Debates of Dec. 10th, 2018

Opioid Crisis in Canada

[Dan Albas, Conservative, Central Okanagan—Similkameen—Nicola, BC]

Mr. Chair, this is a very challenging problem. People who are involved in it will say that a multi-pillar approach is needed for us to be able to more effectively respond to the opioid crisis, and that involves institutional change.

As I said in my speech, there are safe injection sites that are opening and there are safe injection kits that are being given. Canadians cannot hold a structure that can take the weight of this problem if they only have a single pillar. There needs to be a proper balancing, and when Conservative voices say that we would like to see further emphasis on the other pillars, I do not think that is being unreasonable. Canadians deserve to know that a complex problem involves deliberation and a nuanced approach so that we can incorporate different ways of thinking to come up with a way to solve this, and that means a multi-pillar approach. We cannot say it is a multi-pillar approach and focus on just one component—

[The Assistant Deputy Chair, Liberal, Anthony Rota]

Questions and comments, the hon. member for Oakville.

[John Oliver, Parliamentary Secretary to the Minister of Health, Lib.]

Mr. Chair, I feel that there has been an unwillingness to listen to what the government is doing and what actions have been taken. There is a multi-pillar approach going forward. The member is raising the continued question about treatment and treatment beds. I need to remind him that the opening of treatment beds is a provincial-territorial responsibility. We have a $150-million fund created. We cannot create nurses and infrastructure and places for treatment. That is a provincial-territorial responsibility. The biggest problem we have is that we are playing catch-up after nine years of the Harper government's failing to making any investment in treatment and prevention. That is the biggest problem we are facing tonight.

[Dan Albas, Conservative, Central Okanagan—Similkameen—Nicola, BC]

Mr. Chair, the government's own member, the chair of the heritage committee, said that if this had happened in Ontario there would have been a much different response.

I will say this to it. Leadership matters. In either 2007 or 2009 the government made a commitment to work on provincial wait-lists, on dealing with wait times on certain things. That leadership was a commitment to the Canadian people. Provinces worked together with it and they were able to come together. It is a matter of will, leadership and implementation.

[Gary Anandasangaree, Parliamentary Secretary to the Minister of Canadian Heritage and Multiculturalism (Multiculturalism), Lib.]

Mr. Chair, there is no doubt that Canada is currently in the midst of an unprecedented national public health crisis. Since the beginning of 2016, more than 8,000 Canadians have lost their lives as a result of opioid overdose. This is nothing short of tragic. Every community in Canada has been affected by it, from small towns to big cities. Many lives have been lost senselessly.

Last year, I met a mother who lost her only daughter to an opioid overdose. She told me of her pain and anguish when thinking about her daughter in the wee hours of the night. She could not find answers. She did not know where to turn. She just wanted to prevent other young people from being victims of this crisis.

Just recently, I attended the funeral of a young man who I have known for many years, whose best years were ahead of him. He was passionate, energetic, brilliant and had a heart of gold. We lose countless young men and women like this each and every day.

I want to thank many of the members in this chamber who shared their personal experiences, because I do not think that a single person in this chamber is immune to this loss.

I also want to thank, acknowledge and extend my deepest condolences to the families of the many young people who have died during these years. We share their pain. We weep with them. We will always remember these young men and women in the work we do. They are not a statistic. They are our sons, our daughters, our neighbours and our friends.

I want to give members a sense of the things that our government has undertaken since taking office in 2015.

In 2016, our government invested more than $331 million in an effort to respond to the crisis and address the broader issue of substance use.

In budget 2017, $100 million was allocated, over five years, which equals $22.7 million annually, to ongoing efforts to enhance related harm reductions, as well as to strengthen the evidence base.

The substantive portion of my debate will be focused on the evidence base. However, let me just outline some of the other things that our government has undertaken.

In budget 2018, $231.4 million, over five years, was put toward establishing an emergency treatment fund, developing a national public education campaign, enhancing stability of front-line personnel to detect and intercept illegal drugs at the border, as well as to accelerate and expand access to timely national public health data and analysis.

