Mr. Speaker, I am pleased to be able to participate in such an important debate.
I wish we had longer to discuss such a critical issue, but the government, of course, has issued another one of its time allocation motions. I cannot remember if it is 91 or 92 times thus far. We will have a grand total of two and a quarter hours to debate this pressing public health issue, but that is the way it is.
In my remarks today, I want to first examine how we got here on safe injection sites. Second, I want to talk about the bill itself. Third, I want to talk about the ideological underpinnings that are self-evident in this legislation.
I cannot do better, frankly, than to start with an almost poetic description of the crisis that led to this. This is from the Supreme Court of Canada in its famous 2011 judgment relating to the Insite centre in Downtown Eastside Vancouver:
In the early 1990s, injection drug use reached crisis levels in Vancouver’s downtown eastside.... Epidemics of HIV/AIDS and hepatitis C soon followed, and a public health emergency was declared in...September 1997. Health authorities recognized that creative solutions would be required to address the needs of the population of the [downtown eastside], a marginalized population with complex mental, physical, and emotional health issues. After years of research, planning, and intergovernmental cooperation, the authorities proposed a scheme of care for drug users that would assist them at all points in the treatment of their disease....
Operating a supervised injection site required an exemption from the prohibitions of possession and trafficking of controlled substances under s. 56 of the CDSA, which provides for exemption at the discretion of the Minister of Health, for medical and scientific purposes. Insite received a conditional exemption in September 2003, and opened its doors days later. North America’s first government-sanctioned safe injection facility, it has operated constantly since then. [...] It does not provide drugs to its clients, who must check in, sign a waiver, and are closely monitored during and after injection. Its clients are provided with health care information, counselling, and referrals to various service providers or an on-site, on demand detox centre. The experiment has proven successful. Insite has saved lives and improved health without increasing the incidence of drug use and crime in the surrounding area. It is supported by the Vancouver police, the city and provincial governments.
The court ordered the minister of health to grant a “constitutional exemption”, as it called it, to the Insite facility, so it could continue to operate free from federal drug laws. The minister was then ordered by the court to grant an exemption under section 56. That is what happened.
The government responded with Bill C-2, which is before us today. It is my strong belief that the bill before us will be declared unconstitutional by the Supreme Court of Canada. Many lawyers and experts have said the same thing. Why? Because it is a thinly veiled attempt to not do what the Supreme Court of Canada required.
This is a public health emergency, and the response is to provide a list of criteria that is so vast that no one believes there will ever be a safe injection site as a function of this legislation. It is absolutely opposed to the spirit, if not the letter, of the Supreme Court of Canada's decision.
The parliamentary secretary just spoke about the criteria being perfectly normal. Of course, it was all very much in place when the city of Vancouver got its Insite facility.
No one is suggesting that there should not be public consultation and the like. I have had a raging debate with my colleagues as to just how many hoops will have to be jumped through to ever get one of these safe injection facilities under Bill C-2. I cannot decide. There are 26 criteria listed in the bill, but, as they say on television, there is more. After the 26, the long, many-paged list of criteria that has be jumped through before the exemption can be granted, there are two at the end that raise a number of eyebrows.
I will just read them, so members can see why it is so difficult to know. One of them at the end is “any other information that the Minister considers relevant to the consideration of the application”. I have no idea what that means. It is entirely subjective. She could consider the price of tea in China and that might be considered relevant.
However, there is more. It says, “any prescribed information that is submitted in the prescribed manner”. I guess they can make a regulation and prescribe a bunch more. It is 26-plus open criteria, plus a whole list of others that might be prescribed later. This is not a normal series of criteria for granting an exemption.
It then goes on and provides a series of principles that seem to swallow the entire thing. It states, in part, “The Minister may only grant an exemption for a medical purpose” to allow these safe injection sites in exceptional circumstances and after considering a whole bunch of other principles, including criminal activity, organized crime, risks of overdose, and unadulterated controlled substances.
We cannot read this legislation without basically saying that the government is trying to make it as hard as possible to do what the Supreme Court ordered in one of Canada's leading public health emergencies ever.
There is no need to take my word for that. The British Columbia Medical Journal had an article, before this legislation, by a number of leading AIDS researchers. It starts with this, “Our current approach to the epidemic has been an utter failure”.
