The Federal Response to the Opioid Crisis

The Federal response to the Opioid Crisis

Updated edition

The Hill Times’ guide to the news, analysis, key players, press releases, committees, legislation, and House of Commons debates on this issue from November 2015 to December 2017

Edited by Katie Schultz and Christina Leadlay Hill Times Books

An imprint of Hill Times Publishing Inc. Published at 246 Queen Street, Ottawa, Ont., K1P 5E4

First Published 2017

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted in any form or by any means without the prior written permission of both the copyright owner and the above publisher of this book.

Parliament Now, a division of Hill Times Publishing Inc. The Federal response to the Opioid Crisis: The Hill Times guide to the news, analysis, key players, press releases, committees, legislation, and House of Commons debates on this issue from November 2015 to January 2018

Editors: Katie Schultz and Christina Leadlay Copy editing: Katie Schultz and Christina Leadlay Cover and interior text design: Benoit Deneault, Melanie Brown and Joey Sabourin

The author and publisher have made every attempt to locate the sources of written excerpts. Should there be errors or omissions, please contact the author and publisher for correction in future editions.

Visit The Hill Times at www.hilltimes.com The Federal response to the Opioid Crisis Table of Contents

Executive Summary...... 1-2

Key Players...... 3-10

House and Senate Committees...... 11-130

Press Releases...... 131-139

Debates in the House of Commons...... 140-270

Mentions in Question Period...... 271-278

Opioid-related articles from Hill Times archives...... 279-308

The Look Forward...... 309 The Federal response to the Opioid Crisis Executive Summary

The Opioid Crisis from November 2015 urging the Liberal government to create a national taskforce and to December 2017 to repeal Bill C-2. In December 2016, the federal, provincial and territorial When the Trudeau Liberals formed a majority government in governments established the Special Advisory Committee on the October 2015, the opioid crisis in Canada was already well underway. Epidemic of Opioid Overdoses. Two months’ prior to calling the general election, in June Bill C-37 was introduced on December 12, aiming to repeal 2015, the Conservative government introduced tamper-resis- Bill C-2, banning unregistered devices such as pill pressers and tant regulations on prescription opioids in an attempt to reduce encapsulators, amending the Customs Act to stop drugs such prescription-drug abuse. That same month, the government also as fentanyl from entering Canada through the mail system and passed Bill C-2, the Respect for Communities Act, introducing allowing the temporary scheduling of precursor chemicals. new requirements making it difficult to open supervised injection The health committee’s final report on the opioid crisis was sites. The Liberals had expressed commitment to repealing C-2 tabled in Parliament on December 12, 2016. Philpott appeared during the election campaign. before the committee the next day. A few months after the Liberals formed government, in Febru- By mid-January 2017, the Conservative Party joined the NDP in ary 2016, Health Minister Jane Philpott announced $4.4-million calling the government to declare a national public health emergency. in funding through the Canadian Institutes of Health Research to In early February, the Federation of Canadian Municipalities’ help address prescription-drug abuse, particularly with opioids. Big City Mayors Caucus launched the Mayor’s Task Force on That summer, Philpott signed an Interim Order to temporarily the Opioid Crisis, chaired by Vancouver mayor Gregor Robert- allow U.S. imports of the naloxone nasal spray into Canada. This son. The group’s main objectives were to share best practices in was an important measure in tackling overdoses from opioids. addressing the crisis, and to work with all levels of government to Before then, the only form of naloxone available in Canada was coordinate a national response. the injectable version. On February 9, the health committee met to consider Bill In August 2016, Health Canada issued proposed regulations C-37. Many of the proposed amendments were on Clause 42 con- to ban the chemicals used to produce the opioid fentanyl. The cerning supervised injection sites. Only one of the amendments ban expedited a proposal originally put forward by Conserva- carried. The committee tabled its report on February 10, 2017. tive Senator Vernon White’s Senate public Bill S-225, substances That same month, Health Canada authorized three supervised used in the production of fentanyl. In November, these chemicals injection sites in Montreal, Que. Philpott stated the approach to were added to the Controlled Drugs and Substances Act and the addressing the crisis must be comprehensive, including supervised Precursor Control Regulations making their unauthorized impor- injection sites in communities that want them. Health Canada also tation illegal, providing law enforcement with the ability to take put forward a regulatory proposal making warning stickers and action on these substances. information handouts mandatory with all prescription opioids. In In September 2016, NDP MP Don Davies called on the health addition, the government announced $65-million over five years committee to conduct an emergency study of the growing opioid for the implementation of the Opioid Action Plan and $10-million crisis in Canada. The committee spent most of October study- to assist the B.C. provincial government with its response. ing the issue, hearing from a wide variety of panellists including In March 2017, Alberta received $6-million in federal funds to pharmacists, physicians, first responders, frontline workers and assist with the opioid crisis in that province. recovered addicts. On March 22, Budget 2017 featured $116-million to help fight In early October, Health Canada had authorized naloxone the opioid crisis and a $100-million investment over five years for nasal spray for non-prescription use, allowing the general public the new Canadian Drugs and Substances Strategy. Health Canada access to the antidote to help prevent overdoses. also proposed to allow the importation of medications already From November 18-19, 2016, Philpott and Dr. Eric Hoskins, authorized for sale in the U.S. and European Union to aid in treat- Ontario’s Minister of Health and Long-Term Care, co-hosted a ment of opioid addictions. national opioid summit, featuring a number of key players and The Senate Standing Committee on Legal and Constitution- addictions experts. Post-summit, Philpott and Hoskins issued an al Affairs met twice at the end of March to consider Bill C-37. action plan to address the opioid crisis. Witnesses included Philpott, officials from the Canadian Border That same month, the NDP called on the federal government Services Agency, RCMP, Canada Post and the privacy commis- to declare the opioid overdose crisis a national health emergency, sioner. The committee tabled its report on April 13.

1 The Federal response to the Opioid Crisis

In May, Canadian HIV/AIDS Legal Network called on the In advance of the first minsters’ meeting for health in mid-Oc- government for a more robust response to the opioid crisis. The tober, CNA president Barb Shellian called “on the federal govern- FCM task force published its report calling for a coordinated ment to lead efforts for a more coordinated approach between all pan-Canadian response. The Canadian Centre on Substance Use levels of government and to also work with stakeholder groups to and Addiction also released a report outlining key achievements take concrete steps to stem the national opioid crisis.” made since the November 2016 Opioid Summit. In mid-October, Vancouver Mayor Gregor Robertson, Chair of On May 18, 2017, Bill C-37 received Royal Assent, which in Big City Mayors’ Caucus’ Task Force on the Opioid Crisis, issued turn repealed C-2. a similar statement calling for a “coordinated, pan-Canadian In June, the Public Health Agency of Canada issued 2016 response led by the federal government” that would set targets statistics on opioid-related deaths in Canada. Health Canada also and timelines to solve this crisis and promote information sharing authorized the importation of drugs available in the United States between all levels of government. and the European Union used to treat opioid addictions. Following the first ministers’ meeting on October 20, Cana- In July 2017, the Council of the Federation met in Edmonton, da’s premiers “acknowledged that the issue is a national public Alta. with opioids at the top of the agenda. Advocacy groups were health crisis and recognized the significant actions that have been pleased with the government’s response to the crisis, including the undertaken to address it.” The ministers discussed barriers to positive impact supervised injection sites have had thus far. treatment, harm reduction, treatment options and public health In early August 2017, Health Canada gave permission to the policies, including information sharing and best practices. They Vancouver Island Health Authority to open Victoria’s first fixed also addressed the need to expand federal regulatory exemptions supervised injection site. and promote innovative measures to save lives. During a federal cabinet shuffle later that month, Ginette Petit- In mid-November, Health Canada released its report: Actions pas Taylor (Moncton—Riverview—Dieppe, N.B.) was named the on Opioids 2016 and 2017. At the same time, Petitpas Taylor new Health Minister. New Conservative leader Andrew Scheer also indicated the government was implementing four new activities announced a new shadow cabinet, naming Conservative MP Mari- to curb the crisis: promoting a pilot projection for safer pharma- lyn Gladu (Sarnia—Lambton, Ont.) as opposition health critic. ceutical alternatives (hydromorphone); allowing the inclusion of Meanwhile, NDP Health Critic Don Davies (Vancouver King- drug checking services at supervised injection sites; supporting an sway, B.C.) continued to criticize the government for failing to innovative harm reduction pilot program; and creating a stream- call the opioid crisis a national health emergency. He argued this lined protocol for temporary harm reduction sites. would “open up more resources and support for communities that In December 2017, Health Canada hosted a Scientific Advisory are facing this deadly epidemic.” Panel on Opioid Use and Contraindications. The department an- In September, Petitpas Taylor announced an investment of $7.5 nounced it will be working with manufacturers to update labels on million from the Canadian Institutes of Health Research to the all prescription opioid products sold in Canada by January 2019. Canadian Research Initiative in Substance Misuse. This funding The Canadian Pharmacists Association called on the govern- will be used to research overdose prevention, to treat those with ment to “amend the Controlled Drugs and Substances Act to en- opioid dependency and to promote harm reduction. able pharmacists to review, adapt and taper opioid prescriptions.” The Federal, Provincial and Territorial Special Advisory Com- Petitpas Taylor announced $7.5 million in funding to support mittee on the Epidemic of Opioid Overdoses released new data CRISM’s continued work on the opioid crisis. The funding was indicating overdose deaths were continuing to rise. They released divided equally between the four regional nodes (British Colum- an update to the preliminary data on opioid-related deaths for 2016, bia, Ontario, Prairies and Québec and Maritimes). which includes preliminary data for the first quarter of 2017. This eBook contains a list of the key players, committee meet- In late September, in Washington, D.C., Petitpas Taylor met ings, debates, highlights from Question Period, press releases (from with American health leaders and government officials concern- government and non-government groups) touching on the opioid ing the shared opioid crisis afflicting both countries. crisis, as well as stories on the topic published in the Hill Times, In early October, the Canadian Nurses Association (CNA) wel- the Lobby Monitor, and Power & Influence magazine. The team at comed the announcement of the Canadian Health System Impact Parliament Now has compiled this data from their own archives, Fellowship recipients by the CIHR. Chantelle Bailey, M.Sc., PhD, Hansard, and all Hill Times archives. A “Look Forward” provides joined CNA for a two year period for their new project: Enhanc- some key issues that legislators might consider when working on ing Nurses’ Role in Opioid Stewardship. the next set of bills focused on dealing with the opioid crisis.

2 The Federal response to the Opioid Crisis Key Players

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.)

Email: [email protected] Phone: 613-957-0200 First-time Liberal MP Ginette Petitpas Taylor was appointed federal Health Minister in August 2017, taking over from Jane Philpott who had held the portfolio since October 2015. Petitpas Taylor’s mandate letter (dated October 2017) tasks her to “Work closely with other orders of government, as well as substance use experts, service providers, first responders, law enforcement, and people with lived and living experience in order to ensure Canada’s response to the current opioid crisis is robust, well-coordinated, and effective.” Despite this directive, it was Philpott who had done the bulk of the government’s work on opioids, leaving Petitpas Taylor with managing other federal health priorities, namely the Cannabis Act. That said, opioids is an ongoing issue and Petitpas Taylor remains active on the file. She appeared before the health committee in December 2017 and has met twice with B.C.’s mental health minister this past fall.

Conservative Senator Vern White

Phone: 613-996-7602 Email: [email protected] In April 2016, Conservative Senator Vern White tabled Bill S-225, Substances Used in the Production of Fentanyl. The bill passed third reading in June 2016, but instead of going to the House of Commons, Health Canada went ahead with proposed regulations banning fentanyl precursor chemicals in August 2016. However, elements of S-225 live on in Bill C-37, An Act to Amend the Controlled Drugs and Substance Act (substances used in the production of fentanyl), which, among other goals, aims to restrict certain chemicals used in the production of fentanyl. C-37 received Royal Assent in May 2017. White is a former police chief for the City of Ottawa, led the Regional Po- lice Service in Durham, Ont., and spent more than 20 years with the Royal Canadian Mounted Police. He was named to the Senate in 2012.

THE HOUSE OF COMMONS STANDING COMMITTEE ON HEALTH Phone: 613-996-1065 Email: [email protected] Website: parl.gc.ca/Committees/en/HESA

Liberal MP Bill Casey (Cumberland-Colchester, N.S.), chair

Phone: 613-992-3366 Email: [email protected]

Conservative MP Marilyn Gladu (Sarnia-Lambton, Ont.), vice-chair

Phone: 613-957-2649 Email: [email protected]

NDP MP Don Davies (Vancouver Kingsway, B.C.), vice-chair

Phone: 613-943-0267 Email: [email protected]

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.)

Phone: 613-992-2617 Email: [email protected] 3 The Federal response to the Opioid Crisis

Parliamentary Secretary to the Minister of Health Bill Blair (Scarborough-Southwest, Ont.)

Phone: 613-995-0284 Email: [email protected]

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.)

Phone: 613-995-5609 Email: [email protected]

Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.)

Phone: 613-992-9650 Email: [email protected]

Liberal MP John Oliver (Oakville, Ont.)

Phone: 613-995-4014 Email: [email protected]

Liberal MP Sonia Sidhu (Brampton South, Ont.)

Phone: 613-995-5381 Email: [email protected]

Conservative MP Dave Van Kesteren (Chatham-Kent-Leamington, Ont.)

Phone: 613-992-2612 Email: [email protected]

Conservative MP Len Webber (Calgary Confederation, Alta.)

Phone: 613-996-2756 Email: [email protected] The Standing Committee on Health has met more than half a dozen times since October 2015 to discuss the opioid crisis specifically, but the issue has come up often in other related meetings. Find more details about the committee’s work on opioids HERE. Many committee members, including Don Davies, Colin Carrie, Rachael Harder, Sonia Sidhu, Doug Eyolfson and Len Webber have spoken frequently during debates on the opioid crisis in the House of Commons.

OTHER MPS WHO HAVE BEEN ACTIVE IN DEBATES ON THE OPIOID ISSUE INCLUDE:

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.)

Phone: 613-996-6417 Email: [email protected]

Parliamentary Secretary to the Minister of Finance Joël Lightbound (Louis-Hébert, Que.)

Phone: 613-995-4995 Email: [email protected]

4 The Federal response to the Opioid Crisis

Parliamentary Secretary to the Minister of Public Services and Procurement Steven MacKinnon (Gatineau, Que.)

Phone: 613-992-4351 Email: [email protected]

Parliamentary Secretary to the President of the Treasury Board Joyce Murray (Vancouver Quadra, B.C.)

Phone: 613-992-2430 Email: [email protected]

Parliamentary Secretary to the Minister of National Revenue Kamal Khera (Brampton West, Ont.)

Phone: 613-992-0778 Email: [email protected]

Parliamentary Secretary to the Prime Minister (Youth) Peter Schiefke (Vaudreuil-Soulanges, Que.)

Phone: 613-957-3744 Email: [email protected]

Parliamentary Secretary to the Minister of Canadian Heritage (Multiculturalism) Arif Virani (Parkdale– High Park, Ont.)

Phone: 613-992-2936 Email: [email protected]

Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.)

Phone: 613-992-9650 Email: [email protected]

Liberal MP Randy Boissonnault (Edmonton Centre, Alta.)

Phone: 613-992-4524 Email: [email protected]

Liberal MP Darrell Samson (Sackville—Preston—Chezzetcook, N.S.)

Phone: 613-995-5822 Email: [email protected]

Liberal MP Hedy Fry (Vancouver Centre, B.C.)

Phone: 613-992-3213 Email: [email protected]

Liberal MP John Aldag (Cloverdale-Langley City, B.C.)

Phone: 613-992-0884 Email: [email protected]

Conservative MP Cathy McLeod (Kamloops--Thompson--Cariboo, B.C)

Phone: 613-995-6931 Email: [email protected] 5 The Federal response to the Opioid Crisis

Conservative MP Kevin Sorenson (Battle River-Crowfoot, Alta.)

Phone: 613-947-4608 Email: [email protected]

Conservative MP Garnett Genuis (Sherwood Park-Fort Saskatchewan, Alta.)

Phone: 613-995-3611 Email: [email protected]

Conservative MP Karen Vecchio (Elgin--Middlesex—London, Ont.)

Phone: 613-990-7769 Email: [email protected]

Conservative MP Bob Saroya (Markham—Unionville, Ont.)

Phone: 613-992-1178 Email: [email protected]

Conservative Mark Strahl (Chilliwack-Hope, B.C.)

Phone: 613-992-2940 Email: [email protected]

NDP MP Tracey Ramsey (Essex, Ont.)

Phone: 613-992-1812 Email: [email protected]

NDP MP Murray Rankin (Victoria, B.C.)

Phone: 613-996-2358 Email: [email protected]

NDP MP Linda Duncan (Edmonton Strathcona, Alta.)

Phone: 613-995-7325 Email: [email protected]

NDP MP Marjolaine Boutin-Sweet (Hochelaga, Que.)

Phone: 613-947-4576 Email: [email protected]

NDP MP Pierre-Luc Dusseault (Sherbrooke, Que.)

Phone: 613-943-7896 Email: [email protected]

NDP MP Pierre Nantel (Longueuil-Saint-Hubert, Que.)

Phone: 613-992-8514 Email: [email protected]

6 The Federal response to the Opioid Crisis

NDP MP Alexandre Boulerice (Rosemont--La Petite-Patrie, Que.)

Phone: 613-992-0423 Email: [email protected]

NDP MP Gord Johns (Courtenay-Alberni, B.C.)

Phone: 613-992-0903 Email: [email protected]

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.)

Phone: 613-992-5243 Email: [email protected]

Green Party leader Elizabeth May (Saanich-Gulf Islands, B.C.)

Phone: 613-996-1119 Email: [email protected]

Chief Public Health Officer, Public Health Agency of Canada

Phone: 613-957-2983 Website: phac-aspc.gc.ca05 Canada’s chief public health officer (a.k.a. the country’s top doctor) has been working in tandem with the federal health minister on the issue of opioids, issuing joint statements, hosting conferences and appearing before the Standing Committee as it studied the issue. Dr. Gregory Taylor held this role when the federal Liberals formed government in 2015, but retired in December 2016. Dr. Theresa Tam was officially appointed as chief public health officer in June 2017.

Special Advisory Committee on the Epidemic of Opioid Overdoses

Phone: 613-957-2983 Website: phn-rsp.ca/sac-opioid-gcs-opioides/index-eng.php Dr. Theresa Tam, Canada’s chief public health officer, and Dr. Robert Strang, Chief Public Health Officer for Nova Scotia, are co- chairs of the Special Advisory Committee on the Epidemic of Opioid Overdoses, a trilateral group established in December 2016 to focus on urgent issues related to overdoses and deaths linked to the use of opioids. Members of the Public Health Network Council and the Council of Chief Medical Officers of Health sit on the advisory committee, which meets bi-weekly to discuss supporting harm reduction, improving data/surveillance, and prevention and treatment options.

Karen Shepherd, executive advisor to the deputy minister of health

Phone: 613-957-3207 January 15, 2018 was Karen Shepherd’s first day as the deputy health minister’s executive advisor. Health Canada confirmed the former lobbying commissioner will be responsible for policy issues related to the opioid crisis, as well as development of cannabis legislation. Shepherd will be providing advice on issues regarding stakeholder engagement, transparency, and guidance on values and ethics.

Dr. Eric Hoskins, Ontario Minister of Health and Long-Term Care

Phone: 416-327-4450 Email: [email protected] Prior to his career in politics, Dr. Eric Hoskins spent nearly a decade as a doctor in war-torn regions around the world. First elected to Queen’s Park in 2009, Hoskins has held various cabinet posts in the Ontario Liberal government since 2011, including Health since 2014. Hoskins has been working closely with the federal health minister on many issues, particularly the opioid crisis. They co-hosted the Conference and Summit in November 2016. In October 2016, Hoskins released the province’s first opioid strategy, featuring measures to enhance data collection, modernize opioid prescribing practices and increase access to naloxone. 7 The Federal response to the Opioid Crisis

Dr. David Williams, Ontario’s Chief Medical Officer of Health

Phone: 416-327-7513 Dr. David Williams was appointed to his current post in February 2016, after serving in the role in an acting capacity since July 2015, as well as from 2007-2009. In October 2016, he was tapped as the province’s first-ever Provincial Overdose Coordinator in charge of a new surveillance and reporting system to “better respond to opioid overdoses in a timely manner and inform how best to direct care.” In 2018, Ontario is set to publish new standards for health care providers on appropriate opioid prescribing.

British Columbia’s Minister of Health

Phone: 250-952-3387 Email: [email protected] When new British Columbia Premier John Horgan appointed his cabinet in July 2017, he wrote “tackling the opioid crisis” into the Health Minister’s mandate letter, tasking Adrian Dix with the portfolio. Dix is a former journalist who’s been elected to the provincial legislature since 2005. He served as leader of the official opposition from 2011-2014, and has been active on a variety of health policy issues. Dix succeeded Terry Lake as B.C.’s health minister. In a September 2017 interview with the Vancouver Sun, Dix called the opioid crisis “a public health emergency” and that a mid-year budget boost towards opioid addiction crisis measures proves it’s the government’s top priority. In December 2017, Dix told Global News that more resources are needed to support the crisis’ front-line workers who are suffering from burnout and PTSD.

British Columbia’s Minister of Mental Health and Addictions

Phone: 250-952-7623 Email: [email protected] The Ministry of Mental Health and Addictions was created in mid-2017 specifically to help tackle the opioid crisis. Premier Horgan chose Judy Darcy, a long-time advocate for public health and social issues, with leading this new department. Darcy’s mandate letter is very explicit in what her ministry is expected to do concerning the opioid crisis: “Work in partnership to develop an immediate response to the opioid crisis that includes crucial investments and improvements to mental-health and addictions services.” The ministry is also tasked with supporting mental health and substance abuse services and responding to and preventing overdoses. Darcy has met with the federal Health Minister on a couple occasions to discuss the opioid crisis, particularly on regulatory barriers, according to the Georgia Straight. Danish-born Darcy has been a B.C. MLA since 2013.

Dr. Perry Kendall, B.C.’s senior provincial health officer

Phone: 250-952-1330 Email: [email protected] British Columbia will be looking for a new provincial health officer as of January 31, when Dr.Perry Kendall officially retires after 19 years. During his tenure, Kendall declared the opioid crisis a public health emergency in April 2016. He told the Vancouver Sun on Jan. 24 that overdose prevention sites and naloxone kits are having an impact on opioid-related deaths in the province. The senior provincial health officer advises the B.C. health minister and senior officials on health issues, sits on committees, and reports to the public on health issues and related policy changes in the province. Following his retirement, Kendall expects to become a consultant in public health delivery and drug policy.

B.C.’s Joint Task Force on Overdose Response

Phone: 250-952-1887 Website: www2.gov.bc.ca/gov/content/overdose Then-premier Christy Clark launched this Task Force in July 2016, headed by provincial health officer Dr. Perry Kendall and Clayton Pecknold, director of police services. Other members include representatives from the BC Centre of Disease Control and the provincial ministries of Health and Public Safety. In April 2017, the group released a one-year update, following up on seven key areas: • Immediate response to an overdose • Preventing overdoses before they happen • Public education and awareness about overdose prevention and response • Monitoring, surveillance and applied research • Improving the scheduling of substances and equipment under the Controlled Drugs and Substances Act and the Precursor 8 The Federal response to the Opioid Crisis

Control Regulations • Improving federal enforcement and interdiction strategies • Enhancing the capacity of police to support harm reduction efforts related to street drugs

According to this report, “officials from the Ministry of Health and the Ministry of Public Safety and Solicitor General continue to engage with the federal government to remove legislative barriers to addressing B.C.’s opioid overdose emergency.” The Task Force published its latest progress report in May 2017.

Vancouver Mayor Gregor Robertson

Phone: 604-873-7621 Email: [email protected] Three-time Mayor of VancouverGregor Robertson wants the federal government to treat the opioid crisis as a national health emergency. As chair of the Big City Mayors Caucus Mayors’ Task Force on the Opioid Crisis, Robertson is critical of Ottawa’s reaction and wants a more pan-Canadian solution. “We need to join forces to effectively tackle this crisis, and identify specific actions to connect people to the health services and supportive housing they need to end this tragic epidemic,” he stated in a October 2017 press release. Robertson is also pressuring the B.C. government to try more radical programs of dealing with addition.

Canadian Medical Association

Phone: 613-731-8610 Email: [email protected] Website: cma.ca Address: 1867 Alta Vista Dr. Ottawa, ON K1G 5W8 CMA advocates on behalf of Canada’s doctors and is very concerned about the potential harms of opioids. Its vice-president, Dr. Jeff Blackmer, has appeared before the health committee and has been cited in House of Commons debates on the crisis. In 2017, the CMA issued Canadian Guidelines for Opioid Therapy and Chronic Non-Cancer Pain, recommending a comprehensive national strategy to deal with psychoactive drugs in Canada. According to their website, “The CMA supports collaborative efforts by the federal and provincial/territorial governments, and by health professionals and other stakeholders, to develop and implement a comprehensive national strategy.” Dr. Laurent Marcoux is the CMA’s president for 2017-2018.

The Canadian Nurses Association

Phone: 613-237-2133 Email: [email protected] Website: cna-aiic.ca The Canadian Nurses Association is the national professional voice of registered nurses in Canada. It supports Bill C-37 and the repeal of Bill C-2. The group condones safe consumption sites. Aside from the opioid crisis, CNA has lobbied the federal government on a number of issues, including medical assistance in dying, pharmacare and dementia. Barb Shellian has been the group’s president since June 2016, and will remain in the role for a two-year term. She is a former president of the College and Association of Registered Nurses of Alberta.

Canadian Pharmacists Association

Phone: 613-523-0445 Email: [email protected] Website: pharmacists.ca The Canadian Pharmacists Association is a national, non-profit organization representing Canadian pharmacists. CPhA works closely with provincial and national pharmacy associations and helps to influence the healthcare policies, programs, budgets and initiatives affecting both the profession and Canadians.Alistair Bursey was elected CPhA Chair in 2016 and previously served in this role from 2011-2014. He appeared before the health committee in October 2016 to discuss the opioid crisis. He has been in communication with the health minister on this issue, as well. CPhA’s director of profession affairs, Dr. Philip Emberley, has also been influential in raising this issue at the federal level. His name comes up frequently in House of Commons debates on Bill C-37.

9 The Federal response to the Opioid Crisis

Dr. David Juurlink

Phone: 416-480-4055 x 3039 Email: [email protected] Website: sunnybrook.ca Originally from Nova Scotia, Dr. David Juurlink is head of clinical pharmacology and toxicology at Toronto’s Sunnybrook Health Sciences Centre. He has been calling for Canada’s doctors to take responsibility for the current opioid crisis, placing blame on his colleagues for over-prescribing painkillers. His current field of research includes drug safety, adverse drug events and the consequences of drug-drug interactions in clinical practice. He supports calling the opioid crisis a national health emergency. Dr. Juurlink was the keynote speaker at the federal health minister’s opioid summit in November 2016.

Dr. Thomas Kerr

Phone: 604-806-9142 Email: [email protected] Website: bccsu.ca Dr. Thomas Kerr is the associate director of the BC Centre on Substance Use, and is a professor of medicine at the University of British Columbia. His research with Insite, the first safe consumption site in Vancouver, has impacted health policy both at home and abroad. His primary research interests concern illicit drug use, health policy and community-based research methods. Dr. Kerr has appeared before both House of Commons and Senate committees as an expert witness. He advocates for better access to a wider variety of opioid replacement therapies, preferring harm reduction to criminal justice for addicts.

10 The Federal response to the Opioid Crisis House and Senate Committees

The following transcripts have been edited for length and content. To view the full transcripts, visit parl.gc.ca.

COMMITTEE MEMBERS (AS OF SEPTEMBER 2017)

• Liberal MP Bill Casey (Cumberland-Colchester, N.S.), chair • Conservative MP Marilyn Gladu (Sarnia—Lambton, Ont.), vice-chair • NDP MP Don Davies (Vancouver Kingsway, B.C.), vice-chair • Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.) • Parliamentary Secretary to the Minister of Health Bill Blair (Scarborough-Southwest, Ont.) • Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.) • Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.) • Liberal MP John Oliver (Oakville, Ont.) • Liberal MP Sonia Sidhu (Brampton South, Ont.) • Conservative MP Dave Van Kesteren (Chatham-Kent-Leamington, Ont.) • Conservative MP Len Webber (Calgary Confederation, Alta.)

REPORTS Fourth Report: Opioid Crisis in Canada Nov. 18, 2016 Sixth Report: Report and Recommendations on the Opioid Crisis in Canada, December 2016 Seventh Report: Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, Feb. 10, 2017.

SUMMARY The committee met on Sept. 22, 2016. NDP MP Don Davies put forward a motion that the committee undertake an emergency study of the opioid crisis in Canada. The committee held five meetings in October where they heard from a variety of witnesses, including pharmacists, physicians, first responders, indigenous representatives and those who work in harm reduction and recovery. The committee then met three timesin camera to consider the draft version of its interim report on opioids, which was tabled in the House on Nov. 18. The final report was tabled on Dec. 12, 2016. The committee met on Dec. 13 for a briefing on opioids from Health Minister Jane Philpott. The committee then met on Feb. 9, 2017, to consider Bill C-37. The report was tabled on Feb. 10, with the following amendment: That Bill C-37, in Clause 42, be amended • (a) by replacing lines 10 and 11 on page 44 with the following: “shall include information, submitted in the form and manner determined by the Minister, regarding the intended public” • (b) by replacing line 16 on page 44 with the following: • “(c) the administrative structure in place to support the”

December 7, 2017

ON THE AGENDA The committee met to discuss the contents of the Supplementary Estimates (B) 2017-18. During her opening statement, Health Min- ister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.) updated the committee on actions Health Canada has taken in recent months to combat the opioid crisis.

11 The Federal response to the Opioid Crisis

WITNESSES Cabinet Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.) Canadian Food Inspection Agency Yves Bacon, vice-president and chief financial officer, Corporate Management Branch Carolina Giliberti, executive vice-president Department of Health Simon Kennedy, Deputy Minister Canadian Institutes of Health Research Michel Perron, executive vice-president Public Health Agency of Canada Dr. Theresa Tam, Chief Public Health Officer

TRANSCRIPT HIGHLIGHTS: This meeting has been edited to only include instances where opioids were discussed.

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.) opening statement:

Another health priority that we are addressing is the opioid crisis. We continue to use all the tools at our disposal to address the growing number of overdoses and deaths caused by opioids. As you know, there were more than 2,800 apparent opioid-related deaths in Canada in 2016, and the preliminary data for 2017 suggests that the number of opioid-related deaths will exceed 3,000. These estimates include an increase of $6.2 million to address the crisis. This includes funds to support increased access to harm reduction measures and to prevent infectious diseases that may result from sharing drug-use equipment. This is a complex health and social issue, and it will not be fixed overnight. This is why our government will continue to work with partners from across the country to take action on this public health crisis.

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

I’ve also noted the good work that’s been done by the ministry regarding addressing the opioid crisis. Again, I keep coming back to what I was doing in my previous life. It was something I saw a lot of in that job, and sometimes with very tragic results, which I had to witness. I was very pleased that the government was able to pass Bill C-37, which increased the ability of community health groups to make safe consumption sites available. We know this is something that would save lives. The initiatives making naloxone more available have been a very important life-saving tool as well. We undertook a study of the opioid crisis, and we produced a report that had 38 recommendations. Would you be able to tell the committee what progress you’ve had in implementing that series of recommendations?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

With respect to the work that we’ve done in the opioid crisis, first of all, as indicated in my opening statement, we recognized as the government and as all Canadians have that we’re faced with a public health crisis when it comes to the opioid situation. Again today, we’ve seen some numbers that have been released from Ontario, and the numbers are devastating. We recognize that they’re not just numbers. These are people’s children, their mothers, their fathers. They’re personal stories, and the damage that is created by these losses, the collateral damage, is huge to families and to communities. It’s certainly an area of priority of mine as Minister of Health. I have to say that the first briefing that I received as Minister of Health was specifically on the opioid crisis and it’s my number one priority, which I’m dealing with on a regular basis, on a daily basis. As you’ve indicated, in terms of some of the key steps that we’ve been able to take so far, when it comes to Bill C-37 that was certainly an important step in the right direction in order to streamline the application process for the consumption sites that are out there. We certainly need to make sure that we have a harm reduction approach when it comes to dealing with these situations and we are pleased to see the progress that has been made. When we formed government, we had one of these sites available in Canada and now we have a total of 28 supervised consumption sites available. Those are certainly, again, steps in the right direction. Also, when you mentioned about making naloxone more readily available, ensuring that it’s a non-prescribed medication certainly allows many individuals to have access to that tool. That’s exactly what it is, something they need to effectively deal with the situation on

12 The Federal response to the Opioid Crisis the ground. Certain provinces make sure that is available free of charge, but again, that’s a decision that’s brought forward by provinces and territories. We certainly need to do all that we can to ensure that the naloxone product is more readily available. We’ve also made significant investments as well when it comes to addressing this situation. When the Health accord was being negotiated last year, there are a few provinces that indicated that the opioid crisis was an absolute priority in the areas that needed to be addressed. Above and beyond the monies that they received for the health transfers, if we look at the Province of British Columbia, for example, they received $10 million in direct funding to deal with this crisis on the ground. If we look at the Province of Alberta, they received I believe it was $6 million to deal with this crisis on the ground. There’s also Man- itoba, there was a series of targeted issues that they needed funding for but opioids was certainly one of those as well that was listed. They received additional funding as well. Aside from that, we also can’t forget that Canadians as a whole have told us that mental health and addictions is absolutely a priority for them. Through our budget in 2017 and with the health care agreements, we recognize that we made significant investments, $6 billion in the area of mental health. Again, they’re steps in the right direction, but I can’t say enough that we recognize that we cannot be complacent when it comes to this crisis. We have to continuously monitor the situation. We have to address the needs that are out there. We have to be progressive. Also, we can’t deal with this alone. There’s no one single solution to this, and we recognize that we have to work with the provinces and the territories and front-line workers. That’s going to be key.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Minister, in 2009 the H1N1 flu virus caused 428 deaths in Canada. In response, the federal government mobilized an emergency operations centre 24 hours a day, seven days a week. This provided more than 6,000 person-days of assistance to help coordinate emergency responses across the country. Now, in comparison, we had 2,800 deaths in 2016 and 3,000 deaths this year from the opioid overdose crisis, yet only 113 person-days of assistance have been reported by the Public Health Agency of Canada, and that’s to help write two reports. In addition, during the H1N1 outbreak, the Public Health Agency of Canada spent $322 million on communications and advertising alone. In contrast, your government’s total commitment to fight the opioid crisis is $123.5 million, and that’s spread over five years. Minister, given the longer, more entrenched, and more serious death toll of the opioid overdose crisis, why has your government’s response been so substantially less than what was done for the H1N1 health crisis?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

We’ve had an opportunity to discuss this one on one, and I’m happy that you bring up the question again today. We also have to recognize that the issue of the opioid crisis, as I’ve indicated in my earlier remarks, is quite devastating when you look at the numbers that are coming in right now. Again, with the report that came out from Ontario, it’s very alarming to see the numbers that are coming up. I have to say that our government certainly has taken steps so far in order to address the situation. When we formed government, one of the first bills that was brought forward was Bill C-37, a bill that really streamlined the application process to make sure that individuals had access to supervised consumption sites, and we recognized that saves lives. Also with the issue of naloxone, we know that making sure that naloxone was a non-prescription type of medication that was available for people also saves lives. When the provinces and territories told us they were dealing with a targeted situation in their provinces, again, a specific funding was given to them. If you look at British Columbia, your province, they received an additional $10 million with respect to targeted funding and also, with respect to Alberta, they received some additional funding. Just last month when I was in Calgary, we made some announcements. When we look at the Canadian youth substance abuse strategy that was put in place, we’ve also made some investments there as well to look at the issue. Again, when it comes to services that are on the ground, it’s truly important to make sure that we continue to work with provinces and territories. The federal government absolutely has a role to play, and we certainly cannot be complacent when it comes to this crisis.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Minister, the question was asking you to contrast why the federal government spent triple the amount of money on H1N1 than today, and I didn’t hear an answer to that, but I’m going to move to medicinal cannabis. My colleague brought this up. From a health perspective, we know that medicinal cannabis is not zero-rated. Already medicinal cannabis users have to pay GST and HST. We know that most prescription plans in this country don’t cover medicinal cannabis, so already men and women who are struggling already have to pay extra money for medicinal cannabis. Ironically, opioids are covered by most plans and are zero tax-rated exempt. Ironically, patients are incentivized to pursue a riskier option, and that’s even compounded by the fact that studies are now showing that medicinal cannabis is proving very effective at helping people wean themselves off opioids. It’s clearly a flawed policy to make medicinal cannabis more expensive than opioids. 13 The Federal response to the Opioid Crisis

I’m just wondering, at the cabinet table, Minister, would you advocate, from a health perspective, to at least treat medicinal cannabis the same as opioids.

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

As the previous speaker indicated, with respect to tax policy, that’s absolutely the Minister of Finance’s area and the work that he is doing. Again, next week the finance minister will be meeting with his territorial and provincial counterparts. I am certain this issue is going to be coming up. If the finance minister appears before the health committee, this would certainly be a question to be asked.

Conservative MP Marilyn Gladu (Sarnia—Lambton, Ont.):

With respect to the opioid crisis, I saw the numbers as well today showing a 68 per cent increase in the opioid deaths in Ontario, and we know that B.C. was on the front lines of this, and 16 Canadians a day are dying from this. I heard about the amount of money that the federal government is putting forward, the $6.2 million, and then some of the payments that went to the different provinces, but when I compare that with the $500 million that the government is spending to legalize marijuana, it just seems like those two are perhaps not in balance. Minister, what are the actions being taken in the opioid crisis to prevent the drugs from coming into the country, to prevent the over-prescription of drugs, to make sure our first responders are well protected, and to invest in treatment to get people off drugs ultimately?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

When we look at the situation that we’re facing right now, absolutely, as indicated, we are certainly faced with a public health crisis when it comes to this situation. Again, when I heard the numbers this morning, it is devastating to see the number of lives lost in this situation. We cannot minimize the actions that our government has taken to date with respect to regulatory changes and also the issue of Bill C-37. Once again, providing access to individuals to supervised consumption sites saves lives. We know that. Also, ensuring that naloxone products are readily available to individuals as well saves lives. Also, with respect to the changes made with respect to providing provinces and territories with the opportunity to open overdose prevention sites, that was an announcement that I made, I believe, about two weeks ago. When we met with the health ministers at the meeting in October, some provinces had indicated that they thought it would be appropriate if the provinces had more powers. Again, they’re closer to their constituents and they know what’s going on on the ground. We took that back, and just two weeks ago we indicated that we were prepared to look at providing class exemptions to provinces if they choose to open overdose prevention sites. There is a difference between an overdose-prevention site and a supervised consumption site. Sometimes we talk about these terms and people aren’t aware of the difference. On the supervised consumption site, when they choose to apply, the municipalities or the areas will get in touch with Health Canada and then from there the licensing will go through that department. It can take a bit more time. When it comes to overdose prevention sites, however, we can certainly go through those requests in a very timely fashion. [Ontario Health] Minister [Eric] Hoskins got in touch with us yesterday, and just today we were able to approve a class exemption. From there, the Province of Ontario will be able to determine what services need to be put on the ground in order to provide services to the individuals in their community. At the end of the day—

Liberal MP John Oliver (Oakville, Ont.):

My first question is around health research and whether we are making adequate investments in health research and support to CIHR [Canadian Institutes of Health Research]. We’ve heard from virtually every study we’ve done that research is required. On antimicrobials, we heard how important it was. Because the pharma companies were not investing in that, there had to be investments made for antimicrobial research. On the cannabis bill, we heard about the need for research now around cannabis, its health effects, and the longer-term consequences of it. On the opioid study, we heard from virtually every person that there was a need for treatment, and research into treatment protocols and directions, yet I didn’t see where you sit on research, Mr. Kennedy and Mr. Perron. Do you feel that CIHR is adequately funded? I have to say that the majority of groups that come to see me do not feel that there are sufficient funds through CIHR and the other granting bodies to cover the degree of research that’s needed.

Michel Perron, Canadian Institutes of Health Research:

Clearly, with regard to the supplementary estimates that this committee is examining, we were delighted to receive an additional $5 million, which has gone to some of the items that you indicated. One is the funding for the Canadian drugs and substances strategy, which the deputy referred to earlier. This is very much to address many of the issues specific to the opioid crisis.

14 The Federal response to the Opioid Crisis

This is in addition to our annual grant funding level of approximately $1.1 billion in available authorities. This is a significant amount of money that we try to invest as wisely as possible, given the very significant expectations and pressure on health research generally in the area of antimicrobial resistance that you referred to. For instance, in the past five years, we’ve spent well over $100 million in [antimicrobial resistance] research, an average of $22 million a year. We work very closely with the Public Health Agency and the like. With regard to opioids, I would just indicate that many of the investments recently—whether through the Canadian drug strategy or our funding more generally—are to provide clear evidence of what works best in what setting and to provide the direct kind of clinical guidance required for clinicians and first-line providers to ensure that those efforts are well done. For instance, there’s a study under way right now to evaluate models of care. Is it methadone or—

FEBRUARY 9, 2017

ON THE AGENDA The Committee commenced consideration of Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts. Main topics discussed: clause 42, which pertained to supervised injection sites.

WITNESSES Department of Health: • Miriam Brouillet, Legal Counsel, Health Canada Legal Services • Kirsten Mattison, Director, Controlled Substances Directorate, Healthy Environments and Consumer Safety Branch Canada Border Services Agency: • Megan Imrie, Director General, Commercial Program Directorate • Cathy Toxopeus, Director, Program Performance and Reporting Division

TRANSCRIPT HIGHLIGHTS:

Liberal MP John Oliver (Oakville, Ont.):

I want to thank Mr. Davies for the amendment he’s brought forward. I wanted to start by saying I think we all agree with the spirit of what he’s trying to accomplish, which is to make it easier and more expedited to get these applications through. I want to remind everybody that there used to be 26 criteria that basically froze the development of these safe sites, so there’s already a significant loosening of the strictures that were there and that what is in the act is from the Supreme Court. That was a Supreme Court decision. I just wanted to start with that. I think the suggestion to move from “evidence” to “information” is a really good idea. There are significantly different criteria and interpretation around that, so I think we would support that. I think removing the “if any” clauses for the (a), (b), and (c) criteria actually reduces the minister’s flexibility and discretion, so I’m a little bit uncomfortable to see the “if any” removed for (a), (b), and (c). Unfortunately, I’ve been stuck on the scrutiny committee for regulations, so I’m starting to understand acts and regs and how departments interpret things. I think overall, what we’re trying to do here is dip into how an application process should be construct- ed and prescribe an application process, so I want to ask the department if they could walk the committee through the impact of this amendment and tell us what impact it would have on the proposed application process. Could you talk about the application process to us a bit and give us any concerns you might have about moving away from the Supreme Court’s recommendations?

Kirsten Mattison, Health Canada:

There are some distinct sections of the amendment, and I’ll talk you through those. I don’t want to use your time unnecessarily, so please stop me if something is clear and we can move on to the next portion. The first part of the change is to substitute the word “evidence” for “information”.

Liberal MP John Oliver (Oakville, Ont.):

We’re okay on that one.

Kirsten Mattison, Health Canada:

The word “evidence” was only used once in the provision. It was linked to the intended public health benefits of the site.” 15 The Federal response to the Opioid Crisis

Liberal MP John Oliver (Oakville, Ont.):

I think we’re okay with that. I think where the issue for debate here might be is around the reordering of what is required to be submitted and who’s going to be submitting it.

Kirsten Mattison, Health Canada:

Yes. I just want to be very clear of the difference between the public health benefits versus the other five factors. The public health benefits are to allow the minister to confirm that she has the authority to take the decision under section 56.1, because that decision is taken when it’s necessary for a medical benefit. That was why that was necessary. The other five factors were grouped as a block in order to demonstrate that those were elements that the Supreme Court of Canada indicated should be considered in making a decision on an application. The reordering of the requirements does change what the legislation sets out as what must be in an application. Currently the five factors are equally weighted; they’re presented together. That’s in line with the Supreme Court of Canada decision. Of course, you’re absolutely correct that the legislation sets a framework, sets a high-level overview of how the application process works. It’s the department’s job, and that is sometimes accomplished through regulations under this framework and sometimes through guidance documents, application forms. In the case of supervised consumption sites in particular, there have been typically a series of discussions between departmental officials and the applicant. There’s an application form, there’s guidance on how to fill out that application form, and there’s an ongoing- con versation if applicants have any questions or concerns about how they should be providing information or what they should be providing.

Liberal MP John Oliver (Oakville, Ont.):

I don’t want to put words in Mr. Davies’ mouth, but my understanding is the (a), (b), and (c), he feels, would be appropriate to be submitted by the applicant, but then under his amendment, the proposed new subsection 56.1(2.1), the part about (a), (b), (c) isn’t clear, actually. The minister may take it into account, but it’s not clear who’s actually submitting it. Do you or does the minister have any way of collecting that information if it doesn’t come through the application process?