Our government has also used existing resources to support and then respond to the crisis. For example, $16 million in emergency funding to B.C. and Alberta alone is currently funding 28 opioid-specific projects through the substance use and addictions program at a value of $9.5 million a year. There have been 32 supervised consumption sites approved in Canada. There have been 12 federally trained public health officers deployed to jurisdictions. More than 42 kilograms of fentanyl has been seized between April of 2016 to September of this year. We moved the overdose antidote naloxone to a non-prescription status and made it more widely available. There are a number of other initiatives. However, let me speak primarily on the need for data.

I have heard many people speak this evening and I know everyone here means well. I think everybody comes to this debate from the right place. However, I think we need to be frank with each other. Nobody knows the answer. There is no silver bullet. There are things that governments can do, and as a government we are doing, but at the core of it we need more data, more information and more research. This is why we have supported and we will continue to support research at the Canadian Institutes of Health Research. Over the last five years, the CIHR has invested more than $88 million in research in areas related to problematic substance use. This includes $22 million in research related to problematic opioid use. Research supported by these investments provide new knowledge and the evidence needed to make informed policies in order to better address the needs of Canadians suffering from opioid use.

For example, CIHR recently announced an investment of $1.1 million for a project by the University of British Columbia that focuses on evaluating the benefits of expanding the availability of prescribed opioids for the treatment of opioid use disorder. More specifically, this research project will explore how patients with different characteristics respond to treatment, which will help in the design of expanded services for patients.

In addition to this research project, CIHR is supporting various research initiatives aimed at addressing the opioid crisis. I would like to provide an overview of some of these initiatives that are providing important evidence needed by governments to made informed decisions.

I wish to begin by highlighting a pan-Canadian research consortium on problematic substance use that CIHR is supporting, the Canadian research initiative in substance misuse, or CRISM. CRISM is generating timely evidence related to the treatment of opioid use disorder by facilitating communication and collaboration between researchers, service providers, policy-makers, patients and people who use substances. In effect, it has a wraparound approach. It aims to translate evidence-based interventions with substance use into clinical practice, community-based prevention, harm reduction and health system changes. For example, CRISM developed the first Canadian guideline for managing opioid use disorder. This guideline, released in March of this year, addresses current gaps in care of opioid use disorder. It serves as an educational tool for Canadian health professionals and provides clinical practice recommendations for the treatment of opioid use disorder. The guideline also serves as a main resource informing development of evidence-based strategies related to treatment access policies on opioid use disorder across Canada.

CRISM is also addressing evidence gaps related to medication-assisted therapy for treating prescription opioid use disorder. With a $4.4 million investment from CIHR, CRISM is conducting the OPTIMA study, a national clinical trial to compare and evaluate two models of care for prescription opioid use disorder. OPTIMA will generate evidence in real life clinical practice settings and will be used to inform patient care and improve health outcomes for all Canadians. In addition to providing guidance on OPTIMA strategies for treatment of problematic opioid use, CRISM is conducting research to facilitate and scale up promising interventions that reduce the harms associated with opioid consumption.

CIHR is providing an additional $7.5 million to CRISM for the implementation science program on opioid interventions and services.

There are a number of other initiatives that I can speak about. For example, the knowledge synthesis initiative, another initiative of CIHR, invests $1.9 million in 22 research teams of experts and policy-makers to rapidly inform policies on opioids by addressing the most pressing evidence needs. These research projects were directly informed by stakeholders that are on the front lines of the opioid crisis, including service providers, community advocates and policy-makers at all levels of government.

There is no question that we need more information to make sound decisions. While we are waiting for that information, our government has undertaken a number of very important initiatives that I spoke about earlier, including investing in a number of different initiatives directly targeted at this crisis.

There is no silver bullet, but research is going to be at the core of a long-term solution that could address some of the underlying issues related to this crisis.

In conclusion, we all need to work together as parliamentarians. It is important that we recognize this to be an issue, a crisis, that needs to transcend party divisions and party lines. We need to look at this with a science-based approach, one that focuses on research and that undertakes immediate interventions, so that this crisis can ultimately be curtailed.

I know this is a difficult conversation for many, and I want to thank all my colleagues for their participation today.

