Thank you for inviting me to speak to this committee today on such an important issue for Canadians, especially those experiencing severe addiction and mental health issues.
In our brief, which is a collaboration with the Canadian HIV/AIDS Legal Network, we have outlined many of the benefits of supervised consumption services around the world and our concerns with Bill C-2 as it is currently drafted. We, along with others appearing before you, have made the point that the services that Bill C-2 is focused on are evidence-based, have been around for close to 30 years in various jurisdictions, and are a part of a comprehensive approach to developing systems of care for people with severe addictions at the margins of society.
I have worked for many years in the field of drug policy and have been a participant in the broad public discussion that has been taking place in Vancouver, B.C. over the past 20 years focused on building a more effective response to drug problems in our country. As a staff person with the City of Vancouver for 22 years, 10 of those working as the city's drug policy coordinator, I know only too well the challenges for municipalities and local health authorities attempting to do the right thing, which is to put in place a comprehensive system of care for people with drug problems in the community. This includes drug treatment facilities, detox units, scaled-up methadone programs, supportive housing projects for people with addictions and mental health issues, needle exchange projects, other types of social development programs, and yes, supervised consumption services.
Because of the stigma of illegal drug use, each one these services is a challenge for municipalities and health authorities to implement at the local level. It requires a great deal of time, energy, commitment, and resources to get these services up and running and provide much-needed help to people. Believe me, there is a great deal of public process at the local municipal level to situate any of the services that I have mentioned.
Bill C-2 will add an extremely onerous extra layer of work for those at the local level that will most certainly have the effect of preventing the scaling up of supervised consumption services across the country where they may be needed. The 26 different pieces of information required before an application can even be considered would not be required of any other type of health service. At the very least, Bill C-2 will cause a significant delay for localities to implement a timely response to what are often the urgent realities of the unregulated illegal drug scene. An example of this urgency is the recent spate, mentioned by my colleague, of overdoses due to fentanyl in Vancouver, when the Vancouver police, to their credit, urged people to use Insite in an effort to prevent overdose deaths. Thirty-one overdoses took place at Insite over Thanksgiving weekend, none of them fatal. This is a tool that other localities do not have access to at this time.
We are very sorry that this legislation is not coming before the Standing Committee on Health. After all, the primary purpose of supervised consumption services is to intervene in urgent public health contexts where vulnerable citizens are at high risk of serious and sometimes deadly consequences of injection drug use. Consumption services can mitigate this risk, including improving the health and safety of the communities where they might appropriately be located. A hearing only before the Standing Committee on Public Safety and National Security does not seem adequate to consider the complexity of the health and social issues engaged by these kinds of services. Indeed, supervised consumption services are themselves a balanced approach in that they address both public health and public order issues in communities.
Another contextual comment I wish to make is to note the great divide in the testimony of our health and enforcement colleagues. The divide between the leadership of these two fields of work in our communities is of concern to us and seems to be vast, with virtually all professional health associations that have provided expert advice, including the Canadian Medical Association, the Canadian Association of Nurses in AIDS Care, Vancouver Coastal Health, and the Toronto public health department finding Bill C-2 significantly problematic on a number of grounds.
On the enforcement side of things, for the most part, in spite of all the evidence from existing supervised consumption services projects, it seems that there is not even a willingness to consider a trial or pilot project to see what the experience of different models in different localities might be. In the face of all the evidence of 30 years of positive experience of integrated consumption services into the systems of care in Europe, in Vancouver, and in Sydney, Australia, there seems to be a firm position against any such trials on behalf of our police leadership.
We think that the divide between these two critical fields of public service is unfortunate, as we are certain that the health and enforcement institutions in this country share the goals of healthy, safe communities for all Canadian citizens, including those who use drugs.
As we have written in our brief, by advocating a focus on public safety at the expense of public health, the context of these hearings being a prime example, the bill runs counter to the court's emphasis on striking a balance between public safety and public health.
By making it even more difficult to implement supervised consumption services, Bill C-2 ignores the Supreme Court of Canada's assertion that these services are vital for the most vulnerable groups of people who use drugs, and that preventing access to these services violates human rights.
In the words of the chief medical health officer of Vancouver Coastal Health, Bill C-2 as currently configured will “effectively act to block exemptions” and “the provision of life-saving medical services to some of our most marginalized citizens and result in deaths and serious illnesses that are entirely preventable”. If this is the case, it is our judgment that this clearly contradicts the spirit of the Supreme Court decision on Insite.
Making it more difficult to open consumption services in Canada is clearly out of step with the commitment that this government has expressed to address Canada's serious mental health situation as well. Consumption services aim to engage marginalized people who use drugs. In Canada the percentage of homeless people who have either a mental illness or a substance abuse diagnosis is 86%, and the percentage of homeless people with a mental illness who also have a substance abuse problem is 75%. Many of those who inject drugs would benefit greatly from the engagement with health, social workers, and drug treatment professionals through their participation in a comprehensive supervised consumption service program.
At Vancouver's Insite, 65% of participants have had a previous diagnosis of mental illness. Given these numbers, putting barriers in the way of implementing supervised consumption services seems at odds with this government's stated commitment towards the mentally ill in Canada. One would like to think that the government would want to facilitate the development of one more evidence-based tool in the tool box to help address mental health and addictions in this country.
A recent systematic review of injection sites released last week, conducted by four researchers from France and one from Switzerland, reviewed 75 relevant articles. The findings of the systematic review were as follows. All studies converged to find that supervised injection services were efficacious in attracting the most marginalized people who inject drugs, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. Supervised injection services were not found to increase drug injecting, drug trafficking, or crime in the surrounding environments. Supervised injection services were found to be associated with reduced levels of public drug injections and dropped syringes.
I will close by reminding the committee that the issue of supervised consumption services came to the fore after a decade-long public health and public safety disaster in Vancouver, and indeed British Columbia, during the 1990s. Thousands of people died and many more became ill during that period. The epidemics of overdose, HIV, hepatitis C, and injection drug use overwhelmed Vancouver's inner city. At the time, Michael O'Shaughnessy, the director of the B.C. Centre for Excellence in HIV/AIDS, coined the phrase “deadly public policy” to refer to the mix of municipal, provincial, and federal policies in the areas of social assistance, housing, mental health and addictions, and lack of funding for health and social programs, and enforcement practices, etc., that contributed to inadvertently creating the conditions for an HIV epidemic among injection drug users to flourish in Vancouver.
In British Columbia much time has been spent trying to undo those deadly public policies with some good successes. If Bill C-2 is implemented in its current form, our organizations would certainly consider it to be a step backward, creating yet another deadly public policy as it clearly will have the impact of denying marginalized and often seriously ill Canadian citizens and their communities access to proven life-saving health services.
I thank you very much.