Kirsten Mattison, Health Canada:

The department may have access to information, and in considering an application it would certainly use information to which it already has access. It’s helpful to the department in the process, so that’s the reason for the five factors being together and the terminology “if any”. It’s so that the applicant provides information if they’ve been able to obtain it to support the decision-making process. In asking the applicant to provide it if they have it, it’s to help access information that the department might not have access to.

Liberal MP John Oliver (Oakville, Ont.):

Do you have any problem with changing the words “regulatory structure” to “administrative structure”?

Kirsten Mattison, Health Canada:

The term “regulatory” was chosen because it was exactly the term used in paragraph 153 of the Supreme Court of Canada decision. I could see substituting the term “administrative” and having the effect. The term “regulatory” was chosen because it was exactly the term used by the Supreme Court.

Liberal MP John Oliver (Oakville, Ont.):

Thank you very much for the departmental perspective. Again, I think it is important to understand that everybody is supporting getting these sites up and running and trying to find ways to make sure, while we have complete application processes, that they aren’t unnecessarily burdensome. When I looked at the administrative structures in place, the expression of community support, the impact of the site on crime rates, I saw there was an “if any” caveat around that one. I thought those would be relevant. If I put my old hat on as a hospital CEO, if I were applying for something, those look to be reasonable things that I would be submitting as part of an application for minister approval. The impact of the site on crime rates, I think, is a more difficult one for an applicant to assess, and the language as originally drafted is “if any”. Coming back to supporting moving from “evidence” to “information”, supporting moving from “regulatory structures” to “administrative structures”, but otherwise keeping the original five together as envisioned in the act, makes more sense to me. 16 The Federal response to the Opioid Crisis

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

I have a few things. To answer Mr. Carrie’s concern—and I’m not sure this would change his mind in any event—he’s quite right. I didn’t mean to avoid it. When I changed the words “may take into account” from “shall”, the reason I changed it was because of the words “if any”, so I thought “may take into account evidence, if any”, but I’m happy to put that back to “shall” if that makes him more comfortable. I don’t think that would change his view of the amendment anyway. The problem with this, with great respect to Mr. Oliver, is that we continue to say we want to get these running as quickly as possible. That was said a year ago. The minister stood in the House and said she wanted to get these sites done as quickly as possible, while at the same time saying she didn’t think the act necessarily had to be amended. The act is the barrier. The application process is the barrier. We have to acknowledge that. While we’re here at this historic moment with a chance to straighten out the application process, it’s our chance to figure out what burden we want to give to the applicant. Applicants have been telling me for a year, “You’re making me put stuff in that takes me a long time to gather, that is hard to gather.” If you’re saying that the application has to have expressions of community support or opposition, if any—and I’ll get to “if any” in a moment—you’re basically slowing down the process. I’m going to go out there, I’m going to get petitions, and I’m going to go knock on doors in the neighbourhood because I’m going to think my chances of getting the minister to approve it will be better if I have expressions of community support. By the way, there will be other people acting to get evidence of community opposition at the same time. Let’s not forget that. I want to talk about the words “if any”. “If any” is extremely confusing. I’m an applicant, and I’m told by a law of Parliament that an application shall include information, “if any”. What is that telling me? Does it mean information if I want to include it—if I have it, I’ll put it in—or does it mean if any exists? I’ll tell you, there is always information about the impact of the site on crime rates. There are always expressions of community support or opposition. Any person applying under this section who reads it the way it is, with the words “if any”, will think they have to put that information in or they won’t get their application approved, or the chance will be less. That’s going to slow down the process. I also want to be clear that, as I said before, the minister will take into account all those factors. Maybe there will be a countermove and there will be groups organizing to send information to the minister outside the application on expressions of community opposition. The way this is written now, the minister doesn’t take that into account. It’s only expressions of community support or opposition that are contained in the application. What I’m saying is that from my reading of the Supreme Court decision, the minister should broadly exercise her discretion and ask what the impact of this would be on crime rates and find out what the community is saying about this issue. Don’t put the burden on the applicant to provide that. Widen it so the minister can get that information from anybody she wants. The last thing I will say is that in my amendment there’s nothing that would preclude an applicant from including expressions of public support. An applicant could do everything that you said you want them to do, John. I’m removing the legal requirement, the burden placed on them to provide that. Really, all I’m doing here is straightening out the burden. Let’s clearly tell applicants, “You tell us what the public health benefits of the site are. You tell us about the local conditions. You tell us the resources available to support your site.” Then, when you get that application in, and it will get in quicker now, you can have regard—in fact, as Colin says, “shall” have regard—to the impact on crime rates, the administrative structure, and expressions of community support. I’m telling you this is better. If we don’t pass this, you are telling applicants the process will be slower, and you are passing a section that will be confusing to applicants.

Conservative MP Rachael Harder (Lethbridge, Alta.):

Can you further clarify? You talked about this phrase “administrative structure”. I follow you to a point, but I would like you to expand on that further. What exactly is the difference? If we’re moving from a regulatory structure to an administrative structure, what difference will that make in the end?

Kirsten Mattison, Health Canada:

The intent of the legislative drafting was to align with the language used by the Supreme Court of Canada. The alignment provides an advantage for someone reading a piece of legislation and hoping to understand the intent of the provision, because it points very clearly to the Supreme Court decision, and the court in its decision elaborated on all of those points. The intent is to make a clear link between the legislation and the Supreme Court of Canada decision so that the legislation doesn’t bear the burden of that interpretation, and so that the entirety of that court decision can be seen to be a direct link into the legislation, so that the interpretation can be maintained. I would agree that the statements, for example, of nurses present at a site as one of the clarifying statements in the court decision would support the term “regulatory structure”. The intent is to make the link very explicit so that the entire interpretation of the court could be seen to apply to the provision. 17 The Federal response to the Opioid Crisis

Conservative MP Rachael Harder (Lethbridge, Alta.):

I can value the fact that this links back to the Supreme Court of Canada decision. Are there other ways that we could clarify, in the application process, what is required here by this terminology?

Kirsten Mattison, Health Canada:

Absolutely. The intent of the department is to develop a clear application form that applicants would use to structure their application. That form is accompanied by written guidance. We realize that sometimes that’s not enough. The department is committed to working directly with applicants to answer any questions they have as they put together the application. We’ve had telephone discussions and face-to-face discussions to explain to applicants how they can meet the provisions and exactly what information the department is expecting to see. It’s one piece in a very comprehensive process of supporting applicants through understanding their obligations and requirements in submitting an application.

Liberal MP John Oliver (Oakville, Ont.):

I want to respond to some of Mr. Davies’ comments. Yes, there have been delays in getting safe injections sites established, but it is not this bill but the previous bill that was causing the problems. There were 26 requirements in the previous legislation. This is a dramatic reduction, to five. There is really no empirical- evi dence yet that these five conditions are going to stand in the way of a successful, expedited application. My second comment is that this isn’t just about letting these sites happen. The Health has to balance public health with public safety, and she needs to have the information available to her to make assessments of the appropriateness of the site for the community. Having said that, I would like to move a subamendment, Mr. Chair. I move that in proposed subsection 56.1(2), in line 10 the word “evidence” be changed to “information” and in line 16 the word “regulatory” be changed to “administrative”. I’d like to move that subamendment.

Liberal MP Bill Casey (Cumberland—Colchester, N.S.):

Now we have a motion from the floor, which is Mr. Oliver’s motion, to change the words.

Liberal MP John Oliver (Oakville, Ont.):

I move that in proposed subsection 56.1(2), in line 10 the word “evidence” be changed to “information” and in line 16 the word “regulatory” be changed to “administrative”. (Amendment carried)

DECEMBER 13, 2016

ON THE AGENDA The Committee proceeded to a briefing on the Opioid Summit. Main topics discussed: supervised injection sites, calling for a national public health emergency, addictions treatment, and communicable diseases (specifically HIV/AIDs).

WITNESSES Cabinet: • Health Minister Jane Philpott (Markham-Stouffville, Ont.) Department of Health: • Simon Kennedy, Deputy Minister • Hilary Geller, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch • Public Health Agency of Canada • Gregory Taylor, Chief Public Health Officer

18 The Federal response to the Opioid Crisis

TRANSCRIPT HIGHLIGHTS

Health Minister Jane Philpott (Markham-Stouffville, Ont.) opening statement:

These matters are urgent. The number of deaths related to opioids has complex roots. It’s dimensional, and it requires swift action on behalf of all of us in this vocation. I have been addressing this matter since the very beginning of my responsibilities as Minister of Health, and I have been making decisions in an attempt to promote health and to save lives. I believe we need to continue to have a health-focused approach to the opioid crisis. Some of you know that last month I was in British Columbia and visited front-line workers. I was at Fire Hall 2 in downtown Van- couver and met with paramedics and police officers and firefighters as well as many health care providers. Hearing from them about what this means on the ground and the challenges they face every day in trying to save the lives of victims was very moving for me. Later that month I, along with the Ontario Minister of Health, Mr. Hoskins, hosted a large gathering that some of you were able to attend. It was a conference and then a summit, where we had representatives of government, health care professionals, and community members talking together about how we need to respond. We have taken many government actions to date on this, including, of course, the work of this committee. We have continued to focus on a public health approach. You have no doubt heard of some of the announcements yesterday, which I’ll refer to shortly, but first of all I wanted to make sure you were aware of a number of steps that have been taken so far. One of the early steps we took was to make sure that naloxone was available in a non-prescription status. We also heard about the need for a naloxone nasal spray, and we were able to expedite an emergency importation mechanism to get nasal spray into the country. We were later able to expedite an approval of naloxone nasal spray for production in Canada. We realized that one of the things we needed to do was to focus on harm reduction. In that light, early on I approved an exemption for the Dr. Peter AIDS Centre to operate a supervised consumption site in Vancouver. We were also able to give an unprecedented four- year renewal to Insite, which is an extraordinary site based in downtown Vancouver. We also were asked to reverse the federal prohibition on the use of diacetylmorphine, which is pharmaceutical heroin. It is proven as a medication for the treatment of addiction, and it is now available under a special access program. Last week we took steps to schedule fentanyl precursors, making it harder to access some of the chemicals used to make illicit fentanyl. Yesterday we introduced amendments to the Controlled Drugs and Substances Act and other acts. It’s important to recognize the big picture of why we did that. It is fundamentally taking a health-based approach to problematic substance use, and the new Canadian drugs and substances strategy replaces the former national anti-drug strategy. It formalizes the government’s approach to drug policy, which is comprehensive, collaborative, compassionate, and evidence-based. The lead for the strategy has now returned to the Minister of Health, and we have reinstated harm reduction as one of the four pillars of drug policy, along with the pillars of prevention, treatment, and law enforcement. You can ask me more details later, but I wanted to give you a bit of an overview of what’s included in some of the details of that bill. One of the things we did was to streamline the approach for communities that feel there is a need to have a supervised consumption site in the community. In order to do that, we removed the 26 criteria that had been in place in the previous legislation, and we replaced those with a requirement for the Minister of Health to demonstrate evidence of public health and public safety benefits. This comes in part from the 2011 Supreme Court decision, which stated that where the evidence indicates that a supervised injection site will decrease the risk of death and disease and there’s little or no evidence that it will have a negative impact on public safety, the minister has a responsibility generally to grant an exemption. The Supreme Court also gave us guidance on what kinds of things the Minister of Health should take into consideration in making that decision, and there were five factors in particular that were emphasized. The first is that there has to be a demonstration of community need. Second, there has to be a demonstration of community consultation and support. Third, the minister has to have an understanding of the potential impact on crime rates. Fourth, there need to be regulatory systems in place, and fifth, there needs to be evidence that the site has the appropriate resources in place. Given all this, we know that there is an abundance of evidence that well-established and well-maintained supervised consumption sites in communities that want and need them will save lives, prevent infection, and introduce people into the health care system in a way that will not increase crime rates and will not increase problematic drug use. There are a number of other elements in the bill that you may want to ask about. You have probably heard that we will be prohibiting unregistered importation of pill presses and encapsulators to help to address the matter of the illicit supply, production, and distribution of drugs. We will be removing the exception in the Customs Act that currently prevents border officers from inspecting mail that’s 30 grams or less. This will allow us to stop the importation of dangerous substances such as fentanyl, which are often shipped in these very small packets. There are a number of other amendments to the Controlled Drugs and Substances Act. They’re there to help increase the flexibility that we have to address emerging risks. They allow us, for instance, to temporarily add a substance that we believe poses significant risk to public health to a temporary schedule on the Controlled Drugs and Substances Act pending a comprehensive review and a decision on permanent scheduling.

19 The Federal response to the Opioid Crisis

All in all, the response to the opioid crisis requires a comprehensive approach. It requires actions like those we took yesterday to essentially stop people from drowning, as it were, but we also have to take steps to address root causes, the reasons people fall into the water in the first place, if we are to use that water metaphor. The Canadian Mental Health Association talks about the opioid crisis having multiple roots. Some of those roots are in the health care system. Canada is the second-highest per capita consumer of opioids, and we took steps during the summit to address the roots of the crisis with the role of prescription drugs. We brought together at that meeting seven provincial and territorial health ministers and a broad range of stakeholders, and we developed a very interesting and impressive list of actions that these 42 organizations are committed to taking in a joint statement of action. There’s also a commitment on our part to report on the progress quarterly.

SUPERVISED INJECTION SITES

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

The number of criteria for opening supervised injection sites has been reduced to five. There are only two such sites in Canada right now. How many sites do you expect will be opened in Canada and in what timeframe? Is there a specific objective in this regard or are you waiting to have discussions with the provinces and the communities affected? If there is such an objective, how will it be reached?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I encourage members to read the Supreme Court decision of 2011, if you haven’t already. It was informative for us in coming up with this legislation yesterday and it lays out the criteria as to when and if these kinds of sites should be approved. I think you’ll see that it’s quite helpful. You spoke to the matter of the number of sites that there are now, and you’re absolutely right: so far there are two that have received an exemption, the Dr. Peter Centre AIDS Foundation and Insite, both of them in Vancouver. A number of applications are in place. I believe there are three from Montreal, if I’m not mistaken—no, four now from Montreal, two from Vancouver, and three from Toronto. Is that it? Those are the ones for which we have received the full and entire applications. Several other communities have applications that are in process, and my department has been helping them with some of the steps along the way. One of the challenges under the current legislation was that we were not able to comment or to even provide feedback or begin a review of an application until it was complete. That requires, in some cases, as in some of the new applications in Vancouver, that they have an almost complete application. They have some work to do on, for example, renovating the space where they want the site to be available, but we can’t actually do all of the work until things are complete. Our commitment now is to have a much different approach, in a number of ways. One is that we intend to be able to post online the progress that sites are making so they can see where they are and which pieces are missing. The federal government actually takes the heat on not approving these sites, when many times the barriers to site approval have nothing to do with federal jurisdiction but have to do with local municipalities or with provincial governments providing support, for example. We want to be more clear on that, so that advocates who are pushing for this are pushing on the right levers to be able to get these sites open. Once this legislation passes through, we’re also committed to allowing partial reviews of applications that are in process. Hilary may have some other things to add, but I want to also address the last question, which I think is really important in terms of where we foresee these going and how many communities will have them. I think it’s very important that this committee have a central role in this so as not to cause undue anxiety in communities where it’s absolutely not appropriate to have supervised consumption sites. This is a crisis that is spotty in where it affects people. Yes, there are people across the country who die of overdoses, but there are some areas where the crisis is intense, as in southern British Columbia. In those communities that want and need them and where there’s strong community support, we have to be able to make them available to save people’s lives, but there are all kinds of communities in the country where it’s not appropriate, there’s no community desire to have one, and there’s no demonstrated need. Clearly the fear mongering around supervised consumption sites on every street corner is not helpful at all. We need to make sure that these will go to the communities that need them, that are crying out for them because people are dying, and we need to support those places.

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

What will you do to influence, educate or inform the police services that appear to be more reluctant? The Ottawa Police Service, for example, already expressed doubts this morning about the approach, whereas, in other parts of the country, people are very open and are anxiously waiting for sites to be approved. What does Health Canada intend to do to help these municipalities, these cities? Is there a specific approach? 20 The Federal response to the Opioid Crisis

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Those are excellent questions, and it gives me an opportunity to clarify that there will still be an application process involved that speaks to how the minister will get information to be able to make sure that those five factors have been appropriately considered. There will be guidance within the application process to show things like whether an impact on crime could be demonstrated. Some of it could be by, for example, having correspondence related to the chief of police in that particular area. There will be ways that we will support communities to be able to demonstrate that they have met the specific factors given by the Supreme Court. The point that you raise is a very interesting one in terms of sometimes hesitation on behalf of law enforcement as to whether or not this is a helpful mechanism. I would encourage members, if you ever possibly can and you’re in Vancouver, to go visit some of these long-standing supervised consumption sites like Insite. It has been established since 2003. You cannot help but be moved by this place, where people are greeted at the door in a non-judgmental way, where they make every effort to reduce the stigma associated with problematic substance use, and where people are welcomed and given an opportunity to be introduced to the health care system at the point that they are ready. Anyway, I could go on and on about how impressed I was by the work of Insite and how I really see it as being a helpful resource in that community. The interesting thing that happened in Vancouver is that there was.... You’re right, there was not 100% community support at the time that it was originally approved, but all evidence says that many, many people who were initially skeptical about whether or not this would be helpful in terms of decreasing crime rates or decreasing, for instance, the number of dirty needles that were in local parks, etc., have come around. The community support and the support from law enforcement, in particular the Vancouver police, is absolutely stunning. People are convinced that this has been an effective mechanism, and there have been zero deaths despite the fact that there are literally hundreds of people who use these services every day. I would certainly encourage law enforcement officials in other communities who are skeptical to go and see what an effective site can look like.

NATIONAL PUBLIC HEALTH EMERGENCY

NDP MP Don Davies (Vancouver Kingsway, B.C.):

The Minister of Health for British Columbia last night said that the opioid crisis in B.C. is “like a war” and that they can’t wait for this legislation to be passed. I think Dr. Perry Kendall, the public health officer in British Columbia, said the same thing—that they’re not waiting—and you’ve pointed out, I think with some power, the impact in my home province of British Columbia of these opioid deaths: almost 700 British Columbians will die this year. Pop-up clinics are operating right now in British Columbia to provide emergency services, and they’re either illegal or operating in a legal grey zone. As you know, this committee conducted an emergency study into the opioid crisis, and the very first recommendation that this committee made to your government, with all-party support, was to declare this a national public health emergency, as the thalidomide issue was. The reason for this is that it would give the public health officer of Canada extraordinary powers to act immediately while your legislation works through the House over the next three or four or five months, including opening emergency clinics now for safe consumption, for naloxone administration, or for drug testing—whatever these emergency clinics could be used for right now to save lives. My first question to you, Minister, is why don’t you declare a national public health emergency to give the public health officer of Canada these extraordinary powers in the next 90 days so that we can start saving lives now, while your legislation takes time to work through the process?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

The mechanisms available to the federal government on the declaration of an emergency are somewhat different from the powers that are vested in provincial governments for a declaration of an emergency. British Columbia effectively declared a public health emergency, and I have found it helpful to provide them with tools they didn’t already have. Under federal legislation, there is currently an Emergencies Act. It is a modernization of the previous War Measures Act, which was implemented on three occasions: World War I, World War II, and the October Crisis. The current Emergencies Act has never been implemented. I have asked my department, including the Public Health Agency of Canada, to investigate whether a declaration of an emergency would be appropriate under the Emergencies Act. To do so, we would have to have exhausted all other possible resources, and it would essentially take over powers that are currently vested in provincial governments to be able to act on public health. The analysis of the department to date has been that it is not deemed to be appropriate under the circumstances. 21 The Federal response to the Opioid Crisis

That in no way is an indication that we don’t recognize the seriousness of the opioid crisis. I have continued to say that if we felt that declaration of a national emergency would give us tools we don’t already have, then clearly we would have a responsibility to do so. To date we feel that the lack of declaration of an emergency has not impeded us from using all tools at hand. That said, we have looked for other alternatives outside the Emergencies Act to be able to bring further resources and mechanisms to the table. I know British Columbia used their declaration as a way to be able to get better data and surveillance. One of the things that the chief public health officer would be able to speak to if we had the time would be that he has taken steps to open a new special advisory committee. We have decided to look at the opioid crisis in the same frame that we would look at an infectious disease epidemic. The special advisory committee tool has been used in things like the H1N1 crisis and the Ebola crisis, and it was also used in response to the Syrian refugee crisis. It gives the chief public health officer the opportunity to work with medical officers of health in the public health network across the country to be able to do a much better job than we’re doing now, getting as close as possible to real-time information on data and surveillance. I don’t know whether you want me to take the time, but the chief public health officer could give you information. I believe he is meeting tomorrow with medical officers of health and public health officers across the country to talk about getting that kind of information. Thank you for raising this issue. The other thing the committee recommended was a task force, and I’m happy to say we do now have a task force within Health Can- ada, as was recommended by the committee. These are examples of things that we’re doing to be able to pursue this issue.

ADDICTIONS TREATMENT

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Minister, we have not seen a commitment from your government for a substantial investment in addictions treatment in Canada. How can you say that you’re strategy is comprehensive, without that?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

The content of yesterday’s bill spoke in large part to one particular mechanism of treatment, that being the possibility of further measures of harm reduction. It was intended to address the currently onerous process that’s required by communities who are looking to open supervised consumption sites. There were other pieces in the legislation, as you know, that contribute to the comprehensive strategy on opioids. It addressed our need to make sure that we reduce access to unnecessary opioids, and in particular illicit substances. There’s a large part of the bill that related to that. I’m glad you brought up the topic of treatment, and I know this has been raised repeatedly here. I can tell you that when I meet with first responders, for example, and when I meet with health providers who are dealing with this, treatment is one of the most pressing matters. This is an area where I hope we can find ways to work with our partners to do better treatment services that fall largely in the jurisdiction of the provinces and territories. This is an area where I believe provinces and territories need to do work to open more facilities and make those facilities more available. For instance, you know we are in the process of negotiating a health accord with the provinces and territories. I have made it very clear to them that issues of mental health and addiction are very important to us as a government, that we would actually like to be able to invest to provide further support for them to do better in terms of providing mental health care and addiction. We could hear more from the provinces and territories about how we can help them and what their plans are to open more treatment services. That would give us an opportunity, hopefully through the health accord and our commitments to mental health, to be able to invest in better supports for people, both in terms of preventing addiction by treating mental illness at its roots, but also by providing addiction services.

COMMUNICABLE DISEASE

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Your government has commendably made a substantial increase in funding to the Global Fund to address HIV and AIDS on the international stage. Unfortunately, your government has recently denied or cut funding to many HIV support organizations that provide services here in Canada, including some that are key players in responding to the opioid overdose crisis. Will you commit to reversing these cuts and ensure that every group that has historically received funding under the community action fund gets that funding?

22 The Federal response to the Opioid Crisis

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I think you are aware that we have been working with agencies that were potentially going to have an interruption of their funding through the community action fund. I asked the Public Health Agency of Canada to speak directly to each of those organizations and to continue their funding. We are committed to continuing to support those organizations through to 2018. In the meantime, I am seeking further resources to be able to expand our federal approach to sexually transmitted and blood-borne infections, including the community action fund. It’s my hope that we will find mechanisms to continue to support these excellent agencies.

SUPERVISED INJECTION SITES

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Previously, when all the provisions of Bill C-2 were in place, there were concerns about an extended timeline to approve supervised consumption sites. Can you comment in general terms on how removing these barriers is going to change the timeline for approval of a new site? How much time will be saved by these changes?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

That’s an excellent question. What it speaks to is the fact that the current process is terribly onerous. It has made it very difficult to receive an exemption for the communities that really want these sites, and it takes a number of months. Having said that, as I indicated earlier, it’s generally not because the federal government is opposed to providing that exemption; it’s often because the barriers to getting those sites approved rest on, for instance, the municipality getting zoning for the site and getting the work done to provide secure systems and so on. In many of the cases in which there’s been a delay, it’s because of actions that we are waiting for on behalf of municipalities, or sometimes provinces. That said, one of our commitments under the new system will be to institute a service standard, an expectation as to the period of time that it will take. I would be happy to give you further information on that, but I think it’s very important that we provide some assurance that we will deal with these expeditiously.

DECEMBER 8, 2016

ON THE AGENDA The Committee considered the draft report on its study of the Opioid Crisis in Canada during this meeting. The report, Report and Recommendations on the Opioid Crisis in Canada, was adopted with amendments and was presented in the House of Commons on December 12, 2016. The witnesses that appeared before the committee were there to discuss the committee’s study of the Current Blood Donation Re- strictions on Men Who Have Sex with Men. Witness Canadian AIDS Society Gary Lacasse, Executive Director, stated: When we look at MSM [men who have sex with men] and the whole portfolio, at aboriginals, and at different populations, it’s extremely important to understand what is the behaviour. Is it the users of opioids? Is it intravenous drug use? Is it because there are new immigrants coming into Canada who look for different alternatives or whatever? That has to be researched. If we’re going to find the key, it will be based on behaviour, I find, but it’s also scien- tifically based.

NOVEMBER 15, 2016 The Committee metin camera and resumed its study of the Opioid Crisis in Canada. The interim report,Interim Report and Recommendations on the Opioid Crisis in Canada, was adopted with amendments and was presented in the House of Commons on November 18, 2016.

NOVEMBER 14, 2016 The Committee metin camera and resumed the consideration of its draft report on its study of the Opioid Crisis in Canada.

23 The Federal response to the Opioid Crisis

OCTOBER 27, 2016 The Committee metin camera and proceeded to the consideration of matters related to Committee business in regards to the opioids study. It was agreed, — That, in relation to the study of the Opioid Crisis in Canada, a draft report be distributed to the members of the Committee on November 10, 2016; that the members of the Committee submit their recommendations by the end of the day November 1, 2016; and that two meetings, on November 14, 2016, and November 15, 2016, be dedicated to the consideration of the draft report. It was agreed, — That a proposed budget in the amount of $ 17,000.00, for the study of the Opioid Crisis in Canada, be adopted.

OCTOBER 25, 2016

ON THE AGENDA The Committee resumed its study of the Opioid Crisis in Canada. Main topics discussed: addictions in first nations communities/remote communities, Naxalone spray, mental health, OxyContin, addiction rates (lack of data, systems issue), treatment recommendations, “Big Pharma”, fentanyl and marijuana, education and prevention.

WITNESSES Assembly of First Nations • Isadore Day, Ontario Regional Chief • Carol Hopkins, Executive Director, National Native Addictions Partnership Foundation • Sioux Lookout First Nations Health Authority • Claudette Chase, Family Physician As an individual: • Nady el-Guebaly, Professor, Department of Psychiatry, University of Calgary

TRANSCRIPT HIGHLIGHTS

Isadore Day opening statement:

In order to reduce prescription drug abuse in first nations communities, the decolonization of the health care system is essential. It is imperative to fully implement the “First Nations Mental Wellness Continuum Framework”. The framework outlines opportunities to build on community strengths and control of resources in order to improve existing mental wellness programming for first nations communities. This includes: community development, ownership, and capacity building; a quality care system and competent service delivery; collaboration with partners; enhanced flexible funding; and, ensuring culture is at the centre of mental wellness and must be understood as an important social determinant of health. Again, we do have the work. The continuum has been a culmination of several years’ work, and we have a document here that we can leave for the committee members. Full implementation means increasing the amount and flexibility of resources in order to increase capacity, ensure quality care systems, and competent delivery so that all first nations have access to the essential basket of services that make up the continuum of care. A full and adequately funded continuum of services also includes long-term funding for community-based prescription drug abuse programs, such as opioid substitution therapy with buprenorphine, along with land-based treatment and other cultural treatments. I want to note, Mr. Chair and committee members, that we are probably experts in the experience of alternative use to opiates in our communities. One thing I must underscore, however, is that we’re finding that a lot of our remote communities don’t have the amount of services that other regions do. In remote and rural territories in other parts of Canada, there simply are not enough resources. What’s happening is that you’re almost getting to the point of a solution with the alternatives to opiates, but there’s no follow-up. There are no investments being made, and that is really throwing good money after bad. It’s actually perpetuating the ongoing and torturous cycle of addiction. What happens is that if there’s no aftercare, no completion of that continuum of aftercare, then you’re not getting the results you need, and it’s complicating the issues. One of the things we’re looking at, Mr. Chair, is that we definitely need to look at the opiate addiction from a.... If you think about what is done in a crisis situation from a medical perspective, they triage that situation and look at all aspects. They look at the environment, the situation, and the injury, and, in this case, addiction being the injury, they are having to fully address in a very specific way that is meaningful at that community level. In the north, there’s a very different situation. We do need results-based investments. That investment spending has to include land-based programming. It has to include aftercare for those communities in the north. 24 The Federal response to the Opioid Crisis

Carol Hopkins opening statement:

I’d like to start by taking us back to 2004, when the third report from the Auditor General criticized the first nations and Inuit health branch of Health Canada for the third time for not doing enough to mitigate the issues related to prescription drug abuse in first nations and Inuit communities. First Nations and Inuit Health then established a drug utilization prevention and promotion working group. That working group had a mandate to do three things. One was to make data more available from the non-insured health benefits. The second was to engage first nations communities in developing and implementing a community-driven response to prescription drug abuse. The third one was to work with prescribers to address practices and situations of over-prescribing. That was in 2004. It’s 12 years later and one of those issues is still outstanding, that is, the pilot- and proposal-driven nature of funding to first nations communities to address prescription drug use issues. The most critical issue when we talk about the opiate crisis amongst first nations people is that there is annual funding based on proposals, and those proposals are not always fulfilled. It’s year-to-year funding somehow expecting that within a year we’re going to be able to take care of the opiate crisis that exists in first nations communities. Addressing the opiate crisis has been a challenge, then, most significantly because of the inconsistent support to community-governed and culturally based treatment. One community-based opioid misuse study reported that among adults aged 20 to 30 years old, 28% of the community was engaged in a buprenorphine/naloxone program. Now, 28% of the community is double the rate of diabetes in that same community. We have dedicated funding, thankfully, to address the issues related to diabetes in our communities, but we don’t have the same type of resources when it comes to dealing with the opiate crisis. The drug utilization prevention and promotion program was successful in demonstrating and piloting a number of community-based programs. We also have a Lakehead study that demonstrated the success of community-governed programs to address opiate addictions. We have other programs in northern Ontario that you’ll hear more about and that also demonstrate the importance and significance of this success, unfounded in urban environments and other communities, simply because of the team-based, community-driven, culturally based programs that are offered. Yet they do not have annually committed core funding within their health envelopes.

Dr. Claudette Chase opening statement:

I am speaking to you today about what I’m most familiar with, which is how the crisis has impacted northwestern Ontario first nations. I work with a practice that serves remote first nations, and we were the first in the country, I believe, to start community-based treatment programs in partnership with the first nations who wanted help. The first is that the communities have worked with their primary care providers to build locally run and community-based treatment programs. These are grassroots, they’re innovative, and they are effective, effective if you measure them in terms of children coming back to their parents, people being able to return to work, and education. They provide a model that could be offered to indigenous people across Canada, and I say “offered”, not imposed upon. There are ongoing challenges, and I’ll get to those, but I want to go through the key points first to make sure I have time for them. Health Canada’s response to this crisis can be measured along a continuum, with the low point being obstructionist and the high point being woefully inadequate. The nurses have been forbidden to work with clients in the addiction program for more than 30 days. If any of you know anything about chronic illnesses, we don’t fix diabetes in 30 days and we don’t fix addiction in 30 days, and there’s abundant scientific evidence to prove that this is a chronic illness. Again, later, I’ll speak to why this is problematic. Number three, I think a key point is disrupting. Our Prime Minister has used the theory of disruption as a positive force, and I believe that. Disrupting the status quo of archaic colonial policies and embracing self-determination for first nations is key to ending intergenerational trauma. I think what this could look like is supporting people to develop the community healing strategies that they believe will work, and that means long-term support. It may also mean funding evaluation so that there is accountability, but I believe this is key. I want to go back to the first point about the treatment programs and what the challenges are. The ongoing challenges include the lack of stable or adequate funding and little access to land-based treatment. The fuel prices are insane on reserve. We’ve seen over and over that when communities can commit to these programs, clients get better, but when they come back, especially because they’re only on the land short-term, the relapse rate is high. I think that’s something very concrete that you could offer to support, and it is something that the communities have asked for—for a long time. There is no real addiction training or treatment of vicarious trauma for front-line staff. I tear up every time I think about this, because our workers are putting themselves on the line to hear the stories of incredible trauma. We have little funding to train them. These are community members who, because Health Canada has refused to step up, have stepped up themselves. They do this and they get traumatized daily, and I have little or no means to support them other than being their family doctor. It’s not acceptable. For the last point, about embracing self-determination, I’ve included the article by Chandler and his colleagues. I’m sorry, but it will be translated; it hasn’t been yet. He speaks very strongly to what was a protective factor against suicide in aboriginal communities in British Columbia. He said that the in terms of the protective factors for the communities that had lower suicide rates than the dominant culture, they weren’t based on economics. They were based on self-determination and attachment to their culture. Those are concrete things that you have the opportunity to support to save lives. 25 The Federal response to the Opioid Crisis

Dr. Nady el-Guebaly opening statement:

The crisis at the moment has three components to it. Number one is the component of overdoses. This is what makes people die. Hundreds of people have died. In terms of lethality, it’s probably been many years since I’ve seen such an amount of people dying so fast. They’re not all addicted; they could be my son or my daughter going to a rock concert and taking those blue pills. Sometimes they don’t even know what they’re taking. Before you know it, respiratory depression occurs, it’s an emergency, and you’re lucky if you only pass out. These are not addicts. These are experimenters. In terms of overdoses, what we are now providing more and more across the population naloxone injections. I want to congratulate Health Canada. It’s not very often that I congratulate Health Canada, so let’s congratulate Health Canada when it’s due. Naloxone spray is a tool that we didn’t have two years ago and is now available to the population for opioids. The second issue we have is a major issue around what to do with chronic pain. We have more and more older people. We have an aging population and we have all kinds of disabilities, all kinds of things. As a physician, I was the recipient of lectures that were given to us in the 1980s and how we were opio-phobic. Physicians were afraid to prescribe opioids, and it was “what’s going on, we’re not treating chronic pain properly, we don’t know what we’re doing”, and opioids would be the solution. As usual, the pendulum swung from A to B, and now we have this epidemic going on with prescriptions. There are two things. First of all, there’s a major effort going on at the moment with educating the physicians. It takes some time to reverse the pendulum, but I think there are some signs that the pendulum will reverse. The other thing is that the treatment of chronic pain is not only about opioids, about giving someone OxyContin. The treatment of chronic pain is a comprehensive program involving a number of alternative methods, one of which is opioids. The third component, then, is addiction—and I agree with my colleagues—but it’s not the only one. In addiction at the moment there are new methods of delivery going on. One of the things that has been a problem for us is the non-compliance from people. Peo- ple are given medication and don’t take it. The same thing applies, actually, to schizophrenic patients, so learning from schizophrenia, increasingly the medication that will be provided would be in an injectable form. We see a number of medications in the United States that are not yet here in Canada. I really would like the committee to make a recommendation about that. There’s a medication called Vivitrol. Some of the medications are implants. In the future, there are probably going to be vaccines. A number of future things are coming up. For some reason, we seem to be delaying its introduction in Canada, and I would recommend that we do something about that. Unfortunately, as the methods of delivery of our medication change, so does the method of delivery of drugs. One of the things that is being singled out at the moment is the famous electronic cigarette. The cartridge for the electronic cigarette, which was supposed to be no problem and all that kind of stuff, can actually be used for a number of things, including the delivery of opiates, including the delivery of your favourite drug and including a number of things. We are really worried about that as, again, a new method of delivery.

ADDICTIONS IN FIRST NATIONS COMMUNITIES

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

What factors do indigenous Canadians face that increase their likelihood of suffering from opioid addiction?

Isadore Day, Assembly of First Nations:

– Primarily an issue of access I was a chief of Serpent River First Nation for 10 years. We used to get the drug reports. The two main drugs that were actually administered in our community, the drugs with the highest rates, were methadone and opiates. This is really a systemic issue. The roots of it are that this is how the medical profession was dealing with the health issues in our communities. They would give opiates as a way to deal with the health issues and concerns of our people. This would then establish not only the culture but a really deep dependence on opiates. I’m going to suggest here very quickly that we have to analyze this problem from a systems and systemic perspective in that this is a shared responsibility. It’s not only the individual. The federal government needs to really examine where they are at fault here. The federal government is to blame for a large portion of the problems we’re faced with. Our people will have to deal with this as individuals, as families, and as communities, but this is a real systemic and chronic issue, and the genesis is found in the programs that are governed by the federal government.

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

We would like to know what are those faults on the federal government side.

26 The Federal response to the Opioid Crisis

Isadore Day, Assembly of First Nations:

What it all boils down to is that there is a two-tiered health system in this country. First nations do not have the level of health that mainstream Canada has. The stats are there. We know that a gap exists. I think it’s levelling the playing field. When our first nations have access to appropriate health programs and services, when we actually achieve health equity in this country, first nations will be able to deal with this issue.

Carol Hopkins, Assembly of First Nations:

Yes, as I said earlier and as you heard from my friend Dr. Claudette Chase, the primary health care system we have in first nations communities is at the nursing station. Nurses employed by Health Canada do not have the scope of practice to engage in supporting first nations people in their own community in addressing opiate issues beyond 30 days. That’s one point. The second point is that we don’t have access to treatment for opiate addiction, and when there is access, it’s short-term access. With- out access to treatment, many people are suffering in their communities, which leads to illicit drug use, and the problem continues. I’m thankful that you mentioned southern Alberta, because I also want to say that the research on addiction says that it’s permanent brain damage and it can’t be undone. I think that’s a racist way of keeping people on methadone, because people in indigenous communities have had to leave their communities to access treatment, and the primary course of treatment has been with methadone by physicians who say it’s a course of treatment for the rest of your life.

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

– Asked about access to naloxone – Differences or similarities between rural and urban populations

Carol Hopkins, Assembly of First Nations:

Access to buprenorphine and naloxone has been a challenge for first nations communities. We have been successful in getting some greater access to buprenorphine and naloxone—it’s by exception on the non-insured health benefits—and then in Ontario the Minister of Health has just announced greater access. The program that Dr. Chase is talking about is successful because it uses buprenorphine and naloxone. I would encourage that buprenorphine and naloxone be the first line of treatment for indigenous populations with an opiate addiction, because it allows them to stay in their community and it allows for a team-based approach. Health Canada has to change its policies around nursing in communities so that it’s a strength-based primary care program and not a “nurse” program, so that they can work with others in communities. No, naloxone kits aren’t widely available. That’s true. We need greater access to naloxone, and we need support for broader distribution to high-risk populations for naloxone.

Conservative MP Colin Carrie (Oshawa, Ont.):

Dr. Chase, you were saying that they get generic OxyContin, they crush it, they snort it, they inject it, and it’s very problematic. I am wondering whether you still support the idea of making that entire class of drugs tamper-resistant. Also, how much money is allocated to mental health and addiction in first nations, and what services are offered with that money?

Dr. Claudette Chase, Sioux Lookout First Nations Health Authority:

– Tamper-resistant doesn’t work I’ll let the others speak to the actual amount that’s allotted, but I can say at the community level in Eabametoong, the community has taken money from other projects so that they can pay someone with a master’s degree in social work to come in and offer counselling. There is one drug and addictions worker in a community where a survey five years ago found 400 people openly admitting that they had an opioid addiction—one worker. Then there are three mental health workers with various levels of training and ability who are from the community and who work with people in the program. The program gets funding from Health Canada, and this is at the higher end of the spectrum of them being helpful. The program was on an annual basis, so the people in the program were using their energy every year to write a new proposal. I heard from a mole within Health Canada that the advice was to fund these programs at approximately 60%. I can’t swear by that, but I think that was accurate information, so here you have a program that’s underfunded and understaffed. We have people on the waiting list who want to join our program. We don’t have enough staff to do the direct administration of the Suboxone, so whatever the funding’s at, it’s not adequate to truly fund a community-based treatment program. 27 The Federal response to the Opioid Crisis

Conservative MP Colin Carrie (Oshawa, Ont.):

-Physicians’ role in the opioid crisis, prescriptions

Dr. Claudette Chase, Sioux Lookout First Nations Health Authority:

I can only speak to my practice, which includes the physicians who serve the Sioux Lookout zone. Our practice of prescribing is very cautious. When we do prescribe opioids, it’s often because there is very little funding for physiotherapy and occupational therapy. Peo- ple get injured at work and we have no access to those services. The basic service that would prevent acute pain from becoming chronic doesn’t happen. We do have some challenges, but increasingly, in Thunder Bay and Winnipeg, specialists are no longer sending home orthopedic patients with 200 Percocets for a procedure where it might be required that they take them for a week. We are very cautious in our prescribing practices. I appreciate your bringing that up. I absolutely own that it was physicians who started this. Our prescribing practices in Ontario started this, but often it’s because we don’t have other services. Getting physio, OT, massage therapy, and chiropractors into these communities would decrease the need for many of my arthritic patients…. OPIOID PRESCRIPTIONS FOR PAIN MANAGEMENT

Conservative MP Colin Carrie (Oshawa, Ont.):

Seventy per cent of these opioids are given for back pain because there are no other services out there.

Dr. Nady el-Guebaly, University of Calgary:

…I have an impression that part of the fentanyl crisis that has occurred has been because of people getting desperate because suddenly their medication was cut down.

ALTERNATIVE METHODS TO PAIN MANAGEMENT

Isadore Day, Assembly of First Nations:

– The Indian Act system, self-determination – Looking at first nation jurisdiction on health

The issue here was looked at by the first nations of Ontario. A few years back, we took the approach of studying this. We did a “take a stand” approach in our report, and it looked at four strategy areas that address prescription drug addiction. The first one is obviously looking at prevention and health promotion. The second is looking at healthy relationships at all levels to address complex issues, because this is a very complex issue. It involves everybody in being part of the solution. The third is reducing the supply, and I think this incremental approach to disentrenchment of this insidious addiction is really where we need to go. The fourth is the need for a continuum of care, that continuum of care being here, again, with first nations being responsible, responsive, and respected within that process. Overall, this is going to require the investment needed to address the issue. The problem we’re looking at right now with respect to the joint review on non-insured health benefits in Canada for first nations is the fact that historically the program is not a needs-based program. It’s based on funding levels, with the allocation that comes down from Treasury Board not so much looking at the cost to deal with the solution. Again, it’s throwing good money after bad and not really addressing the root of it and eradicating terrible issues like the opiate addiction.

ADDICTION RATES

NDP MP Don Davies (Vancouver Kingsway, B.C.):

I want to briefly get each of you to tell me whether, in your experience, the rates of addiction are going up, down, or staying about the same.

28 The Federal response to the Opioid Crisis

Carol Hopkins, Assembly of First Nations:

Addictions continue to be one of the number one issues noted by first nations people. In the first nations regional longitudinal health survey, first nations people—82% across this country—said that substance use is the number one barrier to wellness in first nations communities. We are seeing success with programs that are currently available, but is it meeting the need? No.

Isadore Day, Assembly of First Nations:

I think you have to look at addictions as a systems issue. I think we can look at the numbers and certainly generate the stats, but this is a very complex issue. For example, the cost impacts of alcoholism or marijuana misuse is, in some cases.... I don’t like to use the comparison, because it’s all bad, but when you talk about fentanyl and the types of opiates that are wreaking havoc on our communities, the cost is enormous. I would also suggest there may be a need to start drawing some correlations among poverty, nutrition, diabetes, and addiction. If we have elevating rates of diabetes, chances are we’re going to have elevated rates of addiction as well. That’s just my comment.

Dr. Claudette Chase, Sioux Lookout First Nations Health Authority:

I’ve been in the area of Sioux Lookout since 1982, when I first went as an outpost nurse. When I first arrived, alcoholism was a bigger problem. The introduction and use of OxyContin, many of my patients said, was the first time in their lives that they remembered feeling relaxed and not anxious. You all know the story. It was engineered to have that impact. I would say that there are more people involved than there ever were with alcohol, and I would say the rates are going up and the users are getting younger. We have seen 12-year-olds and 14-year-olds injecting in some of the communities. The numbers appear higher to me, but part of the challenge is that the numbers aren’t there. I would reiterate the point that this is a complex systems issue and we need data.

Dr. Nady el-Guebaly, University of Calgary:

Opioids, I think, are a more episodic phenomenon. I don’t think we have 20-year studies on that. At this point in time, they’ve been on a high, particularly for overdoses and so forth.

RECOMMENDATIONS FOR GOVERNMENT

NDP MP Don Davies (Vancouver Kingsway, B.C.):

To get a resolution, what is a suggestion you have that the federal government should take? If you were the Minister of Health, the Minister of Indigenous and Northern Affairs, or the Prime Minister, what would you be directing right now to help us deal with addictions to opioids and other drugs in this country, in first nations communities and otherwise?