[Sheila Malcolmson, NDP, Nanaimo—Ladysmith, BC]

Mr. Chair, Nanaimo has been hit early and hit hard by the opioid crisis, with 150 deaths in the last five years and overdose rates last year that were 50% higher than in the rest of B.C. Firefighters told me this morning that they are on track to be called out to 500 overdoses, just in our city of 100,000 people. It is colossal.

Given that the Liberals called this debate tonight, we really wanted to hear more oomph and about the new offer for families that are hit so hard. I want to read a letter sent to me by Teena MacKenzie. She wrote it to the Prime Minister and copied me. She said:

My close friend lost her daughter.... [She was] a young mother, just 25-years-old. Three weeks shy of her only son's 4th birthday....

Yes, her mother tried to seek help for her daughter many times. Many times [she was] turned away as a waiting list grows. You can not place an addict on a waiting list for help; it almost appears these human beings are put on a waiting list to die instead....

Justin, where are the changes?....

I have read the Federal Government Action Plan; all I read is observers collecting information and No real action plan; PLEASE STOP stop talking and START DOING!

When is the government going to start doing more to treat this emergency in the way that victims and the families deserve?

[Gary Anandasangaree]

Mr. Chair, my friend was sharing some very personal experiences of her constituents, friends and perhaps neighbours.

It is absolutely a crisis, and I outlined a number of very important initiatives the government is undertaking. However, it is also critical to look at the underlying research that needs to inform us of what the next steps should be. That is what the government is also doing. While we are putting in measures that address the immediate needs, but we are also looking at a longer-term undertaking to ensure that our decisions are based on sound science directed by the evidence that is before us, one that brings together and collaborates with researchers, individuals, patients, families and policy-makers. That is critical to any sound decisions our government could move forward with.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Mr. Chair, one of the areas we have not talked about tonight has been the grief supports that families of people who have died from the opioid crisis need. I am an advocate for palliative care, which has created a lot of grief support across the country. However, that support is being taken up by this opioid crisis and by the families who are suffering.

Will the government look to increase its support for grief counselling that is so needed?

[Gary Anandasangaree]

Mr. Chair, that is a very constructive observation. It is an essential part of what the families going through this need, and I believe that this support is lacking, to be honest, at least in the areas I represent. Unfortunately, the support systems are not readily available for families who require this.

As a matter of provincial jurisdiction, I encourage our provinces to assist in that regard. As part of our strategy, we have funds that are going to the provinces to support their overall response to the opioid crisis, and I would hope that support and counselling is an essential part of that.

[Ken Hardie, Liberal, Fleetwood—Port Kells, BC]

Mr. Chair, what we have heard so far tonight is that we need demonstrated action and measurable results. I have also heard tonight that there are 28 safe consumption sites in Canada. My guess is that tens of thousands of people have used these sites over the last number of years, and we know of the statistic that 1,100 have suffered overdoses there, but have been saved. That no one has died as a result of safe consumption sites is a signal that maybe action there has at least paid some dividends.

We have 28 safe consumption sites now. What have we done since 2015 to produce these results?

[Gary Anandasangaree]

Mr. Chair, I believe that since taking office, we have opened 27 safe injection sites, and 32 supervised consumption sites have been approved going forward.

Philosophically, I do think the previous government failed to act on this to ensure that there were appropriate sites to support individuals. I believe there was only one when we took office. That number has expanded substantially in the last three years, and I think it will expand even more in the years to come.

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

Mr. Chair, we have learned that in Portugal, the number of deaths from overdoses is 30 times fewer than in Canada. This tells me that we need to model our approach to tackling this issue after a country that is having success. We need to radically change what we are doing.

We are failing. There has to be some accountability for negligence here. Our overdose rate per million is 30-fold that of Portugal. I do not understand the government's resistance to adopting a decriminalized approach. It would take away the stigma and make this a health issue, which is what it should be. This is what medical health officers are saying it needs to be.

We need this approach immediately. People cannot wait, as we are losing lives every day. The 30-fold difference says it all.

What are we waiting for? Why are we not paying attention?

[Gary Anandasangaree]

Mr. Chair, Portugal is not Canada and Canada is not Portugal. In looking at jurisdictions even within Canada, I note that my friends opposite have outlined issues in their communities. These communities are sometimes even smaller in size compared to, say, places like Toronto. I do not think it is necessarily fair to compare what is happening in different jurisdictions.

