 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.

For the one witness we have by video conference, you're probably already aware of this, but you have translation available at the bottom of your screen. You have a choice of floor, English or French. Close the mic when you're not speaking, and avoid taking screenshots of the screen, please.

Today, from 11 a.m. to 1 p.m., we have a panel on the opioid epidemic and the toxic drug crisis. Pursuant to Standing Order 108(2) and the motion adopted on November 8, we're going to begin that study today.

Before we begin, I'd like to introduce the officials we have with us.

From the Canadian Institutes of Health Research, we have Dr. Samuel Weiss, scientific director of the Institute of Neurosciences, Mental Health and Addiction. Dr. Weiss is the gentleman who is participating by video conference. The other witnesses are here in person.

From the Department of Health, we have Jennifer Saxe, associate assistant deputy minister, controlled substances and cannabis branch; Carol Anne Chénard, acting director general, office of controlled substances; and Kelly Robinson, director general, marketed health products directorate.

From the Department of Indigenous Services, we welcome Jennifer Novak, director general, mental wellness, first nations and Inuit health branch. From the Department of Public Safety and Emergency Preparedness, we have Marie-Hélène Lévesque, director general, law enforcement policy directorate. From the Public Health Agency of Canada, we have Shannon Hurley, associate director general, centre for mental health and well-being.

Thank you all for taking the time to appear today.

Before I hand the floor over to Ms. Saxe, I understand that there is a possibility of bells before we complete this panel. If and when that happens, I'll be asking for unanimous consent to continue.

Also, we have heard from the Minister of Mental Health and Addictions, who has indicated her willingness to come before the committee on this study, probably in the new year.

With that, I'm going to turn the floor over to Jennifer Saxe from the Department of Health for her five-minute opening statement.

[Jennifer Saxe, Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Department of Health]

Thank you very much.

Good afternoon.

Thank you for providing my colleagues and I with the opportunity to address this crucial issue.

In my comments today, I would like to share some information about what we know about the crisis, based on the data we collect at the federal level, and to outline some of the measures we have been advancing to reduce harm, prevent overdoses and related deaths, and to expand access to treatment and support recovery and wellbeing.

The overdose crisis we face today is a profound public health emergency, reaching into the lives of individuals across diverse demographics. This public health crisis is having a tragic impact on people who use substances, their families, and communities across the country, and is shaped by a wide range of factors.

Based on the latest available data, there have been 38,514 opioid overdose deaths since January 2016. While 90% of these deaths in Canada occurred in British Columbia, Alberta and Ontario, it is important to note that elevated rates have also been observed in other areas with smaller population sizes, including Saskatchewan and Yukon.

Most apparent opioid toxicity deaths are among young to middle-aged males. In fact, males accounted for 73% of accidental apparent opioid toxicity deaths.

Indigenous peoples are disproportionately impacted. For example, while first nations make up 3% of British Columbia's total population, 16% of those who died of an overdose identified as first nations. Also, according to data from the Alberta First Nations Information Governance Centre, the rate of opioid poisoning deaths is seven times higher for first nations people compared to non-first nations people in the province.

The data also confirmed that very high rates of overdose deaths are the direct result of increasing street drug toxicity. Of all reported overdose deaths, 81% involved fentanyl. Multi-drug toxicity is a contributing factor to the crisis. Increasingly, people are using a mix of drugs, which is significantly increasing risk.

This crisis is widespread and pervasive. Understanding why people turn to substances engages the full range of social determinants of health, as well as adverse childhood experiences, trauma, poverty, mental illness and chronic pain.

We have worked with experts to ensure we are pursuing evidence-based strategies to comprehensively and compassionately address this crisis. It is within this context that the Government of Canada has been actively working for many years, mobilizing efforts across a continuum of interventions that span prevention, harm reduction, treatment and enforcement, and working together to reduce harmful stigmatizing attitudes and behaviours.

Substance use prevention initiatives are tailored to reach people most at risk. For example, the “ease the burden” campaign is a targeted effort to reach men in the trades, a demographic disproportionately affected by the overdose crisis. This campaign, with over 26 million views, shows how we are raising awareness and reducing stigma in these populations.

Recognizing how important timely access to quality treatment services is, we have made significant investments to expand access, including specialized services for youth and much-needed withdrawal management, commonly referred to as detox.

The government has also made efforts to expand access to services that reduce harms and prevent overdose deaths. This includes the distribution of naloxone and widespread training. We have made it easier for communities to establish and provide consumption sites. There are currently 39 sites across the country, which have seen over 4.3 million visits, responding to nearly 50,000 overdoses. For many, these sites are the only direct experience people will have with health providers. As a result, there have been over 257,000 referrals to health and social services.

Simultaneously, our law enforcement and border officials are actively countering illegal drug production, diversion, trafficking and related crimes.

As part of the response to this crisis, the government also continues to support research that is helping us to better understand substance use in Canada and that allows for the development of evidence-based policies and programs.

