Health committee  First of all, thank you so much. It's an honour and a pleasure to present to this committee again. I am speaking on the use of electronic nicotine delivery devices, commonly known as e-cigarettes. We have sent some speaker's notes to you. I'm sorry they came at the last minute, but they have been sent.

Health committee  Yes. That's exactly right. People end up resorting to using medicines or pain medication like opioids in the belief that this will fix the problem, and they don't have access to covered services like physiotherapy, massages, or relaxation. There are those kinds of issues, and they then resort to opioids because that becomes the easy, magic bullet solution available to them.

Health committee  In Ontario, we have a youth survey of drug use. It has been going on for the last 15 or 20 years, and we're beginning to see the recreational use of opioids come in. To answer your question about what determines whether people get addicted or not, it's not only availability. There's availability and there's the social norm about the use of it.

Health committee  I want to concur with you. As a physician, I actually have seen that happen. When you've given people Narcan, they wake up. Here's where we have to manage what the risk is. The issue is that I'd rather have somebody a bit agitated, as opposed to dying. From that perspective, in Ontario we are actually looking at the naloxone program so that it's not only Public Health Canada handing it out.

Health committee  The national opioid use guidelines for chronic non-malignant pain are now housed in the national pain centre at McMaster University, and every national college of physicians was part of it. Work is ongoing in trying to help disseminate and implement this. The real focus there is how to use opioids safely, how to minimize the harm, how to make sure people are monitored appropriately, advised and educated about the risk, and also know when the medication should not be used and when it should be stopped because it is causing harm.

Health committee  No, you didn't, actually. We've got some models here on primary care whereby we've been able to deploy very rapidly—like a rapid prototype—the program. It would mean getting the program from the U.S. so that it's on a Canadian server. It would mean being able to have it available within the practices where people go.

Health committee  Call it what you will, at the end of the day what we are here for is we want to make sure that Canadians live good, healthy lives, so you want to call it reducing harm while not using the term. The issue is, does the term become divisive, as opposed to integrative. If it is becoming divisive, you'll end up causing more harm by the term itself.

Health committee  Yes. I'd like to add that there are some more technological advances that can be done in our data collection systems. They've actually automated the collection of data that can be done through the cloud, off people who are coming and seeking treatment. For example, when they deployed this in the state of California, they showed that you can get really rapid data access.

Health committee  I think this idea of separating treatment from harm reduction is a bit odd. As a physician, I can tell you that western medicine is entirely about harm reduction. We do not cure hypertension. We do not cure diabetes. We do not cure depression. We do not cure heart failure. We simply treat them and reduce the harm that people have from their diseases.

Health committee  Thank you.

Health committee  Thank you. I'm Dr. Peter Selby, and this is Dr. Sproule on my left. I'm the division chief of the addictions program at CAMH. CAMH, as you may or may not know, is the largest mental health and addiction treatment and research centre in Canada, affiliated with the University of Toronto.