Obviously we need to look at best practices that are based on the best information that is out there. However, we cannot solely base things on one issue alone.

Moreover, decriminalization is not a panacea. It is not the solution. A number of issues need to be addressed in order to reduce the numbers. Certainly it is not a silver bullet, which I discussed earlier.

[Alex Nuttall, Conservative, Barrie—Springwater—Oro-Medonte, ON]

Mr. Chair, I would like to thank the members for appealing to some real change in terms of dealing with the crisis itself, but also dealing with grieving parents and family members.

It was just brought up that in Portugal there was a move toward decriminalization. This is not actually true. Portugal created a sort of third tier called administrative offences. However, at the same time, Portugal put beds everywhere.

We heard the geographical difference between Portugal and Canada, and to say that we cannot compared the two is, I think, actually inaccurate. We need to compare ourselves with those who are doing better than we are and strive for some similar results.

To the member, do you believe that the government should be investing as much money in rehabilitation and recovery as it is investing in injection sites? In other words, do you believe that the government should be providing more than one recovery bed's worth of funding for every injection site opened by the government?

[The Assistant Deputy Chair, Liberal, Anthony Rota]

I want to remind the hon. members to place their questions through the Chair and not to ask the questions to those across. I have seen a few people do that. I know it is kind of familiar, and it is good to see that people feel comfortable, but just to avoid anything getting out of hand, please place your questions through the Chair.

The hon. parliamentary secretary.

[Gary Anandasangaree]

Mr. Chair, we are doing both. I do not think it is necessary to quantify which one supersedes the other. As a government, we believe in a multipronged, multi-pillared approach that essentially captures the different options that are available. I think we are on the right track toward addressing this in a multipronged way.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Chair, I have listened to this debate right from the very start and I appreciate our colleagues sharing their stories and coming at this from a point of respect.

It is interesting to stand here and talk about a national crisis, which is really truly what we have today.

I will gear most of my speech towards the impact that this crisis is having on my province of British Columbia. British Columbia has had a significant number of deaths each month, approximately 100 deaths per month. Last January our minister of health called on her federal counterpart for help with this issue. She asked the federal government to declare this a national health crisis.

I heard some of the arguments and talking points from our government friends. I listened intently to our friends in the NDP. I listened to the passionate speeches given by my friend from Sarnia—Lambton as well as my good friend from Barrie—Springwater—Oro-Medonte. It is clear that we are not there yet. We still have a crisis. People are still dying every day.

I listened to a comment by the government House leader. I hope she was not heckling me.

We cannot stand up and say we are winning this war. I get it. I understand this is an election year and government members are standing up and saying their government has pledged $350 million for this. This is a take-note debate. We should be listening. The government should be taking notes. We should be trying to move forward. We should be having a healthy discussion.

I will bring us back to the very first emergency debate that we had here in the House after the last election. It was on the suicide epidemic on Attawapiskat First Nation.

I do want to offer this before getting more heckles from anybody across the way. I have come to this debate with some personal experience in terms of a loss from an overdose.

I will bring members back to the debate that we had when our colleague from Coquitlam—Port Coquitlam brought forward his good Samaritan bill, Bill C-224. In that debate I talked about a day in 2008 when I received a call that my brother, who was not a drug user, was found deceased from an apparent overdose. It is still to this day hard to discuss. I strongly believe that our colleague's Bill C-224, the good Samaritan bill, will save lives. It allows people who are with someone who may overdosed or is struggling with some form of massive intoxication from some form of drug to dial 911 and ask for help knowing that they themselves will not be prosecuted.

Since 2016, over 8,000 Canadians have lost their lives because of this. In 2012, the death toll from fentanyl or opioids in British Columbia was 42, and right now we are sitting at over 1,000 in 2018 alone. This is a crisis like we have never seen before.

This past March was the worst month in B.C.'s five-year-old fentanyl crisis. There were 162 deaths. As a matter of fact, the week of July 23 was the worst week for Vancouver Fire and Rescue. It responded to 147 overdoses.

