Health Committee on April 16th, 2026

[The Chair, Liberal, Hedy Fry]

I call this meeting to order.

Welcome to meeting number 28 of the House of Commons Standing Committee on Health.

We recognize that we meet on the unceded territory of the Algonquin Anishinabe peoples. Today's meeting is taking place, as you can see, in a hybrid format, pursuant to the Standing Orders.

I want to do some housekeeping and remind everyone of the following points.

Please wait until I recognize you by name before speaking. For those participating by video conference, please click on the microphone icon to activate your mic. Please mute yourself when you're not speaking. Otherwise, we will get ancillary noise.

At the bottom of your screen, you can select the appropriate channel for interpretation. It's a little round globe icon. You can pick whatever language you want.

All comments should be addressed through the chair.

For members in the room, if you wish to speak, please raise your hand and the clerk and I will manage the speaking order as best we can. We appreciate your patience and understanding in this regard.

Pursuant to Standing Order 108(2) and the motion adopted on Tuesday, January 27, the committee shall commence its study on the Canadian Centre on Substance Use and Addiction.

I would like to welcome our witnesses.

They are Dr. Alexander Caudarella, chief executive officer; Neil Arao, board member, who is here by video conference; Scott Elliott, board member, by video conference; Susan Russell-Csanyi, board member, by video conference; and Dr. Louis Hugo Francescutti, board member, by video conference.

We also have one of our committee members, MP Parm Bains, who is here by video conference.

This is how it's going to work. I will give every person five minutes to speak. At one minute before your time is up, I'm literally going to give you a shout-out and say “one minute” and then “thirty seconds”, so you can wrap up. If you cannot finish your presentation in that time, you have an opportunity during the question and answer session to elaborate on anything you felt you didn't get to say the first time around.

Yes, go ahead.

[Dan Mazier, Conservative, Riding Mountain, MB]

In recognition of the fact that we started 15 minutes late—

[The Chair, Liberal, Hedy Fry]

I always recognize that, Mr. Mazier.

[Dan Mazier, Conservative, Riding Mountain, MB]

Are we going to have a full two-hour meeting?

[The Chair, Liberal, Hedy Fry]

Yes, we will.

[Dan Mazier, Conservative, Riding Mountain, MB]

Do we have resources?

[The Chair, Liberal, Hedy Fry]

We always do. For future reference, we always take into consideration when we begin and put two hours on to that. That's standard.

[Dan Mazier, Conservative, Riding Mountain, MB]

Thank you for clarifying.

[The Chair, Liberal, Hedy Fry]

We now begin with Dr. Caudarella.

Please begin. You have five minutes.

[Dr. Alexander Caudarella, Chief Executive Officer, Canadian Centre on Substance Use and Addiction]

Thank you, Madam Chair and honourable members.

I'm Alex Caudarella, and I had the privilege of joining the CCSA three years ago as CEO.

In 1988, all-party support created the CCSA act. It created this arm's-length charity to bring together expertise from across the country and to increase the participation of people in Canada.

CCSA is the only national organization mandated to address both the health aspects and the public safety aspects of substance use. We work to address alcohol and other drug-related harms through a balanced approach that prioritizes both individual and collective well-being.

As a family physician with experience across multiple provinces and territories, I bring evidence-based, compassionate and collaborative leadership grounded in a need to have a real-world impact.

CCSA's CEO is appointed by its board of directors and must be approved by the Governor in Council. This model reflects CCSA's status as an independent national organization created by and accountable to Parliament. CCSA's board is a volunteer board of directors made up of 13 members. Together, they provide governance and strategic oversight, which I'm very thankful to have.

The chair and up to four other directors are appointed by the Governor in Council. Eight additional directors—members at large—are appointed by the board itself.

CCSA has many achievements, from launching the country’s first addiction and recovery surveys to producing a Canadian substance use costs and harms report repeatedly referred to as the most robust analysis of the impacts of drugs and alcohol.

Since then, our work together has prioritized the many communities we serve, working with them to better understand their needs and leverage science to bring evidence, as a trusted partner, to the grassroots.

Our CCENDU network is a partnership of academics, governments—

[Dan Mazier, Conservative, Riding Mountain, MB]

On a point of order, interpretation seems to—

[The Chair, Liberal, Hedy Fry]

I was about to say that we're having some interpretation problems.

Is it fixed? Good, let's go ahead then.

We stopped the clock, so we didn't take your time.

Go ahead, Dr. Caudarella.

[Dr. Alexander Caudarella]

Do I go back to the part I did in French and do it again?

[The Chair, Liberal, Hedy Fry]

Start from the top, please. I'm sorry, Dr. Caudarella.

[Dr. Alexander Caudarella]

It's no problem. I'm sorry you have to hear me say the same thing twice. I'll insert a new word as a surprise, perhaps.

