Health Committee on Feb. 1st, 2024

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Dealing with opioids and safe use.

[Eric Costen]

To use an example, the drug strategy, which the minister referred to in her comments, was the product of work done by the department in order to sort of shape and give substance and form to the policy direction that the government itself set.

That would be an example of where—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Okay. You haven't advised them to change policy.

The next question then comes to the reality, as you've indicated to us, that there's never been a discussion on legalizing other drugs. Is that correct?

[Eric Costen]

There's been no discussion that I've been part of.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Minister Bennett stated in May of 2023, “We have to move to a safer supply of drugs, as we have with alcohol [and] cannabis....”

Therefore the policy from the government is to move to a safer supply of drugs, and yet you've never put forward that policy and you've never discussed that policy with the minister.

[Jennifer Saxe]

In terms of policy discussions—if I'm understanding correctly, I think it's with reference to prescribed alternatives or what you've been referring to as a safer supply—there have been a range of discussions in terms of prescribed alternatives and how to support people through a harm reduction measure as well as through treatment. We've been looking at—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

The question was about what the minister has stated, which is safer supply of drugs, whether that might be supply of cocaine, etc., and you've said that you've never had that discussion. The minister has clearly stated in the House that this is where the policy is. Are you advising them for it or are you advising them against it?

[Eric Costen]

Thank you for the question.

The policy around the prescribed alternatives—or “safer supply”, as it's referred to sometimes—exists and is well documented on the Health Canada website. That's the one we advise the minister on. To my knowledge, there's no—

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

You indicated to me that you would advise the minister against things as well, but it doesn't sound like that's the case.

[Eric Costen]

In the normal course of public service and giving advice to the government, we provide a range of options: for, against, big, small, fast, slow. In the context of executing on the safer supply initiative, we would have provided all sorts of advice on the manner in which the initiative should be rolling out.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Have you advised the minister on supplying alcohol and cannabis in retail stores?

[Eric Costen]

We provided the government much advice on how to legalize and regulate cannabis, yes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Was the advice in favour of that, and will it therefore concur with other drugs?

[Eric Costen]

In the case of cannabis, the government had a policy that they wanted to move to regulate and legalize. The advice that we provided was on how to do that.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Kitchen.

Thank you, Mr. Costen.

Next we have Dr. Hanley for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much. I'm pleased to have the opportunity to ask a few more questions.

I want to make two quick points about diversion.

One—and perhaps it's stating the obvious—is that diversion has been around for as long as prescription drugs have been around. A well-run safe supply that provides drugs to people legally when they are not doing well or are not candidates for opioid substitution therapy has been shown to have extensive benefits. Yes, the more evidence we can gather on that the better.

Second, I want to say that I was lucky to travel to the Downtown East Side at the beginning of last week with my colleague Mr. Johns. We were told at one of the sites that the rhetoric and politicization of conversation around safe supply is literally killing people. We heard, “Please, can you talk about the evidence and evidence-based policies, and not let politics get in the way of saving people's lives?”

I just wanted to put that on the record.

Dr. Tam, you haven't had a chance to speak yet. You may be relieved, but I'd certainly like to give you a chance to give a few perspectives in the couple of minutes I have left.

Look, I know this issue is hugely complex. On average, we have 22 Canadians dying per day now, which means that collectively, as a country, we're not doing enough to address this epidemic. As CPHO of the country, what do you see as the main challenges in addressing this crisis?

I have a couple more questions after that.

[Dr. Theresa Tam, Chief Public Health Officer of Canada, Public Health Agency of Canada]

I think the data or facts about this crisis show that right now it is the extremely toxic illegal supply that is causing the most harm. I think that's one factor everyone should bear in mind. Some of the application of the range of measures is because of that.

Right now I work very closely with my colleagues, the other chief medical officers of health. We stood up a special advisory committee, as we did with the COVID-19 pandemic, to try to collectively provide support in whatever way we can to address this crisis.

It's complicated, but what we saw through data was that this crisis evolved over time. When we started in 2016, fentanyl had appeared but hadn't swamped the whole supply. Right now, 84% of all apparent opioid-related deaths are a result of this extreme toxicity. That is not necessarily the case in another country like Portugal, which, of course, has many great practices we can examine.

We worked very closely to get the data. People talked about the data. You've seen some of the B.C. data and the B.C. coroner's data. You can certainly follow up with her, but the people who are dying from this crisis are not dying from a prescribed drug. They found this as they did their examinations. The vast majority are from toxic opioid drugs.

I think, as the minister said, that there is no simple solution to this very complex issue. It's a whole-of-society and whole-of-government response across all pillars, from prevention to recovery with, of course, treatment and harm reduction.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

You mentioned the special advisory committee. Is that still in action? Is it still active?

[Dr. Theresa Tam]

Yes. We support, of course, an overarching federal-provincial-territorial committee that is looking at mental health, substance use or addiction. Our focus, absolutely, is to try to get that data. The Public Health Agency continues to even put public health offices inside jurisdictions to support the coroners and medical examiners to get as much detail as we can. When we started, there was very little capacity. Now we can at least give some ongoing quarterly updates.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

There may not be time for much of an answer.

In 2018, you wrote a report on youth and substance use. I know this is an area you're quite passionate about. You talk about the complex interplay of risk factors, but you also talk about the protective factors of youth.

In five years, has anything changed in your point of view about the importance of youth and prevention?

[Dr. Theresa Tam]

I think prevention is perhaps one area that everybody would agree on. I think that agnostic of the type of substance, youth will access the whole range of psychoactive substances, from alcohol to cannabis to, indeed, potentially opioids. I think the root cause of some of the reasons youth enter this epidemic has to be addressed.

What I'm really happy about in terms of advancement is that, for example, budget 2023 actually has this $20 million for the youth prevention approach, the Icelandic model. I was actually really happy, because a lot of the attention has been on the other components. If we don't address this, this cohort of youth will then fall into the epidemic itself.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Tam.

Ms. Larouche, you have the floor for two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Mr. Chair.

My question is for Mr. Costen, but other witnesses may answer if they want.

To follow up on your previous answer, you may not be from Public Safety, but you should provide border services officers with the tools to identify and restrict fentanyl and other toxic substances safely and effectively at the border.

I have questions, because the Canadian border often seems as effective as a sieve. Have you successfully dismantled any networks and are there fewer illegal drugs coming into the country through the border?

[Jennifer Saxe]

Thank you for your question.

A lot of work is being done at the border. It's being done in Canada, as Mr. Costen already said, but it's also being done by working with the United States.

Were networks dismantled? Yes. Aside from what we've heard in the news, however, I have no exact details to offer. My colleagues from Public Safety can provide them.

As for whether a smaller volume of drugs is being trafficked between both countries, my colleagues could provide you with those details as well.

I don't have those details at hand, but I am absolutely certain that networks were dismantled. We get reports on it.