Health Committee on Dec. 4th, 2023

[Jennifer Saxe]

I think we look at a variety of different international experiences. We also look at our Canadian.... For the specific crisis we are facing in Canada, I would say that what the U.S. is facing is most like what Canada is facing right now in terms of the drug toxicity, but we also look at best practices internationally to inform our approach.

[Shuv Majumdar, Conservative, Calgary Heritage, AB]

Have you had a chance to meet with Portuguese officials?

[Jennifer Saxe]

We have met with Portuguese officials, as well as other previous officials who have been.... I personally have not gone to Portugal but have met with other Portuguese colleagues internationally, and other colleagues of mine have met with Portuguese officials.

[Shuv Majumdar, Conservative, Calgary Heritage, AB]

Are they presently experiencing an epidemic?

[Jennifer Saxe]

They take a range of actions. I can't speak to the specific drug toxicity they are facing, but it is not the same drug toxicity crisis we are facing in Canada in terms of fentanyl and in terms of contamination with benzodiazepines and other substances. Also, I think—as was mentioned before—that in Canada it is quite complex. It's not the same. We talk about an overdose crisis with people and the substances that are being consumed in B.C. versus the Maritimes versus the Prairies.

[Shuv Majumdar, Conservative, Calgary Heritage, AB]

Have they seen an increase in addictions—

[The Chair, Liberal, Sean Casey]

That is your time, Mr. Majumdar.

Finish your answer, Ms. Saxe, and then we're going to move on.

[Jennifer Saxe]

There are regional variations in terms of the drug toxicity and the substances people consume, which is important in terms of how we respond and in terms of the public health response we take. That's also why we need to be looking in a community-based way and working collectively to address it in specifically targeted responses.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Saxe.

Dr. Powlowski, go head, please, for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Dr. Weiss, I wanted to ask you a question.

You made an interesting response to an earlier question. With respect to the early data, you said it showed that for those highly marginalized people, a bunch of parameters had changed, including a lower death rate from overdose. You didn't mention those people who are not highly marginalized.

What are the numbers with respect to people who aren't highly marginalized?

[Dr. Samuel Weiss]

Unfortunately, the numbers are vanishingly small because currently the safe supply programs are small in number and the number of people actually receiving safe supply is small. In the majority of cases, these are people in marginalized communities who have been seeking the safe supply.

The other issue, of course, is that we don't have an accurate number of the total number of people who are using substances and what type of substances they are. This is something we will be undertaking in some new research studies. In other words, if we're going to actually intervene through services of one sort or another, we need to be able to not just understand the number of people who are receiving treatment, but also understand the total number of people who are using substances. This is part of the research that is going to be undertaken going forward.

If more people can access the full suite of services, we'll have a better idea of the trends over time of improved outcomes for people who are addicted to opioids and other illicit substances.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Even if the numbers are small.... You said that the vast majority of people who are getting safe supply are marginalized, but you didn't say that no people who are not marginalized were getting it.

Are there any numbers for those who are not marginalized? What's that showing, even if the number is small?

[Dr. Samuel Weiss]

Again, I think the data to date on safer supply suggests that anyone who receives it together with allied services is at a lower likelihood of overdosing and having adverse outcomes from street drugs.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Let me turn to decriminalization.

In 2020, Portland, Oregon, passed referendum measure 110, which eliminated penalties for possession of small amounts of drugs. In the two years since—this is according to the Globe and Mail's numbers—the number of overdoses in the state has increased 61%, as opposed to 13% across the United States.

What is Portland doing wrong? In comparison, Portugal seems to be doing better.

What can we learn from Portland?

[Dr. Samuel Weiss]

I can't really speak to comparing and contrasting Portland and Portugal at this point.

What I can say—I think it was discussed previously—is that having in place community-driven, comprehensive wraparound services for people who use substances is critically important when we look to begin to destigmatize drug use. Decriminalization is really part of an effort to destigmatize and direct people who use substances to the health care system.

We need a health care system that treats addiction as a public health challenge and allows people to have access to those services in a user-friendly manner. We're definitely not there yet. We do not have adequate access to services. Without that, a lot of the efforts that are being made, which may be effective, will be less effective until the allied services are available.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I would ask the same question of people who are actually there.

Is that the problem with the Portland system? Is the problem so far with our safe supply system that we don't have adequate treatment for those who are addicted?