Carol Hopkins, Assembly of First Nations:

I would suggest that the federal government seriously look at the resources to fully implement the first nations mental wellness continuum framework. It addresses the lifespan. It has a core basket of services that are required. Neonatal abstinence syndrome has grown at four times the rate. First nations schools have now classrooms full of children who were born on methadone. We don’t know the long-term impacts of methadone. With in utero, infant, toddler, and early childhood development, we don’t know what those long-term impacts are, but we have classrooms full of kids who are struggling with that. We also have a senior population with chronic health issues and substance use issues. This mental wellness continuum framework is a model that is intended to address that, and it relies on indigenous culture and indigenous governance over those services, and we need the resources to implement this. We keep developing these frameworks, but we don’t have resources to implement them.

29 The Federal response to the Opioid Crisis

Isadore Day, Assembly of First Nations:

I think this is going to require that we don’t just do a committee report. I think there needs to be the commissioning of an opiate crisis response strategy for Canada. That would include the engineering of a meaningful, shared, and effective national response to opiate addiction and the crisis. In Ontario, for example, we do have the taking-a-stand strategy, but it doesn’t have all the jurisdictions around the table investing in a shared solution and response, and that would include the individual. That would also include the families, and it would certainly include first nations jurisdictions.

Liberal MP John Oliver (Oakville, Ont.):

What I’ve heard is that the opioid crisis in Canada is absolutely magnified in first nation communities, both in terms of rate of use and lack of treatment. The frame I’ve been using for this, which came from one of our earlier presentations in testimony, is that we need to move from a specialized model of addiction treatment to primary care. We need to have primary care physicians and nurses, providing treatment. We need a nationally agreed to and evidence-based treatment plan, so that we are all using the same frame and are moving forward on treatment. There has to be far better access to treatment programs, both from ER referrals and from safe consumption site referrals, so that people are getting follow-up and are not just left in that state of addiction. Also, there has to be a dramatic increase—and this is what I wanted to come back to—in funding directed to treatment centres, not filtered through a mental health frame but directly to those treatment centres. Listening to your testimony, I’m looking for specific recommendations to deal with first nation communities. What I heard was that for northern communities in particular it’s going to be very difficult to get treatment programs and centres based in those northern communities. I think the terminology was “land-based”. Does that mean services right in those communities? We don’t want to fly people out for treatment, right? We want the treatment services there. The second thing I heard was that there are significant problems with Health Canada program restrictions, particularly around scope of practice for RNs, with almost artificial time limits in terms of what service limitations they can provide. The third was an overreliance by first nations on pilot funding and year-by-year funding. You can’t get these programs established and funded and get permanent staff recruited. It’s really hard to recruit people in southern Ontario on year-to-year contracts, let alone in northern Ontario or northern Canadian communities. The fourth thing was health care worker burnout and the fact that there doesn’t seem to be adequate training and adequate consultation services for the health care workers. They burn out much more rapidly in northern communities. First of all, is that a fair summary? Those four things are differentiating a bit in first nations, without getting into root causes…. Besides those four, are there any others that you would add to the list that would add to the complexity of treatment in first nations?

Isadore Day, Assembly of First Nations:

I think integration of aftercare is one. I think it’s really important to recognize that one of the bigger complex issues is poverty.

TREATMENT RECOMMENDATIONS

Liberal MP John Oliver (Oakville, Ont.):

– Asks whether funding should go to the first nations mental wellness continuum or into addiction treatments programs

Isadore Day, Assembly of First Nations:

We definitely need both. On this continuum, the work has been done. We have the capability. We have the experts in our communities. We need both. We need the treatment and we need to fund the continuum.

Dr. Claudette Chase, Sioux Lookout First Nations Health Authority:

One very specific thing that I think could be done to decrease mortality is that the nursing stations are allowed to give out safer injection kits between the hours of 8 a.m. and 5 p.m., and I think naloxone should be included in those kits.

30 The Federal response to the Opioid Crisis

Liberal MP John Oliver (Oakville, Ont.):

Are there any other recommendations around treatment?

Dr. Nady el-Guebaly, University of Calgary:

For me, it would be around overdose and longer-term education of physicians—and health professionals, by the way, not only physicians— and looking at what’s evidence-based and so forth, because what we’re providing right now is not evidence-based, I have to admit.

BIG PHARMA

Liberal MP John Oliver (Oakville, Ont.):

Big pharma: the prescription practices of physicians seem to be following through on advice, direction, and training from pharma on the use of opioids. Do you have any thoughts or comments on the role and responsibility of pharma in this crisis?

Carol Hopkins, Assembly of First Nations:

They need to be held accountable for the education they provide. We’ve seen that history with Purdue Pharma, specifically with the misinformation they provided to prescribers related to the issues of OxyContin. We need more education on harm reduction. I want to recognize Minister Philpott’s championing of harm reduction in international conversations. We need to apply that at home. We need much more investment in educational resources to support harm reduction.

FENTANYL-LACED MARIJUANA/LEGALIZATION OF MARIJUANA

Conservative MP Len Webber (Calgary Confederation, Alta.):

– Fentanyl laced drugs (marijuana, etc.) at parties.

I’ve been doing a bit of reading with respect to the testing of these drugs and the access to tests that these kids or these individuals who are taking these drugs might have. They could then test to see whether there’s fentanyl in the particular drug or if it’s laced in a marijuana bag. Are you familiar with these test strips at all, Doctor, in regard to the way they work or if they even do work?

Dr. Nady el-Guebaly, University of Calgary:

Now, with regard to the strips, I am unaware that somebody who starts doing a test strip.... Suddenly the kid is going to—I don’t know why I say “kid”, because all kinds of people take it—take the product that’s been given and test it? I’m not that encouraged by that kind of thing.

Conservative MP Len Webber (Calgary Confederation, Alta.):

– Concerned about legalization of marijuana

Dr. Nady el-Guebaly, University of Calgary:

I think the wisdom at the moment is that our recommendation for physicians is to go through a phase of decriminalization, which is urgently needed, the next step being legalization. We are worried, as physicians, to move from criminalization to legalization without going through the step of decriminalization.

31 The Federal response to the Opioid Crisis

DRUG-USE EDUCATION OF FIRST NATIONS CHILDREN

Conservative MP Len Webber (Calgary Confederation, Alta.):

– How are kids taught about drugs, experimentation, etc. – Education in the classroom

Carol Hopkins, Assembly of First Nations:

– Early intervention program called Buffalo Riders, aimed at middle school students. – Has been introduced and implemented in schools in at risk communities. Again, one of the issues is that there are not enough resources to expand it. The Thunderbird Partnership Foundation has a mandate to serve all of Canada, and I have eight staff. We are developing a train-the-trainer model to expand the capacity to deliver this early intervention program. It’s had good results in terms of reducing substance use. It’s been used as an alternative justice measure as well, so it’s had good success.

Isadore Day, Assembly of First Nations:

I’ll take a different approach and look at this issue of legalization of marijuana and recreational use. There is a very important process that’s under way in Canada right now. It’s the examining of the regulatory landscape on marijuana use. I think it will be critical that first nations are directly involved and participating in that, because the situation as it unfolds in terms of access to marijuana in our communities is going to have a very interesting, complex, and sometimes insidious impact. My point is that we all need to be involved. There’s a shared solution approach that’s needed. If we get in on the ground floor with something like the regulatory landscape on the recreational use of marijuana and the decriminalization of marijuana, then certainly our first nations communities will have to be involved in the very wide education of these issues.

FIRST NATIONS COMMUNITIES – SIOUX LOOKOUT

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

The situation in Sioux Lookout is nothing new. It has not been going on for a week, two weeks, a month or since we noticed the crisis. Studies show that it dates back to 2013 and perhaps even earlier. I am interested to know the causes of this crisis. We must of course have a short-term plan to save lives immediately. We also need a long-term plan to change the situation so that we do not see the same problems in two years or five years from now. I would like to hear your views on this. What is your plan for the medium and long term? What do you expect from the government? What has been done already that did not work and what in your opinion might work? In short, we have to consult you and we have to change things. There is no point doing the same things that may not have worked. I would like your comments on that.

Carol Hopkins, Assembly of First Nations:

One of the things I’d like to contribute to the answers among the panel is that this framework talks about the paradigm shifts that are necessary to implement this—so it’s systems change—and one of them is in the background colour of this model. The colour is what they call “P.E.I. red”. It’s a colour to represent culture. One of the significant changes we need to make is to shift from an evidence-based absence of indigenous knowledge and cultural practices to the inclusion of indigenous knowledge and cultural practices. That has not been consistently part of our answer in addressing any issues in first nations communities because it’s not recognized as credible evidence, but we do have evidence now that says culture makes a difference. In fact, in the centre of this framework, we talk about four outcome measures—hope, belonging, meaning, and purpose—and there are 13 measurable indicators. We have the instrument to measure that and to demonstrate the impact that culture makes, but again, we need capacity to be able to help communities use instruments to collect data and to demonstrate change that they make both for individuals and for overall community wellness. It’s about shifting from evidence-absent to evidence-inclusive. Results were achieved with this approach. I was the director of a youth treatment centre for 13 years. In that time, we had 100% of the youth completing the program. Nation- ally, in any program, mainstream or first nations, the outcome is 50%. Not only did they complete their course of treatment, they also

32 The Federal response to the Opioid Crisis returned to school at a increase of 40%: 40% coming into treatment and 40% more returning to school post-treatment. Eighty-six per cent of youth discontinued sniffing gas and solvent abuse post-treatment, and the reason they did was the access to culture. Their -com mon statement to us was, why did my life have to end up in such turmoil before I had access to culture? That’s just a little insight. With the native wellness assessment, we’re seeing an increase of at least 30% from a whole-person perspective, meaning a 30% increase in having hope in their lives, knowing where they belong, having a sense of meaning, and having a sense of purpose in their lives through the use of cultural practices.

ADDICTIONS AND PREVENTION

Conservative MP Gerry Ritz (Battlefords—Lloydminster, Sask.):

It’s tremendous knowledge that you possess, and you have some of the answers in front of you, I guess. The problem is, how do we coordinate all of that and have a footprint that means something? A lot of what Mr. el-Guebaly was saying is that we’re pushing a bubble through society here. As you said, there have been addictions throughout history. You talked about heroin and alcohol, and now it’s designer drugs. How do we ever get ahead of that bubble and start to make a real difference? What’s it going to take? I know that funding is a big part of it, but how do we put that money on target to see results that then draw more funding? That’s the key with government funding: to show those early results to start building on those successes. Ms. Hopkins, you talked about some successes you’ve had. How do we get that message out?

Dr. Nady el-Guebaly, University of Calgary:

There is no magic bullet. I think at the moment some of the programs that provide the best data have, first of all, two levels of prevention: primary prevention for everybody in the schools, for example, and having that there, and then the second level, for people who we identify as being at risk. That starts with children whose parents are already using drugs. My personal preference would be to start with the people at risk as being a good prevention program, but I don’t have a magic prevention program.

Carol Hopkins, Assembly of First Nations:

As I was saying earlier, a number of pilot programs have been tested and have demonstrated good evidence, but there has never been any continuity to those programs, and the investment in them has often been short term. We do have a demonstration. We do have the evidence. There are a number of journal articles showing that this is the type of evidence you’re looking for. Some of these speak to the success of programs like those in Sioux Lookout in northern Ontario. We have the evidence from the drug utilization prevention and promotion program, which didn’t get sustained in the long term. The youth treatment programs and the residential treatment programs also have good data, but lack the resources to make the difference that they could. For example, with that network of resources, they could be a part of the solution in supporting youth when they go home. There could be added resources for web-based mental health services or social-media-based services. We don’t have that capacity right now to reach youth. We have the implementation of a brand new helpline, which is fantastic, but it’s not enough. We still need to keep going.

Conservative MP Gerry Ritz (Battlefords—Lloydminster, Sask.):

I understand your concern with project-by-project and year-by-year funding. You never get the critical mass that lets you start to roll towards the finish line to show you can actually do it. I think it was Chief Day who mentioned the aftercare and how important it is to maintain the continuum.

– Asks how they see the aftercare being implemented.

Isadore Day, Assembly of First Nations:

I think there’s a social contract required in this country. This addiction affects everybody. It’s not just in the remote areas. It’s everywhere. We need a new configuration of shared responsibility matched with investment spending that is innovated to address the issues of today. That hasn’t happened yet. We’re still passing the buck. 33 The Federal response to the Opioid Crisis

We’re still looking for data. We’re still looking for solutions and approaches, but we need to approach this from a perspective of shared responsibility. I think it’s incumbent upon this committee to call for getting everybody at the table at the same time to reconfig- ure a shared responsibility and put the investment into it.

Conservative MP Gerry Ritz (Battlefords—Lloydminster, Sask.):

There are also some gaps and overlaps when you consider that on-reserve is federal, while off-reserve people slide into the social services at the provincial level. Of course, there are a lot of cracks to fall through in between. How do we streamline that operation so those cracks shrink?

Isadore Day, Assembly of First Nations:

That’s where first nations come in. We are the experts. We understand the landscape of the multi-jurisdictional overlaps on primary health care and on policy. We have the ability to do that. I think we need to be involved in the solutions, and we need to be there at the table to help configure those solutions.

Dr. Claudette Chase, Sioux Lookout First Nations Health Authority:

I just wanted to speak to the fact that we have the evidence of prevention in this room: good nutrition, good education, solid housing, and an overall sense of well-being. As the dominant culture, we have deliberately not allowed this in the first nations and our indigenous peoples in Canada. I think the evidence for prevention is strong before us all. We just need to acknowledge it and support what my colleagues have talked about: a new social contract.

Dr. Nady el-Guebaly, University of Calgary:

I have something that I would like to add. Taking the kids out of their culture and sending them somewhere by plane somewhere else is an utter disaster. Unfortunately, I’ve seen Health Canada do that several times. If there’s a crisis, they send kids somewhere else. We’ve had this experience in Calgary with people from the northern communities coming in. I’m not too sure what the recovery rate there was, but I think it was very close to zero. Establishing programs within the people’s communities is critical.

RACISM IN HEALTH CARE SYSTEM

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Going back to what we were talking about before, there are a couple of different physicians groups, the College of Family Physicians, and the Indigenous Physicians Association of Canada, and there is a guide, “Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada”, which was released in 2016. It noted that there was unintentional racism that would manifest in the way of erroneous assumptions. Again, having been in the health care system for 20 years, I’d say that not all of it was unintentional. It said that these assumptions would change how health care providers, all the way from first responders up through nurses and physicians, might affect care. Ms. Hopkins and Mr. Day, in your experience, has this kind of racism in the health care system affected how victims of addiction are treated?

Carol Hopkins, Assembly of First Nations:

I believe in methadone. It’s an absolutely necessary part of the solution. But when the solution is absent of and disrespectful of first nations governance, who then have to carry the burden of risks related to methadone in that community, that, to me, is racism, as is telling first nations people that once you are on methadone, you are on methadone for the rest of your life, meaning you can no longer go home. You can’t take your new children to meet their grandparents in the isolated remote community. You have to live in an urban environment, in poverty, outside of a family system of support. That’s racism. We have seen evidence where first nations people have been moved from methadone to Suboxone, to being opiate replacement therapy-free and living well in their communities. The connection to land, to people, their lineage, and their language, is critical for their overall wellness. I offer that as an example.

34 The Federal response to the Opioid Crisis

Isadore Day, Assembly of First Nations:

We met last week with about 40 to 50 service providers, dental, vision, and rheumatology. What we were doing, sir, is asking questions about providing service to first nations under the non-insured health benefits program right now and what the problems are, and every one of them was experiencing the same thing. They were saying that they want to treat the issues and they want to deliver solutions, but they can’t because there are constraints and policy guidelines that are based on the Indian Act system. That is very much at the root of the problem, because this is a race-based program. What we’re finding is that the situation and the impacts are exacerbated by racism at the institutional level within the funded program of non-insured health benefits. The joint review right now is critical. I think the committee should take a very close look at the outcomes there and deal with racism at the source.

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Do you find that there’s been any improvement in the training of health care providers in terms of them having more awareness of the particular challenges of our first nations people? Carol Hopkins, Assembly of First Nations:

Certainly, there’s a great movement in cultural competency training, but do we have measures to demonstrate the impact of cultural competency and client outcomes? We don’t have that data currently. I know there’s greater interest in the College of Family Physicians to ensure that physicians have appropriate training in addictions, but also in understanding how to provide trauma-informed care to first nations populations. We don’t know what the outcome of that is yet.

FIRST NATIONS TREATMENT PROGRAMS

NDP MP Don Davies (Vancouver Kingsway, B.C.):

– Asks about a program that takes patients out onto the land as part of their treatment program.

Dr. Claudette Chase, Sioux Lookout First Nations Health Authority:

I mentioned that Eabametoong has a program that has evolved over the years. We started in 2010 in response to the state of emergency, and it has evolved. Whenever there is funding, people are taken out, with elders involved. They go out by canoe or by motorboat, and they get back in touch with their culture. One of the first minor successes we had in the program was I had someone say to me, “For the first time in three years, my wife and I went out and got wood.” That may sound simple to you, but it wasn’t just a trip to get fuel. It was a day out on the land. They laughed together and they worked together. They came back feeling really proud that they had gotten it. It was a spiritual connection that I don’t fully understand—I am not Anishinabe—but I could witness it. That’s where the successes come. Sandy Lake also had a program. They took people out for two weeks. They were abstinent for two weeks, and they felt great at the end of the two weeks. When they went back to their community, where there was so much around and no real ongoing support, they all relapsed. It was a 100% relapse.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Chief Day, on October 1, 2013, as a result of the British Columbia tripartite agreement on first nations health governance, B.C.’s First Nations Health Authority assumed the programs, services, and responsibilities that were formerly handled by Health Canada. Has this transfer or type of transfer of authority helped to support improved health and well-being for indigenous people and communities in that province? Is that a model you would suggest to us that might help in the transferring of authorities to first nations communities?

Isadore Day, Assembly of First Nations:

It certainly is the direction that we’re going in. Last week we met with the health ministers. We in the indigenous communities were at the table representing the Assembly of First Nations. What we put forward is the first nations health transformation agenda. That is

35 The Federal response to the Opioid Crisis going to be conjoined to the health accord discussions and negotiations going forward. It essentially says to get first nations into the process in moving forward on first nation health jurisdiction. We know that the B.C. experience is happening in smaller isolated areas throughout Canada. For first nations, once we have a place in configuring our solutions, and once we have that authority, we then start to put forward the real costs of treatment and the real costs of prevention and we get results. Certainly, first nation jurisdiction on health is key.

OCTOBER 20, 2016

ON THE AGENDA The Committee resumed its study of the Opioid Crisis in Canada. Main topics discussed: addictions and treatment, “Big Pharma”, health care, supervised injection sites, role of government, naloxone, short-term treatment and investment in addictions treatment.

WITNESSES British Columbia Centre on Substance Use: • Evan Wood, Professor of Medicine, University of British Columbia, Interim Director, British Columbia Centre for Excellence in HIV/AIDS Méta d’Âme • Guy-Pierre Lévesque, Director and Founder Recovery Ottawa • Mark Ujjainwalla, Medical Director TRANSCRIPT HIGHLIGHTS

Guy-Pierre Lévesque opening statement:

I am the founder of the organization Méta d’Âme, which is a peer-led organization. At our facility we are all peers, people who did or are still using opioids. We initiated a program, starting in 2013, called PROFAN. We call it Aller plus loin, or going further. The program focuses on prevention, reducing overdoses, peer training and access to naloxone. Méta d’Âme is a users’ association based on the principles of empowerment. We work to improve the quality of life those who use opioids—such as heroin, morphine and other drugs—through our day centre and our 22 housing units, with community support provided by peers, of course. PROFAN is a response to a recommendation made by United Nations Commission on Narcotic Drugs in 2011. According to this recommendation, the continuum of care offered to opioid users must include greater access to naloxone and be rounded out with training and education programs. That was resolution 55/7. It referred to promoting measures to prevent drug overdose, in particular opioid overdose. PROFAN is a French acronym for prevention, reduction, overdose, training, access and naloxone. So it is really a prevention program. It is designed to empower users to recognize the signs and symptoms and to differentiate among overdoses of various drugs. Unfor- tunately, there is an epidemic of opioid overdoses, but there are also stimulant overdoses. We train people to recognize these things. We also train users to do cardiopulmonary resuscitation or CPR. We also teach them how to react to an overdose so they can call 911. For users, there are several things preventing them from doing this. We train them to react the right way. Reducing the number of overdose deaths is of course our ultimate objective. As to the community, the objectives are as follows: develop a strategy for one or more physicians to become partners in the initiative and to prescribe naloxone to participants who have completed the training; demonstrate the feasibility and accessibility of the overdose prevention and naloxone access project as part of peer training, which is the unique characteristic of this program; document and evaluate the steps taken in the pilot project and establish a data gathering system, which has already been done; give the community tools to deal with overdoses, that is, first responders, ambulance attendants, police officers, and any other person who can respond to an emergency. The program consists of two training sessions: a shorter one lasting two and a half hours and a longer one lasting five and half hours. The shorter training does not include CPR. The workshops are divided up as follows. The first one pertains to overdose prevention and education. The second workshop shows how to respond in the event of an overdose, that is, what are the signs and symptoms of an overdose of opioids or other drugs, CPR techniques, and administering naloxone. All the trainers are peers. We called upon members of our association who are users and took the time to train them properly so they can give the training themselves. They are people who use or have used opioids or other drugs, as well as staff who work for agencies whose services are used by persons who use or have used opioids or other drugs. At the community level, this creates a safety net that is very close to the street, which is an asset.

36 The Federal response to the Opioid Crisis

I would like to highlight an important aspect. Depending on the resources, the staff working in the field may or may not be users or former users of opioids or other drugs. Why? Because drug users are often part of community groups. They work in certain areas and become part of work teams. They are users but they are part of a community group and are employees of that group. The participants who are trained receive a certificate that enables them to respond to overdoses and to use naloxone appropriately in opioid overdose cases. In conclusion, PROFAN is a community response to the problem. Peers began developing PROFAN in 2013. Why? Because at the various conferences I have attended, whether in Canada or in Europe, I heard that overdoses are on the rise. This helped me understand that a phenomenon was developing. In the organization’s action plan, I included the objective of creating a training program. That is what I have just presented. The partners who joined the initiative in 2014 were the Centre de recherche et d’aide pour narcomanes, or CRAN, the Douglas Insti- tute, Montreal’s public health department, and Quebec’s ministry of health and social services. From the start, peers, community organizations, and network pharmacists have been part of PROFAN. We got all these stakeholders to sit down around a table to evaluate the project and to establish a plan for its first year. We are now planning our third year of operations. Since the program was established 18 months go, 378 people have been trained and 21 lives have been saved. We are seeing changes in the behaviour of the users who have been trained, but this must still be proven empirically. The researcher, Michel Perreault, who is affiliated with the Douglas Institute, is currently evaluating these changes, so our project is being evaluated. We are also trying to understand how to retain people who have taken the training, how far peers can go in the training, and their ability to do it. We found that when peers train people, they saw themselves as lifeguards and felt much more responsible in the community. That is where their behaviour starts to change, and that is very important. These people feel they are playing an important role and it means a lot to them. We had thought that this program would be disparate but it has turned out to be very specific and there is a high level of participation. We recommend that programs similar to PROFAN be created for drug users wherever possible. Training must also be given to everyone who is in substitution treatment programs and who frequently relapses. These people are the most likely to overdose. They should be trained while they are receiving methadone, for example. These people often associate with other users and they will be able to save someone. For those receiving pain treatment, it should be recommended that they keep a naloxone kit with them. There are a lot of accidents and non-prescribed drugs that are taken. They can be taken from their mother’s or father’s medicine cabinet. In our opinion, people with such prescriptions should be given a short awareness training before they receive their kit. That might save lives. If they are trained to prevent overdoses, they will recognize when there is a problem. Drugs that are kept at home must be locked up. Of course, a kit should be on hand should an adolescent, for instance, take pain medication that was prescribed for their father or mother. This has to be done. Peer outreach workers must be able to train drug users right in the field, giving them brief and specific training. For example, we have outreach workers in downtown Montreal. They come into contact with many opioid users, both sellers or users. These people should be given brief training in the field along with a permit to get naloxone. There is a legislative void in Quebec because no rules have yet been established surrounding naloxone management. In Montreal, we use a collective prescription for the time being. That only covers the Montreal area, the users and their entourage. They could be parents, roommates, friends or even community workers who work for an organization such as ours or Cactus. All kinds of non-governmental agencies can play a role. That is essentially what we do. We drafted the documentation in 2013 and, in 2014, we joined CRAN, as I mentioned before. There was a spike in overdoses in Montreal in spring of 2014, and we were of course encouraged to launch our project. The use of fentanyl and other contraband drugs made in labs is not as much of a problem right now in Montreal. There was, however, a seizure at a fentanyl lab in the north of Montreal a year and a half ago. Fortunately, we have not yet seen an increase in overdoses, although there are still too many. In our opinion, this problem will eventually spread across the Quebec, so we have to be ready.

Dr. Evan Wood opening statement:

The first issue I think Canada can really pursue, to the betterment of public health and public safety and exploring this challenge, is the fact that we have not traditionally, in Canada, as in other jurisdictions, trained health care providers in addiction care. I’ll just ask you to imagine a scenario of somebody having an acute medical condition like a heart attack. They would be taken into an acute care environment. They would be seen by a medical team with expertise in cardiology. The cardiovascular team would then look to guidelines and standards to diagnose the condition and to effectively treat it. Unfortunately, in Canada, because we haven’t traditionally trained health care providers in addiction medicine, we have health care providers who don’t know what to do and routinely do things that actually put patients at risk. With respect to the origins of the opioid epidemic in Canada, when it comes to prescription opioids like OxyContin, clearly there has been the exploitation of a knowledge gap, leading to unsafe prescribing. Of course, the failure to employ evidence-based treatments for alcohol and drug addiction suffers from this concern as well. 37 The Federal response to the Opioid Crisis

In addition to the lack of training for health care providers, the overall lack of investments in this area has meant that there aren’t standards and guidelines for the treatment of addiction. In British Columbia the long-standing approach to treatment of opioid addiction has been the use of methadone maintenance therapy. That approach has been disconnected from recovery-oriented systems of care and has overlooked a much safer medication in the form of buprenorphine or naloxone. In British Columbia, within Vancouver Coastal Health, we have recently developed a guideline for the treatment of opioid addiction, using an evidence-based medicine approach to look at what treatment should be first-line, second-line, or third-line as best ways to help people recover from opioid addiction. This is something we’re looking to pursue nationally through the Canadian research initiative in substance misuse, which I’m happy to talk about. Another structural barrier I want to flag for you is that in Canada we have increasingly lumped together the concepts of mental health and addiction. While we have large mental health challenges in this country, and I certainly support approaches to strengthen a system of care for people struggling with mental illness, when we look at addiction through the lens of mental health it results in a number of concerns. The first is that funding for mental health and substance use, when it’s directed in that way, overwhelmingly goes towards other mental health conditions besides substance use. Addiction really is one of Canada’s most seriously neglected diseases, and I strongly encourage you to think about funding and support that’s aimed at addressing substance use being clearly earmarked for that. Otherwise, it regularly goes into this sort of mental- health-and-substance-use black hole, and addiction is overlooked. There are tangible ways of focusing energy here, which I can talk about shortly, but certainly focusing on mental health and substance use has unintended consequences. Of course there are individuals who struggle with both mental health and substance use, but your average person who becomes addicted, whether it be to tobacco or alcohol or opioids, shouldn’t be thought of as a mentally ill person. The interventions they commonly receive are more tailored toward people with serious mental illness and can actually worsen an overdose crisis. For example, there are the benzodiazepine medications that people with anxiety traditionally have been prescribed. Individuals with addiction regularly are prescribed these medications, again due to a lack of physician training. These medications themselves are associated with increased risk of fatal overdose. I anticipate that you saw the report released earlier this week on the need for prescription monitoring programs. British Columbia actually has one of the nation’s leading monitoring programs to look at prescriptions being provided by physicians. It enables us to look at the patient in front of us, see what prescriptions have been filled, and address such issues as people getting multiple prescriptions and selling medications on the street. Even in British Columbia, however, it’s a reactive approach. There is the ability to establish monitoring programs where colleges of physicians and surgeons could actually look for unsafe prescribing and routinely address that concern. It’s certainly something that needs to be done in Canada. A point that I think needs to be made is that we continue to overwhelmingly treat substance use and addiction as a criminal justice issue. Ultimately that worsens public health and safety. Of course we need to support law enforcement due to the intersection between drug use and crime, but we really need to look at solutions that are evidence-based, that support addiction treatment, and that can support people in their recovery rather than take an approach that reinforces stigma and ultimately worsens community health and safety. I’ll leave a couple of take-away points with you. Then I’ll be happy to take any questions. The first point is with regard to the training of health care providers. The college of physicians and surgeons and the college of family physicians are currently pursuing these strategies. I certainly encourage you to support this. A point I didn’t make earlier, which I think I’ll leave with you, is that addiction is much too common a disease to be left with specialist physicians. We should really be looking to family practitioners being adequately trained in the prevention and treatment of addiction. My next point is with regard to a focus on addiction as a disease that’s both preventable and treatable, and not getting lost in this muddy mix of mental health and addiction. I would use as an example something that could be done by the Canadian Institutes of Health Research, for instance, in terms of dedicated resources toward substance use. In the United States there is a dedicated institute focused on drug use, and that’s the National Institute on Drug Abuse. CIHR has no such institute. It means that Canada is kind of punching in the dark when it comes to approaches to substance use. Certainly through the Canadian research initiative on substance misuse, which is CIHR funded, there are positive things happening, but certainly we could do much more with focused intervention. As I alluded earlier, prescription monitoring programs provide a huge opportunity to reduce unsafe prescribing and to ensure that the issues that emerged with OxyContin don’t happen again. We obviously need strategies for the safe treatment of pain. We are increasingly learning that in the context of chronic pain, opioids can be very dangerous for conditions that could be addressed with non-opioid medications.

Dr. Mark Ujjainwalla opening statement:

I developed the Ontario Medical Association physician health program in 1995. I’ve spent most of my career helping professionals and sending them primarily to the United States for treatment, primarily physicians and people who had a lot to lose. That was in the eighties and nineties. I can tell you that in the eighties and nineties we had the gold standard treatment for addiction, certainly in North America, and that’s because we hooked into the United States. 38 The Federal response to the Opioid Crisis

In Ontario—and I can only speak for Ontario—in the seventies, eighties, and nineties, we could send people to the United States for comprehensive treatment at the Betty Ford Center at Hazelden or at the Talbott Center. It didn’t really matter. They went there, OHIP paid for that, and when they came back, they had aftercare. We had an amazing program that helped many Canadians. In the nineties, the government decided that they were going to stop this practice. They were going to take the money and develop treatment centres here in Ontario. Unfortunately, that didn’t happen. In fact, in my observation, the only thing that happened was that they started closing psychiatric facilities and throwing those types of patients under the bus, unfortunately. They did not develop comprehensive treatment programs as they promised. That was the start of the downfall, of our crisis. I agree wholeheartedly with many of the comments that Dr. Wood made. The problem we face here is that the real issue with addiction is not opiates. The real issue is the inability of the present health care system to treat the disease of addiction. An addiction is a biopsychosocial illness that affects 10% of society, probably more if you include families, and it is the most underfunded medical illness in our society. The problem also is that it’s a highly preventable and very highly treatable illness. It’s very unfortunate that people don’t see that. When it affects your family or you, you can feel the pain and suffering, and you watch the tragedy unfold in front of you. Dr. Wood commented about cardiology and on what would happen if you had chest pain. I submit to you that if one of you were going blind in here right now and I asked you if you would rather that I give you a white cane or take you to the eye institute to see a retinal surgeon, I’m guessing you would go to the retinal surgeon. The problem we face is the lack of knowledge and understanding on the part of everybody—society, physicians, people in general, and the government especially—in terms of understanding what this disease is and how to treat it. I’ve run the addiction curriculum at the medical school here in Ottawa for the last 25 years. We’ve been decreased from 25 hours of curriculum time to three hours. Seemingly, people don’t want to take this seriously, but at the same time, they want to talk about and sensationalize fentanyl and all of these other drugs. It doesn’t matter what you die from; if you die from a Glock or from a rocket launcher, you’re still dying from a gun. It doesn’t really matter. The problem is that we have an issue here that’s poorly understood, and I think it’s people like you, who are taking the time to listen to this, who could maybe change this. That would be my hope. I started an opiate withdrawal management centre here in Ottawa. We are self-funded. There’s no government funding whatsoever for this. We started with no patients and now we have a thousand patients on Suboxone and methadone, in Vanier. We have seven doctors. My observation is that these people desperately want help. They’re victimized, they’re marginalized, and they’re diminished. They’re the people who really are the lost souls of the world and who we desperately need to help. I got a card the other day, and I’ll share it with you. It’s a thank you card from one of my patients. They told me: I just wanted you to know how much my life has changed because of you and your staff. I will be forever grateful for your services. Thank you so much for helping me become who I am today. I think that’s what keeps me going, despite the fact that there is no funding and no treatment. Some of you live in Ottawa. I sent somebody to a psychiatrist, and this is the message I got back from the psychiatrist the other day, after waiting six months: Dear physician, due to the high number of referrals received, there is currently a two-year wait to be seen. We are unable to accept your referral. Why don’t you call the Royal Ottawa hospital? I called the Royal Ottawa hospital, which is our CAMH here in Ottawa. Number one, if you don’t have an OHIP card, you can’t go in there. You can go to jail without an OHIP card, I can tell you that, but you can’t go into a hospital without an OHIP card. They will not see you. It doesn’t matter if you have a needle coming out of your neck, they won’t see you. It’s a one- to three-month wait to see a doctor for an assessment, and after that it’s upwards of nine months before you can even get into any type of program. You’re looking at a year, and these people are desperate. They are injecting drugs. It’s a $600- to $1,000-a-day habit, and they don’t have a job. Of course, they have to get money every day. They have to prostitute, sell drugs, or steal. The crime is unconscionable, and we are all part of that. Then I said, okay, I will call our detox centre here in Ottawa, which is heavily funded. Guess what? It’s not a medical detox. If you call there and ask what to do if you’re in withdrawal from benzos, alcohol, or opiates, they’ll tell you there’s no doctor or nurse there and you have to go to the hospital. But when you call the hospital, they tell you that they can’t help you. You can’t go to the Royal. There is no emergency department in our psychiatric hospital, so you go to the emergency department at the General hospital, our teaching hospital, and ask where the department of addiction is. You’re told there isn’t one. When you ask them what you should do, they tell you to wait, which you do for 13 to 20 hours while you are in serious withdrawal. Then you see a first-year medical student or a resident who, as Dr. Wood says, has no training in addiction whatsoever. This is a case I had here, where someone went to the hospital by ambulance. They were unconscious. I can’t really read this—it’s all scrib- bled, as doctors will do—but it says the patient was found unconscious at a bus station. They woke him up and the diagnosis was “intoxication”. The disposition was to follow up with his GP, which he doesn’t have, for a refill on his pills. And that’s it. That’s at a teaching hospital in our country. That is poor. I do a lot of teaching at the university, and I am a Royal College examiner. If that’s what you did on an exam, you would fail. You can’t let people who are dying leave a hospital. It’s ridiculous. But that’s what we do all the time—constantly, all day long. The smokescreen answer of the government appears to be, “Let’s put up injection sites; that will solve our problem. Oh, and give them a pamphlet, by the way.” Here is the pamphlet they give you. I had several media sit with me for four hours. I said, “Let’s go through this pamphlet. We’ll call everybody and see whether we can get help.” After four hours, they went, “Oh my God, there’s no help.”

39 The Federal response to the Opioid Crisis

Nobody will help you. You can’t be at any treatment centre on methadone or Suboxone. There is no medically assisted treatment. There are no physicians involved. There is nothing. You have to fill out forms with a thing called OAARS, a 12-page report. How does that help you? You’re dying of a disease, and you are filling out reports. Imagine if you had crushing chest pain and they told you to fill out a 12-page report first and then go stand over there for 13 hours. It wouldn’t happen. I feel ashamed, as a physician and as an addiction physician in this province, that this is what it has come to. You can tell by my voice and by my enthusiasm. I have a thousand patients right now: a thousand. I deal with it every day. We try to help these people as best we can. We are integrating with the CAS, the parole boards, and the jails. It’s a bureaucratic nightmare. This is a health problem that’s highly treatable, and we are doing nothing about it except say let’s talk about care fentanyl, this fentanyl, that fentanyl. It’s like a group of people who don’t know what they are talking about, or sensationalists followed by the media, rather than saying we have a treatable illness that’s called “addiction” and we should take the time to go back to the 1980s and see what we were doing back then, when we didn’t have this problem. We had a lot. We still had 10% to 20% of the people with the issues, but we were treating them. Now, though, if they can’t get a psychiatrist, they can’t get an addiction doctor, they can’t get treatment, what do we expect these people to do? Of course they’re going to go around in the market area. Every person you’ve seen in the news lately has been one of our patients. The girl who got stabbed the other day didn’t get stabbed because of fentanyl. She got stabbed because she cheated a guy on cocaine for $15. The guy came back, he was so high, and he stabbed and killed her right in front of the shelter. Another guy got shot the other day. It was another drug-related thing. He was also our patient. These people need help. They’re desperate. They’re living in a war zone here. You can just go downtown and look. You can come with me; I’ll show it to you. It’s right here in Canada’s capital, and it’s shameful. We as a group should take this opportunity to say that we’re all going to leave here and do something meaningful about this. We’re not going to let these people die.

ADDICTIONS DIAGNOSIS AND TREATMENT

Liberal MP John Oliver (Oakville, Ont.):

From Dr. Wood I heard pretty clearly about training primary health care providers in addiction care and treatment strategies, establishing guidelines and practice standards so that there’s a methodology to it, directed funding to addictions versus mental health and addictions, and the online prescription database. I’m trying to figure out, Dr. Ujjainwalla, what the advice is; I heard about the gap. Is it that we don’t have a proper diagnostic category for this? For the person who was left at the emergency department, there was no diagnosis.

Dr. Mark Ujjainwalla, Recovery Ottawa:

Where are all the addiction physicians? Where are Dr. Wood and I on all these committees that are trying to explain to hospital boards and the LHIN and all these people that give them money? You need to develop a comprehensive treatment program for the treatment of addiction. Just go on the Internet and Google “Hazelden Betty Ford”. It’s the gold standard of treatment.

Dr. Evan Wood, British Columbia Centre on Substance Use:

– College of family physicians curriculum should include prevention and treatment of addictions (federally mandated)

I don’t want to bash specialists—I’m a specialist myself—but this disease is so common. It’s not something rare like rheumatoid arthritis or something that’s relatively uncommon. As you’ve heard, this is 10% of the population. So we need a primary-care-based strategy to train physicians. In the example that was given with the emergency room, they’re saying it’s intoxication, but they know exactly what’s going on. It’s just that the health care system is a deer in the headlights; it does not know what to do. So it’s about training health care providers and developing evidence-based guidelines and standards. There should be standards in the emergency room and evidence-based pathways and referrals to programs, because I tell you, the Canadian taxpayer is hemorrhaging money to send ambulances, to send police, to treat the infections, to treat the lung disease or the liver disease—all the things that go along with untreated addiction. So there’s money to be saved, but what’s required is to train health care practitioners and establish guidelines.

40 The Federal response to the Opioid Crisis

BIG PHARMA

Liberal MP John Oliver (Oakville, Ont.):

We haven’t heard any advice or comment around pharma: the introduction of OxyContin, the introduction of opioids, the initial encouragement to prescribe these or the recommendation to physicians to prescribe. Do any of you have any comment about the role of pharma in this, and do you have any advice there?

Dr. Evan Wood, British Columbia Centre on Substance Use:

It has been well documented, and there are lawsuits for hundreds of millions of dollars in the United States because of the shenani- gans of the makers of OxyContin. As I alluded to, there was a void in physician knowledge. This promotion of pain as a fifth vital sign and implying that OxyContin was safe and non-addictive was clearly not true. The influence in the pharmaceutical industry on physicians had a hugely negative impact. So there’s regulatory opportunity there, too.

Dr. Mark Ujjainwalla, Recovery Ottawa:

As I said, you could go on the Hazelden Betty Ford website, present that to the federal government, and say this is what we had in the seventies, eighties, and nineties. We need to open those doors up. To Dr. Wood’s point about the 2,700 people who came in with non-fatal overdoses, what a unique time to put them on Suboxone. Why would you not just put that guy on Suboxone, send him to my clinic, and then get treatment? It’s simple: bang, bang, bang, done. Instead, they don’t know what they’re doing. They’re irritated by these people. They spend, as he said, lots of the resources and they dump them back on the street. They get picked up by the police and are back in jail. That’s the issue. Really the message is that you have to open the doors again. You can’t have a two-year waiting time for a psychiatrist. It’s ridiculous. You can’t have no treatment centres. It’s ridiculous. You can’t have no non-medical detox. It’s ridiculous. This is 2016.

HEALTH CARE FOR ADDICTS AND TREATMENT

Conservative MP Colin Carrie (Oshawa, Ont.):

(to Dr. Mark Ujjainwalla) I wonder if you could elaborate on the kind of appropriate care that you would provide an opioid-dependent individual in contrast to what has been brought up a lot here, these supervised or safe injection sites. You made a comment just now about dumping them back on the street, so they’re in and are just dumped back, dumped back, and dumped back. Could you give us some advice on appropriate care? You’re giving them care today. You’re helping people today. Could you elaborate on that?

Dr. Mark Ujjainwalla, Recovery Ottawa:

How do you help them? You have to deal with it from a medical detox point of view, depending on whether it’s alcohol, benzodiazepines, opiates, or amphetamines; it doesn’t really matter. You have to develop a comprehensive plan to say we’re going to deal with each of these issues, and you have to do that properly. Unfortunately, you can’t do that in 10 minutes. It requires hospitalization, often, to be able to take the time to investigate it, to understand the biopsychosocial element of this woman to treat her withdrawal properly. For us in the opiate world, Suboxone and methadone have been godsends. It’s not the treatment; it’s the transitioning away from that horrible existence that you’ve developed of acquiring pharmaceuticals or heroin to a place where you’re now stable enough to deal with your life. And then, that’s the next part of it. If you go into an actual treatment centre, whether it’s Bellwood, Homewood, or any of these places, then they start dealing with life. It is the thinking process that’s the problem. We get focused on the behaviour, i.e., using the drug. They’re using that to deal with all their problems. They like to use that because it makes them feel normal. The problem is that the consequences of using are the issue. What we need to do, then, is look at the person’s physical problems, the person’s emotional problems, the person’s psychological problems, career, money, family, and all that stuff. Again, for 25 years I sent professionals, physicians, and lots of politicians to treatment in the U.S. They stayed down there for three months, and when they came back, they were really in an excellent position and maintained sobriety. If I could try to help you guys understand what a comprehensive treatment program looks like, then you could explain that to the rest of the world.

41 The Federal response to the Opioid Crisis

Conservative MP Colin Carrie (Oshawa, Ont.):

We’ve had a lot of witnesses say these safe injection sites are the solution. I see that as kind of giving up on people, just throwing them back into what they’ve been doing day in and day out. I’m wondering if you could share the success of the recovery centre you have.

Dr. Mark Ujjainwalla, Recovery Ottawa:

First off, I’m sure you’ve heard a lot about this injection site thing. The word “safe” is a marketing thing. If I had a needle right now full of fentanyl, would anybody volunteer to let me stick it in their neck? I doubt it, because it’s not a safe thing to put a needle full of fentanyl into your neck. On the word “supervise”, the idea I think came out of their issue—Dr. Wood, I’m sure, can speak to this—in the upper east side of Vancouver. Fair enough, it’s a public health HIV and hepatitis C issue. It’s not really an addiction issue, in my opinion. It’s almost like a government smokescreen to say that if we do this, then we don’t have to do a comprehensive program that would cost billions versus maybe half a million for the injection site. The problem, I think, is that the door is closed everywhere. It’s like this has become a quote-unquote treatment option when instead it’s just an idea that homeless people could go to this place and I guess somebody would wake them up if they stopped breathing. The thing is that we have in Ottawa alone probably 3,000 to 4,000 people injecting at home every day, and they inject five to eight times a day. That’s about 30,000 injections a day. You don’t see everybody dying from it. I opened that door because I saw a need. We had a thousand people within three years. We have had seven physicians within three years working flat-out, all day long, trying to keep people out of withdrawal. Our problem is that we don’t have the next step. We don’t have any funding for any kind of psychological help or any kind of treatment programs. There are just roadblocks and barriers everywhere. It almost seems like there’s this conspiracy not to treat addiction, but to say, listen, this is the answer; you can come into our little basement thing, inject, we’ll give you a pamphlet, and bye-bye. That will be the answer for the treatment of addiction. I don’t think, as Canadians, we believe that. I know a lot of really wonderful people who are supportive of a foundation I’m going to try to start, to pri- vatize this, to develop our own centres. If the government’s not going to do it, I think we’re going to have to do it. I just can’t stand here and watch these people die every day, and suffer.