Before I close, I wanted to mention that on October 30, 2023, the Minister of Mental Health and Addictions and Associate Minister of Health launched a renewed Canadian drugs and substances strategy. This strategy presents a compassionate, equitable, collaborative, and comprehensive federal approach to this crisis and may be of interest as you conduct your study.

In conclusion, it is essential to understand that federal actions alone will not end the overdose crisis. We stand committed to ongoing collaboration with provinces and territories, indigenous communities, families and people with lived or living experience.

We welcome the opportunity to inform your important study and are prepared to respond to any questions you may have.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Saxe.

We're going to begin right away with rounds of questions, beginning with the Conservatives and Dr. Ellis for six minutes, please.

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

Good morning, everyone.

Thanks for getting to this very important study.

Obviously, we know the statistics. Canadians know the number of people dying and, of course, 1,900 people have died thus far in 2023.

Ms. Saxe, maybe you could tell listeners out there what is the leading cause of death in B.C. in 10- to 18-year-olds.

[Jennifer Saxe]

For 10- to 59-year-olds in B.C., overdose from opioids is the leading cause of death.

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

What about 10- to 18-year-olds specifically?

[Jennifer Saxe]

I believe the leading cause of death for the 10-to-18 age group is also overdose.

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

Yes. It's a very sad state of affairs.

I guess I have a bit of a rhetorical question, but we'll get to that. What's it going to take to stop this experiment, the safe supply, safer supply, whatever euphemism we're going to use?

There's a recent article that came out on Friday from a person with lived experience who talked about being at Leslieville, the South Riverdale site, and was speaking about safe supply. Are you aware of that article?

[Jennifer Saxe]

I'm not aware of the specific article. I would need more details, but I know that there have been a number of articles about safer supply, as well as supervised consumption sites, in recent days.

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

This article specifically talks about safer supply. It talks about a few other things, but is the Government of Canada aware that these so-called safer supplies are ending up in the hands of folks who previously have not used opioids?

[Jennifer Saxe]

What the government is doing right now is undertaking and investing in a suite of services to include prevention, education, harm reduction, treatment, recovery—

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

I'm sorry. Maybe you misheard me. I'll interrupt you. I apologize for that.

Are you aware that these so-called safer supplies are ending up in the hands of folks who have never used opioids before? I didn't ask what the government was doing. I asked a very specific question.

Thank you.

[Jennifer Saxe]

The government is aware that there is a range of use regarding prescribed pharmaceutical alternatives that are being used in harm reduction and treatment processes for individuals who use substances.

We are listening to those. We are listening to concerns as well and taking those very seriously. There are a number of actions we are taking—

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

Thank you for that. I'll interrupt you there.

We have a convention here that your answer will be the length of my question. Thank you.

Is the government aware that the price on the street of an 8-milligram tablet of hydromorphone has gone from approximately $20 a pill to $2 a pill?

[Jennifer Saxe]

Again, I would repeat that we understand there are a range of uses, perspectives and reports in terms of prescribed pharmaceutical alternatives. We are taking concerns that are being raised seriously. We are looking into those. We are taking a number of actions—

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

Thank you very much.

I'm trying to be very kind here, but I'm asking very specific questions that you're really not answering.

Is the government aware and is your department aware that the on-the-street price for 8-milligram tablets of hydromorphone has gone from $20 to about $2 a tablet?

[Jennifer Saxe]

We are aware that there are reported concerns about the diversion of prescribed pharmaceutical alternatives, including as a result of the price of that.

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

Is the government aware that these 8-milligram tablets of hydromorphone—the equivalent of about 30 tablets of Tylenol 3—are being used in high schools around this country?

[Jennifer Saxe]

I think the government is aware that the use of illegal drugs is absolutely of concern for youth across the country. That is why we're investing in prevention and education in a suite of services and supports, to—

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

Once again, I'm going to interrupt you. I'm trying to be kind, but it seems you're purposely avoiding answers to my questions.

Is the government aware that the so-called safe supply is actually being used in high schools in Canada?

[Jennifer Saxe]

We are aware that there are people who are concerned that there is a diversion of prescribed safer supply.

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

I guess if you're aware that people are concerned.... I'm sorry. If you are aware that people are concerned that this is happening, wouldn't that mean you're aware that it's happening?

[Jennifer Saxe]

We are taking reports of diversion seriously. There are a number of actions we are taking. We are committed to taking those actions. They include working with safer supply providers to understand the risk mitigation measures they are taking, including patient screening and urine drug screening, and working with health care providers and patients to ensure that risk mitigation measures are in place to reduce any diversion.

We are looking at evaluations and studies, and I'm happy to turn it over to my colleague at CIHR for further information on some of the evaluations we are doing on prescribed drugs.

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

Thank you for that.

When the opioid experiment began—and I'm using the words of my colleague Dr. Hanley, which were in the text of this motion—what was the original null hypothesis that the government put forward for the experiment?

[Jennifer Saxe]

Could you repeat the beginning of the question?