[Jennifer Saxe]

I don't think I'm well positioned to speak specifically to the Portland statistics. There are a variety of issues and a specific context around that.

In the Canadian context, I think Dr. Weiss really captured it. We need to be able to have a range of services available for people when and where they need it. Those are life-saving services and connection to health and social services—those wraparound services. When they are connecting, it is to health, housing and food security. It is a range of services to support people through their journey.

We know that people need to have access to treatment, but they may relapse. They may come in and out. We really need that comprehensive, allied suite of health services, as Dr. Weiss mentioned.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Powlowski and Ms. Saxe.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

From the outset, it has been pointed out that the provinces, the territories and Quebec are responsible for applying policies on the ground and implementing the action plan.

Firstly, has the collaboration been working? How could it be improved to provide us with a much more accurate picture of what is happening on the ground?

I'm asking because I didn't get much information in replies to my questions about the status of things on the ground. Is that because information is not being transmitted? How could collaboration be improved to ensure that money spent on fieldwork has the desired effect?

[Jennifer Saxe]

We've been working with our counterparts in the provinces and territories. The Minister of Health, the deputy minister and senior officials like me, sit on various committees. We work closely with our counterparts in the provinces and territories to discuss our best practices and a wide range of measures.

For instance, we introduced the substance use and addictions program, the SUAP, under which some effective projects were implemented in the provinces. We organized some forums to exchange information on best practices. We believe it is extremely important to continue this collaboration, because others can learn from these exchanges.

That being said, some things could definitely be improved. For instance, we could improve data gathering, standardize indices, and improve the range of services and supports across Canada.

As we just said, it's truly important to work together. This collaborative effort ought not to come from just one partner, but all the partners, including the federal government, the provinces, the territories, and the communities. Work needs to be done with indigenous groups and health experts. Also required are assessments and data to allow us to track the impact of the programs we implement on an ongoing basis.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Saxe.

Mr. Johns will pose the final few questions for today's panel.

Go ahead, Mr. Johns. You have two and a half minutes.

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

Thank you, Mr. Chair.

I'm going to read a quick quote from just two weeks ago in the Vancouver Sun. It states:

In July 2020, the Canadian Association of Chiefs of Police expressed support for evidence-based medical treatment that included safe supply.

Victoria Police Staff Sgt. Connor King said that based on his experience, Dilaudid is not the drug most people want and so the pills “are indeed being sold illegally.”

But various prescription drugs have been sold on the streets for decades, said King, a court-certified expert witness on the trafficking of fentanyl, heroin, oxycodone, cocaine, and methamphetamine. “There has always been Dilaudid and oxycodone and other powerful opioids in the teen environment in high school and university campuses.”

In addition, King said, “when I look at the coroner data, we're not seeing a link between safer-supply drugs and lethal overdoses.”

King called diversion of safe supply a “small piece” of an “enormous picture,” as illicit drugs flow into B.C. via organized crime. Fentanyl coming into the province is highly toxic and deadly, and methamphetamines manufactured in Mexico and shipped or smuggled across the U.S.-Canada border are plentiful, powerful and cheap, he said.

“There has never been greater availability of cheaper drugs that are more toxic than the situation we face right now,” he said. “And none of that has anything to do with prescribed or safer-supply drugs.”

Later, he went on to say, “I'm a fan of looking for alternate ways for people to access drugs that are going to keep them alive, but I leave that to the medical community to sort out”.

We have heard similar responses from the City of Vancouver and their police department and the chief coroner of B.C. What are you hearing from police? Is there consensus? Overall, are you hearing that support is still there for moving forward with safer supply as a replacement to the unregulated toxic drugs?

[Jennifer Saxe]

As I mentioned earlier, there are diverse views. We know people who have expressed concerns. There are some who support it, as well. When we hear it, it is as part of the suite of services. It is a connection to health and social services. Someone who is reaching out for prescribed pharmaceutical alternatives is someone who's reaching out and connecting to—

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

The reason I'm bringing it up is that these are experts. They're on the front lines.

[The Chair, Liberal, Sean Casey]

Mr. Johns, you have to let her answer the question. Your question lasted about two minutes and then you cut her off. Let her finish and then we're going to bid them good day.

Go ahead, Ms. Saxe.