Health committee  Absolutely. It's a market-driven economy. As there has been more diversion and more available.... My understanding from patients and from living in the area is that in 2016, a D8 was about $20. If you're close to the supply—close to where more diversion takes place or the core of London—then it varies, but it's usually about one to two dollars.

Health committee  Thank you for that question. Opioid agonist therapy is about having people on a treatment that can stabilize them neurochemically, having them not chase what we talked about earlier with withdrawal and really allowing for recovery. The two main types of opioid agonist therapy are methadone, which has been around for years, and buprenorphine.

Health committee  I think anything that happens in Toronto is definitely going to have an impact on London. What we're seeing in London has been largely affected, I think, by decriminalization as it is. We're certainly seeing a lot more open drug use. It's very common to see people injecting in parks, smoking fentanyl in parks and injecting Dilaudid in public spaces already, so I think that's something we'll have a problem with.

Health committee  Absolutely. I don't know how to answer that very quickly, but the first thing I'll say is that in 2016, our overdose deaths were equal to the province's. In 2022, for which we have information, the provincial rates went up by about 2.7% and London's went up almost fourfold. There's a significant increase in overdose deaths compared to the provincial average.

Health committee  I can—

Health committee  That is correct.

Health committee  Absolutely. One tablet is also equivalent to four Percocet or 20 milligrams of OxyContin. Those are doses we consider fairly high during the opioid crisis. Taking two of them would essentially be considered relatively safe for most people. Even one can be considered toxic if someone is not used to taking it.

Health committee  The guideline is the equivalent of 100 milligrams of morphine per day or less.

Health committee  Yes—or more.

Health committee  Absolutely. That is one of the significant problems with opioids. As you take them, your brain has changes in neurochemicals. What you're taking, your brain becomes used to. That becomes your normal. To get the same effect, you have to increase the dose you're taking. To get the same euphoria, you have to continue to increase the dose.

Health committee  Thank you, Mr. Chair and members of the committee. I have been a physician for 39 years. I have my certificate of added competence in palliative care and addiction medicine from the College of Family Physicians of Canada. I began working in addiction medicine in 2012. Until 2021, I was the sole health care provider offering comprehensive consultations in addiction medicine at the London Health Sciences Centre, where, in 2023, an interprofessional addiction team was established.