In preparation for this debate, I talked with a friend of mine who is with the RCMP. I also talked with a friend of mine who is with Vancouver Fire and Rescue. I asked if safe injection sites were helping. They did say that safe injection sites probably do help. However, they said that it probably helps those who are on the streets more so than the blue collar worker or the teenager, or the real estate agent that died recently of an overdose, who did not know what was in the drugs. They said the challenge that we have, and I do not think I have heard this brought up yet, is the drug is getting across our border. We are powerless.

People can say what they want about President Trump but at the G20 recently, he managed to get China to designate fentanyl as an illegal substance. I have to get the exact words. It is a controlled substance, “China agrees to make fentanyl a controlled substance after talks with the U.S. at G20 summit.” That means that people from China who sell fentanyl to the U.S. will be subject to China's maximum penalty under the law. We need to get tough on this ourselves.

To give an example of what we are dealing with here, fentanyl is 100 times more powerful than heroin. A dose the size of a grain of sand can kill. When prescribed by doctors, it is prescribed in the millionths of a gram. If someone takes ibuprofen for a headache, the dosage is usually around 400 milligrams. Imagine cutting that pill into 400 pieces. Fentanyl is 100 times more powerful than heroin.

It has been described as readily available to purchase on the Internet, that it is as simple as ordering a book from Amazon. That is how easy it is to get. A kilogram of fentanyl over the Internet costs around $23,000. A kilogram of fentanyl would be about the size of a cantaloupe, and on the streets that kilogram which costs $23,000 sells for $20 million.

That is the problem we have today. We need to be investing in things that will help us along the way, but we need to get people the treatment they need. Is a blue collar worker who is addicted to fentanyl going to check into a safe injection site? What about that real estate agent? What about a high school student who is at a rave or a party and ingests something, and he or she has no idea what he or she ingested?

It is now found in marijuana. It is found in cocaine. It is found in ecstasy. It is found in crack. It is coming across our borders, and we seem to be powerless to stop it. I would offer, respectfully, that our first line of defence is to make sure that this drug does not come into this country. We have to make it tougher for those who are importing it. We have to make it tougher for those who are selling it.

We have to educate Canadians that it could be found in anything they are trying. How many times do we have to pick up the newspaper and read about a teenager who went to a party or who was on a party bus and ingested a pop or a drink and overdosed? That is the reality. That is what we are hearing.

I do not have the answers. The people I have talked to who have been tasked to save lives, whether it is the RCMP or other police officers, say that safe injection sites may help, but we need to get people the treatment. We need to get beds. We need to stop the drug from coming into our country. When drugs the size of a grain of sand can kill, we have to do whatever we can to stop them from coming into our country. With that, I will cede the floor.

[Nathaniel Erskine-Smith, Liberal, Beaches—East York, ON]

Mr. Chair, I trust in the sincerity of the member when he says that this is a public health crisis and that we need to put all options on the table to address it because thousands of Canadians are losing their lives.

The member said that he does not have all the answers. I certainly do not have all the answers either, but I know that health professionals have the answers. Health professionals, whether it is mental health professionals through the Canadian Mental Health Association or our chief medical officers, all say that providing treatment options is the first step and that once we have treatment options in place, it is incredibly important to ensure that people are accessing treatment options, which means ensuring there is not the stigma associated with seeking treatment. It means we have to move it out of the criminal system and into the health system.

If we want to save lives and put all options on the table, is the Conservative member willing to say that we should treat drug use as a health issue and move it out of the criminal system and into the health system where it belongs?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Chair, I deeply respect our hon. colleague across the way. I am going to offer that I have not read the same reports that he is referring to. I would think we should first make sure that we have beds available. Let us make sure that we have treatment facilities available. Let us make sure that the drugs are not getting into our communities, whether it is our major centres or rural communities. Let us make sure that the drugs are not getting into the hands of youth. It is staggering to see the reports that this is an all ages epidemic. Children as young as 10 are ingesting this drug and they are dying. It is cut into everything.

