Health Committee on Dec. 4th, 2023

[Jennifer Saxe]

Some pharmaceutical alternatives can be for opioids. There are some prescribed pharmaceutical alternatives that can be for stimulants as well. It is not as commonly done and prescribed, but it does exist.

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

Are people prescribing cocaine and crack in B.C.?

[Jennifer Saxe]

They're not prescribing cocaine or crack. It's a prescribed pharmaceutical alternative. There are pharmaceutical alternatives such as Adderall or other medications that could be prescribed potentially.

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

A lot of people are going to do crack or cocaine, though, and unless you're going to provide a safe supply of that.... If you're getting toxic drugs because they're cut with fentanyl, you're not going to be addressing that with safe supply, I take it.

[Jennifer Saxe]

I think this is where it becomes important.... We're talking about prescribed pharmaceutical alternatives. It is the health provider who is prescribing and who sees what the best interests are in responding to the patient before them. They are working with their patient in terms of what is best to prescribe in that situation.

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

Where does the majority of fentanyl on the market come from?

[Jennifer Saxe]

There are fentanyl precursors that come into Canada or are produced in Canada. There are also imports.

I will turn it over to Marie-Hélène for additional information.

[Marie-Hélène Lévesque]

Since China scheduled fentanyl as a finished drug in 2019, CBSA has seen the number of seizures with finished fentanyl decrease dramatically. On the other hand, the seizure of precursors has increased. We're seeing increased seizures of precursors. We've also seen an increase in seizures of labs—in super labs. You will have seen some of the major drug busts that occurred both in Saskatchewan and British Columbia in recent months.

We're also seeing a number of reports from other countries. Australia, New Zealand and the U.S. are reporting that they are seeing the arrival of finished fentanyl through their borders that appears to be coming from Canada. This indicates that there could be a production of finished fentanyl in Canada.

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

Okay, I'd like to pursue that, but—

[The Chair, Liberal, Sean Casey]

I think you should pursue getting to the airport, Dr. Powlowski. Thank you for that.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

In 2016, at hearings of the committee, Dr. Bonnie Henry, the provincial health officer for British Columbia, said that detoxification programs for users of opioids were not working, because the physiological dependence created by opioids required opioid substitution therapy, based on products like Suboxone. There was also discussion of Vivitrol at the hearings.

All of that led to recommendation 21 in a committee report, which I believe was adopted unanimously.

The recommendation reads as follows:

That the Government of Canada improve access to medications for opioid addiction treatment such as Suboxone® and other effective medications not currently available in Canada, especially for people at high risk of complication and death.

In British Columbia, do you have data on the number of substitution therapies, access to these substitution therapies, and their efficacy in terms of medium-term recovery?

[Jennifer Saxe]

I don't have data specifically for British Columbia in front of me. We'd have to track it down.

[Luc Thériault, Bloc, Montcalm, QC]

Could you have it sent to the committee?

[Jennifer Saxe]

Our statistics on this have in fact already been published on a British Columbia Internet site. They report how many people have access to therapies…

[Luc Thériault, Bloc, Montcalm, QC]

Do you have an idea of which substitution therapies have been implemented?

[Jennifer Saxe]

There are some agonist opioid therapies. The chart published in British Columbia shows how many people have access to them every month.

[Luc Thériault, Bloc, Montcalm, QC]

Do you have an idea of the number of substitution therapies available in all regions of Canada? This seems to be a major treatment option to help people stop using opioids.

[Jennifer Saxe]

We've taken several steps to improve treatment access. We've changed the regulations...

[Luc Thériault, Bloc, Montcalm, QC]

You don't know anything about the results, the number of substitution therapies available, or whether they are effective. If they are effective, you don't know what it is that makes them effective.

Is that correct?

[The Chair, Liberal, Sean Casey]

Please reply briefly.

[Jennifer Saxe]

We are going to increase potential access to these treatments. After that it's up to the provinces and territories to take action. I know that British Columbia has developed a chart that shows access to treatment on a month-to-month basis. In Alberta, I'm pretty sure they have a chart showing the number of people who have access to agonist opioid treatment. However, the information is not available in all provinces.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Saxe and Mr. Thériault.

Next we'll go to Mr. Johns, please, for two and a half minutes.

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

I'm going to go back to the need for a national public health emergency.

During COVID, we were able to work through jurisdictional barriers constantly, and within hours, with provinces, municipalities and territories, and with indigenous communities. We haven't been able to do that when it comes to the toxic drug crisis because of this lack of action.

I want to talk about jurisdiction, because there is a lot of politics going on here. We have had record amounts of deaths in B.C. under an NDP government, in Alberta, Ontario and Saskatchewan under Conservative governments, and in the Yukon under a Liberal government. In the U.S., 30 states have doubled in overdoses in the last two years, and in the top 10, the majority of them are Republican. This isn't a Republican-Democrat issue. It's not an NDP-Conservative-Liberal issue. This is a societal issue. This is a failure in terms of ideology within society. That's what I believe.

We went to Portugal this summer, my colleague MP Hanley and I, on our own dime. We learned what a response to a public health emergency looked like. They scaled up methadone delivery from 250 people to 35,000 in two years. They engaged the military to create labs, scale it up, and get it out to people.

Is this government looking at an emergency-type response? We haven't seen it yet. I really want to encourage everybody around the table here to work collectively, because that's.... The big win in Portugal was that the politicians took off their gloves, let the experts lead and supported them with the resources. That's how they actually got things done.

[Jennifer Saxe]

I think it's exactly the information and advice from experts that informed our renewed strategy, which looks at making sure we take some short-term urgent actions as well as long-term actions, and that it's an integrated suite of actions that take a compassionate approach. Again, we need to look at evidence-based actions and scaling those up. We also need to look at innovative approaches and, when we're taking those innovative approaches, make sure we are working with CIHR, CRISM and others to look at the evaluation, learning from those and implementing those changes, as well as learning from other countries, which we're doing.

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

Ms. Saxe, we still don't have a timeline and a plan with resources to back those up. That's the problem. Without those, we're never going to get there. It's piecemeal and it's not working. Incrementalism kills in a health crisis, and so does disinformation.