Thank you, Madam Chair and honourable members. I'm Alex Caudarella, and I had the privilege of joining CCSA as CEO three years ago.

In 1988, with all-party support, the CCSA Act created this arm's-length charity to bring together expertise from across the country and increase the participation of people in Canada on this matter. CCSA is the only national organization in Canada mandated to address both the health and the public safety aspects of substance use. We work to address alcohol and other drug-related harms through a balanced approach that prioritizes both individual and collective well-being.

As a family physician with experience across multiple provinces and territories, I bring evidence-based, compassionate and collaborative leadership grounded in a need to have a real-world impact. CCSA's CEO is appointed by its board of directors and must be approved by the Governor in Council. The model reflects CCSA's status as an independent national organization created by and accountable to Parliament.

CCSA's board is a volunteer board of directors. It's made up of 13 members who provide governance and strategic oversight. The chair and up to four other directors are appointed by the Governor in Council, and eight additional directors, who are members at large, are selected and appointed by the board itself.

CCSA has many achievements, from launching the country’s first addiction and recovery surveys to producing a Canadian substance use costs and harms report repeatedly referred to globally as the most robust analysis of the impacts of drugs and alcohol.

Since then, our work together has prioritized the many communities we serve, working with them to understand their needs and leveraging science, as well as bringing evidence directly to the grassroots. Our CCENDU data network is a partnership of academics, governments, people with lived experience and law enforcement, and it was the first to raise the alarm about fentanyl in 2013. It has continued to expand and now exists in all provinces.

I came to CCSA because of a pair of white shoes I couldn't forget. As a medical student, I met a 10-year-old girl who was crying that she was doomed to suffer a fate like that of her parents around alcohol. She was looking for a way to help her family. I remember her shoes but not her face, because I couldn't bring myself to look at her as I had no tools; I felt so embarrassed. She wanted to build her community, and I came to CCSA because I see this as the vehicle to provide support to communities so they can find the help, the connection and the future this little girl was looking for.

We've been working to build hope and make it clear and easy for everyone to have a role in solving these issues no matter who they are and set them up for success. Our pediatric guidance works with children's hospitals across the country to increase treatment access. Our small cities initiative is working with mayors of diverse backgrounds to find solutions that fit their communities. Our work with industries like trucking, mining and tourism helps them solve these challenges unique to their fields.

Canada's guidance on alcohol and health has put information into Canadians' hands to make their own health decisions. Our public education efforts have led to the most significant decrease in alcohol consumption ever recorded in Canada. Over the past 10 years, weekly consumption has gone from 10 to nine drinks. This is 34 million fewer drinks of alcohol every week, a substantial and impactful decline.

Substance use challenges touch every part of society—from health systems, families and communities to law enforcement and governments—and an effective response requires collaboration across all sectors and at all levels.

While communities across the country have common challenges, they are dealing with a series of distinct crises. These hyperlocal contexts must also be considered in identifying solutions.

There are countless other examples of how CCSA is increasing the participation of people, organizations and sectors across prevention, treatment, harm reduction, recovery and public safety.

I'm pleased, Madam Chair, with the committee's continued interest in substance use health, and my team and I remain available to provide the committee with the latest science, evidence and best practices to help inform your work.

Thank you for having me today.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Dr. Caudarella.

I now go to Neil Arao, board member.

Neil, go ahead for five minutes, please.

[Neil Arao, Board Member, Canadian Centre on Substance Use and Addiction]

Madam Chair and members of the committee, thank you for the opportunity to be here today with you.

My name is Neil Arao. I serve as a Governor in Council appointee to the board of the Canadian Centre on Substance Use and Addiction. I'm also a registered social worker here in British Columbia. In my day job, I'm CEO of one of the largest community-based health and social service organizations in greater Vancouver.

My career has spanned the mental health and substance use system. I began as a concurrent disorders clinician with Vancouver Coastal Health and worked at the Vancouver Detox Centre and with the assertive community treatment teams, supporting people living with severe and persistent mental illness.

I later managed mental health, substance use and criminal justice programs; led psychosocial rehabilitation and predischarge units at the Forensic Psychiatric Hospital; and oversaw homelessness, housing, mental health and substance use services as an executive director. In my spare time, I continue to practise privately as a counsellor.

Through this work, I have supported people experiencing substance use in emergency settings, treatment programs, justice systems and their homes.

From my perspective, substance use impacts people, families, communities and systems in very interconnected ways, and in my work, I have seen approaches grounded in compassion and inclusion in which people with lived and living experience and families help shape responses. I've also seen the challenges that arise when accountability, evaluation and evidence-informed approaches are not consistently applied.