The article then lists the costs for people having to go to the hospital, There is a cost of $500,000 per patient to deal with AIDS, and the cost of emergency care in hospitals, not to mention the homeless. That is why the police have been so strong in Vancouver in support of Insite. The article goes on to talk about how it has been a failure because of the traditional law enforcement paradigm of the current government: more crime, more legislation to deal with crime, more police. It has been an utter failure, according to the police themselves.
I had a chance to meet with Dr. Simpson of the Canadian Medical Association yesterday, and the CMA is strongly in favour of this kind of harm reduction approach. It is reflected in the strategy that Vancouver, the Vancouver Board of Trade, and small business have embraced. It seems that everyone has embraced it but the Conservative government, which seems to think it will help its base in passing a law that is so obviously contrary to the spirit of the Supreme Court.
The four-pillars approach has been what Vancouver has embraced. Those four pillars to dealing with the crisis are the following: one is enforcement, that is granted; second is treatment; third is prevention; and fourth is harm reduction. It is harm reduction of the kind that is reflected in the Downtown Eastside Insite facility, and a very comprehensive plan was put in place by the city to address this.
At this point, I must pay tribute to the retiring member for Vancouver East, in whose riding this occurred. She has been utterly amazing in her advocacy on behalf of the poorest people in our community: aboriginal people, frequently; people from cultural communities; people who have come from all over the country to live in the Downtown Eastside and deal with addiction. They are dying at overdose rates that are absolutely staggering.
I want to pay tribute, as well, to Senator Larry Campbell, who was then the mayor of the City of Vancouver. He embraced a harm reduction strategy from the start and deserves a lot of credit for helping implement the four-pillars strategy in Vancouver.
All that the health advocates have been saying is that we need this in other communities. We need it in my community, and I will come to that. The public health officer of Toronto has been pleading for meaningful legislation. What they are getting from the current government is a farce. They know it, and the courts will soon know it. We will have wasted a lot of time doing something that is so obviously not a public health measure but simply a sop to the Conservative Party base. I will demonstrate the truth of that in a moment.
That is where we have landed with Bill C-2. This is a government that is more concerned with punishment than compassion; a government that is putting ideology over evidence.
Let me speak about the Canadian Medical Association and its members response to this legislation. They were asked, like so many, to be consulted on this, and they were. What they said was quite staggering. They said the following:
The CMA fully endorses harm reduction strategies and tools, including supervised injection sites....
Bill C-2...proposes new, far reaching, and stringent conditions that must be met by a proponent who is applying to establish a supervised injection site. The CMA maintains that safe injection sites are a legitimate form of treatment for the disease of addiction, that their benefit is supported by a body of research, and that the conditions proposed under Bill C-2 are overly restrictive.
That is what the doctors are telling us. It is obvious to them, and it is obvious to most Canadians who have had an opportunity to read this thinly veiled effort to stop supervised injection sites.
When the government looked at the evidence and consulted on this, it was self-evident that it needed a harm reduction strategy, that it needed to make exemptions possible under section 56 more readily available. What it ended up with is what has brought us here today.
The number of people who are opposed to this legislation is staggering, such as the Canadian Medical Association and the Canadian Nurses Association. However, we also need to address those people who are trying to get safe injection sites in their communities. There is only one in Canada, and it is in danger now I suppose, but certainly Toronto wants one. Dr. David McKeown, the Medical Health Officer of that great city said:
I come at it from a public health point of view. Toronto was one of several cities in Canada looking to implement supervised injection sites as part of an evidence-based, comprehensive approach to health services for people who address drugs. The board feels the proposed Bill C-2 is not consistent with the decision of the Supreme Court on supervised injection. If Bill C-2 is passed as written, we believe it will be a significant barrier for any community or health system in any province that has come to the decision that those services would serve both the public health and public safety interests of local residents.
Good luck trying to get one, Toronto. Good luck, Victoria.
I happen to represent the city of Victoria, and I am proud to do so. Let me tell everyone what is going on in my city. Many local agencies have expressed an interest in opening a safe injection site, but there is no application because it is considered that there is no way they would get it. Why bother? There are so many conditions that are required, that they do not think there is any chance.
Nevertheless, people are dying in the streets. Katrina Jensen, AIDS Vancouver Island executive director, in 2013, said:
We have had eight overdose deaths in the last six months and those are deaths that could have been prevented if we had a supervised consumption site....
Good luck getting one, Victoria. I am here to say that the chances of doing so are remote at best.
That is where we are. That is why I asked the parliamentary secretary whether or not Conservatives had any projection as to how many of these facilities would be up and running a year later. I did not get any answer at all.
