Evidence of meeting #93 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was actions.
A video is available from Parliament.
Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
I'm sorry. When you say “early response to safer supply”.... I'm not sure I understand the question.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
What are some early results or a little bit of early data that you might have on the safer supply program?
I think maybe it would be good for us to understand and get clarity on tragic opioid and fentanyl deaths as they may or may not relate to safer supply.
Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
We have funded an arms-length study, through the Canadian Research Initiative in Substance Misuse, on safe supply programs in 11 sites across the country.
The early research results coming out suggest that for highly marginalized clients—those who have limited access to health services—safe supply is helpful and effective in reducing cravings, time on the streets and deaths. However, it has also been shown that it works best when wraparound services are also there. The critical element is that with wraparound services, clients are expected to attend and participate in allied health and social services. That's when safe supply is most effective.
I will also mention, of course, that safe supply really is part of prescribing practices overall, which started in the 1990s and led to the situation we're in today. The term “diversion” is also not new. It's been around since the 1990s because of prescribing practices.
When prescribing practices were curtailed, more people went to the streets. The second wave of the opioid crisis was when people could no longer receive prescribed opioids, so they went to the streets and started to overdose on heroin. The heroin, which was the second wave of the toxic drug crisis, was then supplanted in approximately 2010-13, when fentanyl arrived for the first time. It took over from heroin and became the drug of choice on the streets, where very small amounts lead to overdose deaths.
I think it's important to note that when we speak about safe supply, we're talking about part of a range of prescribing practices—good and bad—that have been part of how this crisis began in the first place. These would have to be considered scientifically as part of the go-forward regardless, because prescribing opioids is one of the few approaches we have right now for treating chronic pain and cancer pain.
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
Just to sum that up, the experts believe it has to happen within a suite of different actions to be successful.
Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
That's correct. It's with different actions, but most importantly it's within allied health and social services that seek to tackle the social determinants of health and the needs of individuals, to be able to attend to other elements that are causing them to seek opioids for both trauma and pain reduction.
December 4th, 2023 / 12:15 p.m.
Liberal
Liberal
Darren Fisher Liberal Dartmouth—Cole Harbour, NS
I would like to ask a question of the folks from ISC.
Ms. Saxe spoke about the disproportionate impact on indigenous peoples. Can you talk a little bit about culturally safe and trauma-informed supports?
Jennifer Novak Director General, Mental Wellness, First Nations and Inuit Health Branch, Department of Indigenous Services
Yes, I'm happy to do so.
It is clear that indigenous people in this country are disproportionately impacted by this crisis. In B.C. and Alberta, you're looking at an impact of five to seven times the rate of non-indigenous people.
For us at Indigenous Services Canada, we're really trying to connect people to services and to harm reduction products. That includes naloxone, but specifically opioid agonists, which we've been talking about today. We've been trying to access wraparound sites. Basically, 82 sites across the country are delivering opioid agonist treatment in over 100 communities.
We're also trying to get mental wellness teams. Jennifer Saxe mentioned that continuum of services. Those mental wellness teams are there. There are 75 of them serving 385 communities across the country.
What we're trying to do there is to get people to go through withdrawal management first, to stabilize people first, and then move them through opioid agonist treatment. It's also on-the-land training, healing centres, connecting them with culture and, really, what comes after. After they've gone through their treatment, what can we do to support people in a more longitudinal way?
We're really looking at innovative systems. We have an interesting pilot happening right now in Ontario. Most indigenous populations are in rural and remote areas, so we are trying to connect them with new virtual supports. The Oculus headset is one of them, where people can have access to wraparound services.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Novak. We're well past the time.
Mr. Thériault, you have the floor for two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Mr. Weiss, if I have properly understood your previous answers, from a scientific standpoint, harm reduction should continue to be the key pillar of the strategy.
Is that correct?
Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
Harm reduction is one of the pillars. I would say it's not more important than treatment; it's one of them.
Bloc
Luc Thériault Bloc Montcalm, QC
So if we had strictly relied on repression, there would probably be more deaths?
Right?
Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
Did you mean prescribed opiates, or did you mean supply on the street itself? I'm sorry. I didn't understand.
Bloc
Luc Thériault Bloc Montcalm, QC
If the harm reduction approach had not been adopted, then scientifically speaking, there would have been more deaths.
Are you in agreement with that?
Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
Absolutely.
Bloc
Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
What I would say is what we've heard from experts for many years. There has to be a coordination of care within communities. The communities have to play a critical role in this because that's where the problem is happening. It's different in different communities. In western Canada, there are opioids. In eastern Canada, amphetamines are a much bigger problem. The commonality is that they're all contaminated with fentanyl. A lot of that contamination with fentanyl is coming from organized crime. It is actually delivering that contamination within the country.
That said, we need a coordination of care. We have to overcome the fact that there are very few resources being provided for treatment and for harm reduction. We also have to combat the social determinants and the societal ills that are actually driving people to addiction.
What's critically important is that the stigma of illicit drug use is still overwhelming, including within the health system and within government itself. Until we destigmatize it, we have a significant challenge.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Weiss.
Next is Mr. Johns, please, for two and a half minutes.
NDP
Gord Johns NDP Courtenay—Alberni, BC
From 2016 to 2021, we saw opioid toxicity deaths double here in Canada. Would you consider that a failure?
Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Department of Health
I'd consider it a public health crisis.
NDP
Gord Johns NDP Courtenay—Alberni, BC
Okay.
In the U.S., it went up 279%—more than doubled—and there was no safe supply. Many states didn't have safe consumption sites.
Would you consider that a failure?
Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Department of Health
I think those harm reductions are life-saving services, absolutely.
NDP
Gord Johns NDP Courtenay—Alberni, BC
We're not seeing a big difference. In terms of the number of deaths, in terms of policies, we've seen a failed North American strategy, really. We can look to Portugal, where they had 100,000 chronic drug users at the height of their crisis. Now they're down to 22,000. Over 70% of HIV transmission was through intravenous drug use, and now that's down to less than 2%.
Would you consider that a success story?
Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Department of Health
I think the comprehensive approach that Portugal took is absolutely a success and is something that absolutely informs our way forward.