I joined the CCSA board because I believe this complex issue can benefit from perspectives across provinces, community-based organizations, clinical systems and professions. CCSA's work, including its focus on accountability and quality in bed-based treatment settings and its examination of the intersections between housing instability and substance use, reflects the importance of taking a systems-level approach.

In my experience, when people speak about a continuum of care, there's often an absence, whether it's prevention, harm reduction, treatment, recovery or enforcement. All these components must be discussed, but not in isolation. It must also reflect culturally relevant and community-based approaches within each stage. Approaches do not need to be mutually exclusive, and they can all be part of a coordinated system of care.

Many of the people I have worked with who experience significant substance use challenges have also experienced trauma over time, and addressing trauma early, supporting prevention and providing people with tools and supports can influence longer-term outcomes. Recovery is supported when the systems that interact with people, including health care, housing, justice, education and child welfare, are all aligned and responsive to their needs.

My role as a board member is in governance, and this includes supporting scientific integrity, ensuring public funds are stewarded responsibly and reinforcing the importance of accountability and outcome measurement. It also includes ensuring that CCSA continues to provide Parliament with balanced, evidence-informed guidance.

Canadians expect compassion; they expect competence, and they expect accountability.

Thank you. I look forward to any questions.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Mr. Arao.

I now go to Scott Elliott.

Welcome, Scott. You have five minutes, please.

[Scott Elliott, Board Member, Canadian Centre on Substance Use and Addiction]

Madam Chair and members of the committee, my name is Scott Elliott and I'm from Vancouver, British Columbia.

For the past eight and a half years, I've served as CEO of the Dr. Peter AIDS Foundation in Vancouver. Prior to this, I was a senior executive and leader for notable organizations, and I served on numerous not-for-profit boards.

I'm a gay, HIV- and hep C-positive man living through 39 years of active recovery from drug and alcohol addictions.

Stigma, shame and discrimination are not abstract concepts to me; I've lived with them for most of my life. However, rather than limit my ambitions, my lived realities have given direction to my career and purpose to my life. I have earned my voice as a trusted leader in the complex care space. It has shaped my empathy for Canadians who struggle with mental health issues and addiction. This is part and parcel of the reason I chose to volunteer as a board member for the Canadian Centre on Substance Use and Addiction.

My organization, the Dr. Peter Centre, has been operating since 1997. We manage a clinical day health program for more than 500 participants, a 24-hour licensed care residence and enhanced supportive housing that balances dignity and health care.

While we began as an AIDS organization, the centre is never about serving just one population. We have 28 years of experience working with what we call the “sidelined 2%”. The sidelined 2% is the nearly 750,000 Canadians who face extreme overlapping challenges—mental illness, addiction, homelessness, cognitive decline, trauma, institutionalized racism and medical issues, including HIV, HCV, etc.

In my decades of experience, I've seen that many will never be able to achieve sobriety and that many will never live independently without support. I've seen over the decades hundreds who have relapsed time and time again and hundreds who've died because the support and services they needed did not exist for them.

Today, I appear before this committee and provide witness testimony as a volunteer board member for the Canadian Centre on Substance Use and Addiction. The capacity of my role is to work alongside my fellow board members to further the CCSA's legislated mandate to provide leadership on substance use health and to reduce alcohol, drug and other addiction-related harms.

The CCSA acts as an independent adviser to governments, producing evidence-based research to inform policy, programs and public awareness, all the while fostering collaboration across sectors to improve community resiliency and safety.

Working on the front line, I see innovative solutions every day. I also see that these solutions remain isolated in one program, in one city or in one province when they could be informing practice across the country. Such complex challenges require coordinated and strategic responses, strategic implementation across jurisdictions and de-siloed funding and policies across health, housing, mental health, indigenous services and public safety.

The CCSA has the mandate and the convening power to help bridge those gaps, connect evidence with action and ensure that Canadians across the country have access to effective care.

This kind of leadership matters now more than ever.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I now go to Susan Russell-Csanyi.

Please begin for five minutes, Ms. Russell-Csanyi.

[Susan Russell-Csanyi, Board Member, Canadian Centre on Substance Use and Addiction]

Thank you, Chair and members of the committee, for the opportunity to speak with you today.

My name is Susan Russell-Csanyi. I bring to this work professional experience, governance experience and first-hand experience supporting those in the intersectionalities of substance use, addiction, child welfare and social systems. I spent the early part of my life in the foster care system, which has informed my understanding of how public systems interact over time and how gaps in coordination can affect outcomes for young people and families. This experience has shaped my professional interest in system effectiveness, risk reduction and accountability.

In my personal life, I have lost five people close to me to the harms related to substance use. Three of them—Adrian, Josh and Katharine—lived in British Columbia. I am speaking from Winnipeg, where I lost my sister Andrea, as well as a young person with whom I worked closely. Four of the five individuals who died had prior involvement with the child welfare system. While each circumstance was different, this overlap reflects a broader, well-documented challenge in the intersection of child welfare, health care and public safety systems. These experiences have reinforced the importance of timely intervention, continuity of care and a coordinated response that reduces health risks and community impacts.