SUPERVISED INJECTION SITES

NDP MP Jenny Kwan (Vancouver East, B.C.):

Has the supervised injection facility in Vancouver been an effective program? Can you tell us, Dr. Wood? As I understand it, there is also a place called Onsite, upstairs from the supervised injection facility. I wonder if you can elaborate on that, and then talk about the critical link that is required following Onsite and what’s missing.

Dr. Evan Wood, British Columbia Centre on Substance Use:

In terms of addressing those costs, Insite has been shown to reduce overdoses as well as syringe sharing and other high-risk behaviour, so of course I support it. I think everybody should, because we already have programs across Canada that, just as an example, in an effort to mitigate these harms and costs, give out clean needles to people. A program like Insite is actually what I would call a more conservative approach, in that it allows the health care system to ensure that a needle doesn’t end up in a park, that young people don’t see a person injecting, that an intervention is delivered in an environment where a person can be encouraged into treatment, such as it is. Unfortunately—and I know this is a huge source of frustration among my addiction medicine colleagues—you see injection sites in the news, and it is implied that the taxpayer is investing a great deal here. I’ll just share with you that Vancouver Coastal Health, of which I’m the medical director for addiction services, spends hundreds of millions of dollars every year on mental health. They spend an almost insignificant amount, less than one-sixth of that, on addiction, and a miniscule amount of that, a really inconsequential amount, on supervised injecting, which then saves the taxpayer a huge amount of money. Among the things it is able to do is that it has a detox program upstairs called Onsite, which can take in individuals, help them through detox, and transition them into treatment. They’re very effective in doing so. To people who want to pit one of these things against another, it really is nonsensical. We need a comprehensive approach. We need an addiction system of care that can meet people where they’re at, and these low-threshold programs are very effective. We need a door to addiction treatment and recovery, but that door, as the literature from Europe would suggest, means meeting people where they’re at. To be honest, these interventions are associated with reduced rates of injecting in the community, so I certainly support a public health approach, and it has been effective in Vancouver. 42 The Federal response to the Opioid Crisis

If there has been any mistake made, it has been the lack of emphasis on addiction treatment going back to the 1990s. That’s something that we’re trying to dig ourselves out of now in terms of some of the interventions I talked about. These include training health care providers and developing standards and guidelines, but from an evidence-based medicine perspective, the supervised injecting facility has certainly been effective. We need a more comprehensive approach, obviously.

NDP MP Jenny Kwan (Vancouver East, B.C.):

Dr. Wood, could you elaborate on what needs to be done in the next phase? In the meantime, we are faced with yet another crisis with fentanyl usage. Deaths are occurring in our communities, not just in my community, but throughout the country. Could you comment on Bill C-2 and whether or not that bill should be repealed?

Dr. Evan Wood, British Columbia Centre on Substance Use:

In terms of your first question, Onsite is located in the Downtown Eastside, so you’re exactly right: it’s a place where people in crisis, whose lives really are a living hell, see the opportunity for something else. They get a bed, but then what next? Obviously we want to get people out of the Downtown Eastside. Investments in recovery-oriented systems of care have not been there. Un- less you have $20,000 to go into an expensive treatment program, the door just isn’t there. Wait lists are long. It makes absolutely no sense. I’m not a lawyer, and I don’t want things to get politicized in terms of Bill C-2. I just think there’s been a lot of misinformation. I’ve seen how, when these things become oppositional, people get entrenched in their thinking. They put their blinders on. They don’t understand that by focusing on preventing public health interventions, it doesn’t achieve the objective of another thing coming forward. I just haven’t seen that. I strongly encourage everybody to try to get beyond historical partisan issues around this crisis and to focus on what’s best. Clearly that will be an evidence-based approach. It was alluded earlier that it will cost a lot of money. I would just reiterate the point that we’re spending that money. We’re spending it on emergency rooms, on HIV and hepatitis C wards, and on programs for people who’ve had hypoxic brain injuries. There’s also a cost to productivity, and of course the cost to families who have lost a loved one. The money is being spent on downstream consequences. If we can reduce those costs through public health programs that are proven effective, of course I support that, but we need a more comprehensive approach in addition to that, one that involves an effective treatment system. Training health care providers and establishing guidelines and best practices: it’s a clear way to identify where those investments should be and then move forward.

DRUG ADDICTIONS AND SOCIAL CLASS

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

Dr. Ujjainwalla, from what I know, drug dependence occurs in all social classes. It strikes all classes indiscriminately. Anyone can become drug dependent. Is that correct? Is drug dependence more prevalent though in a particular class or among people who are less fortunate in life? I am thinking for instance of people who do not have a lot of support and who enter a cycle of dependency with no way out because there is no family support and social assistance is inadequate. Have you seen that to some extent in all your years of practice?

Dr. Mark Ujjainwalla, Recovery Ottawa:

Yes. I believe addiction, like any other disease we face in medicine, crosses all the borders. If you’re diabetic, it doesn’t really matter what your income is. In a general sense, addiction, encompassing substance abuse that includes alcohol and other drugs, affects everybody. For 25 years, as I told you, I dealt with professionals only. Every quote-unquote person suffering from addiction was either an MP, an MPP, a physician, a lawyer, an accountant, a dentist, a pharmacist. That was one element, and I can tell you first-hand that I treated hundreds. In terms of the people we see in the opiate and cocaine world, unfortunately, the amphetamine world, the consequences of the use of their drug, which they may start.... Believe it or not, I have two professional hockey players as patients who injured themselves playing hockey. They’re just regular guys who broke their arm. They went from bad to worse. This happens to many people when they get dependent on the drug. 43 The Federal response to the Opioid Crisis

Guy-Pierre Lévesque, Méta d’Âme:

I came here with an approach to react to overdoses, but in our facility we have a drop-in centre with peers and community workers, and we also have apartments. We reach out to people who are homeless. We try to bring them to treatment and also into a program that runs over three years with a plan of action to change. That’s one thing we do. The other thing is this. When we’re talking about safe injection sites, it would be a big approach for Canadians to talk about consumption rooms, so that way you don’t have only people with needles in those places but also people who smoke crack and use other substances. There is also a reaction to different things that bother society in downtown Vancouver, downtown Montreal, or here in Ottawa. Treatment is also a reaction. Naloxone is also a reaction. I think it’s very important that we start educating our young as soon as possible, starting from the lower grades, with an approach of harm reduction, not with an approach of prohibition. It is the worst thing to do; it makes it tempting for people to use. Also, I want to say that all users are not always in the streets. They also live in houses. I want to say also that people who use drugs get worse and worse in their condition if their conditions in life are bad. If you don’t have proper work, a proper amount of income, you’re not staying in an environmentally safe place, and you don’t eat properly, you will go down very fast. It’s very important to understand that. If you have the capacity to sustain yourself with a good quality of life, you might not end up downtown. You might have your addiction for many years before you seek treatment. From my experience, not all users want to go into treatment. Some don’t see themselves as sick people, so it’s very important to consider that also when you implement programs in Canada.

ROLE OF GOVERNMENT

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

After 25 or 30 years of professional and practical experience, I can say that the same problem still exists today, 25 years later. It might even be worse since it is on the rise. The Band-Aid solutions that were used 10, 15 or 20 years ago no longer work. Yet it seems that more of the same thing is being done all the time to try to fix the problem. We hear about multidisciplinary and intervention teams as part of a preventative approach. What are we waiting for to have a Betty Ford Centre, as you mentioned, Dr. Ujjainwalla? Over all this time, what has been the impact of your work with respect to government action? For my part, I have been here for bare- ly a year. Actually, yesterday was my one-year anniversary and I am very happy to be here. Seeing all of this, though, I have to wonder what kind of world we live in. I think I know part of the answer. I think it costs less to use Band-Aid solutions, to close one’s eyes and say that the last five years went smoothly. Mr. Lévesque, I think you are part of this Band-Aid approach. I do not mean to criticize your approach. It is extremely important because it can save lives in the short term. Yet it does not solve the problem. Would it be wrong to say it is a vicious circle? You talked about water and a lifeguard. We might rescue someone, but we know they will swim again. Yet if the person does not know how to swim because they have not been taught, their problem has not been solved. What should we do? There is the political aspect and the financial aspect. There are limits to everything, but what should we do? What must the government recommend in this regard? I will give you a minute or two to answer these questions.

Dr. Mark Ujjainwalla, Recovery Ottawa:

Those are amazing comments. I’d throw it back to the politicians here. You tell me why it’s not happening. It was good and now it’s gone. So that’s the question and it’s a rhetorical one. I appreciate your comment. If the will is there, if the people want to help these individuals, then you can do it. If you don’t see it as a problem, and you don’t live it or you don’t understand it, then how are you going to develop a comprehensive treatment program like we are talking about? I think that’s the job of this committee, to make Canadians aware of what the disease of addiction is and all the different components of that— the public health components and all the other things that Mr. Lévesque was talking about—so that we don’t see it as a Band-Aid. However, I agree with my colleague that we don’t want to be fighting public health against addiction medicine, against specialists, against social workers. We need to work as a team. I find what has changed now is that we’re not working as a team. It’s so regionalized. There’s so much bureaucracy in it. Everybody is worried about their jobs and stuff. People have ideas such as, “Okay, I’m a harm-reduction guy.” It’s like the Leafs against the Habs, a harm-reduction guy against a treatment guy. That’s ridiculous. What we need to do is work together and realize that there are different strata. Just as in all medicine, some people need to be in an ICU and some people can be treated as an outpatient.

44 The Federal response to the Opioid Crisis

Here is the problem and why I brought these things in. With what we presently have, if you want to see a psychiatrist, it’s a two-year wait to see one. How’s that going to work? You want to see an addiction doctor, and there isn’t one. So how’s that going to work? You can’t get into the psychiatric hospital. That’s my point. If we open these doors again, as they used to be in the seventies and eighties, we can be proud of that system and we can develop it. It’s not complicated. It’s just the ability to say the political will is there and the will of Canadians is there to change this.

ACCESS TO NALOXONE

Conservative MP Len Webber (Calgary Confederation, Alta.):

How difficult is it for you to get the antidote of naloxone?

Guy-Pierre Lévesque, Méta d’Âme:

Actually, we have naloxone because we have what we call a collective prescription from Dr. Massé from the département de santé publique de Montréal. Under this condition, we were able to have this naloxone. It’s vials and injections. It’s a kit that has everything in it that you need. To get it, people have to take the training, actually, at this time. When the legislation is done, it might change. At this moment it’s paid for through the département de santé publique, so it’s the ministry. It was a trial for the first year; with the results, a second year; and now we’re on the third year.

– Not a safe injection site, but people can use in their facilities. – The facility is not able to test drugs to see if they are safe.

REFERRALS TO ONSITE TREATMENT

Conservative MP Len Webber (Calgary Confederation, Alta.):

Dr. Wood, of course you’ve been to Insite and Onsite. You’ve worked in British Columbia. I have a stat here that I want to put out. In 2015 there were over 263,000 visits to Insite. Of those 263,000 visits, 464 were referred to the Onsite treatment centre to get further help. That’s only 7%. I find it quite surprising that it’s so low. Can you comment on that at all?

Dr. Evan Wood, British Columbia Centre on Substance Use:

First of all, the number of injections are not unique individuals. Insite isn’t for everybody. The people who use it tend to be homeless, street-entrenched, and live within a couple of blocks. In the Downtown Eastside, it’s estimated there are only about 4,700 people who inject drugs. Onsite has 12 beds. To answer your question, as I think you’ve heard, the door to a functioning addiction treatment centre is not there. Many people have successfully entered into recovery through Onsite, but it can be viewed as a sort of a crack in the door to a whole other reality that simply has not been invested in. Insite has saved lives. It saves the health care system money. But we haven’t realized the opportunity to address this concern comprehensively, because there hasn’t been an investment in addiction treatment in accordance with the scale of the problem. The money has gone to the consequences of addiction.

Conservative MP Len Webber (Calgary Confederation, Alta.):

…do you have the equipment there at Onsite or Insite to test the drugs they bring in for safe injection?

Dr. Evan Wood, British Columbia Centre on Substance Use:

No, but I think it would help if we addressed regulatory issues there, because we’ve seen this shift toward fentanyl. The average patient of mine is not looking for fentanyl. Fentanyl is a market force. People with a background in economics can understand that it’s cheaper, it can be imported, and it doesn’t have to be grown with a poppy. It’s a market force because of the long-standing illegality of these drugs. Organized crime is seeing an opportunity and exploiting it. The market could be influenced through drug testing.

45 The Federal response to the Opioid Crisis

SUPERVISED INJECTION SITES/HARM REDUCTION, SUBOXONE

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Dr. Ujjainwalla, I practiced emergency medicine for almost 20 years in Winnipeg, much of it at the major teaching hospital downtown. I could not agree with you more that during training we did not receive nearly enough training in addiction. The only addiction training I received in medical school was a two-hour instruction on what to do if one of your own colleagues was addicted. I knew what number to call if I found out one of my colleagues was addicted to drugs. That was pretty much all I learned about it in medical school. I learned more in residency, because I did a five-year emergency residency. Most of what I learned about treating addiction was due to the fortunate coincidence that some of our physicians were part-time emergency physicians and part-time addiction specialists. I learned most of my addiction medicine from them during shifts, just during conversations, which is not a well-structured way to learn a very important topic. I agree that we don’t have the proper facilities we need. Family doctors don’t know what to do. They send them to us. People come to the hospital expecting to be admitted for their morphine or fentanyl addiction. We tell them that we have no place to admit them. We don’t have a program to admit them. Internal medicine won’t admit them. We can’t keep them in our emergency department. We can give them a prescription for clonidine and give them a referral, which is going to take weeks to months. That’s all we have. I initially disagreed, Dr. Ujjainwalla, with what you had said about harm reduction, but maybe I misunderstood. I think we would both come to the agreement that it’s not the only pillar of treatment. If you had nothing but safe consumption sites for drugs, then you’re not addressing the problem. I think you and I would both agree with that. But we talked about it being a Band-Aid solution. As I said in an earlier meeting, when I’m in the emergency department and someone is bleeding, they need the Band-Aid. When someone comes in stabbed, yes, they shouldn’t have been stabbed, and that should have been prevented, but they’re stabbed and they’re bleeding. Would you not agree there’s a role for it in saving lives, improving outcomes, but in addition more investment in addiction is needed? A role for centres such as harm reduction sites and supervised consumption sites, as one of the aspects, as a short-term treatment while you invest further in this.

Dr. Mark Ujjainwalla, Recovery Ottawa:

It’s such a small, minuscule part of what we do; I agree with my colleague. For example, in Ottawa probably only 20 to 40 homeless people would come from the shelter on Nelson Street over there. That’s about it. I deal with people all across Ottawa. Nobody’s going to get on a bus in February from Orleans and drive down there to inject. It would be so easy to implement a program where emergency doctors would call the addiction guy, they’d put them on Suboxone, they’d send them to my clinic the next day, and then we’d get them into treatment with some counsellors whom the government pays for. That’s it. It would happen so fast. What we’re missing is that piece. The emergency doctors aren’t doing that. They’re missing a unique opportunity. They see them as drug seekers.

INSITE TREATMENT AND COSTS

Conservative MP Colin Carrie (Oshawa, Ont.):

Dr. Wood, we’ve looked at the stats for the Insite website itself, and it does seem to be a positive slant. We have the stats from 2007. There have been about 3.5 million visits since it opened its doors, with about 18,000 registrants over that time period. How do you define success and how do you define good value for dollars and resources? I think everybody’s in agreement that you need to have a comprehensive approach, but on the website they’re saying out of those number of visits, 1,200 have gone to transitional housing. It really doesn’t say how many people have actually been managed properly through treatment. There’s nothing there. So 1,200 out of 18,000, that’s 6.6%, if they’re calling going into housing as the success measurement. Is that how they’re measuring success, and is that any indication of how many people are actually being treated properly? Also, Dr. Ujjainwalla, perhaps you could give us an opinion. There is a cost for Insite. The police association said 100 police officers get diverted down there. If we multiply approximately $100,000 per officer, that’s $10 million. That doesn’t include the fire, the paramedics, and things like that. If you were given the resources, those millions of dollars going into treatment, and 18,000 registrants, how would you define a success rate with those numbers?

Dr. Mark Ujjainwalla, Recovery Ottawa:

The thing is that the end points are different. From an infectious disease and public health standpoint, that’s why these things are getting started. We support a safe injection site in Ottawa. I do, and I’m involved. I started a hepatitis C clinic in Ottawa, so I’m all into public health. 46 The Federal response to the Opioid Crisis

I think everybody is getting confused with what you’re saying about success, about what the end point of success is and how you define success. For these people, success might be having their own bed to sleep in and having a meal. That’s the problem. You have to define it properly. Again, in medicine, we take a lot of time to define what success is and what the gold standard treatment is, based on evidence. If the success of your daughter is that the best she can do is get off the street and have a clean bed and that’s what you want.... I tell my patients that it’s like they’re on the C team for hockey, but then there’s a B team, there’s an A team, and there’s a AAA team. They all have different expectations. Do you want to be a guy who has a job and a family and pays taxes and enjoys your life? Or do you want to be the guy who has to go and steal and assault people and rob pharmacies in order to use? I don’t know which team you want to be on. Also, do you even know what the teams look like? It’s very hard to write out on paper that “this is a success and we save lives”. My position always is that you think you’re saving a life, but the people are so unhappy and miserable and they’re living in hell. Why do you say that we’re saving their lives and therefore we should put this money into it? It should be more about what’s important: should you change the whole system so that people have the opportunity to have housing, education, and treatment for their illness? I agree that this argument.... I’ve listened to a lot of police. I’ve been involved with the police chiefs of Ontario. They’re frustrated. Of course they are. Think about it. For these injection sites, when you go in, they’re not giving you the drugs. You have to bring in your own drugs, so in Ottawa, let’s say, you have to go and do all your criminal activity downtown in the market. You have to prostitute, steal, or sell drugs. You get your drugs, you walk over there, and then you inject. You’re finally asleep and you feel good, and somebody wakes you up and asks if you’re dead yet. You wake up and you have to leave, and then you have to go and get more. You need to get $300 more, so you have to do more crime. It’s not really changing anything. To me, the point is that you’re enabling or encouraging a negative existence and at the same time saying, hey, they didn’t die today, so that’s a good statistic for this funding. I just think everybody’s missing the point on it. If that’s all you have, if you live in a war-torn zone and it’s the best you can do, okay, great, but I think we’d all agree that on every other aspect, whether it’s education, or other areas or portfolios that you all have.... In the military, for example, we want the best. We want the best in our military. We want the best in our education. Everybody wants to send their kid to private school. Why is it different in this area? This is about people’s lives. They’re sick. They have a treatable illness. If you can treat it, why don’t you? If you can’t treat it and they’re palliative and they’re going to die, okay, that’s fine, they die, but to Dr. Wood’s point, for these hepatitis C guys, I have these guys, and it’s almost $100,000 a month for the treatment of hepatitis C. Are you kidding me? They’re homeless. Hey, we didn’t really talk about jails yet, but it’s $120,000 a year to put one of these guys in jail. That’s expensive treatment. Trust me, they look better when they come out of jail, simply because they haven’t been exposed to drugs, they’ve been eating, and they have a safe place to live. That could be an end point, but that’s an expensive way to treat somebody.

IMMEDIATE/SHORT-TERM TREATMENT

Liberal MP Hedy Fry (Vancouver Centre, B.C.):

– Public health perspective – Safe injection sites

I would like Dr. Wood to tell me what he thinks we should be doing immediately, right now. I reiterate the question that Bill C-2 has stopped people from accessing this immediate treatment of stopping overdose deaths, which is what we intended to do, and we were very successful. People’s lives were saved. What other things, Dr. Wood, do we need to do on an immediate basis? You talked about the long term and the medium base, which is the training of doctors and looking at clinical guidelines. What are the immediate things we need to do—now—to stop real people from dying? What can we do now?

Dr. Evan Wood, British Columbia Centre on Substance Use:

I’ll try to answer that as well as the earlier question in terms of success and where we should be investing. First, these programs are not clinical trials, so we have to look at data on deaths and things like that. To give people context, when Insite opened, it was in the midst of a public health emergency, as was mentioned, and we had the highest rate of HIV infection in the developed world. Because of the comprehensive approach, which included Insite, we have seen a greater than 90% reduction in new HIV infections. Insite is a public health program. It’s not a housing program. It’s not a treatment program. So having those types of expectations makes no sense. Because people are dying, and British Columbia is on track to have over a thousand people die this year, young people in the prime of their lives, we need public health interventions and we need them now. We need the things that were mentioned like take-home naloxone, absolute- 47 The Federal response to the Opioid Crisis ly, and public health strategies to address overdose, including supervised consumption. I think the Band-Aid point is a good one in that when people are bleeding, you need Band-Aids. But you also need more comprehensive approaches to prevent bleeding in the first place. We don’t want to have a system that just pulls people out of the river without going upstream to figure out why they’re in the river in the first place. These are just structural issues. We need a national approach to the treatment of opioid addiction, and the Canadian research initiative funded by the federal government through CIHR intends to do that. The other is training health care providers. To use the example of Winnipeg and the emergency room, at Vancouver Coastal Health, which has been dealing with this for a long time, there still have not been the dedicated resources so that emergency room physicians can just pick up the phone and say, “I’m sending someone over to be initiated on Suboxone”, or “I’ve started it tonight, and they’re going to have an appointment tomorrow morning.” I’ll go back to my point about mental health and substance use. We need strategies focused on substance use and on shifting money to mental health and substance use or it just will not trickle down to the needed substance use interventions. Focus on guidelines, focus on practitioners, and don’t divide these types of interventions as in opposition.

Liberal MP Hedy Fry (Vancouver Centre, B.C.):

What is the role of heroin as a treatment in opioid addiction? Is there a role for people to go on heroin or heroin substitutes?

Dr. Evan Wood, British Columbia Centre on Substance Use:

Really, what we need, as we have for other diseases, is a stepped care model. Some people who are opioid-addicted actually don’t need Suboxone. They don’t need a medication. By going to a peer support meeting or going into a recovery program, they will go into long-term recovery. They don’t need an intensive medical approach. For other people, Suboxone would be effective. If that’s unsuccessful, by the current Vancouver Coastal guidelines we would look to methadone. There are other new emerging therapies using long-acting oral morphine as an agonist therapy that can extinguish illicit drug use. For some people—again, it’s almost an inconsequential fraction of the population in terms of population size—in terms of costs, it can be extremely costly. These are individuals with huge histories of trauma, oftentimes fetal alcohol syndrome, other sorts of diseases of the brain that result in compulsive behaviour, or hypoxic brain injuries. For those people, the science would suggest that for very tightly controlled programs where people get diacetylmorphine—“Heroin” is actually the trade name of a drug that was once marketed by Bayer Pharmaceuticals—there is a role. It’s not like we’re talking about heroin programs rolling out across the country in suburban areas, but for a sliver of the population it can add a great deal of public health and public safety in terms of being able to successfully engage people in a program. For many others, a huge group, no medication might be required. As my colleague has alluded to, those programs don’t exist, so it’s really a comprehensive approach and an evidence-based medicine approach. There’s a Cochrane Collaboration meta-analysis looking at the trials of diacetylmorphine prescription in demonstrating the benefits. I’d refer to that.

SUPERVISED INJECTION SITES

NDP MP Jenny Kwan (Vancouver East, B.C.):

Dr. Evan Wood, do you know anything about that process and whether or not additional sites would be effective in saving lives?

Dr. Evan Wood, British Columbia Centre on Substance Use:

Yes, for sure. I mean, there are long wait times to use Insite. There are scientific papers showing that’s among the reasons why people will go and inject in the alleys. We need to scale up these programs, but as I’ve said and as you’re hearing, the funding for these things is actually relatively small in comparison to the huge money that’s going into the downstream consequences of addiction. That money would be much better spent on effective treatment programs so that we can do the public health side of things and also the recovery-oriented system of care that does not exist and really needs to be developed. In terms of the legislation itself, it’s my understanding that the federal government is working with Vancouver Coastal Health within the existing legislation, but that public health officials like Dr. Patty Daly, who are involved in that, feel that the legislation is onerous and really is not supporting any sort of positive outcome in terms of what it may have originally been intended to do.

48 The Federal response to the Opioid Crisis

INVESTMENT IN ADDICTIONS TREATMENT

NDP MP Jenny Kwan (Vancouver East, B.C.):

You mentioned investment into addictions and the need for a comprehensive approach. I absolutely agree. I think harm reduction is one pillar. I hate to think that if my daughter or son were addicted they would die injecting; I would want them to survive that experience and be able to move forward to the next phase, hopefully to detox treatment, and then, hopefully, to a successful life. I keep thinking about that because my constituents lose lives; they are somebody’s son or somebody’s daughter, and it’s very real. With that in mind and in terms of the other pillars, we now know what the issues are with harm reduction and the need to move forward. With the other pillars, I get the point about the need for additional treatment dollars. I think you mentioned, Dr. Wood, that we have $40 billion that would otherwise be spent because of addictions. If we were to invest that money into addiction prevention, treatment, and harm reduction services, what would that look like? In your dream world, what would that look like? What kind of investment do we actually need for a comprehensive approach across this country to deal with this issue in a comprehensive way?

Dr. Evan Wood, British Columbia Centre on Substance Use:

From a prevention perspective, unfortunately the science doesn’t point a clear path forward in terms of discussing with youth in high schools. Those types of interventions have traditionally been shown to be ineffective. But from a prevention perspective, certainly a national approach to prevent the unsafe prescribing of opioids is clearly needed, and something that this committee can push for in terms of a monitoring system to ensure that prescriptions are safe. In terms of treatment, we need accessible treatment. We are just spending so much money in terms of downstream consequences of addiction, so absolutely we need that, and we need public health approaches too, as was alluded to by Mr. Lévesque. For many people— and some I’ve described as very traumatized, or with hypoxic brain injuries or fetal alcohol syndrome—even if the door to treatment were open, they may not be motivated to go there. We have prisons, and I agree that prisons are oftentimes a chance for people to turn their lives around, but in far too many cases, at great taxpayer expense, people come out of prison only to relapse and go immediately back to substance use because there’s no treatment in prison. So we need a comprehensive approach. I think we’ve focused way too much energy on treating this as a criminal justice issue, and we’ve spent lots of money there. I would argue that the war on drugs approach has led to ever more potent drugs like fentanyl, and it needs to be looked at as part of the problem.

Dr. Mark Ujjainwalla, Recovery Ottawa:

I’m thinking outside the box. We’ve been approached by a group in Sweden and also a group in Kentucky. They have built facilities where the people are diverted from jail; instead of going to jail they go to these facilities. In those facilities they’re very quickly encouraged to work. The state owns these things. They own companies like painting companies, catering companies, and whatnot. Then the individuals are given a sense of self-esteem and order. They have high productivity. The guys from Sweden came and showed me that program, and it looks amazing. The same thing is happening in Kentucky. They have 2,000 beds in Lexington, where they have the same approach happening, and it’s working really well. I think looking outside the box of Canada could be of use to us.

OCTOBER 18, 2016

ON THE AGENDA The committee resumed its study of the Opioid Crisis in Canada.

Conservative MP Len Webber (Calgary Confederation, Alta.) moved to have Zhaohui LUO, Ambassador for the People’s Republic of China, to appear before this Committee to provide evidence as to the measures being taken by his Government to address the manufacture, distribution and sale of illicit opioids into Canada.

The motion was agreed to. Main topics discussed: opioid situation in Quebec, naloxone, tamper-resistant drugs, pharmacists and prescriptions for pain medication, national public health emergency, first responders, pill pressers, mental health and housing, fentanyl, supervised injection sites.

49 The Federal response to the Opioid Crisis

WITNESSES Canadian Medical Association • Jeff Blackmer, Vice President, Medical Professionalism Canadian Pharmacists Association • Alistair Bursey, Chair • Philip Emberley, Director, Professional Affairs Vancouver Fire Fighters’ Union - Local 18 • Chris Coleman, International Association of Fire Fighters Local 18 Representative • Lee Lax, International Association of Fire Fighters Local 18 Representative Syndicat du préhospitalier (FSSS - CSN) • Réjean Leclerc, Chair

TRANSCRIPTION HIGHLIGHTS

Dr. Jeff Blackmer opening statement:

On behalf of Canada’s doctors, the CMA is deeply concerned with the escalating public health crisis related to problematic opioid and fentanyl use. Physicians are on the front lines of this epidemic in many respects. We are responsible for supporting patients with the management of acute and chronic pain. Policy-makers must also recognize that prescription opioids are an essential tool in the alleviation of this pain and suffering, especially in palliative and cancer care. The CMA has, for a long time, been concerned with the harms associated with opioid use. We appeared before this committee as part of its 2013 study on the government’s role in addressing prescription drug abuse. At the time, we made a number of recommendations on the potential role of government, some of which I will reiterate for the committee today. It’s important for the committee to recognize that inappropriate prescribing of opioids is not the sole contributing factor to our current crisis and that targeting this issue alone will not lead to a resolution of the problem. However, physicians must accept our share of the responsibility, and we are prepared to play our part in doing what is necessary to move forward in addressing this very complex and multi-faceted problem. I’ll now turn briefly to the CMA’s recommendations for the committee’s consideration. These are grouped into four major theme areas, the first of which is harm reduction. Addiction needs to be recognized and treated as a serious, chronic, and relapsing medical condition for which there are effective current treatments. Despite the fact that there is broad recognition that we are in a public health crisis, the focus of the federal national anti-drug strategy is still heavily skewed towards a criminal justice approach rather than a public health approach. In its current form, the strategy does not adequately address the determinants of drug use, treat addictions, or reduce the harms associated with drug use. The CMA strongly recommends that the federal government review the national anti-drug strategy and reinstate harm reduction as a core pillar of the strategy. Supervised consumption sites are an important part of a harm reduction program that must be considered as part of an overall strategy to address the harms associated with opioid use. The availability of supervised consumption sites, as you know, is still highly limited in Canada. The CMA maintains its concerns that the new criteria established by the Respect for Communities Act are overly burdensome and deter the establishment of new sites. We continue to recommend that the act be repealed or, at the least, significantly amended to address this issue. The second theme I will raise is the need to expand treatment options and services. Treatment options and services for both addiction as well as pain management are very under-resourced in Canada. This includes substitution treatments such as Suboxone and methadone, as well as services that help patients taper off opioids or counsel them with intervention such as cognitive behavioural therapy. Availability and access of these resources vary significantly by jurisdiction and region. The federal government has a role to play in prioritizing the expansion of these services across the country. The CMA recommends that the federal government deliver additional funding on an emergency basis to significantly expand the availability and access to addiction treatment as well as pain management programs. The third theme I will raise for the committee’s consideration is the need for greater investment in both prescriber as well as patient education resources. For prescribers, this includes continuing education modules as well as training curricula at all levels of the medical continuum. We need to ensure the availability of unbiased and evidence-based educational programs in opioid-prescribing, pain management, and the management of addictions. Furthermore, support for the development of educational tools and resources, based on the new clinical guidelines that will be released early next year, will play a very important role in the overall approach. Patient and public education on the harms associated with opioid usage is critical. As such, the CMA recommends that the federal government deliver new funding to support the availability and provision of education and training resources, not just for prescribers but for patients and the public as well.

50 The Federal response to the Opioid Crisis

Finally, to support optimal prescribing, it’s critical that prescribers be provided with access to a real-time prescription-monitoring program. Such a program would allow physicians to review a patient’s prescription history for multiple health services at the point of care, prior to prescribing medications. Real-time prescription-monitoring is currently only available in two jurisdictions in Canada. Before closing, I should emphasize that the negative impacts associated with prescription opioids represent a complex issue that will require a multi-faceted, multi-stakeholder response. A key challenge for public policy-makers and prescribers is to mitigate the harms associated with prescription opioid use without negatively affecting patient access to the appropriate treatment for their clinical conditions. As one CMA past president said, the unfortunate reality is that there is no silver bullet solution, and no one group or government can address this issue alone.

Alistair Bursey opening statement:

I’m here to speak with you about the growing problem of opioid addiction in our communities from the perspective of a practitioner at the front line of an urgent public health crisis. I’m also the chair of the Canadian Pharmacists Association, the CPhA, which is the national voice of Canada’s 40,000 pharmacists. I’m joined today by my colleague Phil Emberley who serves as CPhA’s director of professional affairs and also works as a community pharmacist here in Ottawa. Prevention is where I would like to begin my remarks today. In addition to tackling the existing crisis, we really have to look at some of the underlying causes that have led us to this point. All levels of government need to work together to take a proactive approach to help prevent opioid misuse early on before it becomes a problem. This must be done through a mix of policies and public awareness of the consequences of opioid misuse and inappropriate use of pain medications. A particular focus should be on educating Canadian youth as the evidence demonstrates that many young people are exposed to illegal narcotics before they graduate from high school. A key to success lies in building effective partnerships with health care providers. Community pharmacists play an important role in educating patients about the harms associated with prescription opioids and other potentially harmful medications. For example, medication reviews allow pharmacists to review the patient’s response to the medications. This service provides an opportunity to educate patients on how to take their pain medications safely. It can also flag drug-seeking behaviour. Medication reviews can also reveal patient misconceptions about how and when to take medication, flag medications that are not adequately controlling pain, and confer with their prescribed optimized pain therapy. This valuable interaction between pharmacists and the patient is vital to ensuring safe and optimal use of medications. That fact that we see each Canadian on average 14 times per year provides us a great opportunity to intervene with our expertise and to consult with family physicians to improve patient’s pain control. CPhA supports the government’s recent announcement that it will proceed with regulatory change requiring opioids to carry warning stickers and come with patient information sheets describing addiction and overdose risks. It’s a good start. But pamphlets and warning labels are no substitute for pharmacists’ care. That’s why CPhA recommends that all jurisdictions, including the federal government as a provider of health services, expand funding for pharmacists’ services to include pharmacist pain medication reviews. Funding pharmacists’ consultation and follow-up would go a long way to improving the outcomes of these patients. Education goes hand in hand with better prescribing practices. The government has acknowledged more must be done to support better prescribing of opioids but Canada has fallen behind. We know that outdated Canadian prescribing guidelines simply do not reflect the best available evidence, yet our standards have not caught up. While new guidelines are expected next year, prescribers may feel pressured to prescribe opioids to patients experiencing acute or chronic pain without trying non-drug approaches. In the United States, the Centers for Disease Control encourages prescribers to start patients with low doses while providing a limited supply. We must immediately adopt comparable standards here in Canada to ensure patients receive the best possible care. Prescribing guidelines are not the only thing that must change for our profession to be more effective and decrease the inappropriate use of opioid medications. A pharmacy is the safest, and most effective and efficient and accountable delivery model for dispensing prescription drugs. But pharmacists can only be as effective as the tools at their disposal. The existing patchwork of prescription monitoring programs, also known as PMP, across Canada is no match for the problems of polypharmacy and double doctoring. PMPs are a stopgap solution. Moving beyond prescription monitoring to implementing a fully integrated drug information system, DIS, and functional electronic health records, EHRs, in every province and territory would ensure that pharmacists and physicians have access to the information they need to work collaboratively to monitor inappropriate prescribing and address drug-seeking behaviour. Greater accountability will result when prescribers are unable to claim that they were unaware that a patient was being treated by another physician. The progress of deploying EHRs and a DIS across the country needs to be accelerated to give us the tools we need to reduce opioid addiction. Public drug plans can also help limit the supply of prescription opioids by limiting the number of opioid doses that can be reimbursed within a specific time period. In my home province of New Brunswick, for over 20 years opioids and other controlled drugs have been limited to a maximum 35-day supply, yet similar controls are not in place across the country. Limiting the maximum supply provides pharmacists with more frequent opportunities for monitoring and intervention, and a much tighter turnaround time to engage the prescriber if required. From a public safety perspective, limiting the maximum supply results in a decreased inventory of narcotics in our communities. I know from my own experience that pain and chemotherapy patients have been violently targeted by criminals for their prescription opioids. Dispensing fewer capsules at a time can help reduce the risk of diversion.

51 The Federal response to the Opioid Crisis

However, limiting diversion of prescription opioids from pharmacies is a drop in the bucket in fighting this public health crisis. Counterfeit pharmaceuticals manufactured illegally in clandestine labs are feeding the overdose epidemic, plain and simple. These drugs are highly dangerous, putting users at a high risk of overdose since it’s impossible to know what or how much of a given substance these drugs contain. Illicit manufacturing of synthetic opioids like fentanyl is increasingly common, and law enforcement needs tools at its disposal to curb the growing supply. The government has made good progress through the restriction of precursor chemicals, but more can be done to limit production of these dangerous drugs. The Canadian Association of Chiefs of Police reports that criminals are importing commercial pill presses into Canada, but that border agents don’t have the authority to seize them. To put this in perspective, these machines can be purchased online for less than $10,000, and they can make between 10,000 and 18,000 pills per hour. As a pharmacist I can tell you that there is simply no reason for an individual to possess of one of these machines. The CPhA strongly urges the government to impose penalties for the illegal importation of pill presses and tablet machines, and to limit possession to pharmacists and others who hold an appropriate licence. Finally, we can’t forget the human face of opioid abuse, and we can’t turn our backs on people who have already succumbed to opioid abuse. We need more programs to help those who are currently addicted to opioids. Pharmacists play a front-line role in assisting recovering addicts by dispensing drugs to treat addiction, such as methadone, Suboxone, and naloxone, and by providing regular support, monitoring, and follow-up, sometimes on a daily basis. These programs and the health providers who deliver them need more support. There is no magic bullet that will put an end to a crisis decades in the making, but we also want to be careful of unintended consequences. As we start to restrict legal access to these drugs, front-line health care workers can be put at risk. Pharmacists will be the first to experience intimidation, threats, and robberies. Recently I had a discussion with a colleague from Newfoundland, where oil workers in the throes of addiction returned from Alber- ta to their rural community, and robbed a pharmacy with the aid of gallons of gasoline and a lighter. Pharmacists are very concerned with the challenges that they’re going to face as the supply tightens. Lawmakers, regulators, and health care professionals must work co-operatively to find solutions to stem the tide of addiction. Pharma- cists are committed to being a major part of the solution, and we ask for this committee’s support in combatting opioid abuse in Canada.

Réjean Leclerc opening statement:

While a lot of information has already been given out about the work of this committee, we note that so far, there have been no presentations about the situation in Quebec here. Although the crisis is not comparable, at present, to what some other regions of Canada are experiencing, we are seeing a marked increase in opioid overdoses in Quebec. The Institut national de santé publique du Québec has said that the mortality rate attributable to overdoses associated with drugs and narcotics has increased in the years since 2000. That increase primarily reflects the rise in fatal overdoses after taking opioids. From 2000 to 2012, a total of 1,775 deaths attributable to an overdose after taking opioids were recorded in Quebec, representing a rate of 2.97 deaths per 100,000 people. In addition, we have the article recently published in La Presse. According to the article, in summer 2014, Montreal was at the centre of an epidemic of overdoses linked to the use of street drugs. In the space of a few weeks, 233 cases were recorded and nearly 30 people died. It should be noted that, according to the statistics published by the Régie de l’assurance maladie du Québec, between 2011 and 2015, opioid prescriptions had increased by 29%, rising from 1.9 million to 2.4 million. The Régie also said that the number of people who received prescriptions had risen by 10%, to 377,365 people in 2015. In light of that information, some people will say there is a crisis and others will say there is not. But in any event, it is recognized that we have to continue collecting data on this subject, and even improve the work being done on that, in order to get a better picture of the situation and react better in real time. It has also been brought to our attention that initiatives have been or are being proposed. Whether these consist of training and distributing naloxone kits to friends and family of people at risk of overdosing, wanting to set up supervised injection centres, creating watch groups to do a better job of identifying cases, or the wish expressed by the Collège des médecins du Québec to extend its members’ investigative powers, the objective is the same: to significantly reduce the number of deaths attributable to opioid overdoses. Because we are dedicated to our mission of reducing mortality and morbidity among our fellow citizens, we, as paramedics, support these initiatives, as well as Bill C-224, which was introduced by the member for Coquitlam—Port Coquitlam. We believe that the chances of survival of a person who is the victim of an overdose will be better once this bill is enacted, as long as the public is informed about it. The best thing is therefore to do it as quickly as possible. Everyone agrees that paramedics provide the public with essential care. In Quebec, the responsibility for evaluating and maintaining the quality of that care rests with the physicians designated by the minister of health and social services. There is thus no professional order that governs paramedics in Quebec. Because the paramedic profession is not officially recognized, which will be the case for another several years, does this mean that, if Bill C-224 provides for an exemption from possession of substances charges for persons present on the scene when health professionals arrive, the Quebec public would not be able to benefit from that exemption when only paramedics attend to a person who has overdosed? That is the question we have on this point. 52 The Federal response to the Opioid Crisis

Subject to interpretation by the experts, should Bill C-224 be amended to reflect this situation? In addition, Mr. Chair, I would like to take advantage of the forum I am offered today to draw the attention of MPs and the public to a situation that we believe to be a matter of concern. Given the challenges inherent in the rising numbers of opioid overdoses, we would like to express our concern today about the way that Urgences-santé handles the training of paramedics in the naloxone protocol. In November 2014, when the corporation was offered an opportunity to train all paramedics in the space of a few months, we made a proposal, following the usual procedure, to promote the rapid and uniform deployment of this antidote in Montreal and Laval. To our great surprise, Urgences-santé did not act on our request, claiming budget issues. The corporation preferred to adhere to the austeri- ty vision imposed by the minister of health and social services and chose, in the middle of the opioid crisis, to train only a few dozen managers and paramedics. With only about 50 paramedics authorized to give this invaluable drug, that number being plainly insufficient, in our view, to meet rising demand, it was foreseeable that there would be unfortunate incidents, like the one that occurred and was recently described in La Presse by Dr. Marie-Ève Morin. In the case in question, an ambulance arrived urgently to find that when the paramedics arrived, they were not trained and also did not have the antidote with them that would have enabled them to rapidly reverse the effect of the drug ingested by the person suffering from an overdose. What message are we, as an emergency service, sending the public when a large majority of paramedics are unable to do what is needed when they are called out to provide care in an emergency in the hope that they will make the difference between life and death? Amending legislation to encourage the public to call 911 more often and faster is a fine thing, but if the luck of the draw results in the team of paramedics that are prepared to provide care not being authorized to act in overdose situations, we are failing in our objective and losing all credibility the first time out. Is the public better served in Montreal and Laval today? According to the figures obtained by the CBC from the ministère de la Santé et des Services sociaux in September, only 35% of the thousand paramedics we represent have been trained to administer naloxone. We have to admit that this statistic is disturbing and seems to be incompatible with the efforts and policies supported by this committee and a number of other interested parties. In our view, this regrettable situation must be publicly denounced, until this training for Urgences-santé paramedics has been completed so that they are authorized to administer naloxone in order to save more lives.