We need to make sure that we are doing everything we can to combat this crisis. The first step would be to declare a national state of emergency with respect to the fentanyl and opioid crisis.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, the problem we find ourselves in today is not something that happened in the last few years. It has really taken decades to get here. It has come from a fundamental misunderstanding of the nature of addiction over the decades where we treated addiction as if it were a character defect or an issue of morality instead of a health issue. The result is that we have criminalized drug use and stigmatized addiction. The result of that is the obsession and compulsion to use, and the fog and detachment from reality that accompanies and is a feature of addiction means there is only a brief period of time when a person who suffers from addiction is ready for treatment. The health care system must be receptive and nimble enough to receive that person immediately. However, instead, we have built a system where there are wait-lists of six months, 12 months, 18 months, two years, and so that moment is lost.

We would never tolerate that for any other health issue. What about someone who needed a heart valve replacement or he or she would die within 48 hours? We would not put that person on a wait-list and tell him or her to come back in a year. That would be illogical. It would be absurd. However, that is what we do with addiction today.

The Liberals are patting themselves on the backs for spending $150 million on treatment. However, if we divide that among 10 provinces and three territories, it works out to about $11.5 million per province and territory. That is not enough to open one 50-bed treatment centre per province or territory.

I wonder if my hon. colleague can comment on what kind of investment he thinks is necessary to actually build our health care system so that treatment is available upon demand so that every person suffering from substance use disorder in this country, when they need treatment, can get it immediately so that people do not die, like the touching story of the member's own experience that he related to the House tonight.

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Chair, the member gave me many options with that question.

When the Prime Minister sends a $50 million tweet, and nobody is discounting the good or worthiness of that cause, or if $600 million can be spent to purchase the media just before an election, or $400 million for Statistics Canada to harvest private data, or $800 million toward legalizing cannabis and then $250 million to be pledged, although only $50 million has really gone out the door, we need to do more.

I have said this before in the debate with respect to mental health. If I had a broken arm and walked into a hospital, I would get help right away. I think our hon. colleague said something very similar. If I walked in and said that I was just not feeling right, or may want to hurt myself, or I thought I had PTSD, it would be very similar. However, if someone is addicted to something, that person is told “We'll get to you when we get to you and just to take a number.” The next number served type of attitude just does not work, because we are losing people left, right and centre. People are slipping through the cracks.

I did not bring this up earlier, but I had an uncle who battled addiction for a long period of time. I feel strongly about this. My uncle was in a horrific car accident in the eighties. He went to a clinic in Vancouver, called G.F. Strong, with a head injury.

The dealers and drug pushers know that people are coming out of this with limited cognitive abilities and are taking advantage of them. At every step of the way people are told to wait. They do not have an opportunity for instant access.

I would agree with our hon. colleague across the way that we must do everything in our power to ensure those beds are available and the care that is needed is received on a timely basis.

[Alex Nuttall, Conservative, Barrie—Springwater—Oro-Medonte, ON]

Mr. Chair, specifically with respect to safe injection sites, the member mentioned that those sites could help, depending on where it was, etc. Does the member believe there should be as easy access to rehabilitation and treatment services as there is to a place to go and inject illegal drugs?

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Mr. Chair, people should have the opportunity to go into a treatment facility if needed. They should get the help when needed, wherever needed and for as long as it is needed.

[John Oliver, Parliamentary Secretary to the Minister of Health, Lib.]

Mr. Chair, I just want to emphasize again that there is a multi-faceted approach that the government is bringing to this problem. In budget 2018, $231 million has been invested, establishing an emergency treatment fund for treatment beds just as the member described; developing a national public education program to help address those who might be considering using opioids or moving down that path; enhancing the ability of front-line personnel to detect, intercepting illegal drugs at the border, which is happening; and accelerating and expanding access to public health data so we can track this problem.

However, the real issue here is that we have had three years to play catch-up with this problem. Where was the member in 2014? Where was he in 2013 when this problem began?

We are playing catch-up for the previous crime and punishment approach to opioids and opioid addiction. The former Conservative government did not move into treating this early enough and now we are dealing with the crisis across Canada.

[The Assistant Deputy Chair, Liberal, Anthony Rota]

We were doing so well and it seems that all of a sudden the heckling is starting again. It is a very serious topic and I would ask people to maybe show some consideration to the person who is speaking on both sides. Please take some time, take a deep breath and respect each other.

The hon. member for Cariboo—Prince George.