Health Committee on Feb. 1st, 2024

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Yes.

[Eric Costen]

In the context of their request to us last summer, when they asked for certain amendments, there were absolutely many discussions with the minister—

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Have they made any requests to the Government of B.C., considering that it is an abject failure?

[Eric Costen]

B.C. has a requirement to provide us with regular reporting with the various metrics on the status of their.... We routinely brief the minister on the data that's being provided to us.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Has the Government of Canada made any specific requests of B.C.?

[The Chair, Liberal, Sean Casey]

That's your time.

Go ahead and answer the question; then we're going to move on.

[Eric Costen]

There's a letter of requirements posted on our website. It enumerates a number of requests that we made of the British Columbia government in the context of this exemption. That's maybe the best answer I can provide.

[The Chair, Liberal, Sean Casey]

Thank you.

Next we'll go to Dr. Powlowski for five minutes, please.

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

I don't know if we can say that B.C.'s a failure, at least not yet.

We've heard so much talk about evidence today. I think it was Mr. Weiss who said something about there being no evidence.

Rather than going into evidence for exactly what, I did want to look at one of the pieces of evidence that Gord Johns cited. The Globe and Mail talked about it. It was the BMJ article that came out in January, which certainly seemed, at least in looking at it initially, to provide pretty good support for the idea that safe supply seems to work.

The study found that safe supply “dispensations of one day or more were associated with reduced all cause mortality”—I won't give you the numbers—“and overdose related mortality”. Furthermore, if a supply was dispensed more than four times, there was an even further decrease in mortality.

However, that's not a randomized control trial. That's a cohort study, so I started thinking about it and looking at who their cohort was. They're comparing this group of people who get safe supply with another group of people who don't get safe supply and they're saying that those with safe supply are less likely to die from overdose or die overall.

When you make up that study, for that cohort that is not getting it, where do you get those people's names from? I looked it up. One of the sources was the DAD, the discharge abstract database. These are people who are being discharged from the hospital with a diagnosis. They'd been admitted because of an overdose. They've done it before. They've done it to a degree that they've actually had to be hospitalized for it.

Perhaps this is a sicker group—a group that's more likely to overdose beforehand. When you're comparing the two groups, of course those who have a higher risk are going to show up in the study as having died more often, either from overdose or everything else.

In addition, I looked at their study limitations. One of the limitations was, they said, that perhaps some of the people they put in the safe supply category were actually getting narcotics because they had cancer or something else, which really puzzled me. How could you leave that?

I'm not sure how good these data are about the benefits. It also doesn't calculate any costs due to diversion on the street.

What other evidence is there? I looked at the CMAJ article out of London. That seemed to be looking more at decreased infections with safe supply, which is a different issue.

Last of all, the BMJ study came to the rather interesting conclusion that safe supply dispensation “did not significantly modify the odds of all cause or overdose related acute care visits.” People who got the safe supply were just as likely to have to go to the emergency room or something with an overdose, but they didn't die. Maybe that's because they were on narcotics. As a lot of people know, if you don't take narcotics, you lose the tolerance for it. Those who get safe supply are on it all the time. They're tolerant. If they overdose, they're less likely to die.

I wanted to ask you all about the evidence from the BMJ study. How good is it?

I want to put this in in case I get cut off because I run out of time. Could you please provide this panel with what evidence there is in terms of the scientific research about safety and benefits?

[The Chair, Liberal, Sean Casey]

That was a question with a four-minute preamble. You have a minute to respond.

[Dr. Samuel Weiss]

Thank you.

I'll say that the publication is a very good publication. It's not outstanding. It's a retrospective study and a lot more work is needed in this area. More work is being conducted by this group.

I think the evidence that is emerging from the study by CRISM on the 11 safe supply sites suggests that safe supply is beneficial to highly marginalized patients, assuming they also receive integrated services alongside the safer supply. The evidence there is actually quite strong. It's already been published, but it's qualitative in nature.

I think we are at a point now where safe supply, coupled with opioid agonist therapy, coupled with psychosocial services as a collective to reach people where they are, has a much greater chance of keeping them alive and keeping them out of emergency rooms by not having safe supply, by not having integrated services.

The evidence is growing, but it's—

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

I'm sorry. Can I cut you off there?

Collectively, these work, but I'm interested in safe supply per se, and/or if you could give us the reference to the paper that you say is going to show benefits.

[The Chair, Liberal, Sean Casey]

You have 20 seconds.

[Dr. Samuel Weiss]

I will table that publication. There have been very few studies that have focused exclusively on safe supply without other variables included.

That was indeed one of the problems with this study: The number of variables, particularly for marginalized patients, is exceedingly high and not always documented as part of a research study.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Weiss.

Dr. Kitchen, you have five minutes, please.

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

Thank you, Mr. Chair. I appreciate that.

Thank you for being here. It's appreciated.

What I've heard from you is that the minister and the government come up with a policy and you don't have any input into that policy. You then just implement the policy. Is that correct?

[Eric Costen]

No. We certainly provide advice to the minister.

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

You provide advice, but do you direct the advice to the minister?

[Eric Costen]

We provide advice to the minister.

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

Do you provide advice based on what you've heard or based on what the minister has told you to hear?

[Eric Costen]

The government sets the policy direction and then we execute on it. The advice is informed by many things. It is informed by extensive outreach to interested parties and stakeholders that go across the gamut. It's other governments and a number of things.

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

Have you ever advised the minister to change policy?

[Eric Costen]

Yes.

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

Have you advised the minister to consider changing the policy as we have it right now?

[Eric Costen]

Which policy are you referring to?