Chris Coleman opening statement:

As witnessed in the past, especially the past few months, Vancouver firefighters are on the front lines of the opioid crisis that is sweeping our city—especially the Downtown Eastside, which, for lack of a better expression, is ground zero for this epidemic—which largely results from abuse of fentanyl and even stronger opioids. Only a few years ago, police and public health agencies were warning that fentanyl abuse was a growing problem in Canada. Today, they are warning that “bionic” opioids 100 times stronger than fentanyl are coursing through the streets, finding their way into the hands of everyone, from hardened addicts to teens who are just looking to party on the weekend. Vancouver firefighters are seeing the devastating results of this first-hand. We are witnessing the tragic human toll of this crisis on a daily basis, dozens of times a day. The crisis is also taking a toll on the many agencies and workers on the front lines, including firefighters, and it’s taking a toll on the resources that our department has available for the purpose of safely and effectively protecting the public from all emergencies. To put this problem in perspective, here are some numbers. I’m sure you’ve heard them, but please let me repeat. According to the B.C. coroner’s office, the percentage of illicit drug deaths in which fentanyl is involved rose from 5% in 2012 to 30% in 2015, to 60% so far in 2016. This is moving in the wrong direction. In the first eight months of this year, Vancouver firefighters responded to 2,287 overdose incidents, an average of 286 per month, though that number spiked to 319 overdose incidents in July, and 341 in August. The vast majority of these overdoses were in the catchment of fire hall 2 in the Downtown Eastside, which earlier this month recorded over 1,000 emergency calls in a single month for the first time in our history, and it has remained at that extreme level ever since. In essence, our call volume has doubled since fentanyl entered the picture. Emergency medical response is nothing new for Vancouver firefighters. We arrive quickly on the scene of medical emergencies and use existing personnel and vehicles to improve patient outcomes in a cost-effective manner. Adding the very effective opioid antidote naloxone and the appropriate training to firefighters’ medical skills has made a huge difference in the current opioid crisis. Our medical role is also a great example of a value-added service that has a major benefit at relatively little cost. Our capacity to respond to medical emergencies such as opiate overdoses adds capacity to the existing provincially funded ambulance service. Our ability to respond quickly using existing fire department personnel and vehicles puts a trained professional on scene in a timely and cost-effective manner while freeing ambulance resources for other emergencies. But as our fire department’s resources become increasingly focused on one type of emergency within a six-block area of the city, it can only be expected that there will be impacts in other areas. Responding to the opioid crisis can tie up resources, which means fire apparatus may have to come from a nearby district in order to respond to other emergencies. This, in turn, can affect response times at a time when every second counts. Remarkably, despite booming construction and sharp population growth, there are fewer front-line firefighters in Vancouver than there were 20 years ago. Our association is working hard at the local level to advocate for increased front-line resources, which are a key element of public and firefighter safety. Our role in responding to the opioid crisis has also meant there are fewer resources available for 53 The Federal response to the Opioid Crisis fire prevention work in the communities we serve. There’s less time for the training we normally undergo on a regular basis to ensure that we are skilled and prepared to do our jobs effectively. Another consequence of the opioid crisis is the toll it takes on all those who are on the front lines and who see its results first-hand. Specifically, it takes a toll on an individual’s mental health to see such helplessness and suffering up close on a daily basis; to work extremely hard but to feel that you are having little or no impact on a problem that is growing exponentially, like a tidal wave, on the streets of your city. There is mental strain in watching a population repeatedly harming itself and in ultimately witnessing death and deceased persons who have succumbed to this human tragedy. There’s physical and mental strain in the sheer volume of responses, which ultimately affects a firefighter’s ability to recuperate between shifts. On this point I feel I must be clear. I must stress that our brothers and sisters who work in the Downtown Eastside are in trouble. They feel abandoned and they feel hopeless. In conversations with these firefighters, I hear a lot of “It’s driving me nuts” and “I can’t take it”. I’m told stories of their being in an alley with 20 or 30 drug users. They’re unprepared and untrained for that. Part of their hopelessness comes from having to deal with the same particular overdose patient who has a needle in their neck, who’s rolling around in urine and feces, more than once on the same shift. They feel abandoned and they feel hopeless. It bears mentioning that while Vancouver may be ground zero for the fentanyl crisis, it is a national problem that’s now taken root in cities across Canada. In Ontario 162 deaths were reported as fentanyl overdoses in 2015, and in Atlantic Canada at least 32 deaths, according to news reports. It is a national problem, with provincial and also federal implications, in that illicit opioids, such as the ones wreaking havoc on my Downtown Eastside, are typically shipped to Canada from destinations such as Asia, with Vancouver being an obvious port of entry. As noted, our medical response eases the burden on the provincially funded ambulance system. In that context, the committee should note that Vancouver fire rescue’s role in responding to this opioid crisis is an example of a municipal government shouldering a cost that isn’t borne solely at the municipal level, and that municipal and provincial requests for funding should be viewed through that lens when appropriate. The Vancouver Fire Fighters’ Union commends the work that various government and non-governmental agencies are doing in response to the opioid crisis. We support current social initiatives that are designed to reduce harm, ease suffering, and otherwise assist those who are struggling due to the opioid crisis. I’d like to add that I offer a unique perspective, as not only am I a Vancouver fireman but I also live in the Downtown Eastside. The people who choose to come down there to work with the severely addicted mentally ill deserve our thanks, so that’s what I’m doing. We, as Vancouver firefighters, are but one of the many groups of dedicated people who are doing what they can to alleviate this crisis.

OPIOID SITUATION IN QUEBEC

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

(Directed to Réjean Leclerc) How do you explain the fact that Quebec is not learning from experiments being done elsewhere in Canada? Vancouver is an example of that. How do you explain that in Quebec, the necessary training of the necessary number of people to do this is not getting done? You talked about that briefly, but I would like you to talk in a little more detail about the reasons that explain this situation. I am thinking about training for this in Montreal, particularly. When we look at Quebec as a whole, it seems to be disproportionate, in terms of the impact that this kind of training would have in Montreal. We agree that major centres are more affected by this problem initially.

Réjean Leclerc, Syndicat du préhospitalier:

To summarize, we are currently facing budget restrictions. Urgences-santé is a government body that is directly connected with the department. When the government changed, we had a series of cuts, including cuts relating to the opioid crisis. At the same time, there was also a crisis in 2014. You will recall the apprehension relating to the Ebola virus. A lot of resources were devoted to that dreaded crisis. At the same time, there was also the opioid crisis and a choice had to be made. It is important to understand that the plan was to provide training on naloxone later. It was planned, but for later. It might be by 2019-20. When the crisis occurred, people wanted—maybe for appearances—to train some ambulance paramedics, thinking that these people would serve the entire area. Obviously, that did not work. Even today, we are concerned because there are cuts in training. The ambulance paramedics are still not completely trained, and ordinarily, that takes only a few months. For providing this type of care, we are talking about four hours’ training. We are not talking about three weeks’ training per person; it is about four hours. The important thing is that the drug be available to victims as quickly as possible. In addition, the drug can be given without a prescription today. So that would go without saying, but on the condition that training is given. We still cannot have it being given just any way. The people have to be trained, they have to be....

54 The Federal response to the Opioid Crisis

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

We are currently dealing with the action taken by the federal government concerning health care. Budget issues always come up. Yves Robert, who is the secretary of the Collège des médecins du Québec, says that we always end up with some kind of budget and action being taken. Given the differences that exist between various regions in terms of preparation and planning, whether within Quebec or in Cana- da, what action is the federal government going to take this time, Canada-wide, to ensure that there is monitoring and some degree of uniformity across Canada when it comes to care?

Réjean Leclerc, Syndicat du préhospitalier:

Even though it is less current, I will take the example of the apprehension generated by the Ebola virus disease. Within the border services, everyone was involved. The directives and recommendations were clear. In addition, monitoring afterward was requested. In this case, the unique factor is that the crisis did not break out in the same way from one region to another. It has become national, but in the beginning, for several months, it was happening only in the Vancouver area. I think we have to go about it somewhat in the same way. The directives have to be clear and there has to be monitoring so that resources are allocated to the right places. People have to be able to adapt so that they can incorporate this kind of emergency into their plans. In any case, the directives have to be clear. At present, we are talking about it, but I have the feeling that neither the employer nor the department believes that this crisis needs to be addressed the way the Ebola crisis was at the time.

Liberal MP Ramez Ayoub (Thérèse-De Blainville, Que.):

So you support the government making regulations and giving directives to ensure uniformity in the action taken Canada-wide.

Réjean Leclerc, Syndicat du préhospitalier:

I would make a distinction between regulations and directives. I am talking here about giving directives and explaining clearly that it is important to tackle the situation, given that it is a public health problem. In terms of regulations, which I prefer not to address today, that is another matter. It is up to the government to decide how it is going to proceed. In any case, the directives have to be clear.

NALOXONE

Conservative MP Colin Carrie (Oshawa, Ont.):

I did want to start with the firefighters though. I read an article recently about one of your members, Ryan McConnell, a Vancouver firefighter from fire hall 2, who recently said, “Welcome to Welfare Wednesday in Vancouver.” He was referring to the busiest day for firefighters because it’s the day that people line up to get their monthly welfare cheques. Jason Lynch, another Vancouver firefighter said that he had to revive a 24-year-old girl twice in one month. I think all of us realize that each person has such great potential in this great country of ours, but to hear stories like this—reviving a 24-year-old twice in one month—I think we have to say that we need to do more. I do understand the importance of naloxone on the ground. Is naloxone really the solution or as Mr. Lynch stated, is it just a small Band-Aid on a big cut?

Chris Coleman, Vancouver Fire Fighters’ Union - Local 18:

It’s a great point. Naloxone doesn’t prevent overdoses. It doesn’t fix the problem. Tomorrow our chief could put a hundred more firefighters in the Downtown Eastside, but it doesn’t change a thing.

Conservative MP Colin Carrie (Oshawa, Ont.):

That’s the thing. We can make naloxone available and it may be a temporary solution, but in my opinion, it’s not the solution. A concern out there too is now that addicts know that this is more available, do you think that they may start to feel invincible, especially for young people who might be out there trying this for the first time? Is that a problem we have to be aware of?

55 The Federal response to the Opioid Crisis

Chris Coleman, Vancouver Fire Fighters’ Union - Local 18:

I feel that the problem is a health one. With or without the naloxone, somebody is going to get high. They’re addicts, and I think with or without naloxone....just living there and watching it and working there, no, I don’t think so. Addicts will continue to use because they have to use. I don’t believe naloxone has made anyone more of a superman. There was enormous risk before the stronger drugs.

TAMPER-RESISTANT DRUGS

Conservative MP Colin Carrie (Oshawa, Ont.):

– Mentioned Dr. David Juurlink from the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre. – Government is abandoning tamper-resistant opioid prescriptions.

I was wondering, does the Canadian Pharmacists Association support the use of abuse-deterrent, tamper-resistant opioids as one tactic, part of a broader national opioid strategy? If so, why? Second, would you support a regulatory move to convert the entire class of controlled-release or all opioids to the ADF or tamper-resistant formulations over a short transition period?

Philip Emberley, Canadian Pharmacists Association:

We spoke out in favour of tamper-resistant formulations a few years ago. One of the reasons was that we had a very problematic drug, namely OxyContin, that was introduced in Canada, which we all know created huge problems. As a result of that, there was a tamper-resistant formulation, OxyNEO, that was developed, and we saw this as a move forward. It was not the only solution, but it was one solution. We got some signals from the U.S. that this was going to become a pattern for all new, long-acting opioids to be introduced in this format, and we saw it as a good thing. We are still positive about this technological innovation. However, the other side is that we’ve seen an unintended consequence. People have seemingly turned to illegal sources of narcotics and opiates. They’ve gone to the illicit market. We spoke about the fentanyl prices, with illicit forms of fentanyl being introduced. It creates this whole concept of a balloon effect. If you reduce the attractiveness of one type of medication or formulation, and in fact make all narcotics tamper-resistant, it causes certain elements of our society to move to the illicit form. We have to be very careful. The short answer is yes, we still see tamper-resistance as one solution, not the only solution, but as one solution; there are some numbers out of the U.S. that say it has had some effect. However, we have to be very cautious of the unintended consequences, which may end up being even worse than what we were trying to prevent in the first place.

PRESCRIPTIONS FOR PAIN MANAGEMENT

Conservative MP Colin Carrie (Oshawa, Ont.):

Now it appears that there is a certain percentage of it which is prescribing, but a larger part of it seems to be this illegal fentanyl. You mentioned the pill presses and stuff like that. I was going to ask Mr. Blackmer about it. Your organization has known about and has been working on this issue for the past decade. What have you done to work with colleges to educate and help improve the knowledge of physicians on the ground? I see tamper-resistance as a tool. However, for a 24-year old who maybe gets a broken bone playing sports and before you know it in 30 days is an addict, what have you been doing to help educate physicians on proper prescribing, but also maybe on de-prescribing these substances?

Dr. Jeff Blackmer, Canadian Medical Association:

Those are extremely important issues for a physician. We’ve been working very closely with the regulatory colleges and with our educational colleges as well. As you know, there are a number of medical bodies in Canada that have different responsibilities for different areas. We work primarily on the production and dissemination of educational tools online and in person, across the continuum of medical education.

56 The Federal response to the Opioid Crisis

We need to do a better job of educating medical students when they take their pharmacology courses, at that foundational level, to understand the potential of opioid addiction, the different types of pain medications that can be used, and other approaches to pain management, as well as things like addiction management. However, right now there is a lot of focus on practising physicians, because of the new formulations of medications, the new types, and getting that information out to them to address exactly the types of issues you’re talking about, which are alternatives to opioid medication in certain circumstances. They can be appropriate in some circumstances but not others, then also that de-escalation of dosage, as well, to get them off the medication. We’ve been working hand in glove with these other partners to disseminate those educational products.

Conservative MP Colin Carrie (Oshawa, Ont.):

I’ve heard that prescriptions for opioids are still up by 29% this year. Is the message actually getting out there? Part of the strategy is on the criminal element, because it seems that most of it is coming from the criminal element. There need to be substantial resources there, but for on-the-ground prevention, is it getting out there if there’s a 29% increase in opioids in the last year? What more can we do? What advice can you give us?

Dr. Jeff Blackmer, Canadian Medical Association:

As in all of these discussions, it’s much more complex on the front lines if you have a health care practitioner or a primary care doctor who has only five or 10 minutes with a patient. It would be much better if they had a long time to sit down and talk through all the different alternatives for pain management. They often have a very compressed period of time and they feel very pressured to provide or renew a prescription instead of talking about the other types of alternatives that are available. As well, these front-line physicians feel that they’re under a lot of pressure to provide these prescriptions. You have people coming in demanding access to medication and saying they need it and that if they don’t get it, they’ll go into withdrawal. The physicians are feeling stuck between a rock and a hard place. What we’re seeing sometimes—and I see this in my practice—is that family doctors are saying that this takes too much of their time, it’s too difficult, and they feel under pressure from the regulatory authorities on one hand and the patients and their families on the other hand, so they’re just not going to prescribe narcotics anymore. That will be their solution. From their standpoint, they’ve handled things with their patient population, but those patients just go elsewhere. We need to do a better job of equipping that group of physicians with the tools they need to make the proper decisions, as well as the prescribers, who need more help and guidance in terms of the proper dosing and de-escalation.

NATIONAL PUBLIC HEALTH EMERGENCY

NDP MP Jenny Kwan (Vancouver East, B.C.):

Back in the 1990s, there was a declaration of a health emergency. That’s when we pushed for the first supervised injection facility. Since that time, we now have a second round with a health emergency, with fentanyl and the stats that you presented to us, Mr. Cole- man. It is indeed shocking, even for someone who has known the community for a very long time. To that end, I want to say first off on the question around harm reduction that the work you do is extremely important because, as we know, dead people don’t detox. That’s what we need to get to, and it is a medical health crisis. On that issue in terms of going forward, knowing the crisis that’s before us and that is going through the entire country, what can the federal government do to address this issue? What action do we need to ensure that the federal government undertakes to work in collaboration with the provincial and municipal levels of government, the NGOs, and the community on the ground?

Lee Lax, Vancouver Fire Fighters’ Union - Local 18:

I think, first off, we should encourage the federal government to really look at this crisis like they would any other national disaster, and they should support the municipalities. The move to making naloxone available to first responders, and primarily to firefighters in B.C., has been a great first step. Our death rates from overdoses have stabilized in the short term in Vancouver. Unfortunately, those overdose numbers continue to increase. It should be noted though that naloxone helps, but it’s first responders on the ground who are saving lives. For a person who’s addicted to an opioid, or has an overdose, to walk you through it, the person overdoses on the opioid, and respiration slows to a point where breathing stops. That then leads to cardiac arrest and then to eventually to death. It’s all about the support of first responders on the ground. Without the boots on the ground dealing with these overdoses, we’re not going to be able to save lives. Municipalities at this point are pretty well taxed on that issue.

57 The Federal response to the Opioid Crisis

I think we need to realize that this is as much a mental health emergency as it is a drug emergency. In the Downtown Eastside, almost all of the patients that our members see on a daily basis are dealing with mental health issues. They turn to opioids to relieve them from the stress of their mental illness. Opioids provide them that relief and that temporary reduction in pain. Many of these people don’t have access to proper mental health assistance. Mental health is a very strong point to this. We also have to look toward providing mental health strengthening for first responders. It’s the first responders who day in, day out are dealing with these types of emergencies. As Chris alluded to, there’s a lot of pain and suffering that our members feel from having to see this every day. We appreciate the work that the federal government has done so far in identifying occupational stress injuries. Post-traumatic stress disorder is certainly a hot topic issue for first responders that we need a national approach from the federal government to deal with.

NDP MP Jenny Kwan (Vancouver East, B.C.):

– The use of pilot projects by the federal government and the lack of funding to continue the program once the pilot ends.

Do we need ongoing support to do these programs, so that we can have effective long-term results? When people talk about treatment and prevention, you need to have stabilized housing, and you need to have ongoing mental health support for individuals who are faced with those challenges in our community, for example.

Lee Lax, Vancouver Fire Fighters’ Union - Local 18:

It’s pretty evident, you know, just walking the streets of the Downtown Eastside that there are members of society crying out for help. They don’t have the supports that they need, and they’re just looking to survive on a day-to-day basis. Being able to provide them with long-term assistance with their addictions, or with their challenges with housing, or with their mental wellness will go a long way in helping their lives.

FIRST RESPONDERS

NDP MP Jenny Kwan (Vancouver East, B.C.):

…what action can be taken to take care of the first responders and the people who are on the ground and in the front lines doing this incredible work to save the lives of others? What can we do to ensure that you have the tools you need to do your job effectively and to also support you in this incredibly challenging situation?

Chris Coleman, Vancouver Fire Fighters’ Union - Local 18:

As Lee said, it would be recognizing that it’s a national problem and helping with the limited municipal resources. As was noted, we’re quite active on the local scene trying to work with the council and the chief for more staffing, which they get a lot of push-back about. Since this is a national problem, help from the federal government would certainly help. In the short term, there’s nothing this committee can do, but I have to say my men and women down there do feel hopeless and abandoned. They’re abandoned by their own leadership. They’re abandoned by their own management team. The brothers and sisters don’t feel they’re supported. When our chief spoke at a fentanyl crisis meeting two weeks ago in Vancouver, he assured council that everything is okay as far as mental health goes and not to worry because we have a great critical incident stress management team. Well, everything’s not okay. It would be nice if they had somebody from the management team come to the hall not to say “suck it up”, which is a quote from a deputy, but to be there and to help and listen to these brothers and sisters and to listen to their stories.

HARM REDUCTION

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Dr. Blackmer, you talked about how burdensome the Respect for Communities Act is. What aspects of it, in particular, are causing problems in preventing more harm reduction strategies?

58 The Federal response to the Opioid Crisis

Dr. Jeff Blackmer, Canadian Medical Association:

There are a number of aspects, particularly the number of hoops that communities need to jump through and the barriers that are put in place in terms of the letters of support and a number of the other procedures that people need to go through. I think we all recognize that input from the community is one aspect of that decision-making process. It’s an important aspect, but obviously those letters of support from all of these layers and levels are burdensome in a way that outweighs the potential benefit to having input from that community. That’s one example; there are others as well. I would note that we recognize that harm reduction is one aspect of a full approach to this, but it’s a very important one. We also know that in communities where these clinics have been established, whereas there may have been obstacles prior to the establishment, in fact, surveys done afterward showed that in many cases those communities came to see them as being very beneficial. There are a number of aspects to the bill that while important provide more obstacles than they need to.

ABUSE OF TYLENOL 1S

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

– People were abusing Tylenol 1s since they were over the counter and were developing liver damage. – People also began extracting codeine from Tylenol 1s.

In response to that, Manitoba has made Tylenol 1s prescription only. Would that be a strategy that would be at least somewhat helpful in removing one more source of narcotics from the street?

Alistair Bursey, Canadian Pharmacists Association:

I think it’s a good strategy. In my practice we saw a lot of patients seeking Tylenol 1s, and it got to the point where we required a patient assessment by the pharmacist to see if it was an appropriate therapy, for example, for a migraine or abscessed tooth infection. Then the pharmacist would write a prescription as appropriate, and we would put it on our pharmacy system and it would be fed into the electronic health records so it could be tracked. The idea was that the appropriate patients would be taken care of, and the patients who were drug-seeking would no longer be able to gain access to it, and we would inform them of alternative therapies such as addiction services. I can certainly say what we’ve done in our pharmacy has made a big difference, and I think what Manitoba has done certainly would. I do have concerns with those patients who are getting Tylenol 1s, codeine products, for appropriate therapies. If you do up-schedule it and pharmacists can no longer prescribe it after doing a thorough assessment, I think that could be concerning, but I do think there’s an opportunity there to find solutions that take care of both parties.

PILL PRESSERS

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

That being said, given that it’s such an easy way to package fentanyl for consumption, would banning commercial pill pressers make that much of a difference, or would it just simply divert more of this to another form that makes it onto the street?

Alistair Bursey, Canadian Pharmacists Association:

As we said earlier, I don’t think there’s a magic bullet that’s going to solve all the problems, but I do think we’re going to have to use multiple different ways to find solutions. I think regulating pill presses is one solution. I think obviously there is some work to be done with this particular elephant tranquillizer, and I think as long as we try to deal in a multipronged approach, then we’ll be able to start to make some progress on improving the situation of addiction.

59 The Federal response to the Opioid Crisis

FIRST RESPONDERS, POLICE AND NALOXONE

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

My last question is for the colleagues at the Vancouver Fire Fighters’ Union. Again, I agree naloxone is a Band-Aid, but when someone’s bleeding you need a Band-Aid. Some jurisdictions have started to use police services for different forms of first response. Some American jurisdictions have had police carrying external defibrillators in their cars, calling them on 911 calls to a collapsed person. There is also talk of training police in the use of inter-nasal naloxone. Would the participation of the police in this, particularly with our new law when police are not automatically giving possession sentences now, be helpful in dealing with this disaster until we can get it under control?

Chris Coleman, Vancouver Fire Fighters’ Union - Local 18:

I think so, and that conversation was taking place at that meeting a couple of weeks ago where our chief said everything’s okay. A police officer presented as well on that very subject, so that conversation is happening. If it’s not implemented right now, I’m sure it will be.

SELLING OF PRESCRIPTION PILLS ON THE STREET

Conservative MP Rachael Harder (Lethbridge, Alta.):

I recently had a conversation with an aboriginal teenager in my community who was boasting to me—he was unfamiliar with who I was—about the prescription drugs, opioids, that he would get from his doctor, which he would then sell. He told me that depending on the drug, he would get anywhere from $10 to $25 per capsule. Basically, this is how this young man lives. He’s going to his doctor, he’s having these drug prescribed, and then he’s functioning within an illicit market. Clearly, his doctor is doing this continuously, and it would appear that there’s no accountability. This teenager doesn’t take them, so it is questionable whether or not he even needs them. I guess I’m just looking for your thoughts as to whether this is happening across Canada. Is this a common occurrence? How would we go about bringing a stop to this type of conduct?

Dr. Jeff Blackmer, Canadian Medical Association:

I can’t speak to specific statistics around that, but clearly this is a concern across Canada. The issue of patients selling prescription drugs is not unique to one jurisdiction. We’ve seen this for years. It speaks to some of the challenges that I was alluding to before at the individual patient-practitioner level. In conversation with a patient, it’s very difficult for the practitioner to say, “Oh, this seems like the kind of person who would go and sell these drugs.” You have to understand that the patient is presenting.... Some of these people are very good. If this is their livelihood, they become quite good at this. They present with a lot of pain. They present with a very convincing story, and sometimes they do this to multiple practitioners on the same day. Sometimes it’s a primary care provider, but more often it’s a walk-in clinic or an emergency room where there’s not an established relationship and it’s one-off meeting between that doctor and patient. There are huge challenges for those health care practitioners to really get to the root of some of these problems and to understand how these medications are being used. There are a number of things that can be put in place to try to mitigate that like prescription monitoring programs, so that a doctor can call up the history in real time and say, “Oh, they were just at the emergency department yesterday and they were prescribed the exact same medications they’re asking me for now.” They need more time to have those conversations and to screen for addiction potential, but also to screen for risk factors in terms of patients who might turn around and sell those drugs. Again, there’s no perfect solution to this. There are a number of things that need to be put in place. It is very challenging for front-line physicians and other health care providers to determine in very rapid sequence what will happen to those medications after they’re dispensed.

Conservative MP Rachael Harder (Lethbridge, Alta.):

It would appear to me, then, that it would make a significant difference if we were to implement a national databasing system with regard to the use of prescription drugs to tell us what’s being prescribed, why it’s being prescribed, and how often it’s being prescribed— all of those things. Would you agree with that?

60 The Federal response to the Opioid Crisis

Dr. Jeff Blackmer, Canadian Medical Association:

Absolutely, that would be hugely helpful. I think that’s one important role that the federal government can play in this area. We know people can cross borders in Canada quite easily, and we know that drug seeking happens across borders as well, so being able to access that data in real time.... It’s not enough for a doctor to find out two weeks later that the patient that they saw had been doctor shopping and had multiple prescriptions. That’s helpful for future knowledge and changing practice, but in terms of being able to address the issue of the patient in front of them, they need access to all of that information in real time. We don’t have systems like that in place now.

Conservative MP Rachael Harder (Lethbridge, Alta.):

I recently learned that in places in the United States it’s common practice for doctors to have a preconsult before prescribing. They’ll actually bring patients in, sit down, talk to them, have a conversation with regard to why the prescription is being requested, then have a separate meeting with that same patient on another occasion to do the prescribing. It’s my understanding that this basically creates a bit of a lag period, if you will, which then allows the doctor to make a good judgment, but also creates a bit of a loophole for the individuals seeking the opioid. Could you comment on whether or not you feel that this would be helpful in Canada?

Dr. Jeff Blackmer, Canadian Medical Association:

I know that there are Canadian physicians who are doing that, who are having multiple consultations and meetings at different points in time. That also has its challenges. For someone with severe acute pain who genuinely needs pain medications, asking them to come in for an appointment now and then for another appointment in three weeks—speaking to the access to primary care and access to physicians—can be really difficult. For some situations that might be very appropriate and for others it might be more challenging.

MENTAL HEALTH AND HOUSING

Liberal MP Sonia Sidhu (Brampton South, Ont.):

My question is to the Vancouver Fire Fighters’ Union. Are there any particular communities affected? As you said, it’s not a drug issue; it’s a mental health issue. What kind of education would you recommend and what kind of resources? What are your views about that?

Chris Coleman, Vancouver Fire Fighters’ Union - Local 18:

At the risk of over-simplifying, I think it’s a matter of housing and mental health support. I’m sure you’re familiar with the housing crisis in the city of Vancouver, and it gets no easier in the Downtown Eastside when a single-storey affordable bakery for the local residents is rezoned to 13 stories of condominiums with Starbucks as the anchor tenant.

Liberal MP Sonia Sidhu (Brampton South, Ont.):

For mental health issues, do you have any education perspective or any other resources?

Lee Lax, Vancouver Fire Fighters’ Union - Local 18:

To follow up on Chris’s point, what a lot of these members of society need starts with housing. Stability of housing leads to mental stability. When you’re travelling the street day to day, walking through the cold winter rains in Vancouver, you don’t have the opportunity to find mental stability. You’re just looking to survive. You’re looking for the next place to lay your head in the evening. It’s about survival. If you start with the basic needs of food and shelter, you can move your way up to dealing with mental wellness.

61 The Federal response to the Opioid Crisis

NALOXONE

Liberal MP Sonia Sidhu (Brampton South, Ont.):

My other question has do to with naloxone. I know it’s a temporary relief. Do you agree with it being available to remote, rural, northern, and urban communities, and being easily accessible?

Chris Coleman, Vancouver Fire Fighters’ Union - Local 18:

No barriers, not a prescription, there is a cost for it though.

FENTANYL

Liberal MP Sonia Sidhu (Brampton South, Ont.):

This question is for the CPhA. Do you think the over-prescribing of fentanyl contributes to the opiate crisis?

Alistair Bursey, Canadian Pharmacists Association:

I think the vast majority of the fentanyl that is causing this problem is not coming from traditional fentanyl patches that you would see for treating patients such as cancer patients. The majority of this is coming from outside of Canada in tablet form. It’s slipping through, and unfortunately it doesn’t take much fentanyl to be able to provide these people with euphoria. The majority of it is coming from sources external to this country.

Liberal MP Sonia Sidhu (Brampton South, Ont.):

We’ve heard that the number of fentanyl prescriptions has increased. Why is that?

Alistair Bursey, Canadian Pharmacists Association:

There was an increase in the opioid prescriptions. I’m not 100% sure if it’s fentanyl, morphine, or hydromorphone. Personally, in my practice, I have not seen an increase of fentanyl being dispensed, but I can say from talking to law enforcement that we’re seeing an increase in synthetic fentanyl from outside of the country. That’s primarily where it’s coming from.

Liberal MP Sonia Sidhu (Brampton South, Ont.):

We had a witness here who said that telling someone that fentanyl is a strong drug makes them want to look cool. Is that a fact?

Alistair Bursey, Canadian Pharmacists Association:

I can certainly say that in my own practice I’ve never used the phrase “strong drug” to a patient. I would say this is going to provide significant pain relief or it’s a medication that we have to be careful with. When we counsel our patients day in, day out, we want to make sure they’re fully educated on the particular medication. If it does seem that it’s an inappropriate medication, we consult with physicians and prescribers to make sure that we keep patients safe.

NALOXONE

Conservative MP Len Webber (Calgary Confederation, Alta.):

I do want to focus right now on our first responders and get some more specifics on the administration of the drug naloxone. What exactly has to be done in order to administer it to a patient? Is it an injection into a vein? I hear there’s a nasal spray out there now that you can use. Can you just describe how you administer it to your patient?

62 The Federal response to the Opioid Crisis

Chris Coleman, Vancouver Fire Fighters’ Union - Local 18:

The first responder arriving on the scene would have to establish the patient’s level of consciousness, and determine that there is an overdose. Usually there are good signs because there are needles close by in an alley to determine that. Then a little pain stimuli to see if you can arouse the person. You would next assess and assist the breathing and then we have a small vial that we load the needle with and it’s an intramuscular injection. I’m not sure of the dose. Sometimes you’d have to do multiple injections, but when the naloxone does take effect, you have a patient coming out of their high in 20 seconds and often quite upset you’ve taken their high away.

Réjean Leclerc, Syndicat du préhospitalier:

In Quebec, the situation is different. In cases like these, we use a vaporizer. The drug is drawn from a vial and put in a syringe, and a vaporizer is added to that to administer the drug through the nose. The patient then has to be monitored. Withdrawal is virtually instantaneous. The patient may be very agitated, and the sort of aggressiveness associated with that new state has to be controlled. An electrocardiogram is necessary as part of the monitoring. Depending on the quantity of drug absorbed, the antidote stops having effect after 30 to 40 minutes. If the person is still under the effects of opioids, they can relapse into an overdose. So every time, the patient has to be monitored for about 30 minutes and taken to hospital quickly.

Conservative MP Len Webber (Calgary Confederation, Alta.):

Mr. Leclerc, you had mentioned that in order to administer an EpiPen of naloxone that there’s a four-hour training program that needs to be done in order to learn how to administer this drug. I find that surprising that it would take four hours to be able to work an EpiPen.

Réjean Leclerc, Syndicat du préhospitalier:

For this drug, the training takes about four hours.

SUPERVISED INJECTION SITES

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

Dr. Blackmer, how many safe injection sites do you think we would need to contain this epidemic, and would they be helpful in future crises too?

Dr. Jeff Blackmer, Canadian Medical Association:

I don’t think we have information on the exact number that’s needed. I know that different municipalities have looked at their own individual needs. Certainly here in Ottawa we’ve had a number of conversations that perhaps more than one would be appropriate for our population. They’ve done some analyses in cities like Toronto and Montreal, and in other urban locations as well. I think the point to understand with this is that the harm reduction piece, which would include supervised injection sites, is one part of an overall strategy to combat opioid addiction. It’s not a panacea for this entire issue, as we’ve heard before, but it’s one aspect that deserves some further attention and I think support as well.

HARM REDUCTION

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

What other avenues could we explore, in your opinion, to alleviate this crisis?

Dr. Jeff Blackmer, Canadian Medical Association:

There are a number of pillars. There’s the prevention piece, which we’ve heard about, and education for physicians and other care providers in looking at alternatives, with different types of pain management initiatives and interventions. There’s the treatment for 63 The Federal response to the Opioid Crisis patients who are addicted, whether that’s detox, which does not work very well for narcotic and opioid addictions, or whether that’s substitution therapy with things like Suboxone. Then there are the prescription monitoring programs, which are a very important aspect of this. Again, addressing any one of these issues will lead to unintended consequences, as we’ve already heard. We need a national strategy—we’ve heard a little bit about what that could look like—that will address all of these types of issues. Whether it’s the availability of naloxone at the front line, better education of care providers, or harm reduction strategies, it needs to be multi-faceted.

FENTANYL

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

In your opinion, should legislative barriers be addressed to facilitate individuals to test their own drugs for fentanyl or possibly other substances? If yes, how should the drug test kits be made available to people who use drugs? Do you think this will help alleviate the overdose problem?

Dr. Jeff Blackmer, Canadian Medical Association:

I think that would be one part of an overall strategy, to be able to identify those substances and act accordingly. I think many Canadians have been quite shocked to hear some of those statistics that fentanyl is making its way into other substances through this means. We’ve heard about importation from foreign countries. I think testing these substances makes a lot of sense, but as one part of an overall strategy.

ROLE OF PHARMACISTS

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

Mr. Bursey, what role can pharmacists play in identifying and treating individuals with substance use disorders?

Alistair Bursey, Canadian Pharmacists Association:

Pharmacists often are the eyes and ears of physicians on the front lines. We see patients, especially addiction patients or patients who are receiving pain medications, many times throughout the year. In New Brunswick, the average number of visits by a New Brunswick- er to a pharmacist is 16 times a year. It’s a great opportunity for identifying and for collaborating with our physicians on our addiction programs to find solutions and make sure that these patients who are in the throes of addiction can get treatment. I think pharmacists play a key role in collaborating with other health professionals.

NATIONAL PUBLIC HEALTH EMERGENCY

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

Mr. Emberley, you were quoted last year as saying that this is really a disaster that’s happening all across Canada. We’re hearing that again and again here. In your view, is the opioid overdose crisis a national emergency?

Philip Emberley, Canadian Pharmacists Association:

I believe it is. At first we were hearing of it in pockets. We were hearing that it was a problem in Vancouver, and maybe in the Prai- ries as well, but every community has been affected by this. Working in a pharmacy, we see it. I see in the west end of Ottawa, where I work, that there’s a certain population that has been profoundly affected by this. We see people getting into trouble with medication. We see people coming in early for their opioid prescriptions, and there’s a sense that they’re getting out of control with their own personal use of these medications. It is definitely a national problem; no community is unaffected. For that reason, I believe we have to treat it as a national crisis.

64 The Federal response to the Opioid Crisis

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

Mr. Blackmer, we really appreciate the advocacy that your group is doing. I note that the Government of Ontario recently appointed an overdose coordinator. This is the first province that has taken that position, to put someone in the role of developing surveillance and reporting systems, to gather data on overdose deaths and to make informed decisions about patient care. Do you believe that the federal government should follow suit by tasking our chief public health officer with coordinating a national response to the opioid overdose crisis?

Dr. Jeff Blackmer, Canadian Medical Association:

I do absolutely, and I think there’s a lot that the federal government can learn from what’s being done at the provincial level. You alluded to whether or not this is a national emergency. British Columbia has declared a provincial state of emergency, which it has done primarily to have access to some data that it would not otherwise have, not just on deaths by overdose, but on the actual number of overdoses. I think there’s a lot the federal government can learn by looking at what some of the individual provinces have done and instituted, and then trying to roll that out at the national level.

OCTOBER 6, 2016

ON THE AGENDA The Committee resumed its study of the Opioid Crisis in Canada. The Committee proceeded to the consideration of matters related to Committee business. A motion put forward by Liberal MP Sonia Sidhu (Brampton South, Ont.): and amended, that, pursuant to Standing Order 108(2), the Committee call upon the Minister of Health to move as quickly as possible to conduct a review of the laws and regulations in place with regard to supervised consumption sites; that the Minister be obligated to report back to the Committee on the result of her review; and that this review have as an end goal to improve the health and safety of Canadians, using a strong, evidence-based approach, was carried. Main topics discussed: naloxone, overdoses and deaths, education and prevention for young Canadians, social media campaigns, fentanyl, addictions treatments, supervised injection sites and harm reduction, national public health emergency, prescriptions, drug use demographics.

WITNESSES British Columbia Coroners Service • Lisa Lapointe, Chief Coroner Office of the Provincial Health Officer, British Columbia • Bonnie Henry, Deputy Provincial Health Officer, British Columbia Sunnybrook Health Sciences Centre • David Juurlink, Head, Division of Clinical Pharmacology and Toxicology Drug User Advocacy League • Sean LeBlanc, Founder and Chairperson • Catherine Hacksel, Coordinator

TRANSCRIPT HIGHLIGHTS

Lisa Lapointe opening statement:

I’m going to tell you a little bit about the coroners service’s investigation so you have a bit of an understanding of how we gather this information; some highlights from the data; information on the collaborations we’ve developed in B.C. in an attempt to reduce the number of deaths that are happening; and then some of the strategies we’ve developed moving forward. One of the key points is the importance of thorough death investigations. If you’re not doing the investigations and gathering the information, of course you don’t know that you have a problem. That sounds very much like common sense, and I’ll talk about that in a minute. Then there is strategic surveillance. Again, if you’re not doing the surveillance on the deaths, you don’t know you have a problem. It’s interesting to see across the country the different surveillance and reporting that’s happening on these types of deaths.

65 The Federal response to the Opioid Crisis

The B.C. Coroners Service has 90 coroners across the province. The coroners actually respond to all sudden, unexpected deaths, so they go to the scene of death and do a thorough investigation, which includes an examination of the deceased, an examination of the scene, and then a collection of the medical history of the deceased. That information is critical in determining next steps. If you don’t have the suspicion that this death may be linked to drug use, then you won’t order the appropriate testing and you won’t have the appropriate results. That sounds really like common sense, but it’s really important to do a thorough scene investigation of each of these sudden, unexpected deaths. The coroners work 24-7, and that’s important. People die all over the province at different times. We have a very clear investigative protocol, which ensures that consistent information is collected on every death. Again, that is critically important if you’re looking for patterns. We also have in B.C. a dedicated research unit. Again, that seems to be a matter of common sense, but unless you make a decision to do surveillance on a type of death, you won’t have the data. Across the country this varies, with every province and territory doing something different. In B.C., we decided to do some pretty focused surveillance on our drug deaths, which has resulted in the data that we now have and been able to share publicly. Those strategic decisions really can be made death investigation by death investigation and province by province, and they will vary across the country. Something I want to talk about is how we have always heard the term “overdose”. In my coroners service we are starting to shift our terminology, because “overdose” suggests that there’s a safe dose. It also has a bit of a pejorative tone, implying that perhaps if the user had used the right dose, they wouldn’t have died. In fact, that’s really misleading, because for many of these drugs, there is no safe dose. “Overdose” suggests that there’s a safe dose; there isn’t. We really want to move away from that, so our reporting from now on will no longer talk about overdose deaths. All of these illicit drugs, the opiates and the non-opiates, are manufactured in very suspect circumstances, and you never know what’s in the substance that you’re taking. I also wanted to make clear that I know that the meeting today is focused on the opioid crisis, but the deaths we’ve been reporting are related not just to opioids. While B.C.’s reporting on illicit drug deaths includes opioids, such as heroin and fentanyl, for example, it also includes other illicit drugs, such as cocaine, MDMA or ecstasy, and methamphetamines. The high numbers of illicit drugs, which are going up month by month, include all of those substances, not just opioids. They also include prescription medications that have been diverted; there is a small market for people selling their prescription medications, but we’re not seeing a lot of that in this crisis. Again, toxicology testing is critically important. If you haven’t identified that illicit drug use or any substance use may be a factor in the death, then you won’t order the appropriate testing. That again speaks to the importance of the initial investigation and then the toxicology testing. We have in British Columbia something called “expedited” toxicology testing, which means our provincial toxicology centre will give us results within 48 to 72 hours. That doesn’t happen elsewhere in the country. I’ve spoken to my colleagues, chief coroners and chief medical examiners across the country, and they don’t have that ability. That expedited toxicology, the ability to get information back from the lab very quickly, is really key in getting the messaging out in a timely manner. As I think you know, British Columbia so far, to the end of August, has had 488 illicit drug-related deaths. That compares with 505 for the whole of last year. Just to give you a bit of context, in the whole of last year British Columbia had 300 motor vehicle incident fatalities. This epidemic of death is much more significant than the deaths we’re seeing on our roads, which we have numerous strategies in place to try to resolve. We’re seeing approximately 61 deaths a month due to illicit drugs. If that number continues to the end of the year, we’ll have 732 deaths in 2016. That’s quite a significant increase. The significant rise started in 2012, which is, ironically, when we first saw fentanyl appear on our horizon. Although we’re seeing deaths among all ages, the deaths we’re seeing primarily are among males between the ages of 19 and 39. Most of the deaths involve those who use illicit drugs habitually, but we have seen deaths of recreational users, such as people who all use drugs at a party. We’ve had situations, in fact two or three in the last couple of months, where five or six people at a party “overdosed”, for lack of a better term, became very ill, and were treated. In most of those cases they’ve all survived. although we’ve had one or two fatalities. Generally, then, it’s the people who use drugs habitually that we’re seeing among the deceased, but we are also seeing some recreational users. As well, a number of people who use drugs quite consistently are what we would call “high-functioning users”. That sounds pejorative, and I don’t mean it to be, but it’s people who go to work, hold steady jobs in all sorts of occupations, and routinely use illicit drugs. That’s a fairly significant population as well. Most of the deaths we’re seeing involve mixed substances. Very few involve just heroin, or just fentanyl, or just cocaine. In fact we looked at 207 results recently, and 96% of those were mixed-drug deaths. Cocaine was involved in 46%, alcohol 36%, methamphetamines 34%, and heroin 30%—and that was with fentanyl. The proportion of illicit drug deaths where fentanyl has been detected has grown substantially since 2012. We saw 5% of our illicit drug deaths in B.C. involving fentanyl in 2012. That’s up to 60% in 2016. That’s a significant increase. That’s not to say that fentanyl is the cause of all of those deaths, but fentanyl was detected at varying levels in the toxicology results of all of those deaths. If there were no fentanyl, we don’t know how many deaths we would see. If we removed all the fentanyl deaths, we would have at least 200, but our numbers for previous years suggest that it would be between 200 and 300. The involvement of fentanyl appears to be doubling the deaths we’re seeing.

66 The Federal response to the Opioid Crisis

I won’t spend any time talking about what fentanyl is. I think you know that it’s a synthetic opioid traditionally used for pain management. It’s become increasingly prevalent on the illicit markets, brought in from other countries, primarily Asian countries, but also manufactured in clandestine labs in B.C. When you think of a lab, you tend to think of white coats and sterile circumstances. In fact these labs are people’s kitchens and people’s basements. They are quite random, in a way. They’re trying to measure substances appropriately, but they’re blending them in juice blenders and Mixmasters. The compounds are by no means secure or safe. These labs are often, as we can see with the number of deaths, getting their mixtures wrong. The police are well aware of that. They’re finding fentanyl in pill form and in liquid form. It’s used in a variety of ways. What we’re experiencing in B.C. are deaths due to illicit drugs, including a significant percentage due to fentanyl. We’re often seeing unsuspecting use. People think they’re purchasing cocaine, for example, and it’s laced with fentanyl. They’re either becoming very ill and being treated and surviving, or they’re dying. We found a paradox with warnings. We’ve tried to work closely with our police community on this. The language around this epidemic is very important. We’ve had our law enforcement partners often wanting to go out and say “There’s very strong heroin on the street”, or that fentanyl is “very strong” or “powerful”, but those words can be triggers. Paradoxically, we now have people actively seeking fentanyl because of the bigger high. It’s really important to remember that we should be talking about the risks and the toxic effect, but not necessarily that this is a more powerful drug or a stronger drug. I’ll wrap up. One of the really important things is the messaging. We’ve gone out with public messaging and talking about what to say and what not to say. In B.C., we’ve adopted a harm reduction approach. Shaming and blaming does not help. We want to ensure that people, if they’re going to use, have medical assistance nearby. That’s the biggest message that we’re giving: “Don’t use alone, but have somebody there who can help you out if get into trouble.” We have a multi-sectoral partnership. If not for the collaboration of a variety of groups, we wouldn’t have been able to approach this crisis the way we have. We have BC Ambulance, the health communities, the corner service, law enforcement, and the labs all working together to try to collaboratively come up with solutions. One of the changes that BC Ambulance has adopted is a policy not to call police every time they respond to an overdose. Again, the emphasis on encouraging people to ask for help, as opposed to being afraid they’re going to be arrested or that somebody is going to be in trouble. It’s that the shift toward preventing deaths. Thank you.

