Health Committee on Dec. 4th, 2023

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

Yes. What was the original null hypothesis generated for this experiment? We all know it was an experiment. It has never been done before. In an experiment, you really have an idea of what you want to disprove.

What was it? Was this just something on the back of a napkin? I guess that's the question.

[Jennifer Saxe]

I apologize. I think you will have to clarify for me what you're referring to by “this experiment”.

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

It's in the text of the motion that we're debating here today. This is a drug experiment, so what was the plan?

[Jennifer Saxe]

The government—

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

I'm sorry. Was there a plan?

[Jennifer Saxe]

There's a very clear plan that the minister announced on October 30, which really directs where the government is going. It's the renewed Canadian drugs and substances strategy—

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

I'm sorry. I'm going to interrupt you, because you said October 30—

[The Chair, Liberal, Sean Casey]

That's your time, Dr. Ellis. I'm sorry.

We'll go to Dr. Hanley, please, for six minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you, Mr. Chair.

Before I ask questions, I wanted to provide some opening remarks, given that this is a study that I initiated with a motion passed by committee earlier this year.

Mr. Chair, we have eight meetings, I believe, most of which will be taking place in the new year, in 2024.

We know that 2023 will be another tragic year for Canadians. In 2022, we saw 7,328 deaths. The current death rate is estimated to be 21 Canadians dying daily. Isn't it shocking that we can actually predict with more or less confidence that 600 or more Canadians will die of an opioid or mixed drug overdose between now and the end of the year? Despite this having been recognized as an emergency seven years ago, the death toll continues to be the same or to rise.

When I was CMOH in the Yukon, we witnessed the first fentanyl death occurring in April 2016, the same month that British Columbia's chief public health officer at the time, Dr. Kendall, declared a public health emergency due to a shocking rise in deaths in that province. That's continued to increase since.

Since those earlier days of the epidemic, governments have responded. Many wonderful things have happened. Naloxone kits, for instance, are everywhere in our territory and widespread around the country. We have had the first supervised consumption site in Yukon, north of 60, including one of the first sites in the country with an inhalation room. We've scaled up efforts and treatment in clinical opioid substitution, in harm reduction, and to some degree in prevention.

The Yukon declared a substance use emergency in January 2022, and recently revised its substance use health emergency strategy, just a few months ago, based on the four-pillar approach that we all know so well.

Yet the deaths go on. Lives and families are torn apart with overdose fatalities or injuries. We've done so much, yet the scale of our response has not yet matched the need.

As we take on this study, I plead with all committee members around the table to have one aim—one single aim in mind. I know I'll be thinking of my own two teenagers and their friends, and what more we can do to protect them. Let this be about saving Canadians' lives. Let's not make this about personal attacks or takedowns, or scoring political points. Let's take a hard look at what is working and what is not, and if something is not working, then let us examine why, learn and adapt.

To my colleague Dr. Ellis, “experiment” is really a word for taking a new approach. To your question about a “null hypothesis”, I think we could answer that our current model is clearly not working, so we need to take new directions.

Let us look at models of innovation and success that have shown promise or have been shown to work, either within our country or elsewhere. Let us be able to come up at the end of this study with urgent, thoughtful, evidence-based, compassionate, bold and intelligent recommendations as to what all of us can do to get this epidemic under control—as individuals, as communities, as governments at all levels.

I know that each one of us cares. Please, for the sake of Canadians, let's work together on this with respect, with humility, with urgency, and with the decency that Canadians expect of us.

I know I have only about two minutes left, but I'd like to bring back my questions.

Thank you all for being here.

Budget 2023 proposes an additional $359 million over five years to support a renewed strategy. Ms. Saxe, I wonder if you could describe some of the directions you intend to take with this renewed funding.

I'd like to save time for Ms. Hurley from the Public Health Agency to comment as well on that same question.

[Jennifer Saxe]

I will absolutely make sure to save some time for Shannon Hurley.

Thank you for that question and for your remarks.

The renewed strategy really builds on the previous strategy by ensuring that we have holistic, integrated action that cuts across prevention education and looks at the whole suite of substance use services, including harm reduction, treatment and recovery. It looks at making sure we're building on the evidence and taking a range of actions in terms of substance controls. It looks at law enforcement and at ensuring the appropriate controls are there for the misuse of substances.

Some of the key actions we're taking include a call for proposals for substance use and addictions programs to make sure we can invest in community-based programs. The call for proposals went out at the end of September. We received just over 600 applications at the end of November. We'll be reviewing those to make sure we can invest in promising, evidence-building, innovative projects at the community level.

I'll turn it over to Shannon Hurley in a minute to talk about some of the prevention work, building on the Icelandic prevention model-based program we have.

We're continuing to take action in terms of authorization and making sure people have access to harm reduction services, whether that's supervised consumption sites, access to naloxone, or drug-checking services so people can know what's in their drugs and health workers also can know what's in substances people are consuming.

There are a range of actions. I can turn it over to my colleague after, in terms of the public safety and law enforcement. There are a suite of surveillance activities, and targeted research and evidence we are looking to build up, including on innovative models, so we can learn and adjust as we are doing that.