I will refer to something that I know many people have been concerned, which is why it is taking this long to get here, and why it is that the Conservative government has done everything it can to thwart this legislation coming forward.
Stephen Maher, a journalist, wrote the following in 2013:
On the afternoon of Friday, September 20, [2013, the health minister] sent out a news release announcing she was taking action against Health Canada officials who had approved an application from doctors who wanted to give heroin to addicts.
“Our policy is to take heroin out of the hands of addicts, not to put it into their arms,” she said.
It was odd. Why would [the health minister] issue a news release attacking her own officials? The next morning a clue landed in the inboxes of Conservatives across Canada.
Fred DeLorey, director of political operations for the party sent an e-mail to supporters: “Drug treatment programs should be focused on ending drug use--not giving illicit drugs to drug addicts. That's why I was shocked to learn today that Health Canada approved funding to give heroin to addicts--against the wishes of the elected government.”
There was a link to surprise, surprise a Sun News story:
“What the heck is Health Canada on?”, the anchor asked, throwing to a reporter who said that “government bureaucrats, many are saying, have used a loophole to allow individuals to legally receive prescription heroin”.
DeLorey's email ended with a link to a Conservative Party website with a big picture of a hypodermic needle and a place for people to enter their name and email address.
Here is the punchline. If one enters one's data, half an hour later DeLorey will send an email with a warning “If the NDP or Liberals are elected in 2015, you can bet they would make this heroin-for-addicts program permanent”, and then hits readers with a pitch for $5 to help the Conservatives fight back.
I guess it is clear why we have taken this long. We know about the fundraising efforts on the backs of people who are dying. This is a public health emergency, yet the Conservatives are trying to use it as a fundraiser. I do not know what to say except that people deserve better than such a mean-spirited government addressing the legislation in this kind of way.
I need to go back to the criteria. The parliamentary secretary was making it sound, and I will use her word in her debate, “typical”. However, as a lawyer, I have never seen anything like the criteria the Conservatives have put forward in an apparent attempt to implement the Supreme Court of Canada's response to this public health emergency. Here are the criteria in the new and improved bill, Bill C-2, to get one of these exemptions to allow a safe injection site.
Let me be clear. Talking to the police and the neighbourhood, and doing full consultation is a no-brainer. Everybody understands that. How could any municipality get away with doing otherwise? It is what Vancouver did so effectively. However, there is more criteria set out in the bill, such as:
The Minister may consider an application for an exemption...that would allow certain activities to take place at a supervised consumption site only after the following have been submitted:
Here I will paraphrase.
First, there is the requirement for scientific evidence demonstrating that there is a medical benefit. Duh, there have been 30 studies already on Insite. Europe and Australia have learned about this, but I guess we need more science on this.
The second is the requirement of a letter from the provincial minister, a letter from the local government, a description of the measures that have been taken to address any relevant concerns in the letter, a letter from the police force saying it is okay, a description of this and that. I am only at five, but there are 26 criterion, including this open-ended thing.
I do not want any Canadian to think this is somehow an ordinary list of relevant criteria, because that would be to misstate and distort the evidence before us.
Speaking of evidence, I need to talk about what happened after the safe injection site was opened in Vancouver.
First, there had been a twelvefold increase in overdose deaths in Vancouver between 1987 and 1993. There had been an astounding increase in communicable diseases among injection-drug users, such as hepatitis A, B and C, as well as AIDS. However, when the safe injection site was opened, there was a 35% decrease in overdose deaths, a decrease in crime as well as communicable disease rates and infections and relapse rates for drug users. That was because a science-based, evidence-based approach was taken.
People were now saying, and the Supreme Court of Canada was persuaded, that this health service would save lives. It would save a lot of money as people were no longer presenting at emergency centres and hospitals. It would reduce the amount of crime. That was evidence before the Supreme Court of Canada, and it was why it decided that a constitutional exemption was required by the minister.
The bill before us is public health legislation, although one would never know it. It was sent to the public safety committee, not the health committee, by the government. Public health does not get a lot of mention in the legislation nor in the parliamentary secretary's speech.
If we are to face a public health crisis as adult Canadians, then we need to face up to the fact that the four pillars work, that a comprehensive approach is required, that safe injection sites must be licensed and welcomed into communities when reasonable consultation has occurred, rather than the legislation before us, which thwarts this, sadly, for nothing but political purposes.