Dr. Bonnie Henry’s opening statement:

This response, as our coroner indicated, has been across the health sector and public safety in B.C. This is the first time that we have used the Public Health Act in B.C. to declare an emergency. The provincial health officer, Dr. Perry Kendall, declared an emergency on April 14 of this year, when we started to see the dramatic increase in the number of people who were dying from these overdoses. What that allowed us to do was to collect information that we couldn’t necessarily receive without this order, and it allowed us to get information in a more timely and detailed way. One of the things we needed was to understand a little better who was being affected by this. The data we collect on people who are surviving overdoses is really important in helping direct our programs and our response to this as well. We have started to receive data from emergency departments, from 911 calls, and from our ambulance service about people who are surviving overdoses. That has helped us look at how we can make naloxone, for example, more available. I’ll talk about that in a minute. In June, we had an overdose action summit, where we had people from public safety, law enforcement, and the health sector, as well as people with lived experience and people who use drugs. We had a lot of brainstorming about the things we can do to address the death crisis we are dealing with, but also, longer-term, to address the whole issue of over-prescribing opioids and the other factors that have led to some of the issues. We have developed new guidelines for prescribing opioids that came out of the College of Physicians and Surgeons of British Co- lumbia. Those are being looked at across the country. With the help of the federal government, we’ve made it easier for doctors to prescribe Suboxone, which is a combination opioid substitution treatment that allows people to get away from the use of illicit drugs and gives them the opportunity to take a different path. In July, the premier appointed a joint task force with health and law enforcement that is co-chaired by Dr. Perry Kendall and Clayton Pecknold, our chief of police services in B.C. A couple of things happened after that. As you may be aware, InSite, which is one of the only supervised injection service sites in Vancouver, a stand-alone site in Downtown Eastside, expanded its hours because of the data we were collecting, which showed peaks in overdoses and deaths around certain periods of time. We launched a public awareness campaign, because, as indicated, it is not just about people who are using drugs on a regular basis. There are many different populations being affected, including people who are prescribed opioids for very valid reasons, but in very high doses, and who overdose on those. One of the big successes we’ve had is expanding our take home naloxone program. We started that program in B.C. about three years ago, in 2012. We have now distributed over 13,000 free naloxone kits. These are for people who use drugs to help each other, and many

67 The Federal response to the Opioid Crisis overdoses have been survived because colleagues, friends, or family members have used naloxone. Now, thanks to the delisting and approval of nasal spray naloxone, we have police departments, fire departments, and emergency departments now providing naloxone and using it to help. Just in September, naloxone was deregulated, so now it does not need to be prescribed by a pharmacist, and we can distribute it through many of our public health distribution places across the province. This slide is the data that the coroner described, from which we’ve seen a dramatic increase in overdose deaths in the last two or three years. The final column on this page, on the far right, is just until the end of August 2016. As you can see, we are on track to far exceed the number of deaths that we saw last year. This reflects the number of deaths; it does not reflect the fact that we’re seeing -hun dreds of people in emergency departments across the province who are surviving their overdoses. That is a critical period of time when we can intervene, and a place where people at the very least can get naloxone and training on how to use naloxone. It’s an opportunity to get connected, where they might be amenable to taking another path away from drugs. I’m going to show a series of maps that we put together once we started collecting more detailed data on where overdoses are occurring in B.C. This is to give you a sense of why there has been such an across-government and across-province response. This is rates by population. The darker the red, the higher the rates. This is from the distribution of illicit drug overdose deaths in British Columbia in 2016, from January to March. The comparison is with 2010. In 2010, what we used to see, and what people typically think of, were overdoses in the Downtown Eastside in Vancouver. But we’re now seeing it happening across the province in communities everywhere in B.C., in the north, the interior, the Island, not just the Downtown Eastside in Vancouver. In Vancouver, it’s not just in the areas that we have seen it in the past, but all around Vancouver. People are dying in public places and in their private homes. This is some of the information that Lisa presented as well, just in a pictorial form. It shows you the percentage of these illicit drug deaths where fentanyl has been involved. It has dramatically increased from less than 5% in 2012 to over 60%, but as she indicated, these don’t happen in isolation. Alcohol is very frequently a factor, and other drugs as well. It has been somewhat alarming in that most people we hear from are community members who are partners in this response, and they say there’s very little heroin left in B.C. It’s all illicit fentanyl. It’s much more easily imported than heroin because you need such a small amount, and drug dealers are looking at maximizing their profits. It’s easier for them to manufacture it and bring it in than heroin, so there’s very little heroin left. More disturbing, we are now seeing it being mixed with stimulants like cocaine. People do not necessarily expect to find a depressant, like opioids, like fentanyl, mixed with those drugs. They’re not necessarily prepared and that’s where we’re seeing clusters of overdoses in people who are weekend users of cocaine, for example, where they don’t have naloxone or the training about what to look for and how to respond. As indicated, most of the deaths that we’re seeing are of young men, many of whom had been using drugs for some time. It’s really a case of roulette, if you will. If you’re using on a regular basis, your chances of getting a toxic dose of fentanyl just go up that much higher. Every day that we can keep people alive is a day that they may move on a different path. This is a description of how we have organized our response. We have a joint task force that reports up to our Minister of Public Safety and Solicitor General, and the Minister of Health. It’s chaired by Dr. Kendall and Clayton Pecknold, the director of police services in B.C. We have a large group in the middle of that pink box of people who are stakeholders in this response, from law enforcement and health to people with lived experience, including families of drug users, the drug-using community, people who use drugs. They give us very valuable advice about the issues that are happening on the street, and also about our response, what makes sense and what doesn’t make sense for them. It’s been an invaluable group to help us in shaping what we can do. Then we have a number of task groups, and I’ll talk about some of the things the task groups are working on. Our immediate three- month work plan has a number of specific issues. One of the biggest things we wanted to initiate was to expand the reach of naloxone. Its deregulation at the federal level so that it is now a non-prescription substance has been a huge help for us, because we now have an inter-nasal formulation available. It’s particularly useful for law enforcement, who didn’t feel comfortable using the injectable form. Most of it is the injectable form, and we have a lot of good evidence that the injectable form works well. People can very easily learn to use it. We have some videos that we’ve developed for young people in particular that are entitled, “Naloxone Wakes You Up”, which tell them how to use it. We’d be happy to share those with people. We’ve done a lot of work around opioid substitution treatment, making it more available and teaching physicians how to use it, particularly Suboxone, which is a much safer form of opioid substitution treatment, delinking it from the methadone programs that we’ve had in the past. We’ve also expanded its use to the nursing practice so that nurses can monitor opioid substitution treatment as well.” “Some of the other things we’re expanding are around drug checking, the ability for people to check their drugs to see if there’s fentanyl in them prior to taking them. There are some legislative barriers to those. We are doing monitoring and surveillance, increasing our access to supervised consumption services around the province—and again, there are some legislative barriers at the federal level, which it would be helpful to us if they were addressed. Also, we are doing quite an extensive public education and awareness campaign around licit fentanyl and what to do about it. This is just a graph that shows the number of naloxone kits we’ve distributed in the province. To sum up, there are a couple of things that we would like to bring to your attention. The province would like support in expanding our supervised consumption services. In particular, the Respect for Communities Act has a number of barriers that are quite extreme that we would like to see reduced or eliminated. We understand there’s a need to make sure that these safe consumption services are

68 The Federal response to the Opioid Crisis developed in a way that is safe and that has community support. We have ways of doing that which we think can meet the spirit of the bill without the extreme barriers that the bill puts in place. We would like to work with the federal government to ensure granting of exemptions under the Controlled Drugs and Substances Act for the purpose of drug checking, which is something that we think can be an important service in helping people understand what they’re taking prior to taking it. We want to increase the availability of treatments for opioid use disorder, particularly some of the longer-acting, more effective treatments that are available south of the border. We know that some people in B.C. aren’t able to access these south of the border.

Dr. David Juurlink opening statement:

In the early 1990s, I was a pharmacist in Nova Scotia. I trained there, and during medical school and my internship I practised as a pharmacist. I worked in about three dozen pharmacies across the province. It was the case then that when patients came to the pharmacy with a prescription for morphine, they had cancer. By the late 1990s, when I was finishing my internal medicine training, things had changed quite a lot. We saw OxyContin—a drug that is 1.5 to two times more potent than morphine—prescribed very liberally for chronic back pain, hip pain, osteoarthritis, fibromyal- gia, and you name it. It was even doled out for minor ankle injuries. This happened because physicians were taught that it was safe and effective to use opioids for chronic pain. Most physicians had no reluctance to give opioids to patients at end of life or to patients whose femur was sticking out of their leg, but the chronic-pain market was huge, and every day doctors were faced with patients with pain and we had reluctance to use the other drugs at our disposal. Acetaminophen—Tylenol—just doesn’t work very well. The other drugs—anti-inflammatories—had all kinds of horrible side effects. We’ve all been burned by patients who had bowel problems or kidney problems as a result. So the message that we could use these drugs, and we should use these drugs more liberally, was one we were quite happy to hear. The important thing to realize is that that message came directly and indirectly from the companies that make these drugs, and that have subsequently earned tens of billions of dollars from selling them. They sent drug representatives to doctors’ offices, but there was much more than that. Key opinion leaders in the field of pain all across North America gave talks at CME events, continuing medical education events, at fancy restaurants. I went to them myself and I was told that not only should I use these drugs, but also that if I didn’t use them, I was being “opiophobic” and was depriving my patients of a proven therapy. The virtues of these drugs were extolled. The companies made their way in some instances—including at my own medical school—into the curriculum where individuals in the pay of the companies that make these drugs taught medical students for years without disclosing their conflicts and gave them overly rosy views of the utility of these drugs. As I said before, for many of us, this was a message we were quite happy to hear. We now, however, realize with the benefit of hind- sight that we should have known better. I can tell you that there are no good studies showing that opioids used in the long term improve patients’ outcomes. The overarching goal when I prescribe a drug to a patient is to give more benefits than harms, and there’s never ever been a study that shows that in the long term this happens. Most of the studies, by the way, go for eight or 12 weeks. They involve very carefully selected patients who have no risk factors or as few risk factors for addiction as you can find. They’re not on benzodiazepines. They have no mental health problems. They have no history of having had trauma as a child. They show that over a couple of weeks these drugs lower pain scores. The fact that there are no long-term studies didn’t stop Health Canada and the FDA from approving these drugs for long-term use, and we’ve now seen what amounts to a 20-year experiment on the population. We’ve seen and we know that the beneficial effects of these drugs very often wear off, and increasing the doses doesn’t solve this problem; all it does is add to the toxicity. Virtually everyone who takes these drugs daily is dependent on them, making for a self-perpetuating therapy. You can’t stop these drugs. Even if the pain-reducing effects have worn off, stopping the drugs will make you sick and it will lead patients to perceive that the drugs are needed. Patients need the drugs just to feel normal. Critically, we were taught that addiction was a rare consequence of using these drugs long term. I remember hearing these words: less than 1% of patients will become addicted. That’s not true. The best estimate at the moment is somewhere in the order of about 10%. Just imagine that: hundreds of thousands of patients in Canada are on these drugs as a result of well-intentioned prescribing, and 10% of them may be spiralling into addiction. We also know that high doses kill people. I can’t tell you how often I see patients coming under my care who are on hundreds of milligrams of morphine or the equivalent. We did a study in 2015 that made it very clear that people on high doses of opioids were more likely to die from their medication than from almost anything else. When we talk about addiction and death, there’s a lot more to it than that. The death toll in Canada, as I’m sure you’ve already heard, is not known. It sounds as if B.C., with a population of about 4.7 million, is on track for about 700 deaths. That places it up there with Alabama, the worst state in the U.S. in terms of rates. You can think about it differently. We published a paper in 2014 that looked at deaths in Ontario, and we found that one out of every eight deaths of people aged 25 to 34 involved an opioid. That’s a staggering number. When you total the deaths from opioids in Ontar-

69 The Federal response to the Opioid Crisis io—remember, these are people dying in their twenties and thirties and forties who should have lived to their seventies and eighties and longer—the total years of life lost is somewhere in the order of one-thirteenth of all years lost from all cancers combined. There are other harms here as well. People driving under the influence of opioids are at risk of collisions. We’ve shown that convinc- ingly. There are falls. I see older people all the time who are on opioids for chronic pain—often not benefiting, as far as I can tell—who fall and break hips and necks and have head injuries. There is constipation. It sounds like an annoyance. I have had more than one patient die under my care from constipation caused by these drugs. It might seem counterintuitive, but these drugs can worsen pain. As the doses go up, the pain gets worse because of the drugs. These drugs disrupt sleep. I am convinced they cause depression in some people and cause them to commit suicide, and those suicides are very often blamed on the pain rather than the drugs themselves. There are other epidemics here like neonatal abstinence syndrome. In Ontario, from 1992 to 2011, the number of babies born dependent on drugs went up 15-fold. That’s just from the prescribing. The proliferation of tablets from our well-intentioned prescribing of drugs has left every medicine cabinet in Ontario with some opioids. It’s a bit of an exaggeration, but those drugs are there for people who might want to experiment, 16- or 17-year-olds who are curious and find themselves spiralling into addiction. The epidemic has transformed over the last couple of years, as you’ve been told. It’s not just about OxyContin and Dilaudid, and so on. It’s now about fentanyl and heroin. Those drugs have been used for a long time, but a market has been created in response to our well-intentioned prescribing, a market that did not exist to anywhere near the same degree in the early 1990s. This was a crisis that was largely created by physicians, and it has to do with the fact that opioids, once started, are hard to stop. It was exacerbated in 2012 by the reformulation of OxyContin. Purdue took off their old product, put on a new product that was tamper resistant, and we found a lot of people going to heroin and fentanyl as a result. This can’t be overstated. You can get a kilogram of fentanyl from China for $10,000 or $20,000. It fits in a shoebox and you can turn it into $20 million of profit. That’s not ending up, as you’ve heard, just in heroin. It’s ending up in fake OxyContin tablets, cocaine, meth, in fake Xanax tablets. The scope of the problem in Canada is completely unknown. We know that in the U.S., the CDC estimates that over the last 20 years, about a quarter of a million people have died from opioids, more than half of them from prescription opioids, and about 2.1 million people in the U.S. suffer from addiction. We have no corresponding numbers in Canada. I speculate that somewhere in the order of 20,000 Canadians have died over the last 20 years from these drugs. The fact that no federal politician can tell you that number is a national embarrassment. This is the greatest drug safety crisis of our time, and it’s not hyperbole to say that every one of you knows somebody with an opioid use disorder. Whether you realize it or not, you do, and it’s quite possible that you know someone who’s lost a loved one to these drugs. Yet the Public Health Agency of Canada has been largely silent on this issue, despite its mandate “to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health”. Go to their website, search fentanyl, and you’ll find almost nothing. Health Canada seems to have largely handed this file to CCSA, which I think is a good organization and has all kinds of potential, but it’s not adequately resourced and it’s not focused exclusively on opioids. It has alcohol and other drugs under its consideration. It feels very much as if no one is really in charge of this file and everyone is keen to pass the buck to someone else. Only recently we’ve begun to see some federal leadership on this issue with the hastening of the move of naloxone to non-prescription status; reducing barriers to safe-injection sites, which are very important; and this upcoming summit in November. To solve this problem, I think the response needs to be collaborative, proportional to the scale of the problem, and urgent. If 30 or 40 Canadians were dying every week from the Zika virus, your hair would be on fire with the scope of the problem. I mean, this is actually what’s happening now. We need timely surveillance, and not just in B.C., which is the only province that is doing it in a timely fashion. We need it everywhere, and not just on deaths but on non-fatal overdoses as well. Naloxone saves lives, and it should be everywhere. It should be in corner stores and gas stations for free. Health Canada has good grounds to revisit its decision, its indications, for these drugs. There has never been a study, as I said, that shows that these drugs are safe and effective for chronic pain. I think that the label, the indication, should be revised, and when doctors choose to prescribe these drugs for chronic pain, they should do so off-label, without an official endorsement from our national regulator. We can give serious thought to removing market approval for the highest-potency drugs out there: the fentanyl patches of up to 75 and 100 micrograms, OxyNEO 80, and the highest formulations of Dilaudid. The provisions under Vanessa’s law give the minister the power to do exactly that. We need to change how doctors prescribe. Doctors need to start these drugs much less readily, and escalate doses much less readily than they have. A whole generation of doctors has lost respect for these drugs. We do not see this as we did 20 years ago. The education of physicians is important, but it is not going to solve this problem on its own. It has to be detached completely from industry, and from pain specialists who take money from these drug companies. You’ll see new prescribing guidelines for physicians coming out early next year. I’m on the steering committee for that, and I think that will be helpful. However, the fewer patients who start on these drugs the better. The patients who are on very high doses need to be de-escalated cautiously and closely. 70 The Federal response to the Opioid Crisis

We have a large swath of the population with addiction. I think it is very important that we perceive this as a public health problem and not a criminal one. When somebody steals from a pharmacy or holds up a store, it’s not because they’re a bad person, but a person who needs help. Many of these people want out. They need rapid access to opioid substitution therapies, like Suboxone. They need access to supports. We need many more clinicians who know how to treat these people, and ready access to them. We need safe injection sites. I think the point has been made that the Respect for Communities Act poses a major barrier to the construction of these sites. I will leave you with one last point. This is not your usual epidemic. No one has ever argued for more Ebola, more Zika, or more influenza. There are forces at play that will argue that physicians should not prescribe differently, that we need these drugs for chronic pain, which, I think, is exactly the wrong message. Those sorts of oppositional comments need to be disregarded.

Sean LeBlanc opening statement:

DUAL is a non-profit that was founded in 2010. It neither condones nor condemns drug use, but sees it as a facet of everyday society. People are going to use drugs, and we just try to best educate them about that. We have several services, some of which Catherine runs, with a couple of drop-ins. It’s basically to provide a voice for people who do not have one. I am someone who has survived an addiction to opiates. I used opiates for about 15 years. It’s not a pleasant thing; it certainly isn’t. Coming off of these drugs is extremely, extremely hard. I had pretty well a normal childhood and everything. The last thing I thought I would ever be was someone who would inject opiates. Unfortunately, I suffered through a few traumas during my teenage years, and I just wanted to end the pain. That’s one thing that I will give credit to opiates for: they help you to numb the pain, not in any healthy or helpful way, but for someone who’s really hurting, opiates do deaden that pain. My life pretty well spiralled after that. I ended up homeless, with not much self-worth. I guess I have kind of a stubborn streak, and thankfully, around 2010 I started to do some advocacy, and founded DUAL out of that. It was basically the lack of inclusion that really made me want to start DUAL to create a voice for people. I started being on different committees and everything like that. I’d always see some great doctors and police officers and epidemiologists, but there were never people who actually used drugs on those committees. If they were there, it was usually in a really tokenistic way. This is why I’m so thankful to be invited here today. These offers don’t usually come around. I think the best way we can get results in this crisis is by working in conjunction with each other—doctors, coroners, police officers, and, more so than anybody, people who use drugs, because they really are the experts on this. The Oxy crisis started right around 2010 in Ontario. As my fellow panellists have alluded, it created this whole desire, this need, for fentanyl and heroin. The drugs have gotten so much stronger, and so many younger people are using them now, it’s really, really scary. I think we don’t want to get too far into that, though. These drugs do play a really good role in the lives of some people, those who are really suffering from great pain. I’ve known people who cannot get relief from that pain through an opiate prescription because of the stigma associated with using these drugs. Again, I’m not condoning them or anything, but they do fill a role in our society. Some people need them, and I don’t think we want to get too far away from that. I’ll just speak very briefly and very informally, because my fellow panellists have said everything I wanted to say on this. I alluded earlier a little bit to detoxing off the opiates. When I first started to want to get off opiates, there weren’t really any substitutes out there for me. There was methadone, but there was no treatment offered. I tried to get into a treatment centre, and that was impossible. To this day it’s pretty well a roll of the dice if you can get into treatment or not. We really need to increase all different types of treatment. Right now there’s basically one form, and that’s detox. That’s it. It’s not going to work for everybody. Nobody ever wants to grow up to stick a needle in their arm or use opiates, but it’s a facet of society and I think we need to deal with it responsibly. This is a medical issue, as some of my fellow panellists have pointed out, and not a criminal issue. I think we need to continue to deal with it in that way. Almost all my recommendations have already been said by my fellow panellists, but I think we really need to repeal Bill C-2, or at least different parts of it, and have supervised injection sites. The Supreme Court came out unanimously in favour of keeping InSite open in Vancouver, yet we’ve seen no other supervised injection sites in this country. Frankly, there should be one, if not several, in every major city. They’ve been shown to reduce overdoses, reduce deaths, and reduce the transmission of diseases. Another thing that DUAL does is to go into schools a lot, but we’re very limited in what we can say, especially in public schools. There’s no harm reduction education; it’s all abstinence based. And a lot of people who are starting into drugs, specifically opioids, are doing so at that age. Those teenage years are extremely important and we’re not allowed to have an honest conversation with them. I think there can be some really good benefits to getting to people while they’re young and showing them that in addiction, addiction to opioids specifically, nothing positive is going to come of that. I think we need to be educating people who are being released from jail. Right now there are a lot of overdoses among people being released. They’ll get out, they’ll use, and take the same dose they used before they went in and it is enough to kill them. I’m sorry I’m so emotional, but these are my friends, the people I work with, people I love. I lost my best friend to a fentanyl overdose and it really hits home. In Ottawa we see an overdose on opioids about every 10 days, and that’s obviously just not acceptable. 71 The Federal response to the Opioid Crisis

I brought a naloxone kit here today, which has been really great. I’ve actually used it twice and I’ve seen it, basically, pull people right out of an overdose. The problem with these kits right now is that the dose of the naloxone is so low and the drugs doses are so high it isn’t actually counteracting the overdoses as well as it should. I’d really like to see the dosage of naloxone, a very innocuous and harm- less drug, increased so that it can meet the demand that these drugs are putting out. I’d also like to see and develop other forms of treatment. Right now, even to get somebody into detox is difficult. I’ve got people approaching me every day wanting to clean up their lives per se and we can’t get a bed anywhere. It’s basically just the luck of the draw. If you can get somebody in, great, if you can’t, then that’s a.... What’s most important is that we need to continue to include people with lived experience and people who use drugs in these conversations. We have a wealth of knowledge that I think we could share. As I alluded to earlier, in conjunction with scientists, doctors, and politicians, as well, obviously, we can really get to the guts of this problem. There are solutions out there. I believe that Canadians are really nurturing. We really believe in health care. This is a medical issue and I think we need to continue to treat it as such. A statement that we use at DUAL and other drug-user groups around the country is “nothing for us, without us”. We’d just like to see more inclusion at all levels from the top to the bottom, because there are solutions to these problems. We solved a lot of things with the Oxy crisis and I think we really can do that with the fentanyl crisis. Let’s just keep plugging away and I think these problems can be eradicated really quickly.

NALOXONE

Conservative MP Len Webber (Calgary Confederation, Alta.):

Sean, you do have a minute, so may I ask you a very quick question about that naloxone kit. How easy is it for you to get that and to distribute that to your patients, to your clients?

Sean LeBlanc, Drug User Advocacy League:

I’ve now been trained as a trainer to be able to do it, but it took a lot of work to do that. We’ve only given out 250 kits, or I should say Public Health has only given out 250 kits in Ottawa over five years. That’s less than one kit a week. Now there are a lot of pharmacies that are giving it out, which is really great. They’re not training people maybe as well as they should, and a lot of pharmacies still don’t realize that they’re able to get rid of it. I think someone mentioned there were 13,000 kits given out in B.C. I think we can easily approach that in other provinces too.

DEATHS FROM OPIOIDS

Liberal MP John Oliver (Oakville, Ont.):

Dave, I just want to confirm that I heard from you that one out of eight deaths in Ontario involve opioids now and that the years of life lost from opioid deaths are greater than all the cancer years of life lost. Did I hear that right?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

Not quite. We published a paper a few years ago that simply looked at all of the deaths that occurred in Ontario and at the deaths that involved opioids, and we broke those up into age ranges. I think the key finding there, other than the fact that deaths involving opioids have skyrocketed over the years, which is no surprise, is that in 2010 in the age group of 25 to 34 years —that’s the segment of the population where one in eight young people died of an opioid and, collectively, all of the person years of life lost was about one-thirteenth that of all cancers combined.

RECOMMENDATIONS FOR GOVERNMENT

Liberal MP John Oliver (Oakville, Ont.):

All of you referenced better surveillance, and that we need a national surveillance program for this. I heard from John that the dosage of naloxone needs to be increased in some of these kits. Are there any other recommendations beyond these? The minister is convening a workshop in November as a special consultation. Is there any other advice you can give us to better the situation or to give advice to the minister?

72 The Federal response to the Opioid Crisis

Lisa Lapointe, British Columbia Coroners Service:

We would recommend more regulation of the precursors, the sorts of chemicals that combine to make these drugs, and drug regulation of those. The commercial pill presses need to be regulated. We would advocate a good Samaritan law, which I believe has been introduced in the House. It’s a small measure, but it will be a health response to overdoses.

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

I said in my comments and I can’t emphasize it enough that I really think Health Canada needs to revisit its grounds for the indications for using these drugs. If you find yourself in a hole, then the first thing you have to do is stop digging. Unless we stop prescribing these drugs, as we have for 20 years, this problem is not going to go away.

Sean LeBlanc, Drug User Advocacy League:

I would like to see increased education, especially at the public school and high school levels. Harm reduction, frankly, saved my life. When it comes to needle distribution, distribution of these kits, and methadone, we can’t talk right now, frankly, about drugs in a real sense, because of a lot of school boards and everything. I think loosening of those restrictions would be really great.

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

I would like to see federal enforcement and interdiction strategies around importation of illicit drugs. Anything we can do through CBSA, the Canada Border Services Agency, to try to improve our ability to prevent these from getting in and improving relationships with other countries, particularly China, where a lot of these substances are being manufactured, would be good.

YOUNG CANADIANS AND SOCIAL MEDIA CAMPAIGNS

Liberal MP John Oliver (Oakville, Ont.):

When focusing on the younger population who might be looking at experimental or recreational use of these drugs versus the other sort of categories, what would be the key messages you’d deliver to younger Canadians?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

Number one is that these are dangerous things, so don’t do them, obviously. As our colleagues mentioned, we recognize that young people are going to try these. The messages are around how to look after each other and how to use naloxone. We have a whole campaign around “Naloxone Wakes You Up”, so that people understand the use of it and understand and recognize that when their friends are overdosing, they need to call 911. We’ve done a lot of work with law enforcement in B.C. to make that a positive experience, so they aren’t arresting people when they respond to overdoses, which has been an issue in the past. We’ve involved a lot of youth in developing these tools, and having people with the lived experience involved in helping us speak frankly about these issues to children. I would encourage people to go to Towardtheheart.com. It’s a website that we’ve developed in B.C., a collaboration among people who use drugs, people with lived experience, and the health sector. We have a lot of tools there for young people and for all age groups around what to do, what the risks are, and how to respond.

73 The Federal response to the Opioid Crisis

FENTANYL USE IN ONTARIO

Liberal MP John Oliver (Oakville, Ont.):

I have one last question for David. This epidemic of fentanyl in British Columbia has been staggering. I think the percentage of illicit drug deaths involving fentanyl went from 5% in 2012 to 62% by 2015. Do you have any data on the incidence or presence of fentanyl in Ontario?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

In Ontario, it has roughly doubled over the last four years. In Alberta, I think fentanyl-related deaths have gone up about 5,000% over the span three or four years. That’s no longer the prescription stuff; it’s the illicit stuff that’s coming into Canada from China, and being produced domestically to a certain extent. I’ll make a comment very quickly. There are scarier forms of fentanyl out there. In Ontario, we aren’t even testing for that. I know they’re around. We’re not looking for them.

TESTING FOR FENTANYL AND NALOXONE

Conservative MP Rachael Harder (Lethbridge, Alta.):

I’m going to start with a question for Ms. Henry. You talked a bit about providing naloxone. I think we would all agree that’s a very positive thing to do. One of my concerns with that, though, is that we’re also talking about testing for fentanyl in these drugs that are being used, and we would like to do that. With the combination of being able to test for fentanyl and providing naloxone kits, I would imagine that some drug users would make the decision, regardless of testing for and finding fentanyl, to go ahead and use anyway because they have access to naloxone. I am concerned about that. It feels as though that could actually perhaps perpetuate the problem rather than solve it. I would be interested in hearing your thoughts on that.

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

You’re absolutely right. As a matter of fact, some people seek out the testing. We’ve heard that some of the dealers are actually sending people in to have the drugs checked, because they don’t want to be giving fentanyl to their cocaine users. Anyway.... I don’t think it’s an issue around perpetuating use. We did a pilot study at InSite, the supervised injection service site in Vancouver. Some people didn’t test. People go to InSite because they don’t want to die from their drug addiction. It’s an opportunity for us to intervene, to treat them with respect, to give them the chance to get off that cycle they’re in. We don’t see it as a way of perpetuating the use or encouraging people to use. What we find is that every day they stay alive, it’s an opportunity to get off that cycle. The naloxone keeps people alive. What we’re finding is that people will check their drugs, and because you have to use a bit of your drug, if it’s hard to come by and you’re in that situation, you might not want to do that. We’re finding that people will do it after they’ve overdosed to see if that was the cause of it. It’s a challenge still, because with the tests that are available for drug checking, we don’t know the parameters. They’re not designed for drugs. They’re designed for urine testing. We don’t have good drug checking capabilities yet, but we’re working on it.

DETOX TREATMENTS AND SUPERVISED INJECTION SITES

Conservative MP Rachael Harder (Lethbridge, Alta.):

Another thing that has been said across this table is that there is an emphasis on safe injection sites, safe use, safe consumption, if you will. There’s a focus on substitution treatment. I’m not hearing much with regard to detox or therapy treatments where we would want to see people actually off illicit drugs. I am of the belief, and I would be interested in hearing your thoughts on it, that every single person on this planet is very valuable and born with incredible potential. I’m also of the belief that this potential can only be fulfilled if that individual is given the opportunity to be healthy. It would seem reasonable for me to then believe that using illicit drugs certainly prevents that individual from being able to realize his or her full potential. 74 The Federal response to the Opioid Crisis

With that belief in mind, I am clearly an advocate for treatment that would help people get off illicit drugs and be able to step into their full capacity as people. So I wonder, why not focus on treatment? Why not focus on helping people overcome these addictions which most of them probably don’t want anyway, and help them step into their full capacity as people and reach that potential with which they were born? Why not take that approach and put our energy and money toward that instead of these other things? I understand that there are intermediate stages. I understand that. I just wonder why that isn’t part of the conversation at this table.

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

It is a large and very important part of our conversation. I’m sure that David will talk about this. The challenge is that we need to have immediate actions to prevent people from dying so they can get to that point. You’re absolutely right. Sean just said it: nobody grows up wanting to be addicted to these drugs and wanting to die on the street from fentanyl. That is not people’s aim in life. For example, we have found through InSite—where we have InSite and OnSite—that treating people with respect, getting them to the point where they are managing their addictions and not dying from them, helps them make that shift and get into treatment and off drugs. I think one of the challenges we have is that we’re stuck in an anachronism around detox and treatment that is based on alcohol and on 28-day abstinence programs for alcohol. These do not work for opioids. The physiological dependence on opioids and what they do to your body and your mind are very different from alcohol addiction. Opioid substitution treatment is a way of getting people off illicit drug use. It is used instead of detoxing, which is something that puts people at great risk of overdosing and dying and is very traumatic and difficult. The substitution treatment is not meant to be lifelong for most people. It’s a period of time that allows them to get off the illicit drugs and to then taper off the substitutes in time. I think you have misunderstood his approach. The purpose of InSite is not to tell people they need to get off drugs; it’s to help them on that day. However, there’s an OnSite detox treatment program that’s actually based in the same building. So InSite does have the philosophy that these are opportunities to find ways to support people to get off drugs, as well. I’ve visited it many times, and I know that the philosophy in the injection room is not that they’re going to tell you every time you come in that you should stop doing this. It’s to say, “How are you doing today? Can we help you today?” But there are definitely connections with allowing people to get off drugs, and there’s an OnSite treatment program there. We are looking at the whole spectrum of how we respond.

NATIONAL PUBLIC HEALTH EMERGENCY

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Could you briefly explain to us what led Dr. Kendall to declare a public health emergency in British Columbia, and do you believe that we need a national public health emergency declared?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

I’m Dr. Kendall’s deputy, and we made this decision in consultation with our colleagues in the coroners service. We have a network of people who have been watching this. The reason we declared an emergency, as this graph shows, is that even though we had probably the best detection, monitoring, surveillance in the country for this, we were not making an impact. We had a take-home naloxone program, but people were still dying. Two people a day are dying in our province from these overdoses. We felt we needed a much more comprehensive response, and we needed the ability to collect information that we couldn’t collect under the current legislative framework in B.C. It was having more data to help us understand who was being affected, where they were being affected, and where were the programs, the points of intervention, that we could set up. It was partly to raise awareness and partly to give us those extra powers to be able to gather more information to help us respond in a more coordinated way.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Ms. Henry, do you think we need a national public health emergency?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

I do. As the coroner reported, we are not measuring this across the country. It is affecting our entire country. I would like us to have a national approach to this, and I think national leadership would be very helpful. 75 The Federal response to the Opioid Crisis

POLICE RESPONSE TO OVERDOSE CALLS

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Ms. Lapointe, the Vancouver Police Department has a policy of not attending at 911 calls for overdoses, and the RCMP testified on Tuesday that they’ve not even considered such a policy. Should they?

Lisa Lapointe, British Columbia Coroners Service:

Absolutely. I heard our Minister of Public Safety say recently that we cannot arrest ourselves out of this situation. We know that approach—the shaming, blaming, and arresting of people—has not worked. It significantly has not worked. In fact, the deaths and rates of overdose have only increased. Treating this as a health problem, such that if somebody becomes ill from a drug they call an ambulance and are treated at a hospital, is the only way we are going to save lives. In keeping with the treatment aspect as well, if you develop a terminal illness, or an illness that is potentially terminal, a cancer, for example, you expect that you will be treated and that treatment will be available. If you become addicted to drugs, treatment should be available.

SUPERVISED INJECTION SITES AND BILL C-2

NDP MP Don Davies (Vancouver Kingsway, B.C.):

The Liberal government seems to suggest that the problem isn’t with Bill C-2. It’s just explaining the requirements to groups, and if we can facilitate that, we can get more safe injection sites. The facts are that we have two injection sites in the country, InSite and the Dr. Peter Centre. There is not a single site that has opened in this country in the last year and a half. We have one application currently, and that’s from the City of Montreal. With the Toronto Board of Health, everybody is telling me that with the barriers, it takes months and hundreds of hours to get an application in. My question is, what are the barriers in Bill C-2 that you think are unnecessary?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

I could talk for a long time on that. Some of them are outlined in the written report that we sent in. There are about 25 different pieces of Bill C-2 that I find are barriers. One of the key ones is requirement for opinions from neighbourhoods that are not necessarily based on fact, and the types of opinions that need to come in. It›s a challenge to get those, because it reopens questioning around supervised consumption services and their worth. It›s a challenging part. The other part that is just ridiculous is that you have to name every single person who will work in the facility, and none of them can have a criminal record. People like Sean would be excluded from working in a site, which we think is ridiculous, because peer support is really important and it helps. There are a whole variety of them that I can certainly list for you.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

You have to get the approval of the local chief of police. What other medical or health service do we have in this country that you have to get the chief of police to sign? Shouldn’t that be a medical decision, not a criminal decision?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

I believe so, and it’s the opinion of the chief of police. I will say that we have had a lot of positive response from the policing services in B.C., including the RCMP E Division. Through the minister, Health Canada has expressed interest in working with us on trying to overcome some of these barriers, but we do still feel that repeal or an extensive revision of Bill C-2 would be most appropriate.

76 The Federal response to the Opioid Crisis

RECOMMENDATIONS FOR GOVERNMENT

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Dr. Juurlink, I want to give you a chance. You’ve talked about there being no national system of surveillance in Canada. Even the number of Canadians who die annually from opioids is unknown. You’ve talked about the CCSA. You’ve called that an inadequately resourced non-governmental organization. They’ve made 58 recommendations that you say have not been prioritized or implemented. What can you tell us about those recommendations? Have they been implemented? Which ones do you think ought to be implemented?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

I think some of them have. I’d have to direct you back to the CCSA itself for the status of the various recommendations. I guess my point in making that comment earlier was that of those 58 recommendations, by definition some of them are more important than others. I have one in front of me here Improve and promote access to treatment, which should include: i. Pharmacological interventions; ii. Psychosocial support and counselling; and iii. Withdrawal management programs. The proposed leads there are health care institutions. That can’t happen fast enough. This is a three and half year-old document. It should be happening everywhere now. That’s why I think that the assigning of priority was something that should have happened and did not.

OPIOID PRESCRIPTIONS

Liberal MP Sonia Sidhu (Brampton South, Ont.):

Dr. Juurlink, you mentioned opiate prescription by physicians. What kind of restrictions need to be placed on the doctors who are prescribing opioids? …can you talk about any preventative measures? You said that one in eight deaths of those aged 25 to 34 in Ontario are due to opioid overdoses, so what kinds of preventative measures are you thinking of, such as physicians not being allowed to prescribe higher opioid doses?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

I think there are certainly different constructs, but from the prescribing perspective, I think as a physician I am conditioned to want to help my patient. I see pain all the time, and I’m scared of the other drugs, and I’ve become comfortable with opioids because of what we’ve been taught, much of which is untrue. What I’m saying is that I think physicians need to be re-educated—de-educated—about these drugs.

Liberal MP Sonia Sidhu (Brampton South, Ont.):

What kind of education do you think needs to be utilized.

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

Education should focus on the fact that the goals of a drug are to impart more benefit than harm, and opioids very frequently don’t do that. They can be beneficial to some patients in the long term, but the higher the dose goes the less likely that will happen. That’s why I think doctors shouldn’t be allowed to prescribe ridiculous doses of 200 milligrams or 300 milligrams. It’s inconceivable that someone is benefiting from that. I also think that when these high-dose formulations are used as directed, like the OxyNEO 80 and the high-dose fentanyl patches, you are exceeding the threshold dose from the old Canadian guidelines—a dose above which it’s very likely that harms exceed benefits. It shouldn’t be happening, yet it still is. It’s a cultural thing now. We’ve been doing it for 20 years, and we have to stop doing it.

77 The Federal response to the Opioid Crisis

EDUCATING CHILDREN ON HARM REDUCTION

Liberal MP Sonia Sidhu (Brampton South, Ont.):

Mr. LeBlanc, you said that we need to educate our kids about harm reduction. At what age does this need to be taught? Is it in ele- mentary school or middle school?

Sean LeBlanc, Drug User Advocacy League:

I see, at least in Ottawa, children as young as 13 even getting into fentanyl. There seems to be no progression. When I was young, people would start with marijuana, then alcohol, and kind of progress their way up. They’re starting at fentanyl and these hard-core opiates at a really young age, so yes, I would say that education about it should start in junior high school, at grade 7 and 8.

OVERDOSE DEATHS

Liberal MP Sonia Sidhu (Brampton South, Ont.):

Is there any strong language with respect to heroin that would have an impact on the crisis? Is there a great impact with the language? Can you outline any other example of how language and definition have impacted the crisis in B.C.?

Lisa Lapointe, British Columbia Coroners Service:

Before I answer that, I’d like to emphasize that we have a dearth of research in this area. We do not have evidence across the country as to exactly who’s dying, when they’re dying, and why they’re dying. We don’t know, for example, how many people who are currently dying were prescribed opiates. If you’re going to implement evidence-based solutions, you need evidence, and we do not have that. I would certainly call on this committee to seek some investment in the research. To answer your questions, one of the things we hear anecdotally from the people are working with illicit drug users is that the language around stronger drugs, more powerful drugs, will cause a certain segment of the drug-using population to seek out those drugs. We’re talking about people who are now actively seeking fentanyl because it’s a better high, because it’s stronger than the heroin they’ve been using, for example. I also want to be clear that the drug deaths that we’re seeing in B.C. are not just from opiates. Cocaine is also often involved. Alcohol is often involved. We are starting to do the research to pull out the different substances, but without knowing exactly what substances are killing people and how they started to use those substances, I would argue that we really can’t implement any meaningful solutions.

SUPERVISED INJECTION SITES

Liberal MP Randeep Sarai (Surrey Centre, B.C.):

Dr. Juurlink, what are the benefits of a supervised consumption service site in avoiding this opioid crisis?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

It’s invaluable. People are always going to use drugs. Not everybody who has an addiction wants to keep using. Many of them want out, and they should be given the opportunity to get out. But it’s simply a fact that people do not die in safe injection sites. I agree with Sean that there should be one in every community in this country. The barriers are there, and as the wheels turn to try to get approval, people are dying in public bathrooms. It shouldn’t be happening.

PRESCRIPTION OPIOID DEATHS

Liberal MP Randeep Sarai (Surrey Centre, B.C.):

Dr. Henry, in British Columbia what percentage of the people dying from this opioid crisis are dying because of prescription-based addictions versus recreational-based addictions? Do we have any data—even preliminary? 78 The Federal response to the Opioid Crisis

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

We don’t have data on that, though I can say that the crisis in B.C. has evolved, and it’s slightly different from what they’re seeing in Ontario right now. It’s generally not prescription opioids that we’re seeing as the issue; it’s illicit opioids that people are buying on the street. It may have started with some diversion of illicit fentanyl, but clearly the issues right now are around illicit fentanyl that’s mostly being manufactured offshore and imported into B.C.

TESTING FOR FENTANYL

Liberal MP Randeep Sarai (Surrey Centre, B.C.):

If somebody went to a safe consumption site and wanted to test the product that they’re using, are there any detection devices that can see the level of fentanyl or if it is laced? Is there any technology like that out there that would be helpful to have in places such as safe consumption sites so that people can test their product really quickly to make sure they won’t be overdosing afterward?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

The short answer is “kind of.” There are ticket tests that we’ve done a pilot of at InSite. They’re like those pregnancy tests—those little bars—but they can only detect fentanyl, not some of the other illicit opioids that we’re seeing out there, and we don’t know how well they work. This was just a pilot. Some of the challenges we’re having under the Controlled Drugs and Substances Act are that the people who work at InSite cannot handle the drugs, so the people themselves have to test their own drug. It’s a bit tricky and complicated, and they need some help. There are some mass spectrometer machines that can do a better job at detecting what is in substances, but again, they have to be used by somebody. That’s where we think we can get helpful exemptions under the Controlled Drugs and Substances Act to allow that service to be available more widely in places. It is illegal for me to test someone’s drug for them at the moment.

SUPERVISED INJECTION SITES

Conservative MP Colin Carrie (Oshawa, Ont.):

– Respect for Communities Act (Bill C-2) – Mentioned Bill Blair (Liberal MP, former policeman in Toronto)

Do you actually think that communities shouldn’t have an opinion, shouldn’t have a say? I would think that if the community doesn’t support a supervised injection site, it won’t be successful. Calling for the repeal of that, is that really what you think?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

I think communities absolutely have to have an opinion, but it needs to be an informed opinion, and informed on the evidence. There is a lot of evidence about InSite and its effectiveness, not just at saving people’s lives but also its impact on crime, the impact on the community. You’re absolutely right that the Downtown Eastside in Vancouver is a community like no other, thankfully, in this country. There are many challenges in that community. I think the model of InSite as a stand-alone safe injection site is not what we’re looking at in many communities. What we’re looking at are what we’re calling “safe consumption services”, meaning the ability of people to use it in an environment where they can obtain the health care they need if they need it. But I think we miss the very first part of our message, that this is dangerous and you shouldn’t do it. As Dr. Juurlink says, people are going to use drugs, and what we have to do is to provide the opportunity for them to stay alive long enough to reach their potential in life. I think safe consumption services do that, but they need to be integrated into the health service system. The Dr. Peter Centre is another good example of this, where they’re working very quietly within the provision of other health services. It’s been a very effective service. We’ve done a lot of work with our law enforcement colleagues in B.C., and they have talked to the Vancouver Police Depart- ment about how well this is working. People’s ideas have changed, and what they need to be is informed about the effectiveness of these services and how they benefit communities.

79 The Federal response to the Opioid Crisis

Conservative MP Colin Carrie (Oshawa, Ont.):

That’s what I’m talking about—informed and good data—and we just said that we didn’t have it. But InSite keeps being held up as if this is where we want to go, or that this is the flagship for Canada. I looked at the literature, and it seems that it’s written by one or two different guys who keep quoting each other. There’s a guy named Kerr; there’s a guy, I believe, whose name is Montaner. When you’re looking at it from a government standpoint, it seems that injection sites are an effort to put all the eggs into one basket. I believe the police association president was saying on CTV that as a result InSite, they’ve had to divert 100 officers to police and make sure that area is safe for people who are down there. If you look at the costs, at $100,000 per officer, that’s $10 million per year. If you look at treatment beds, that money could treat over 1,000 people in 90-day treatment programs.

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

I think there is some very rigorous research that was done around InSite. Dr. Kerr is one of the lead researchers in that. Those are independent research grants that he received. As I mentioned, there are many different models that we are looking at around safe consumption that are integrated into health services and the continuum of services for people, including treatment options.

PRESCRIPTIONS

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Would you think that the colleges, the regulatory agencies in each provinces, could have a greater role in helping to change physician behaviour in prescribing?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

Yes, I do. I think B.C. has already done that. In fact, the CDC in the U.S. introduced prescribing guidelines earlier this year, and I think B.C. has mandated their use. There is some danger in that, because those guidelines don’t deal with the people on hundreds of milligrams a day. Those people, when cut off suddenly, will go to the street and they’ll die because they get something with fentanyl in it, for example. As someone on the steering committee of the new Canadian prescribing guidelines for chronic pain, I think it’s important that every provincial and territorial regulatory agency strongly encourages, if not actually mandates, that the guidelines to come out in early 2017 be followed.