Professionally, I have worked across child welfare, health and advocacy settings. I am here today to speak to the intersections in the walks of life as a board member of the Canadian Centre on Substance Use and Addiction. My colleagues have already highlighted that CCSA is a national organization with a legislative mandate to provide objective, evidence-informed health advice on substance use and addiction. Our work spans through public health and public safety. Our work supports government. Our work supports service providers and communities through research, surveillance, knowledge mobilization and cross-sector collaboration. CCSA's mandate is to reduce substance-related harms while improving the safety, health and population-level outcomes for all Canadians.

As a member of the board of directors, my role is one of governance and stewardship. This includes upholding the CCSA's non-partisan mandate while ensuring that the organization's work remains evidence-based, credible and aligned with public interest and responsibilities. It is also to provide oversight and to support strong leadership, sound decision-making and effective use of public resources. My perspective as a board member is informed by my frontline experience, my youth advocacy and my work across multiple public systems. My work includes the appropriate and respectful inclusion of lived expertise when it strengthens relevance to the program and system effectiveness across all non-profit, business and political sectors.

Beyond my role at CCSA, I am actively involved in community service. I am a founding and current member of the national council of youth in care advocates, which works hand in hand to broaden the knowledge related to public health and public policy. My academic background includes a bachelor's degree in kinesiology from the University of Manitoba, with a focus on physical health, wellness and well-being, along with a public policy certificate from the United Way. Together, these things support my interest in prevention-oriented, health-centred approaches that contribute to public safety and system sustainability.

I chose to join the CCSA board in January 2026 and serve alongside all of my colleagues, who remain committed to fulfilling the governance responsibilities in support of evidence-informed, balanced approaches to substance use and addiction that protect both individual well-being and community safety.

Thank you for your time. I would be pleased to take your questions.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Ms. Russell-Csanyi.

We'll now go to Dr. Louis Hugo Francescutti for five minutes, please.

[Dr. Louis Hugo Francescutti, Board Member, Canadian Centre on Substance Use and Addiction]

Thank you, Madam Chair.

Thank you to the other members of the committee.

I left my beautiful province 46 years ago and moved to Alberta. I'm always happy to have an opportunity to speak French, but today I'm going to speak to you in English.

I'm an emergency physician. I'm 72, and I love what I do. I'm still practising at the Royal Alexandra Hospital in Edmonton, one of Canada's busiest emergency departments.

As my colleagues have attested to, we have a problem across the country with patients who present as homeless, with mental health issues, with addiction issues or all the above. These are, without a doubt, the most complex patients we see in health care today.

I'm excited. It is the highlight of my week to join you and share a bit about what I know—and, more importantly, to find out what you know—that we could do differently in our society to better meet the needs of these individuals.

As past president of the Canadian Medical Association, as past president of the Royal College of Physicians and Surgeons and having sat on the board of Accreditation Canada and other organizations that are national, I bring a bit of depth to the conversation.

When I was asked to serve as chair of this board in December, it was an honour that I couldn't pass up. Having had one board meeting, I can say that the men and women who surround us in the staff at the CCSA are amongst the best I've ever worked with. If there's any way the CCSA can be of value to you as you set policy in this area, which is so important, and then try to bring along our partners in the provincial governments, territorial governments and municipal governments, we're here to serve your needs.

I look forward to any questions you may have today.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

We will now go to the question and answer period.

I want to let the witnesses know that there's a time limit on the question and answer period. Whether it's six minutes or five minutes, it includes both the question and the answer. I'm going to ask you to be as concise as you can so that we don't run over time, which would mean that you don't get to finish what you're saying.

We will begin with Ms. Konanz for the Conservatives.

[Helena Konanz, Conservative, Similkameen—South Okanagan—West Kootenay, BC]

Thank you to all of you for coming. Thank you for your work in the field of addiction. It's extremely important.

This week marks the 10-year anniversary of B.C.'s declaration of a public health emergency due to the overdose crisis, yet more Canadians since then have died of a deadly drug overdose than on every battlefield during the Second World War. Eighteen thousand of them were British Columbians.

There is a reason The Canadian Press called this a “Decade of death”. Overdose deaths peaked during the decriminalization pilot project in B.C. Too many public spaces look unrecognizable compared to even a few years ago. Too many lives are still lost.

Dr. Caudarella, during your testimony to the Senate in June 2024, you said, “supervised consumption sites [should] become more embedded in the overall health and social systems...as a front door to wellness.”

Is it still your advice to the Canadian government today that more drug consumption sites be embedded across Canada?