For prescribed pharmaceutical alternatives and supervised consumption sites, we are looking at what the evidence is showing and we're monitoring those programs so we can learn, adapt and put in best practices.

Maybe I'll turn it over to Shannon on prevention.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Saxe.

We're past Dr. Hanley's time. I'm sure if another member wants to use part of their time to have some further comments with respect to that, then that may very well happen.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I'd like to welcome all the witnesses to the Standing Committee on Health.

In 2016, this committee tabled a report in the House of Commons that included 38 recommendations. One of these recommendations said that the Canadian drugs and substances strategy should be focused on reducing harm and that the government should define what harm reduction means.

Seven years on, could you briefly tell us what harm reduction consists of and what its goals are?

[Jennifer Saxe]

Thank you very much for the question.

Harm reduction continues to be a key element in the strategy, which was launched by the Government of Canada to address the overdose crisis and substance abuse. To be clear, let's say that harm reduction is part of a continuum of measures and care. It is based on accurate data, and it reduces harm and saves lives.

It's important to make every effort to reduce harm because of the growing toxicity and unpredictability of illicit drugs currently in circulation.

We are continuing our focus on harm reduction because not everyone has access to treatment services. Such services may not be available in some regions. Private treatment can be expensive or inaccessible. Harm reduction can help connect people and services.

Harm reduction is a medical and a health service.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Ms. Saxe.

Ms. Lévesque, in the government's response to the committee, the emphasis was on tightening up the borders and the act. The example it gave was Bill C‑37, which would give border officers more latitude to intercept fentanyl, because they would be able to inspect baggage weighing less than 30 grams.

Seven years on, it's perfectly clear that the illicit production of fentanyl has not changed since the passage of that bill.

What's missing? What's needed to tighten up border controls?

What could be done to make this action plan more effective, given that it is not currently producing the desired results?

[Marie-Hélène Lévesque, Director General, Law Enforcement Policy Directorate, Department of Public Safety and Emergency Preparedness]

Good morning.

I'm pleased to be here today.

Mr. Chair, I'd like to thank the member for his question.

The Department of Public Safety and Emergency Preparedness administers several areas. The Canada Border Services Agency has already implemented several measures, the most recent of which was creating a targeting centre for opiates, which we expect will yield rapid results. It has just been established. We want to collect accurate data, and to act on information received from the international community and law enforcement agencies.

[Luc Thériault, Bloc, Montcalm, QC]

So, seven years on, you're saying that you've fixed things only recently.

Is that right?

[Marie-Hélène Lévesque]

That's not all that happened. We are continuing to intercept huge quantities at points of entry and are taking action not only locally and nationally, but also internationally, on the basis of information we receive.

[Luc Thériault, Bloc, Montcalm, QC]

So that alone will not be enough to deal with the crisis. No matter how effective you and the measures you're taking may be, the fact is that after seven years, the problem has still not been fixed. Action is therefore needed on other fronts.

Ms. Saxe, after seven years of implementation, what is missing from this strategy that might make it more effective and thwart this crisis?

[Jennifer Saxe]

It's important. As Ms. Lévesque pointed out, we took steps that led to some progress, and the new measures planned for the renewed strategy really give us a range of measures.

[Luc Thériault, Bloc, Montcalm, QC]

Where has there been progress? Do you have any reliable statistics on the progress made over seven years?

[Jennifer Saxe]

Progress has been made in several areas, including supervised consumption sites, the number of lives saved and the number of people referred to other social or health services. On the public safety side of things, there have been seizures at the border.

[Luc Thériault, Bloc, Montcalm, QC]

So lives were saved, which means that without this strategy, these measures, and this action plan, there would have been more deaths.

Is that what you're telling us?

[Jennifer Saxe]

Yes, that's it exactly. There would have been more deaths.

That's indicative of how important it is to have collaboration between the federal government, the provinces and territories, experts, and people in the community, as I said in my opening remarks. Everyone, all Canadians have a responsibility with respect to stigmatization. We need to work together and increase our efforts.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Saxe and Mr. Thériault.

Next, we have Mr. Johns, please, for six minutes.

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

Thank you for being here and for the work that you're doing.

I want to reiterate what Dr. Hanley said about what's working and what's not working. Clearly, what we're doing isn't working. I like the idea of not only talking about models of innovation and success, but also using sound data so that we have evidence-based decision-making and policies that are going to respond to this crisis.

One thing we heard from doctors at the beginning, in 2016, when B.C. declared a public health emergency, was that they were calling for the federal government to also declare a national public health emergency. Can you explain why that hasn't happened?

The reason, and you've heard me talk about this many times—I met with all of you on this panel—is the need for a plan and a timeline, and that is not in the renewed Canadian drugs and substances strategy. It was something I outlined in Bill C-216, which was defeated by the Conservatives and most Liberals. That would have provided a timeline. That bill directed government to provide a timeline and a plan.

Why has no national public health emergency been declared?