HARM REDUCTION AND REHAB IN CORRECTIONAL SERVICES

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Ms. Henry, one of things we talked about was alluded to by Mr. LeBlanc, who I thank for his courage in showing up today and sharing his story. We talked about the justice system. Many people who use drugs are in the justice system, and the justice system has woefully inadequate treatment facilities. Would you agree that we need better drug rehab in our correctional system?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

Absolutely, and one of our partners, in our response, is our correctional services, the provincial and federal correctional services. We’ve started with naloxone, and making it available in our provincial corrections facilities. Treatment availability is being worked on. These are really important issues. We do see, as was mentioned, a critical period when people get out of a correctional facility. They have not had regular access to drugs in the facility, and they are at a high risk of dying from an overdose in that period of time, and so supporting them around that period of time is important. We also hear in the correctional facilities themselves that because drugs apparently come in quite regularly, people need to use them all up very quickly prior to their being detected. As a result, there’s a high rate of overdoses happening in our facilities now. How to manage those appropriately, to encourage people, and to provide the opportunity for opioid substitution and treatment while in prison is something that we think is really important.

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Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Several months ago, it was brought up in the news that they are refusing to have anything like needle exchange programs in prisons because of a “zero tolerance”. Would you agree that a harm reduction program needs to be introduced in our correctional system?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

Absolutely. That’s something we’ve been advocating for some time. We think harm reduction is one of the important pillars in this response, and it should be in our correctional facilities as well.

PRESCRIPTIONS

Conservative MP Colin Carrie (Oshawa, Ont.):

We can argue about that. Should these drugs—the entire class—be made more difficult to access, both tamper-resistant and more restrictive for physicians to prescribe?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

I just want to correct that. I think you cited me as saying that these drugs shouldn’t be prescribed. I didn’t say that: they do have a role. I think abuse-deterrent formulations are a good thing generally. You can crush them, and you can chew them, and you can get a much higher level in your blood than you would by taking them intact, but you can’t powderize them, inject them, or snort them, but it is a mistake to think this is the way out of this problem. These products tend to materialize on the market as the patent on the original product expires, so a cynic might wonder if this is primarily a business decision. I’m just saying that. The fact is that the primary route by which opioids are abused is oral. I know for a fact that physicians, when they hear about these abuse-deterrent formulations, think that these are somehow impervious to abuse. They are totally abusable. If you could snap your fingers and have them all be abuse deterred, great. It is not a major part of the solution to this problem, in my view.

DRUG USE DEMOGRAPHICS

Conservative MP Rachael Harder (Lethbridge, Alta.):

Can you comment on the demographic that we’re looking at? I know that more males than females are involved, but are we seeing a specific ethnicity involved in this at a higher percentage? That would be question number one.

Lisa Lapointe, British Columbia Coroners Service:

We don’t collect data around ethnicity, so I can’t tell you that. We have started collecting data for the First Nations Health Authority in British Columbia, so we will be able to report at some point about the number of first nations people or indigenous people who are dying. The demographic is, for the most part, as you said, male and aged 29 to 49—sometimes a little bit older—and from all walks of life. Primarily we’re talking about people who have used illicit drugs for a long time. I want to be clear: our criteria only includes illicit drugs; prescribed drugs are not included in these deaths.

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

Because we have been collecting data on people who are surviving overdoses, the picture that we’re seeing of those who have survived overdoses is different, at least in some parts of the province. As well, we’re seeing geographic differences. In some parts of the province, it’s more equally weighted between boys and girls, men and women, and those who survive overdoses are more often not the long-time users, but people who are more recreational users and often in private homes rather than in public places. There is a difference, and that’s why this data is so helpful for us in looking at points where we can intervene to prevent ongoing drug use by people.

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Conservative MP Rachael Harder (Lethbridge, Alta.):

One, I’m wondering why the province of B.C. is so hard hit. Perhaps you could reflect on that a bit. B.C. seems to have exponential numbers in comparison with other provinces. Second, as part of that, why has there been such a drastic increase in the last five years? When I look at that map up there, when you show me the colours, that really hits home for me. I really would love to understand why this has become such an epidemic in the last five years.

Lisa Lapointe, British Columbia Coroners Service:

You only have a problem if you know you have a problem. That’s my first response. The B.C. Coroners Service has adopted a fairly risk-tolerant approach to reporting this data. We get the data within 48 to 72 hours, and we are reporting these deaths monthly. You will not see that across the other provinces or territories. They do not collect the information the same, and if they do, they’re not reporting it the same. The surveillance we’re doing is letting us know there’s a problem. We may find that out in other parts of the country months or years from now, when the data is rolled out. In terms of the increasing number of deaths we’re seeing, fentanyl is driving that hugely. I would say, because we are on the coast, and a great deal of this product is coming from China, that it’s hitting our ports and moving into our communities that way. I think that’s also why you see it in B.C. and Alberta. If I may, I want to mention something else. You talked about treatment a few minutes ago. I didn’t want to leave that, because I do want to advocate for treatment. We see, from the families we talk to who have lost their loved ones, that they banged their heads against brick walls for months, if not years, trying to get appropriate treatment for their loved ones. Sean may be able to talk about this better than I can, but there is a time when someone who is using wants treatment, wants to get off. That window is small. If that treatment is not there when they are ready for it, then they will go back and they will die, or they will continue to use. The window is lost. So you’re absolutely right that treatment is a critical piece of this. It has to be available for people and it has to be at no cost. We also know that families have spent tens of thousands of dollars, if not hundreds of thousands, trying to access treatment for their loved ones. Not everybody has that kind of money, so that’s a very good point.

PREVENTION EDUCATION

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

Do you think we’re doing prevention and education in a proper way so that we don’t encourage youth to get into drugs?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

We can look at this in terms of other things we’ve done. We can look at how we’ve educated children around alcohol use. From studies we’ve done in B.C., alcohol use is actually decreasing in teenagers. Around cigarette use, smoking is just not done anymore in that age group. We’ve talked to students about these things. We’ve talked to them about marijuana, for example, and we’ve talked to them about drugs. They say, “Oh, we never hear anything. Since we don’t get information in a formal way in school, we hear about it on the streets. We hear untruths, and that’s what makes it tempting to us.” I think we do need to talk to people in a very forthright and open way about drugs, about their uses, their benefits, and their harms, so they can make those informed decisions. When we do it right, we’ve seen that it works.

Liberal MP Darshan Singh Kang (Calgary Skyview, Alta.):

Is there enough getting done? It took five years to come to this fentanyl crisis. Couldn’t we have seen it back then, when the crisis was brewing? As well, is there another drug on the horizon that you think could be after this one? Are we being vigilant about any other drugs?

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

You’ll notice there was a peak in the 1990s, and that was when crack came into B.C. We’ve been looking at that for some time, and that peak was mainly confined to the Downtown Eastside. We were seeing a lot of people dying. The response was quite different. We have a partnership in B.C. that has been looking at this data, the coroner’s office and others, for a number of years. We did see things coming up.

82 The Federal response to the Opioid Crisis

We finally reached the point that we declared the emergency because all of our usual measures to try to intervene, to increase awareness on the street, to make sure that people know what’s happening, via a number of campaigns, weren’t going anywhere. We needed a much broader partnership to try to address these crises as the deaths were coming up. A variety of factors have led to increased use. We’ve seen issues related to economic conditions in certain parts of the province. I think our understanding that it was no longer confined to, or just a problem in, one part of the province was one of the reasons we declared an emergency to address it.

PRESCRIPTIONS

Liberal MP Darshan Singh (Calgary Skyview, Alta.):

We’ve been talking about Bill C-2. I think the Minister of Health is going to look at the barriers in Bill C-2. Dr. Juurlink, you said something about doctors prescribing medications. I know some people will go from doctor to doctor to get OxyContin, for example. They will get it, and sell it too. How can we control the medications? Is there some kind of mechanism in place, so the doctor knows that—

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

[Inaudible—Editor] to stop that problem, but we can take lessons, again, from B.C., which in the mid-1990s began a program called PharmaNet. Almost overnight, every doctor, and every pharmacist had access to real-time data. If you got a prescription in Richmond and the following day you got a prescription in Burnaby, the person looking at the prescription profile would know. We showed some years ago that this was associated with a very rapid and dramatic drop in double-doctoring for both opioids and benzodiazepines. That sort of model that tracks all drugs prescribed to all people should exist in every province and territory in Cana- da. There’s no good argument against it.

DRUG ADDICTION AND CORRECTIONAL SERVICES

NDP MP Don Davies (Vancouver Kingsway, B.C.):

A few years ago, the public safety committee did a study on the rate of addiction and mental illness in the federal correctional system. The conclusion we came to was that 80% of inmates in the federal system had an addiction. Would an increased use of drug courts and treatment diversion programs in the justice system be a positive measure to help people entering prison have a chance of dealing with their addiction?

Lisa Lapointe, British Columbia Coroners Service:

That’s a very good question. There’s a drug treatment court in Vancouver, and I haven’t seen the data coming out of that. I know anecdotally from those who work in that field that they believe it’s very successful. I can tell you, I have worked in the provincial correction system, and at the time I was there around 2006, 2007, and 2008, we found the same, that 63% of those in jail had either a substance abuse and/or mental health disorder, and generally both. It’s very challenging treating those with substance abuse or mental health disorders in jail. It’s not an optimal place for people. Again, if you want to adopt a health approach, if somebody has an illness, putting them in jail isn’t the best way to treat them. Absolutely, we need to be looking at novel ways of treating populations that really are just going to cycle back through the jail.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. LeBlanc, in your experience and that of people you know, if people were facing a criminal charge and had an addiction, if they were given the opportunity to avoid the corrections system and go into treatment, would that be something people would choose?

83 The Federal response to the Opioid Crisis

Sean LeBlanc, Drug User Advocacy League:

I think so for the most part. I think it needs a bit of tailoring, though. The drug court right now is pretty well abstinence-based. When people are failing, they’re still being punished for their original crimes. In a lot of cases, though, it’s worked really well for people. There are a lot of limitations though. People can’t work when they’re on it, and people are unable to attend school while they’re on it because of the time commitment involved. I think if we could make a couple of adjustments, it would be even more successful.

DATA ON DEATHS FROM OPIOIDS

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Dr. Juurlink, I want to come back to you. You said there was no national system of surveillance in Canada and even the number of Canadians who die annually from opioids is unknown. How do we fix that? Who should be collecting the data and how do we do that?

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

You need data on deaths and data on non-fatal overdoses. The data on deaths should come from the regional coroners, who should be empowered to collect data in real time and report it in real time. You can’t fix what you’re not even measuring. The information on non-fatal overdoses should come, I think, primarily from CIHI, which contains national records on emergency department and hospital visits. Those two things together, I think, will give you a pretty clear picture of the problem.

Bonnie Henry, B.C.’s Deputy Provincial Health Officer:

The challenge would be that CIHI doesn’t have timely data, and emergency department data is not universal across the country, but it’s a start.

NATIONAL TASKFORCE

NDP MP Don Davies (Vancouver Kingsway, B.C.):

I know there’s a summit in November, but it sounds to me as though the joint task force in British Columbia has come up with some great recommendations. Do we need a national joint task force made up of the federal government and all the provinces and territories to get a handle on this Canadian issue.

Lisa Lapointe, British Columbia Coroners Service:

Yes. First of all, and I don’t want to harp on this, but we need to establish criteria, because we don’t even know if we’re talking about the same thing across the country. Is the data that Ontario is collecting around fatalities the same data that B.C. is collecting and the same as Nova Scotia is collecting? We need a definition that is standard, and I think it will require federal leadership to say here’s the definition for the information we want to collect, and then the provinces and territories will start to collect it.

Dr. David Juurlink, Sunnybrook Health Sciences Centre:

Every hospital in the country could have a person who is empowered to report each week the number of drug overdoses that came to their emergency department. That would be easy. They report all kinds of other things that are far less important. It would not be hard to do.

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OCTOBER 4, 2016

ON THE AGENDA The Committee resumed its study of the Opioid Crisis in Canada. Main topics discussed: RCMP and law enforcement, prescriptions, supervised injection sites and harm reduction, national public health emergency, addictions demographics, treatments, tamper-resistant prescription opioids, prevention and education in schools, fentanyl, Canada Border Services Agency, naloxone, pill presses.

WITNESSES Department of Health • Hilary Geller, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch • Supriya Sharma, Senior Medical Advisor, Health Products and Food Branch Canadian Institute for Health Information • Brent Diverty, Vice President, Programs Royal Canadian Mounted Police • Todd G. Shean, Assistant Commissioner, Federal Policing Special Services • Luc Chicoine, National Drug Coordinator, Federal Coordination Centre, Federal and International Support Services Canada Border Services Agency • Caroline Xavier, Vice President, Operations Branch Canadian Centre on Substance Abuse • Rita Notarandrea, Chief Executive Officer • Matthew Young, Senior Research and Policy Analyst

TRANSCRIPT HIGHLIGHTS

Hilary Geller opening statement:

As you know, British Columbia is at the epicentre of the current crisis of drug overdose and deaths, with the B.C. Coroners Service reporting that there was a 62% increase in illicit drug overdoses from January to August of this year compared to the same period of last year. According to the B.C. Centre for Disease Control, if this trend continues, B.C. could see 800 illicit drug overdose deaths by the end of the year, with nearly half of those expected to involve fentanyl. Yet, the most recently available national data from the Canadian tobacco, alcohol and drugs survey did not show increases in the use of the most common illicit drugs. What has changed? What seems to be accounting for the unprecedented rise in deaths is the increased presence of fentanyl on the illicit market, an opioid that is significantly stronger than morphine. According to the B.C. coroner, there were 264 illicit drug overdose deaths where fentanyl was detected from January through July, a 222% increase from the same period in 2015. lnsite, one of two supervised consumption sites in Canada, recently began providing test strips as a pilot project at their site so that users of their services could test their drugs. They report that 86% of those samples tested positive for fentanyl. As you’ll no doubt hear from the CEO of the Canadian Centre on Substance Abuse, the Canadian Community Epidemiology Net- work on Drug Use flagged that deaths linked to fentanyl have increased markedly across the country. As you will no doubt hear from our colleagues from the RCMP, this also reflects what law enforcement is seeing. While illicit drug use has always been a high-risk behaviour, with the exact composition and strength of the substance being unknown, fentanyl has increased those risks immeasurably. As British Columbia’s provincial health officer, Dr. Perry Kendall, has said, no one is immune. People with long histories of drug use are overdosing, as are people trying drugs for the very first time. In terms of critical actions to deal with the immediate crisis of overdose and deaths, many experts are calling for three things: increased availability of naloxone, increased availability of supervised consumption sites, and increased availability of treatment, including medication-assisted therapies. Health Canada is responding to each of these three calls to action. We have made naloxone more widely available by removing the requirement to have a prescription. This was the first time that Health Canada initiated the removal of the prescription requirement for a drug to respond to a public health need. In addition, the Minister of Health issued an emergency order on July 5 to allow immediate access to the more user-friendly nasal spray form of this medication. I’m pleased to note that yesterday it was announced that the department has completed its expedited review of this nasal spray form of naloxone, thereby regularizing its availability in Canada.

85 The Federal response to the Opioid Crisis

In the case of supervised consumption sites, evidence has shown that, when properly established and maintained, they can save lives, all without increasing drug use and crime in the surrounding area. These supervised consumption sites decrease the number of deaths by overdose, and they can redirect injection drug users to health and social services. In addition, they reduce public drug use, rates of infection, and unsafe syringe disposal. I would like to note that Health Canada has heard concerns with regard to the legislative requirements contained in the Controlled Drugs and Substances Act related to the establishment of supervised consumption sites. Further to direction from our minister, we are working closely with potential applicants to explain the legislative requirements in order to ensure there are no unnecessary barriers for communities that wish to open such a site. In addition, we are looking at the legislation to assess whether amendments may be advisable. In this context, it is important to recognize that the application review and authorization process seeks to ensure that supervised consumption sites are established based on evidence and with sufficient support so that these sites will be properly maintained. These rigorous criteria protect the health and safety of both the clients and staff and give confidence to the community that there is a process in place to ensure that these facilities are operating responsibly. Health Canada is also supporting access to medication-assisted treatment options. For example, a regulatory amendment was recently published to allow for the consideration of applications for medical-grade diacetylmorphine under Health Canada’s special access program, as scientific evidence supports the use of heroin in select cases for the treatment of chronic relapsing opioid dependence. This same type of medical treatment with heroin has also been used in several European countries under very specific circumstances and provides a treatment option for the very small percentage of patients who have not responded to other treatments. This winter, we also intend to consult stakeholders on the regulatory requirements for physicians to obtain an exemption to prescribe methadone in order to determine whether that requirement is an unnecessary barrier to treatment. Health Canada also recognizes the importance of research to assist us in making evidence-based decisions, including as it relates to medication-assisted treatment. Through the Canadian Institutes of Health Research, we are making important investments in research to help build the evidence on which key policy decisions are made. The OPTIMA study is just one project the CIHR is supporting. It will compare and evaluate the effectiveness of two treatments for prescription opioid dependence—methadone and the combination of buprenorphine and naloxone—with the goal of generating practice-based evidence that will inform patient care and improve health outcomes in Canada. Beyond the harm reduction measures described above, I anticipate that others, including the RCMP, will highlight the importance of addressing the supply side of the opioid crisis. Within the purview of Health Canada, the intention to put forward regulatory amendments to control six chemicals that are used in the illicit production of fentanyl was announced last month. The comment period for this regulatory proposal closed yesterday, and we will be moving forward expeditiously to control these precursor chemicals. The Minister of Health has also stated that she intends to bring forward legislative options for consideration on the issue of pill presses. Stepping back from the immediate crisis of overdose and death, it’s important that the numerous individuals and organizations with a role to play in addressing various aspects related to the root cause of the opioid crisis come together. It’s only by taking a collaborative, comprehensive, evidence-based, and sustained approach that we can make a difference in the long term. Important foundational work is well under way. Following the 2014 HESA report on the government’s role in addressing prescription drug abuse, the report of the Canadian Centre on Substance Abuse, “First Do No Harm”, and the input of many stakeholders, budget 2014 funding of $44 million over five years has allowed many of the initiatives identified in these studies to move forward. I will give just a few examples. Updated opioid prescribing guidelines will be available early in the new year. Nineteen new inspectors have been hired and are on track for over 1,000 inspections of community pharmacies. Public awareness campaigns have been run. The Canadian Institute for Health Information is using $4 million in funding to strengthen surveillance and data collection. The first nations and Inuit health branch of Health Canada is investing $13 million over five years to increase support for improved training for community-based addictions workers and to establish crisis response teams. Building on this, Minister Philpott called on the department in April to look at all possible options to take action in addressing this crisis. That work led to Minister Philpott›s announcement in June of a five-point action plan that aims to influence the root causes and reduce the potential for harm, both in its most extreme manifestations as an overdose death but also for so many other Canadians who experience harm from problematic opioid use. Given the challenges and complexities of this public health emergency, it’s clear that our response to the crisis requires leadership among many different players, as well as a coordinated approach. To quote the Canadian Medical Association in a statement they made last year, “The unfortunate reality is that no single level of government, no single health provider group and no single sector of our society can resolve this complex crisis on its own.” For this reason, the Minister of Health and the Honourable Eric Hoskins, Ontario’s Minister of Health, as co-chairs of the conference of federal, provincial and territorial ministers of health, will be co-hosting a conference and summit in the middle of next month to discuss the current problem of opioid misuse in Canada and to identify further potential ways forward. The smaller summit following the conference will bring together individuals and organizations who have both the authorities and the commitment to take concrete action in combatting the opioid crisis.

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Todd Shean opening statement:

As we are well aware, there has been a staggering increase in opioid overdoses in Canada, both lethal and non-lethal, which is the reason that this issue must be treated as a crisis. Canada and the U.S. have been facing a similar crisis related to the abuse of opioids causing a large incidence of overdoses. As such, the U.S. has had the most fatal overdoses from opioids in the world while Canada follows in second place. The increase in overdoses and fatalities linked to opioid abuse can be associated with the diversion of licit pharmaceutical opioids as well as with the increased availability and access to illicit opioids such as the fentanyls. The highly potent nature of synthetic opioids is well documented; in particular, fentanyl is estimated to be up to 100 times more potent than morphine. The mere exposure to it, whether it is via inhalation of air-borne powder or absorption through the skin, can result in serious and life-threatening consequences. Since 2010, seizures of illicit fentanyl have been made all across the country, and this continues to increase. Important seizures continue to be made on a regular basis in areas of the country, such as British Columbia, Alberta, Saskatchewan, and Ontario, where high numbers of overdoses are also being reported regularly. The current upsurge in illicit fentanyl is expanding geographically, facilitated by known organized crime groups and local drug trafficking networks. The constant demand has promoted the illicit importation of several analogues to fentanyl. For decades, Cana- da-based organized crime networks and drug traffickers have produced illicit synthetic drugs in both powder and tablet forms. Illicit fentanyl has been accessed as a replacement to conventional drugs of abuse, as well as used as an additive to other drugs, often without the user’s knowledge. Fentanyl is a significant concern, but the illicit opioid market is evolving at an alarming rate. As a primary example, in December 2015, a substance known as W-18 emerged in Canada, in what was thought to be a fentanyl seizure. Also imported from abroad, it was reported that W-18 is 100 times stronger than fentanyl and known to be fatal in very small doses. Investigations and intelligence reports indicate that British Columbia is the main distribution point for fentanyl tablets and is the most affected province. This may be due to its geographical situation in relation to the main producer of fentanyl in the world, China. Domestic production of fentanyl has also been identified, but in low numbers. Our federal investigators are currently working on a variety of investigations involving fentanyl importations. Shipments are coming into Canada disguised or labelled in a variety of ways such as printer ink, toys and DVDs. Once in Canada, pure fentanyl is diluted using cutting agents. It is then manufactured in the final product, which can be in tablet form or powder form, in clandestine labs before being distributed throughout Canada and to a lesser extent the U.S. Illicit fentanyl trafficking offers a significant profit margin. By way of example, it is reported that the raw material cost to produce one million fentanyl pills is under $100,000, but once sold, these tablets can yield profits of upwards to $20 million. These profits, coupled with easy access to supply markets and a growing demand, are likely to mean that the situation will not abate any time soon. Recognizing the potency of synthetic opioids has highlighted the immediate urgency to ensure the protection and safety of front- line police officers, border officers, postal workers, and the public writ large. As a result, the RCMP has engaged in a number of safety awareness initiatives for front-line officers and the general public. In the past year and more recently, officer safety bulletins were distributed throughout the RCMP, addressing the safe handling of unknown substances, including fentanyl, and outlining the risks, hazards, and necessary precautions that must be taken. We have made presentations to the provincial law enforcement community and other government departments as well as publicly releasing a video via social media which highlights some of the dangers that synthetic opioids pose to first responders and the public, and steps to protect themselves if there is a suspicion of possible exposure. The RCMP has purchased 13,700 naloxone nasal spray kits which were distributed across the Force. Naloxone is an antidote to fentanyl that quickly reverses the symptoms of exposure to fentanyl and other opioids. The kits are being carried by on-duty operational police officers and employees who are at risk of accidental exposure and who may be required to provide first-aid treatment to citizens in an emergency situation if an opiate overdose is suspected. The RCMP has developed mandatory training for officers, as well as operational policies that address fentanyl and other opiate overdoses. With respect to collaborative efforts, the RCMP continues to consult with various stakeholders on outreach materials, and we are currently working to produce additional awareness of products to help police, youth, and parents to understand the impact of fentanyl. Where are these illicit synthetic opioids coming from? According to RCMP criminal intelligence reports and investigations, it is apparent that China is the main source country for these drugs entering Canada, particularly fentanyl. The growing threat from fentanyl, related precursors, and other novel synthetic opioids is directly correlated with a huge industry producing these substances within China. Anchored between domestic criminal entities and those based in China is the Internet. The surface web and the dark web enable criminals to anonymously create global supply chains for a range of illegal goods and services, and acts as a platform for criminal expert forums. The RCMP has been building relations with our law enforcement counterparts in China in an effort to strengthen collaboration wherever possible to combat criminal activities with the goal of disrupting international drug trafficking networks.

87 The Federal response to the Opioid Crisis

In October 2015, the Chinese government completed regulatory amendments controlling 116 new substances, including some fentanyl analogues, but the drugs that made it to Canada are not controlled in China. In addition, there’s a disparity between what Canada and China consider a public health crisis simply based on population numbers. Fentanyl abuse has not been identified in China. The Chinese government’s focus is on other synthetic drugs of abuse like methamphetamine and ketamine. As mentioned earlier, our U.S. counterparts have also been faced with the illicit synthetic opioid epidemic and have identified Mexico as their main source of distribution. However, it must be noted that the drugs that are entering Canada from China are also evident in the U.S. The RCMP is working at home here in Canada with other government departments to raise awareness about the challenge, gather data on the scope of the problem, and collaborate with communities to stem the flow of illicit synthetic opioids that are having such a destructive impact. Alerts were put out as early as June 2013 by the Canadian Centre on Substance Abuse. Internationally, the RCMP has liaison officers and analysts who are deployed all around the world. They are tasked with providing direction, support and assistance to Canadian law enforcement agencies in the prevention and detection of offences relating to Canadian laws. As such, they liaise with foreign agencies and develop partnerships to address issues of concern to the RCMP and Canadian government. The RCMP actively participates in the international narcotics control task force, which is a forum of countries that discuss both domestic issues as well as investigations with international dimensions. Over 30 countries, including China, participate in the task force. We have used this focus group to share information in relation to the Canadian opioid crisis. Discussions at these meetings can strengthen international co-operation by assisting respective countries in considering amendments to the regulatory framework. In addition, initiatives are being proposed in international forums, such as the G7 law enforcement project groups, to address issues around equipment and new technologies that facilitate the ability to manufacture pills made from bulk active ingredients. Criminals are profiting from new psychoactive substances that haven’t yet been regulated by importing these powdered bulk ingredients. As such, law enforcement must think of novel ways to mitigate the presence of these threatening substances within our country. Let me be clear - as long as criminal entities in Canada maintain vested interests in the opioid market, its expansion will likely continue to accelerate. Continued collaboration and support from Canadian agencies, government departments and our international partners will be necessary to combat this issue. With that said, I believe that measures taken, under way, or under consideration across Canada will significantly assist in the prevention of fatal overdoses, advancing deterrent strategies and developing early warning systems to rapidly identify and respond to high- threat opioid substances circulating on the illicit market.

Caroline Xavier opening statement:

The opiate situation in Canada is a subject that is of immediate and ongoing concern to the CBSA. Our mandate to keep Canadians safe encompasses a wide range of enforcement and facilitative activities, not least of which is the seizure of harmful drugs at the border. Part of our job is to interrupt the flow of drugs through our borders. This is a job that requires a combination of partnership, technology, and constant vigilance. Today, I will divide my remarks into three sections. To begin, I will summarize the operational mandate and role of the CBSA in interdicting drugs at the border, including the importance of partnerships. Next, I will describe some of the technology we are using in identifying and seizing drugs. Finally, I will speak directly to how we are dealing with the fentanyl issue. Mr. Chair, our operational mandate covers a range of pre, post, and at-border activities. We ensure public safety and national security through risk assessment and intelligence, and through coordinated responses to emergencies, threats, and emerging issues. Clearly, fentanyl and similar opioids fall in this category. These are the newest and latest substances appearing in increasing volumes, most often found in our postal and courier stream. The most effective approach is to develop awareness of the threat and to mobilize a commanding response. Our national targeting centre, which is a 24/7 facility, works to identify suspected high-risk people, goods, and conveyances through an integrated, comprehensive risk assessment program. Likewise, we deploy officers around the globe, pushing the border out to manage threats before they arrive at our doorstep. These measures demonstrate our capacity to look beyond the border, to the point of origin, for contraband and other threats. In addition to our in-house capacities, we are deeply integrated with our law enforcement partners across the spectrum, including the local police services, provincial law enforcement, the RCMP, and our counterparts in the U.S. and other like-minded countries. The border is an obvious nexus for cooperative enforcement against drug trafficking and major crime. We are also constantly developing and researching innovative detection technology to assist our officers. There are a number of tools and systems in use at the moment. At the border, digital fingerprint machines allow us to quickly and securely transmit electronic fingerprint data to our partners in the RCMP. Density meters at major border and marine ports can determine the density of a surface or an object. These meters can discover hidden walls and help us detect contraband. 88 The Federal response to the Opioid Crisis

We also use flexible video probes and X-rays to locate undeclared currency and contraband and fibre scopes to view areas of vehicles and cargo that are not visible to the naked eye. Various tools help us inspect the undercarriage of vehicles and other hard-to-reach areas. Trace detection technology is used to detect trace amounts of narcotics and explosives on sampled goods and conveyances. Finally, we are supported as well by a team of detector dogs that assist in the detection of illegal narcotics, firearms, and currency, which is further enhanced by the training we are giving our officers to identify threats and risks, and also supported by a world-recognized science and engineering laboratory. Mr. Chair, with respect to fentanyl in particular, we’ve seen an increase in the number of seizures since 2014. Fentanyl powder and equivalent substances are most often smuggled into Canada mainly from China, as was stated by our RCMP colleague, through the postal stream in our case. From January 1, 2010, to September 22, 2016, the CBSA recorded over 115 fentanyl seizures. Due to the increased volume of packages sent through the postal and courier streams, it can be a challenge for the CBSA to identify and intercept all shipments of concern. Postal and courier shipments are often accompanied by false declarations or are intentionally mislabelled. The CBSA takes its employees’ health and safety very seriously. To that end, safe handling procedures and adequate control measures are in place, including personal protective equipment, to prevent accidental exposures. Furthermore, given the pace of evolution with these products, the agency reviews their adequacy on an on-going basis. Again, this is where partnerships and our intelligence are important. The CBSA’s collaborative efforts to address the fentanyl threat to public safety are ongoing, at the regional, national, and international levels. We leverage our intelligence and work with partners to identify and risk assess subjects and businesses that may be involved in fentanyl trafficking. We have a number of commercial risk assessment projects designed to intercept fentanyl and other controlled substances arriving via air and marine cargo shipments from China and Hong Kong. Our regional operations are participating in policy agency projects, and our international network has been engaged with customs authorities in China on the fentanyl issue. The opiate crisis is a challenge that requires considerable resources and coordination. We have a responsibility to all Canadians to focus our efforts and strengthen our collaboration wherever possible. This is a multi-dimensional challenge. There are significant social, public health, and criminal justice impacts, and part of the solution lies in keeping the substance out of Canada to the greatest extent possible. This is where the CBSA’s responsibility lies, and we welcome the opportunity to discuss this further today.

Rita Notarandrea opening statement:

For those of you unfamiliar with CCSA, it was created in 1988, and we are Canada’s only agency with a legislated national mandate to reduce the harms of alcohol and other drugs on Canadian society. Today I will touch briefly on the crisis, given that others have already spoken to the prevalence and the devastation that individuals and families are experiencing in Canada. I will also mention CCSA’s contributions to the federal response. Then, based on our experience with this issue as well as with our partners, I will highlight a few areas for action. In the past decade, the use of opioids and the harms associated with them have increased dramatically. In response, in 2012 CCSA brought together more than 40 dedicated experts and organizations to determine how best to tackle this national health problem. This diverse group, with ownership in both the problem and its solutions, included physicians, nurses, dentists, pharmacists, coroners, medical examiners, first nations, law enforcement, researchers, and governments. We all recognized that this was a complex and multi-faceted issue that could not be addressed by one level of government or one organization. Everyone was tackling this in silos. In fact, there were at least 70 reports that were being looked at. We also knew that there was no one solution and that many of the intended benefits of these drugs in treating chronic pain also came with unintended harms, like addiction, overdose, and death. In 2013, 12 months later, the group released an ambitious 10-year national road map entitled, “First Do No Harm”, responding to Canada’s prescription drug crisis. This vision was reliant on efforts by everyone at the table and everyone sharing the responsibility of addressing this significant health crisis in our society. Designed to be comprehensive in its approach, the strategy included 58 recommendations for action in areas of prevention, education, treatment, enforcement, legislation, regulation, as well as monitoring and surveillance. In the past three years, we have made progress, and by “we” I am referring to the collective “we”. My colleagues here today have highlighted some of this work. Other experts at that table also received funding related to recommendations in the report. Again, it’s a shared responsibility. I’d be happy to share copies of the initial strategy, the progress report, and an update of current activities by many of those partners. Under the direction of Dr. Young, CCSA leads the Canadian Community Epidemiology Network on Drug Use, or CCENDU. This nationwide network of community partners serves as an early warning system by investigating reported emerging issues, communicating alerts and bulletins on topics of immediate concern, and informing communities on lessons learned in responding to local drug use issues.

89 The Federal response to the Opioid Crisis

CCENDU first alerted its network to the sale of fentanyl in the illicit drug market in July 2013 and followed up with alerts on fentanyl being disguised as OxyContin pills in February 2014. I mention this as an example of the unintended consequences of addressing the supply of prescription opioids and diversion, where organized crime steps in to produce and sell powdered fentanyl pressed into counterfeit pills or added to powders and sold in the illicit market. In fact, given increasing concerns about the harms associated with fentanyl, from both illicit and pharmaceutical sources, and the lack of national data on deaths involving fentanyl, in August 2015 the CCENDU network decided to collect and collate the number of deaths involving fentanyl in Canada, spanning 2009 to 2014, to better understand this evolving situation and to plan for appropriate interventions, as needed. Although the use of any opioid can result in harm, such as overdose or other health complications, illicit fentanyl and other new synthetic opioids pose an even greater health threat for a number of reasons, including the lack of regulation and quality control as well as their potency relative to other opioids. People take these drugs believing them to be other less-toxic substances. We knew when we released “First Do No Harm” that this is a complex health and social issue, one that is part of a broader issue of substance use in Canada. We knew the strategy would require some refinements to keep it relevant and responsive as new information became available. We knew that priorities might shift. While the solution continues to be challenging, the positive news is that we don’t have to start at square one. “First Do No Harm” provides a road map that speaks to prevention and professional education, treatment, monitoring and surveillance, but it’s all based on the evidence. We, and again I mean the collective “we”, recognize the need for interventions aimed at reducing the supply of prescription and illicit opioids, as has been presented. These are important and should continue or be enhanced. We also recognize that we need to address demand and availability of appropriate interventions in a timely way. To that end, we recommend a few areas for attention. These relate to evidence-based interventions, monitoring and surveillance data, public education and awareness, stigma, and collective efforts. First, the opioid crisis has shed light on the system of care for substance use disorders. We recommend increasing access to effective evidence-informed treatment services along the continuum of care. That includes primary care, treatment services, and supports. We need to ensure that treatment is available. We need to ensure that these services are based on the evidence so that people seeking help get the help they need and the support they need. We need to promote accreditation and licensing of facilities providing treatment and the required qualifications of the health professionals. Every door opened should lead to help in getting the needed treatment and supports from those with the competencies, the current knowledge and skills to provide those supports. Yet sadly, we have heard in the news of facilities, many privately funded, providing health services to those with an addiction problem, lacking in qualified staff, and in fact, giving wrong information to clients. We have discovered through the opioid crisis what is needed to be added to the health system to properly respond to effectively treat those with an addiction to opioids. We learned that primary care professionals were not well-equipped with competencies in pain management and addiction, that the curricula did not effectively address these areas. Therefore, we need to provide education and resources to help primary care professionals, as an example, to prescribe according to guidelines, to identify and intervene early. As we deal with the crisis, we know that many are looking for evidence-informed services to meet the needs of those with an addiction to opioids. As has been mentioned, there are interventions such as naloxone, overdose education, opioid substitution therapy, supervised consumption sites. Effective medications like Vivitrol are unfortunately not yet available in Canada. As I continue to refer to the evidence in addressing the opioid crisis and treating those who need support with effective interventions, I would like to draw your attention to a new report by the WHO, the World Health Organization, and the United Nations Office on Drugs and Crime, entitled “International Standards for the Treatment of Drug Use Disorders”. It speaks to the continuum of care, different interventions, along with the strength of the research supporting these interventions. Mr. Chair, we would be pleased to send copies of this report to the committee clerk. Second, in order to address what is happening across the country and the impact of our actions, we need a comprehensive national monitoring and surveillance system, the national picture. In many countries this work is undertaken by a national drug observatory, NDO. As was mentioned just yesterday, Health Canada, CCSA, and the Canadian Institutes of Health Research hosted a best brains exchange to examine possible models for establishing a Canadian observatory and to assess how these models could support general and targeted drug surveillance. But this also includes in each province prescription monitoring programs. CCSA will be meeting with Health Canada and other leaders in this area to explore how best to develop this Canadian drug observatory in Canada, and an early warning system. Given the enormous amount of work that is required to develop a Canadian national drug observatory as well as the strength of many national leaders who are working in this area, such as Health Canada, CCSA, CIHI, the key to successful establishment of a Canadian observatory will be a clear vision, an understanding of the roles and responsibilities of leaders in this area as well as the jurisdictions, and a delineation of what is needed over the short and medium terms to identify emerging issues, and respond quickly. We do this well when it comes to physical health and infectious diseases, as an example. Third, Canadians need access to accurate information to make informed decisions about their health. We need to do a better job of informing and educating Canadians about opioid-related harms and how to share in the decision-making when seeing their health professionals. Canadians also need to know about evidence, form non-pharmacological treatments for pain, and learn about 90 The Federal response to the Opioid Crisis quality-accredited treatment services for their substance use disorders. And they need to know the symptoms of overdose. They need to understand the importance of the safe storage and disposal of their unused medication and the dangers of driving while impaired by opioids. Finally, one of the biggest challenges we face in addressing this crisis is societal stigma. Many still believe that addiction is a moral weakness. This means that people have to pay to get timely access to treatment, and when they do, this does not guarantee that the facility will provide quality care and treatment. We need to elevate awareness about the science that surrounds these disorders. Mr. Chair, I look forward to continuing to work with our partners to bring about the needed changes to help address the opioid crisis and the devastation of people’s lives. We look forward to collaborating with Health Canada, particularly on the opioid conference and summit that is coming up in November. There will be opportunities to connect with the “First Do No Harm” partners in addressing this issue and in developing concrete actions. CCSA will continue to coordinate collective efforts, connect partners, gather and share evidence, identify emerging issues, and address stakeholders’ needs as per our mandate.

RCMP AND LAW ENFORCEMENT

Liberal MP Randeep Sarai (Surrey Centre, B.C.):

I’d like to know what sort of strategy the RCMP has in place to address the crisis, given the negative impact it’s had in our community.

Todd G. Shean, Royal Canadian Mounted Police:

The RCMP has a number of strategies involved. A number of years ago, the RCMP instituted what we called a synthetic drug strategy, which focused on prevention, enforcement, and of course education. Also, within the ranks of the RCMP here in Ottawa, as I said in my opening remarks, we have liaison officers and analysts who are posted around the world, to build those relationships we need around the world because, as we shared with the committee, a lot of the fentanyl that we’re looking at is coming into the country. So how do we build those relationships with those particular countries to be able to address it at source and prevent some of those products from entering the Canadian market? Just last week I spoke at a Canada-U.S. border symposium. It was addressed by the administrator of the DEA, Mr. Rosenberg. The issue that he raised as well was the issue of fentanyl and the emergence of W-18 and carfentanil, which they’re seeing in the U.S., and the significance that they’re placing on the prevention and education efforts within the U.S. to reach the youth at risk. He stated that what he sees as significant is the partnership and the collaboration between the Royal Canadian Mounted Police and the American authorities in securing our borders as we work along with our border enforcement officers, our CBSA counterparts who are also there. As I said, through our office with Mr. Chicoine here and our federal coordination centre, we’ve done a lot of work with our communities. This includes videos and printed products; our front-line officers; adjusted our policies; issuance of naloxone to our front-line officers; and collaboration throughout the spectrum of government departments and consultations to inform, from an enforcement perspective, what the RCMP can bring to the table. As we’ve heard today from all the counterparts here, it’s a collaborative effort among a number of departments. There’s a number of things, from the international to the domestic, to our front-line officers, to being part of the team that’s before you here to inform each other to advance a Canadian effort against this crisis.

Liberal MP Randeep Sarai (Surrey Centre, B.C.):

Along those same lines, is there any support in our Criminal Code or elsewhere that would help you prevent this or enforce this? Is there anything you think that our Criminal Code or perhaps our legal streams are lacking?

Todd G. Shean, Royal Canadian Mounted Police:

I think we can always look at other areas and say that they have this or that. My approach to this has always been that there are bodies within Canada that decide what the laws within Canada will be, and we are there to enforce those laws. If laws are being considered and our opinion is asked, we will certainly inform those discussions, but at present we work within what the Criminal Code of Canada provides us today.

91 The Federal response to the Opioid Crisis

PRESCRIPTIONS

Liberal MP Randeep Sarai (Surrey Centre, B.C.):

As you may well know, Surrey, along with other areas in British Columbia and Alberta, has been hit hard by the opioid crisis, particularly by fentanyl-laced recreational drugs. My colleague Sukh Dhaliwal held an emergency summit with health professionals who work with individuals on the street who have substance abuse issues. Through these dialogues, I’ve heard conflicting conclusions as to whether or not opioid prescriptions should be reduced. I’m curious. Could you disclose what your research indicates on this matter? Some have stated that the prescriptions should not stop and that some of the opioid-based prescriptions are helpful in reducing addictions; otherwise, the alternative is fentanyl-laced drugs. Others have said that prescription-based opioid use is very high. What’s your opinion on that?

Rita Notarandrea, Canadian Centre on Substance Abuse:

I do want to stress one thing. When we first did our “First Do No Harm” report, there was an impression that there was one solution to the issue. As all of us have said, I think, there is no one magic bullet, no one solution. I think we do need to address prescriber education. I think we need to look at ensuring that clinical practice guidelines are being utilized in the physicians’ offices by primary care professionals. At the same time, we also need to look at diversion. We need to ensure first of all that the physicians are complying with those guidelines, and we do have that evidence that indicates what those guidelines ought to be. We then need to look at what physicians are prescribing that is higher than those guidelines. When I mentioned prescription monitoring programs, I was referring to that. As to the diversion, there is a lot of diversion right now. I think that was mentioned, and we’re seeing that. There isn’t one answer to the problem. We have to look at both.

SUPERVISED INJECTION SITES

Liberal MP Sonia Sidhu (Brampton South, Ont.):

I would like to start by discussing safe injection sites. Recently we have seen many media articles about municipalities that are thinking about having safe injection sites to help reduce overdoses and address addiction problems. What does the current evidence say about the positive impacts of safe injection sites?

Hilary Geller, Health Canada:

The evidence is overwhelmingly clear that when a supervised consumption site is properly established and properly maintained, it saves lives without increasing rates of crime in the surrounding area. There have been numerous studies, both domestic and international, that point to that. There is a relatively long history of experience with supervised consumption sites in Europe upon which to draw, and over a decade now of experience with Insite in Vancouver. It all points to that fact.

CONTAMINATED DRUGS

Conservative MP Colin Carrie (Oshawa, Ont.):

Because of the seriousness of opioids on the street, if there are reports going back about contaminated or adulterated drugs on the street, I think it’s very important. We heard from the media, unfortunately, that Tilray, a company in British Columbia, sent information to Health Canada that, in dispensaries, there is marijuana that was adulterated with carcinogens, fungicides, and pesticides. The minister chose not to let Canadians know about this. As the senior medical adviser for the health products and food branch, if information came across your desk about an adulterated opioid that was on the street, do you think it would be important to get that information out to Canadians, through a press release or something along those lines, or through the media, so that Canadians who may be using these substances would know about it? Do you think that would help in protecting the health and safety of Canadians?

92 The Federal response to the Opioid Crisis

Dr. Supriya Sharma, Health Canada:

In terms of the authorizations in Canada for opioids, they’re a marketed product. So if there was a situation where there was an adul- teration or contamination, we would embark upon an assessment to see what the risks associated with that would be. Then we would look at whether or not there were compliance and enforcement actions that we would need to take. There is a whole suite of compliance and enforcement actions that we can take, such as recalling the product, changing labels, etc.

Conservative MP Colin Carrie (Oshawa, Ont.):

You could get it off the street and you could do something about it, let Canadians know about it, and not wait a year, right? You wouldn’t do that would you?

Dr. Supriya Sharma, Health Canada:

Once we know what the risk is and what the action is, we make a decision about what the most appropriate form of communication is. Again, that could be putting something out on the web. It could be a news release. It really depends, on a case-by-case basis, on what the risks are and on what the assessment is.

SALOME STUDY, HYDROMORPHONE

Conservative MP Colin Carrie (Oshawa, Ont.):

– The SALOME study Did that study find that hydromorphone was a valid alternative to actual heroin and had less risk?

Dr. Supriya Sharma, Health Canada:

SALOME was a study to assess long-term medication opioid use. The aim of the study was to compare the use of injectable pharmaceutical grade heroin or diacetylmorphine with the use of hydromorphone, an injectable form of a pain medication that’s approved in Canada but not approved for use in opioid addiction at this point in time. The results of that study did show that, in the study population, hydromorphone was equally as effective as pharmaceutical grade heroin, and it did show some advantages in terms of adverse events. However, that’s one study and, obviously, that has to be taken into the context of the body of scientific and medical literature that is there.

Conservative MP Colin Carrie (Oshawa, Ont.):

Madam Geller mentioned that the special access program—developed for patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or are unavailable—is being used to get the pharmaceutical heroin out there. It was never really intended for that. If you have a legal alternative to it—even in the access statement here on your website—don’t you think we should be trying to substitute a legal, safer alternative rather than get more heroin out on the streets?

Dr. Supriya Sharma, Health Canada:

The special access program, as you’ve said, is intended for emergency and life-threatening conditions. An individual physician comes in and makes a request for an individual patient and it’s assessed as such. When requests come in, we do look at the information that the physician has provided and there are assurances that the physician has spoken to the patient about the potential risks and benefits, and then they’re assessed on a case-by-case basis. Comparing the two products, hydromorphone is a marketed product, but it is not marketed for that use, and diacetylmorphine has also a body of evidence that supports its use in terms of chronic relapsing opioid dependence and it has been used in a number of different countries. As with any request to the special access program, we would look at that individual’s information and the request that’s being made, to make sure that it fulfills the criteria of the special access program and that it’s reasonable. In some cases, you’re right, in that we have authorized the use of diacetylmorphine. It has to be when all other treatments that could be applied have unfortunately failed, so it’s a very small percentage of patients.

93 The Federal response to the Opioid Crisis

NATIONAL PUBLIC HEALTH EMERGENCY

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Ms. Geller, my question for you is this: Is the national opioid overdose crisis a national public health emergency?

Hilary Geller, Health Canada:

Certainly B.C. has declared it a public health emergency in B.C. If you look at the definition of an epidemic as set out by the World Health Organization, it has to do with levels of death or disease above an average level. By that definition, certainly in British Columbia, as declared by the government, it is indeed an emergency. If you go with that strict definition, I can honestly say, because of some of the data limitations unfortunately, it’s impossible to tell you if that definition would be met in every other province, but certainly we see growth in Alberta as you said and signs that it is moving eastward. We’ve heard from police in Ontario indicating that. I think from our point of view we are treating it as an emergency to help jurisdictions across the country have what they need in order to be able to respond. We as the federal health department are putting everything in place within our areas of authority and encouraging others to do the same, so that not only can we respond in B.C., but we’re ready for when it emerges elsewhere.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Doesn’t the Public Health Agency of Canada have the ability to actually declare a national public health emergency?

Hilary Geller, Health Canada:

I’m not familiar with their legislation.

SUPERVISED INJECTION SITES

NDP MP Don Davies (Vancouver Kingsway, B.C.):

My question is actually for Ms. Notarandrea. Does your group support the repeal or the streamlining of Bill C-2 so we can get more safe consumption sites up and running and save lives?

Rita Notarandrea, Canadian Centre on Substance Abuse:

Our group is really an organization that looks at the evidence. I think Ms. Geller has spoken to the evidence on consumption sites. We also look at ensuring that the public is protected. I think there is always a balance. Right now, in terms of the bill and what I have been told, it’s being facilitated. People who are putting forth proposals are being given a lot of assistance in ensuring that those proposals are successful.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

So you’re happy with the state of affairs in Bill C-2. Is that the position of your organization?

Rita Notarandrea, Canadian Centre on Substance Abuse:

Again, we don’t have a position, per se. We ask what the evidence says about consumption sites. What does it say in terms of being part of a continuum of care? We support that it be part of the continuum of care. What we have been told is that every effort is being made to ensure that the public is protected and that those individuals who are suffering are protected.

94 The Federal response to the Opioid Crisis

RCMP

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Shean, Dr. Jane Buxton, a professor at the University of British Columbia, recently told this committee that about 82% of people in Vancouver call 911 during overdose events, but that number falls to less than 60% in regions outside Vancouver, primarily where the RCMP is the police force. Dr. Buxton attributed this in large part to the VPD’s policy of non-attendance at 911 calls for overdoses. Has the RCMP explored such a policy?

Todd G. Shean, Royal Canadian Mounted Police:

I’m not aware that the RCMP looked at such a policy. SUPERVISED INJECTION SITES

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Ms. Geller, Mr. Davies was talking about Bill C-2 and some restrictions it placed on safe consumption sites. In your view, has this bill impeded your ability to monitor the crisis by slowing down the development of safe consumption sites in cities?

Hilary Geller, Health Canada:

I think it’s important to recall that before the amendments to the CDSA, the Controlled Drugs and Substances Act, known as Bill C-2—and Bill C-2 was not a stand-alone piece of legislation; It was a series of amendments to an act —there were a set of published and rigorous criteria that potential applicants had to fulfill. With or without a piece of legislation, there would inevitably need to be some strict guidelines so that the decision-maker had all the information he or she needed in order to make an informed decision and to ensure that if it was to be established, it would be properly run and properly maintained. I think it’s also interesting to note that most of the criteria, the 26 application criteria that are in the CDSA, are very similar to guidance documents issued both by the British Columbia government and the Quebec government, which were designed to inform people in their provinces about the types of information that they should be prepared to provide if they were considering opening a supervised consumption site. What I will say is there’s certainly a tremendous amount of interest out there in opening new facilities. Staff in my department have regular, very detailed conversations with those potential applicants. What I am told is that after having had those levels of engagement, the general view is: “Thank you very much. You’ve really helped clarify what is needed. You’ve helped me understand how this sort of information was provided by others, in particular Insite, and we now know what we need to do in order to submit a proper application.

HARM REDUCTION

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

If there had been less objection or less resistance to harm reduction throughout the past few years, would that have made it easier for surveillance and treatment to get ahead of this problem earlier with the crisis?

Hilary Geller, Health Canada:

Surveillance and treatment are two different things. I will say on the surveillance side—and it’s no secret that we and colleagues here refer to it—we don’t have a terrific system of surveillance at the national level. The development of surveillance systems, I think, is variable across the country. In places like B.C. it’s excellent, in other places, it’s not quite there. That is something we’re working on. That’s what I would say on surveillance. On treatment, I think it’s always been recognized that treatment is incredibly important. There was a significant investment into treatment in the 2014 budget coming out of the work of this committee and the work that Rita had referred to earlier on in “First Do No Harm”. There is certainly more that can be done both in terms of work on medication-assisted therapy but also treatment indicators, work on first nations. I’d say that is continuing to be a focus of ours.

95 The Federal response to the Opioid Crisis

RCMP AND LAW ENFORCEMENT

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

There have been different philosophies on drugs, and from the legislative and law enforcement perspective there has sometimes been the tough-on-crime approach and the zero tolerance approach. There are others who have said this zero tolerance, tough-on-crime approach has sometimes made things worse in driving people underground to not seek treatment. What would your views on that be? Do you think that primarily criminalizing these activities is making things worse by driving them underground?

Todd G. Shean, Royal Canadian Mounted Police:

What I’d like to share from a law enforcement perspective is that when asked, we will inform discussions around any legislation, and our role is to enforce the legislation that our government puts forward. That’s essentially where we stand with that. Often we’re asked about it as new legislation comes forward, and we will certainly provide input if requested, and then our role is to enforce the laws that our parliamentarians have decided are the laws of the land.

SUPERVISED INJECTION SITES AND LAW ENFORCEMENT

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

We only have one safe injection site in Canada right now. From the law enforcement point of view, has law enforcement in the B.C. area seen any increase in crime due to a safe consumption site?

Todd G. Shean, Royal Canadian Mounted Police:

I’m not aware that we’ve done a specific study with regard to a crime increase around a supervised site, so I wouldn’t be able to give you an answer other than that I’m not aware of any particular study being done in that regard from an RCMP perspective.

SUPERVISED INJECTION SITES AND PUBLIC SAFETY

Conservative MP Rachael Harder (Lethbridge, Alta.):

You talked about needing to strike a balance between the safety of the public and wanting to pursue some sort of safe injection venue, let’s say, for those who use drugs. With regard to finding that balance, what would you say are some of the challenges that are posed with regard to the general safety of the public?

Rita Notarandrea, Canadian Centre on Substance Abuse:

When I talk about treatment, we’ve been focusing on safe injection sites and safe consumption sites. There is an array of treatment options and I do want to say that when I talked about those standards from the WHO and UNODC, there is a variety of treatment options for the treatment of substance use disorders. I do want to say that we need to look at interventions that are based on the evidence. Those are all the options available for people who are suffering from substance use disorders. As part of the bigger bucket of substance abuse disorders, there are those who are suffering from an addiction to opioids. What I am saying is that we need to look at all options to effectively treat the individual when they present with all of the complications that come with addiction. We need to have a comprehensive approach. We have to help them in terms of their disorder and we have to meet them where they are and keep them safe as well.

96 The Federal response to the Opioid Crisis

ADDICTION TREATMENTS

Conservative MP Rachael Harder (Lethbridge, Alta.):

As part of a comprehensive approach, then, it seems that it would be appropriate to have a prevention mechanism in place. That should be a part of that comprehensive approach. What about getting people off addictive behaviours, out of addiction? Is that part of this comprehensive approach and what would that look like?

Rita Notarandrea, Canadian Centre on Substance Abuse:

Absolutely, it is. That comprehensive approach, when I referred to the “First Do No Harm” road map, did speak to all of that comprehensive approach. It did speak to prevention. It talked about consumer education and public awareness; how to have that conversation with your physician; how to speak about other options besides opioids in terms of pain management. That is one of them. The other part of that is the physicians themselves, primary care. I did mention in my remarks about primary care not having the competencies, as they have reported, in terms of pain management, in treating and recognizing addiction, also the whole treatment continuum. I talked about prevention, education. In terms of that treatment continuum, what does that treatment continuum entail? Do we have all the evidence to support the treatment that is out there? As I mentioned earlier, some residential treatment facilities.... I think in B.C., there was an interesting article that spoke to 150 residential facilities and some of the information they were providing to desperate families that were looking for care for their loved one. The evidence is there. I think we have to ensure that that evidence is applied all the way in that continuum, from prevention, from education, from treatment, and in recovery.

Conservative MP Rachael Harder (Lethbridge, Alta.):

In your estimation, what are some of the best treatments? What would evidence show us? What should we be pursuing with regard to treatment?

Rita Notarandrea, Canadian Centre on Substance Abuse:

It’s very comprehensive. That’s why I indicated I’d be more than happy to share that report. It speaks to the latest evidence and it speaks to the strength of the evidence along that continuum, including the prescribing of opioids.

CAUSE OF THE OPIOID CRISIS

Conservative MP Rachael Harder (Lethbridge, Alta.):

At the end of the day, if you had to name the root cause of this opioid crisis we’re seeing in Canada today, what would you estimate that to be?

Rita Notarandrea, Canadian Centre on Substance Abuse:

I’m sorry to say that I don’t think there is one cause, and I do think it’s all the things that you touched on. It is about prevention. It is about prescriber education. It is the whole continuum. It is about enforcement and what more can be done there. It is about the public knowing that you don’t have 40 opioids sitting in your cabinet, because three-quarters of the students said they were getting their opioids from home. I believe it is a comprehensive approach, as has been stated. There is no one solution.

SUPERVISED INJECTION SITES

Liberal MP Sonia Sidhu (Brampton South, Ont.):

Under the previous government, was Bill C-2 regarding safe injections sites a stand-alone bill that can be amended?

Hilary Geller, Health Canada:

No, Bill C-2 contained a series of amendments to the Controlled Drugs and Substances Act. 97 The Federal response to the Opioid Crisis

Liberal MP Sonia Sidhu (Brampton South, Ont.):

We have heard comments from some people that the current process for applying for safe injection sites is too difficult or obstructive. I recall most recently seeing the mayor of Vancouver talk about this. I know the minister has said that there should be a review of the legislation. Can you tell me the status of that review? What areas of the legislation could be improved if there is a review?

Hilary Geller, Health Canada:

That review is ongoing, so I think it’s premature to say any conclusions have been drawn yet, but we are assessing the bill, the CDSA portions that relate to the specific provisions on applying for a supervised consumption site, against the experiences we’re having now. Over a period of many months, we’ve had numerous discussions with potential applicants. There is actually currently only one applicant that has submitted, which is well known, and that is Montreal. Obviously, we have the most experience with Montreal, because they are furthest along. We are trying to have very detailed conversations with them to understand whether there are any specific criteria that are problematic for them. If perhaps it’s just more of an issue around not really understanding what’s required, as I think I mentioned earlier, they are finding it very useful, particularly when we can very accurately describe for them in the context of InSite’s application precisely the type of information they need to submit. In that context of the real lived experience we have had over the last year along with analyzing that against the legislation, we will be able to make some recommendations to the minister in due course.

DEMOGRAPHICS

Liberal MP Sonia Sidhu (Brampton South, Ont.):

I noticed in particular that the discussion was headed in the direction of CDSA, and the minister recently commented regarding it. I would like to understand the impact of overdose and addiction problems on addicts and whether there are any effects on the broader community that we should be aware of. Has there been any discussion?

Rita Notarandrea, Canadian Centre on Substance Abuse:

If I understand your question correctly, you’re talking about different populations that have been affected. Matthew has some more recent information, but I would say that the population we are seeing is the older adults. As well, in some of the work on utilization, we are seeing increases among youth and first nations communities. When we look at the different prescription drugs, I know we’re dealing with opioids, but certainly when it comes to women, it has to do more with benzos. There are different populations and there are different issues, and utilization is certainly showing increases, as I mentioned, in two key areas, and those are the older adult and youth, as well as first nations.

TAMPER-RESISTANT PRESCRIPTION OPIOIDS

Conservative MP Colin Carrie (Oshawa, Ont.):

Our government was moving in step with other people around the world. I know we received letters from United States governors and the White House asking us to look at this entire class of drugs and move them toward tamper-resistant or abuse-deterrent formulations. That was where we were going. This past June, Minister Philpott, at a Toronto drug policy conference, said there was strong anec- dotal evidence that the introduction of a tamper-resistant form of OxyContin in Canada caused the current fentanyl crisis in Canada. I just wondered, is this true, or is this situation more nuanced and complex than that?

Dr. Matthew Young, Canadian Centre on Substance Abuse:

One of the things we’ve seen for quite some time is that there are a lot of interventions that have been put into place that will ideally, if they are effective, decrease the demand for opioids in the long term, but one of the immediate impacts they’ve had is to decrease the supply. I think that probably these formulations fit into one of those. One of the things is that if you have a supply that is in excess of the demand, then you have what we see now, which is organized crime stepping in and filling a market. I don’t think that directly answers your question, but that’s the landscape that we’re in right now. 98 The Federal response to the Opioid Crisis

Conservative MP Colin Carrie (Oshawa, Ont.):

I know that we’re in that landscape now, but it seems that—and it would make sense to me, and be the proof of the pudding—once OxyContin was made tamper resistant, people couldn’t use it, or it would be much more difficult to use it. If you had a strategy to make the entire classification of drugs, if they are available, tamper resistant, then that should slow down the access of diverted OxyContin or a similar type of opioids. It doesn’t make sense to me. Isn’t it true that generic OxyContin is available in Canada even after 2012, and that provincial regulatory colleges started to advise of shorter prescription lengths and lower opioid dosages in 2012? For those who are suffering from addiction, don’t they just chase the next drug that is around? By moving away from tamper resistance, doesn’t it make sense to utilize the technologies that are out there when you’re looking at an overall strategy toward opioid abuse?

Dr. Matthew Young, Canadian Centre on Substance Abuse:

Around 2014, we became aware of organized crime taking fentanyl and putting it into counterfeit OxyContin tablets. I don’t know a lot of the answers to your specific question about whether that intervention was the key one that should have been done. I do know that around that time, there was a market that was satisfied by organized crime using counterfeit OxyContin tablets, and presumably that was because there was a decreased supply of diverted pharmaceutical opioids into the illicit marketplace.

GENERIC OXYCONTIN

Conservative MP Colin Carrie (Oshawa, Ont.):

I think one of the challenges now, having generics out there so readily available.... I think the governors of northern states have written to the Minister of Health. I was wondering if we could ask Border Services if we are starting to see this generic OxyContin going back and forth. Is it causing problems at the border with the northern governors? Are they getting a little upset about this?

Caroline Xavier, Canada Border Services Agency:

I can’t speak to whether it’s specific to OxyContin. I’d have to get back to you on that specifically, if that’s what you’re looking for. What I can tell you, as I mentioned in my opening remarks, is that we are seeing increased contrabandists trying to make their way through, for example, a courier in our postal stream, specifically. As was mentioned by our RCMP colleagues, contraband management continues to be dealt with within the larger context of illegal contraband activities.

DEMOGRAPHICS

Liberal MP John Oliver (Oakville, Ont.):

I want to focus on changing the behaviours of the people who are illicitly seeking fentanyl and opioids. It seems to me there are three categories. There are the recreational experimental users, and I’m thinking young adults and teenagers; there are people with substance use disorders, mental health disorders, and addictions; and there’s a third category of what I would call the unintended addictions from pain management. Mr. Diverty or perhaps Dr. Sharma, have you done the analysis? I would think there are different strategies to deal with those three populations. Have you done the analysis? What’s the percentage? How does that break down?

Brent Diverty, Canadian Institute for Health Information:

We actually have a study coming out in about a month that looks at hospitalizations due to opioids, and one of the things we’re seeing in that study is, in fact, that seniors and young people do have a different profile when it comes to the reason for the hospitalization. In the senior population you do see more of the accidental and unintended opioid poisonings. In younger people, they’re more intentional. We’re still finalizing the numbers for this study. That’s why I can only give you the overall trend at this point.

99 The Federal response to the Opioid Crisis

OPIOID PRESCRIPTIONS AND ADDICTIONS

Liberal MP John Oliver (Oakville, Ont.):

Dr. Sharma, would there be different strategies? If you knew the majority were people who had unintended addictions and were now seeking them, would you have different strategies for that? I’ll come back to big pharma. Purdue, I think, for instance, has moved over to hydromorphone content, and they’re still wrestling with getting that into a tamper-proof form. All provinces are using it now except, I think, for B.C. What’s the role of big pharma in educating doctors on prescriptions? Are we monitoring doctors’ prescription-writing habits?

Dr. Supriya Sharma, Health Canada:

If we have clear information on what the risks are, then you can have appropriate strategies. You’re correct that for different circumstances there would be different strategies. The situation in Canada is more complicated than that because people may enter into a situation around use of opioids from one channel, but then it may be fluid, so that you might be moving from one place to another and, over the course of a single patient, that might change as well. I think that’s why we’re talking about a multi-pronged, comprehensive strategy, so that we’re actually able to address various different factors simultaneously. In terms of the role of the pharmaceutical companies, certainly they’re the ones manufacturing and marketing the products, and they are partly responsible for the way that those are used. But there’s also, obviously, the role of the pharmacist, the role of the physicians and the practitioners. That’s why you have to address it as, very much as I said, a comprehensive strategy.

Liberal MP John Oliver (Oakville, Ont.):

So there are strategies under way to influence prescription writing. It seems that this is an increasing problem. Unintended addictions are still occurring. Have you seen any breakthrough strategies that will stop that particular group of people from falling into this behaviour?

Dr. Supriya Sharma, Health Canada:

Well, from the Health Canada perspective, because we’re the ones who actually authorize the medications, our goal is to make sure that people have accurate and adequate information to be able to make those decisions. When I went through medical school, we were very trepidatious about the use of opioids. I think there was a change in terms of the use, and we’re trying to re-centre the pendulum. One way is making sure that there is appropriate information that’s available. As well, Health Canada is actually working with the DeGroote Pain Centre to provide guidance and guidance documents for practitioners to be able to use the medications appropriately.

YOUTH AND EDUCATION IN SCHOOLS

Liberal MP John Oliver (Oakville, Ont.):

For young kids—I don’t know what percentage they are—who are experimenting with overdoses and hospitalization is occurring, it will be good to see the outcome of the study from CIHI. What are we doing at the school level of public health to talk about the dangers of fentanyl and the dangers of using the stamped green drugs that could potentially kill an 18-year-old experimenting at a party?

Hilary Geller, Health Canada:

The problem with the younger people, not exclusively but in general, tends to be more about using prescription medication recreationally that they find in their parents’ medicine cabinets. Surveys show that somewhere between 2% and 4% of young people use prescription medication recreationally in that way. There has been a campaign run by Health Canada over the last number of years that’s designed to get at that problem. That work will continue and as part of the minister’s five-point plan, she’s also undertaken to ensure that international best practices on prevention are part of our plan. It has been proven that the scare tactics, the “just say no to drugs” approach doesn’t work. The approaches that do work are much more about building resiliency in very young children. 100 The Federal response to the Opioid Crisis

FENTANYL AND CANADA BORDER SERVICES AGENCY

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Ms. Xavier, I’ll give you a chance to answer that question I asked you. Why has the CBSA not responded to the B.C. task force’s request to search small packages for fentanyl?

Caroline Xavier, Canada Border Services Agency:

The Customs Act, section 99, subsection 2, stipulates that the CBSA is not able to open packages under 30 grams. As a result, we wouldn’t be able to open those packages or we’d be breaking the law. Having said that, it is stated in the act to not open small packages without consent, so we ask for consent. If it’s not received within 30 days, we work with Canada Post as well as our RCMP colleagues to determine what to do with the package. Although we can’t open it, Canada Post may be able to and, working with police jurisdiction, have a different approach to deal with it. Our primary role is to ensure that it does not get into the domestic stream and that’s what we do to prevent that.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Would you recommend that we change that legislation to permit CBSA to open packages under 30 grams?

Caroline Xavier, Canada Border Services Agency:

As part of the ongoing review of our own mandate and of the work we’re doing with our partners, we review legislation to see whether or not this will be one of the options in the way forward against this crisis.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

If I wanted to export fentanyl into Canada and I knew about this, I would be sending my fentanyl in packages under 30 grams, wouldn’t I?

Caroline Xavier, Canada Border Services Agency:

We do use all the various detection technology tools that I talked about. My goal is to ensure that if there’s something that I suspect is of that type of contraband or something that should not be entering, it does not enter the stream based on my mandate, whether I open it or not.

ADDICTIONS TREATMENT

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Ms. Geller, are there any plans in your department to provide increased funding, so we can open up treatment facilities in this country to help people recover who are addicted to opioids?

Hilary Geller, Health Canada:

Certainly, within our area of responsibility for first nations and Inuit health, there has been a significant influx of funds to improve approaches to treatment in areas where we are responsible. There’s also been a significant influx of funds to organizations like the CIHR to do some extensive research on the best approaches to treatment. Rita could speak more to that, but the CCSA is also doing work in that regard. At the provincial level, I’m aware that B.C. has been doing some innovative things. I’m sure you know more about that than I do, including the premier’s announcement last week, I think, of $5 million. We are, within our area of jurisdiction, beyond the first nations and Inuit health, looking for ways to support the provinces and others in making sure that the treatment that is available is the most efficient and effective possible.

101 The Federal response to the Opioid Crisis

NALOXONE

Conservative MP Len Webber (Calgary Confederation, Alta.):

I know our police force carry naloxone but I don’t know if all our first responders do or not. Would it not be a good idea to have our safe injection sites stocked with that drug as well? Why can’t it be distributed out there more than it is right now?

Dr. Supriya Sharma, Health Canada:

In terms of naloxone, there are two forms. There’s the injectable form and now there’s the nasal spray form. We did take steps to make both forms available without a prescription, which significantly aided access. Naloxone was already being used in such areas as supervised injection sites, by first responders, and in emergency departments. That was already available. Now there are various strategies under way to be able to increase the access. Many provinces have undertaken to provide naloxone free of charge. They will put naloxone either in the injectable form or now in the nasal spray form in specific kits, with instructions on how to use it. I think the steps that have already been taken have increased access already. I think we will see increased access to both forms as well as we move forward.

ADDICTIONS AND SOCIAL ISSUES

Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.):

I’ll go in a little bit of a different direction here. Historically our approach to drugs and drug addiction has been to control substances that we consider highly addictive, and dangerous in that sense. However, in recent years, research done by people like Dr. Bruce Al- exander in Vancouver and Dr. Gabor Maté suggests that people get addicted not because of the substances but because they lack human connections. If you address the human connections in their lives, you improve their quality of life and they’re no longer as susceptible to addiction. This question is for the Canadian Centre on Substance Abuse and probably also to the health department. Are you aware of these studies, and do you have an opinion on them? If so, would you share that with me?

Rita Notarandrea, Canadian Centre on Substance Abuse:

Certainly when we look at prevention, we look at risk and protective factors. For instance, we’re looking at resiliency. When you look at the risk factors, some of the risk factors are genetic. Some of the risk factors are the environment. When you look at protective factors, it speaks to connectivity in the school. It speaks to connectivity and parental nurturance at home. There is a listing that, yes, we do consider when we look at prevention practices. It looks at both the risk factors and the protective factors.

Hilary Geller, Health Canada:

To be honest, I don’t think I have much to add to what Rita just said. Certainly we are aware of the literature around the root causes of substance abuse disorders. We keep on top of that. I think some of that thinking perhaps is behind the fact that different countries take different approaches on their drug policies.

Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.):

Yes. It seems to me that if we’re wrong about what causes addiction, then we would likely go off in different directions, wrong directions perhaps, in how to treat it and how to prevent it. If we are, in fact, focusing wrongly on the substances when we should be focusing more on the people, that would affect our ability to educate people on the problem, to treat people, and to prevent the occurrence. Can either organization offer any more insight into this?

Rita Notarandrea, Canadian Centre on Substance Abuse:

To repeat what I said earlier, I think it’s both. I think we need to look at the prevention opportunities that are there. We also need to look at current practices, whether those practices be in education and prescribing or whether those practices be in the delivery of treatment services.

102 The Federal response to the Opioid Crisis

PUBLIC SAFETY AND SUPERVISED INJECTION SITES

Conservative MP Colin Carrie (Oshawa, Ont.):

I was wondering if you could get some of those statistics back to us, because they say one of the reasons for putting these safe injection sites into communities is it won’t increase the crime rate. But we do know that addicts usually are not people of means. My understanding is that to get their hit for the day, they have to commit between four and eight crimes. If this is petty crime, prostitution, break and enter, or whatever they need to do, wherever you locate that safe injection site, within the area around it, it will cause an increase in crime, and the police officers we had a chance to talk to down there said there were all kinds of petty crime down there. I think it’s really important when you’re looking at Bill C-2, that you see that public safety in the communities, the neighbourhoods, with the moms and dads, the kids in the area is balanced with just the desire to put these through. Is that information you could get back to us with?

Todd G. Shean, Royal Canadian Mounted Police:

The specific one we’re discussing now is located in the Vancouver city police jurisdiction, which is not an RCMP jurisdiction, so we’d have to actually go to another police force’s jurisdiction and ask them if they have the statistics on that. It’s not something we would keep. It would be within the City of Vancouver’s data banks.

YOUTH DEMOGRAPHICS

Conservative MP Rachael Harder (Lethbridge, Alta.):

Mr. Oliver summed this up really well in terms of the three different groups of users. I find that framework helpful. I’m just wondering with regard to young experimenters, what the recommendation would be in terms of helping to prevent the use and abuse of opioids. This is a group that I’m very passionate about.

Rita Notarandrea, Canadian Centre on Substance Abuse:

I would look at it as preventing the use and abuse of any psychoactive substance, so I would put it as part of a bigger.... I think opioids are one of those that we’re dealing with today. Meth was in the past. Heroin was in the past. I think we need to look at it as I had mentioned earlier: what are some of the prevention initiatives that are proven in the evidence that address both the risk and protective factors. We have done, with respect to different substances...you think about cannabis, for example. We need to address how we deliver those messages in a way that resonates with the youth. We’re doing the same thing pertaining to alcohol, and then delivering messages that resonate with the youth pertaining to alcohol. Your question is a good one in the sense that we need to look at different substances to tailor our messaging, but the general framework that we use is the same in terms of prevention initiatives. We need to look at risk and protective factors, but tailor our messaging based on the particular substance.

TREATMENT FACILITIES

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Are there any federal funds planned to give to the provinces to help them open detox or treatment facilities that you’re aware of?

Hilary Geller, Health Canada:

I’m not aware of funds beyond all of the existing government programs.

PILL PRESSES AND FENTANYL

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Assistant Commissioner Shean, I think I read that the RCMP would like to see controls brought in on high-volume pill presses in this country. Can you confirm that for me and maybe elaborate on it?

103 The Federal response to the Opioid Crisis

Todd G. Shean, Royal Canadian Mounted Police:

I’ve been involved, as I said, when legislation comes forward to inform discussions on some of the things we’re seeing. I’ve been involved in projects in the past through my involvement with the G7 when we looked at equipment. When we are asked we inform discussions on some of the equipment being used so that a determination can be made on whether it would be appropriate to include in future legislation.

DATA ON OPIOIDS

NDP MP Don Davies (Vancouver Kingsway, B.C.):

I think there is broad agreement from all sources that we don’t have a national data collection registry. We don’t really know how many people are dying of opioid overdoses. We don’t have clear information on prescription practices, etc. Mr. Diverty or Ms. Geller, either of you, what steps would you suggest we take? Do we need to have national data on this issue, and if so, how do we go about getting that data?

Brent Diverty, Canadian Institute for Health Information:

I think it’s critical that we have national data. You have the opportunity through national data to understand the problem in the whole of the country, to compare our situation with that of other countries and other jurisdictions. There are challenges. On the harm side, you have death data. Detecting that a death is the result of opioid poisoning is challenging. We’re working on some guidelines for coroners, with their participation, to help standardize this. You can have dramatically different results on a death certificate with respect to the cause of death, depending on who the coroner is. We really don’t have comparable data nationally, and we need to work on that. On the drug claims side, which is one part of the supply equation, we’re working towards nationally comparable data for all drug claims. We don’t have nationally comparable data in private prescription claims. We only have that for three provinces at the moment, but through some of the new electronic records, drug information systems, we ought to have more complete data soon. These are priority areas that we’re working on now, and part of the investment from Health Canada is directed toward those aims.

OPIOID OVERDOSES AND PREVENTION

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Ms. Notarandrea, if you could suggest one measure we could take quickly that might have an immediate effect on saving people’s lives from opioid overdoses, what would that be?

Rita Notarandrea, Canadian Centre on Substance Abuse:

I would say the most important thing would be a national drug observatory. Included in that would be prescription-monitoring programs in each jurisdiction together with an early warning system. We need to have the data. We have it for physical health issues. If there is a flu across Canada, we can zero in on where the pockets of flu are. We need the same kind of data for substance use disorders and for what we’re dealing with today, opioids and opioid deaths. If I had to really zero in, that would be it.

PRESCRIPTION OPIOIDS

NDP MP Don Davies (Vancouver Kingsway, B.C.):

I know that the guidelines are expected to be updated in January, but given the severity of the overdose crisis, Ms. Geller, do you think that we should be speeding up that process so that we can update our national prescribing guidelines?

Hilary Geller, Health Canada:

The updating of Canada’s national prescribing guidelines, which I think date from 2010, was one of the initiatives funded out of the 2014 budget. It is very close to finalization. I think it’s going through the final peer review process, which is an important last step. There is also a lot of work being done to ensure that these guidelines end up in the hands of prescribers very quickly after the guidelines are in place. I think that’s a very important step. The U.S. Surgeon General wrote to every single physician in the United States providing copies of the guidelines in an easy-to-use form. That’s certainly something we would like to see here as well. 104 The Federal response to the Opioid Crisis

We are hopeful that other provincial physician regulators will copy British Columbia and perhaps adopt the new Canadian guidelines as a standard of practice, because that is one of the key ways to get at one of the root causes of this problem, which is physician prescribing.

INTERNATIONAL MAIL

Conservative MP Len Webber (Calgary Confederation, Alta.):

What percentage of the postal stream that comes in internationally is tested and traced for opioids?

Caroline Xavier, Canada Border Services Agency:

All mail, both postal and courier, must be presented to the CBSA. We use a risk assessment lens. In terms of any mail coming in from Asia, we are looking at it 100%, as a result of knowing that’s one of our high-risk areas. When we do seize a package and have determined that it has potential links to organized crime or it’s breaking a particular contraband law, we work with our police of local jurisdiction or our RCMP colleagues and then share that information. From that, there are decisions that are made as to how to get to the source aspect of it.

SEPTEMBER 22, 2016

ON THE AGENDA The committee proceeded to the consideration of matters related to Committee business. NDP MP Don Davies (Vancouver Kingsway, B.C.) moved that pursuant to Standing Order 108(2), the Committee undertake an emergency study of the opioid crisis in Canada. The question was put on the motion and it was agreed to, by a show of hands: YEAS: 9; NAYS: 0.

SENATE STANDING COMMITTEE ON LEGAL AND CONSTITUTIONAL AFFAIRS

COMMITTEE MEMBERS • Chair – Senator Bob Runciman, Conservative • Deputy Chair – George Baker, Liberal • Denise Batters, Conservative • Jean-Guy Dagenais, Conservative • Serge Joyal, Liberal • Kim Pate, Independent • Vernon White, Conservative • Pierre-Hugues Boisvenu, Conservative • Renée Dupuis, Independent • Paul E. McIntyre, Conservative • André Pratte, Independent • Gwen Boniface, Independent • Mobina S.B. Jaffer, Liberal • Ratna Omidvar, Independent • Murray Sinclair, Independent

REPORTS Fourteenth Report: Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, with amendment

SUMMARY The committee met twice at the end of March 2017 to consider Bill C-37. On March 29, Health Minister Jane Philpott appeared before the committee. She gave an opening statement and answered questions from senators. The committee met again on March 30 where they heard from officials from the CBSA, RCMP, Canada Post and from the privacy commissioner. The committee tabled its report on Bill C-37 on April 13, 2017. 105 The Federal response to the Opioid Crisis

MARCH 30, 2017

ON THE AGENDA Consideration of Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts Main topics discussed: fentanyl, Canada Post, Canada Border Services Agency, Customs Act amendments, supervised injection sites and harm reduction, RCMP, law enforcement and organized crime, pill pressers.

WITNESSES Canada Border Services Agency • Lisa Janes, Director General, Border Operations Royal Canadian Mounted Police • Acting Chief Superintendent Andris Zarins, Director General, Federal Coordination Centres and Covert Operations, Federal Policing Canada Post • Chad Schella, General Manager, Government Affairs Office of the Privacy Commissioner of Canada • Daniel Therrien, Privacy Commissioner

TRANSCRIPT HIGHLIGHTS

Lisa Janes opening statement:

Fentanyl and its analogues are the newest illicit substances appearing at the border, in increasing volumes. We have noted that the fentanyl powder and equivalent substances that are most often smuggled into Canada come mainly from China. With extreme potency, where an amount measured in milligrams can cause a fatal overdose, a package weighing 30 grams could contain as many as 15,000 fatal doses. Small but deadly amounts of drugs can be smuggled into Canada through international mail. Postal and courier shipments are often accompanied by false declarations or are intentionally mislabelled to avoid detection. All mail that arrives in Canada is subject to inspection, since the Canada Border Service Agency officers have authority under the Customs Act to examine any mail that enters Canada. The CBSA uses a variety of detection techniques and technologies, including X-rays, trace detection technology and detector dogs. Offi- cers may select high-risk mail for closer examination. There are, however, specific limitations to opening mail that weighs 30 grams or less. A CBSA officer who forms reasonable grounds to suspect that mail weighing 30 grams or less contains illicit goods may only open it or cause it to be opened if consent from the addressee is obtained or if the sender has completed and attached a specific label to the mail. When consent is not forthcoming from the addressee, or when no label is completed and attached, the shipment is returned to Can- ada Post and prevented from entering the domestic mail stream. Bill C-37 proposes to repeal certain provisions of the Customs Act and the Proceeds of Crime (Money Laundering) and Terrorist Financing Act to allow officers to open mail that weighs 30 grams or less in order to detain or seize illicit substances, such as fentanyl, that may be in those smaller mail packages. The proposed amendments would result in granting CBSA officers the authority to open all items, regardless of weight, in the- in ternational mail stream, when an officer has reasonable grounds to suspect the mail contains goods referred to in the customs tariff or goods whose importation is prohibited, controlled or regulated under an act of Parliament. The Government of Canada is committed to respecting the privacy of mail recipients, which is why officers must have reasonable grounds of suspicion before opening mail. Bill C-37 also proposes amendments that would require that certain devices, such as pill presses or encapsulators, be registered with Health Canada. While the CBSA does not regulate these devices, the trafficking and use of pill presses to produce illicit drugs is a growing concern for the public safety and public health community. The proposed amendment would require that proof of registration for these goods be presented upon importation. In cases where no proof of registration is provided, CBSA would detain the goods to assess compliance and have Health Canada or the Royal Canadian Mounted Police undertake further admissibility measures. In conclusion, the CBSA fully supports the proposed amendments to the Customs Act and the Proceeds of Crime (Money Launder- ing) and Terrorist Financing Act, and the regulation and control of pill presses and encapsulators. These changes will protect Canadians by helping keep harmful substances off the streets and out of the hands of criminals. 106 The Federal response to the Opioid Crisis

Andris Zarins opening statement:

Bill C-37 proposes a number of amendments to the CDSA that would support the Canadian law enforcement community in addressing the ongoing opioid crisis. Of particular interest for the RCMP, Bill C-37 proposes to accelerate the scheduling of substances; streamline the disposition process for controlled substances and precursors; create a registry for the importation of designated devices such as pill presses; extend the offences applicable to unauthorized activities involving precursors and other materials used in the production and trafficking of methamphetamine to all controlled substances; and provide the CBSA with the authority to open mail under 30 grams. Allow me to briefly outline the threat environment from the RCMP’s perspective. We know that organized crime groups operate in Canada and are heavily involved in the importation, production and trafficking of illicit drugs and precursor chemicals. In fact, nearly all of the organized crime groups that have been identified and assessed in Canada are involved in one or more aspects of the illicit drug market. According to Criminal Intelligence Service Canada, in 2016 it was 89 per cent of these groups. Sophisticated organized crime groups and criminal facilitators are exploiting Canada’s drug control efforts by producing and trafficking new substances that have yet to be captured in our laws and, as such, are not illegal. For instance, in order to circumvent current drug control laws, some of these groups make slight modifications to the chemical structure of a controlled substance and are thereby able to produce and traffic them with relative impunity. The RCMP’s federal policing program prioritizes its enforcement efforts against those organized crime groups and networks that pose the greatest risk to the safety and security of Canadians, including those involved in the illicit drug market. It is the policing community’s view that the additional enforcement measures proposed in this bill will enhance our ability to combat these pervasive organized crime groups and networks. By providing the authority to the Minister of Health to rapidly schedule new substances that appear on the Canadian illicit market, police will be provided the ability to take criminal enforcement action against criminals and organized crime groups engaging in such activities and therefore stem the distribution of newly identified illicit substances earlier. Additionally, the provisions of Bill C-37 allowing for the safe and timely disposal of dangerous substances are advantageous, as they will reduce the number of seized dangerous goods that are stored in police custody and the associated inherent risks and costs. Estab- lishing a registry to control the importation of the pill presses and related devices provides an additional tool to mitigate the domestic production of illicit tableting operations, which will be welcomed by the Canadian policing community. Further expanding the existing offences applicable to unauthorized activities involving precursors and other materials used in the production of methamphetamine to all controlled substances will provide Canadian police with additional tools when conducting investigations into the manufacturing of illicit substances, including those containing synthetic opioids, such as the various forms of fentanyl. Criminals and organized crime groups heavily depend on the postal stream to traffic contraband, including controlled substances. We have seen an increase in instances where small amounts are sent, due to the level of potency of some illicit substances, as well as to reduce the risk of detection and ensure successful delivery. Providing CBSA with the ability to open mail of less than 30 grams will also assist in the ongoing fight against illicit synthetic opioids that are arriving through the international postal system. We also know that criminals are also exploiting the domestic postal system to traffic illicit drugs. As such, the RCMP works in close collaboration with domestic partners and stakeholders, including my colleague here at Canada Post, to target and disrupt drug trafficking through the domestic mail within the Canadian legislative authorities. Federal policing’s approach to tackling the importation, production and distribution of synthetic opioids by organized crime groups is heavily reliant on successful relationships with our domestic and international partners. To this end, the RCMP is working closely with CBSA, Canada Post and our domestic law enforcement partners to enhance information sharing and enforcement actions. We are also engaging with key international law enforcement agencies, such as the Drug Enforcement Agency in the United States and China’s Ministry of Public Security, to address sharing public safety threats, including those posed by synthetic opioids. Bill C-37 bolsters our work with international partners, as it allows our international partners to see that we can have an impact on this illicit drug trade.

FENTANYL, CANADA POST AND THE CBSA

Liberal Senator Mobina S.B. Jaffer:

There is the concern about the right to open envelopes of less than 30 grams. I’m sure you knew this legislation was coming. I would first like to know what protocol you are putting in place as to which letters will be opened. Would the post office prefer there be a -war rant before that letter is opened?

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Chad Schella, Canada Post:

From our perspective, our role is limited to delivering the mail, as you know. We are not involved in the screening process at all. When Canada Post receives incoming letter mail from international jurisdictions, it goes through one of our three international processing centres. We verify receipt of it and then turn it over to CBSA. Once they have cleared the documents and inspected them as they see fit, they are then returned to Canada Post and we deliver them as per our obligation.

Liberal Senator Mobina S.B. Jaffer:

Ms. Janes, the concern is privacy rights. We want to stop this, but do you have a protocol for which letters you will open? Also, I am interested in that you have identified one source from which a lot of this material is coming in. Could you tell us how have you identified that?

Lisa Janes, Canada Border Services Agency:

First off, I would like to say that the CBSA takes privacy very seriously and that we strive to ensure that the dignity and respect of all persons are maintained. We use non-intrusive technology to help us when we do examine mail, such as X-rays, as I mentioned in my opening remarks. When the CBSA’s officers do look at mail, we have to have reasonable grounds to suspect. It’s not that we just automatically open up the mail; we have to have reasonable grounds to suspect that there may be goods referred to in the customs tariff or that there may be goods that are prohibited, controlled or regulated by an act of Parliament. We have to consider that before we even open mail. We also work very closely with our law enforcement partners, like the RCMP and others, and we follow risk assessments. That’s an important consideration as well from a protocol perspective. Hundreds of thousands of pieces of mail arrive on a daily basis, and we work very closely with Canada Post on which of those items we would like to see, and that’s based on risk assessment. When I referred to China, it would be one country that would be part of that risk assessment. We would look at relying on intelligence and information sharing with partners as to where we would want to focus our attention on the mail.

SUPERVISED INJECTION SITES AND HARM REDUCTION

Conservative Senator Vernon White:

My first question is for you, chief superintendent. We walked through supervised consumption sites and the way they work today. We have organized crime involved in the production of drugs, and they provide it to street dealers who then provide it to addicts. Of- ten, the addicts are involved in criminal activity. They enter a supervised consumption site where they consume the drugs, hoping they don’t die, and if they do, then medical practitioners are there who can help them. This is about medical practitioners and addicts. Strictly from a community crime perspective, would it not be better to look at a model like Switzerland’s and take the criminal organizations out of that equation and actually have medical practitioners provide pharmaceutical solutions to those addicts?

Acting Chief Superintendent Andris Zarins, RCMP:

The RCMP is supportive of harm reduction initiatives. We believe they can encourage the transition to treatment, and that’s where we do not feel these sites should facilitate a state of perpetual use. Statistically, Statistics Canada is responsible for collecting information and determining the crime rate through the Uniform Crime Reporting Survey, and they would be best-placed to respond with respect to crime rates. That said, the local police jurisdiction would be in the best position to speak for crime trends in their communities. So for me to offer an opinion on whether or not it’s better to provide the drugs directly at the site, or the model that’s being proposed, we will enforce whatever law is there, sir.

LAW ENFORCEMENT AND ORGANIZED CRIME

Conservative Senator Vernon White:

Wouldn’t you agree that our purpose at least should be to remove the criminal element and organized crime from the provision of pharmaceuticals to addicts? 108 The Federal response to the Opioid Crisis

Acting Chief Superintendent Andris Zarins, RCMP:

That’s what our focus is, sir. The RCMP is focused on the organized criminal groups that are providing this poison.

Independent Senator Rosa Galvez:

When we want to control hazardous substances, we look at the source. I know that, with this law, things are going to slow down. It seems that they are going to slow down and that some people will be protected. But they seem to me as mitigation measures. The event and the practice will continue if other measures are not taken implicating the people in the medical sector, the doctors, and also the ones that are sending us the drug. You mentioned very clearly that they are already progressing because new substances are coming, and they just slightly modify the chemical composition and then get out of your radar. You also said that the criminal groups have been identified. You said that you’re working with China, so can you please be more specific on the efforts to not only mitigate but tackle the problem at source in order to have a permanent solution and not just mitigation?

Acting Chief Superintendent Andris Zarins, RCMP:

The issue of fentanyl and illicit opioids remains a top concern for the RCMP and Canadian law enforcement. We remain committed to collaborating with domestic and international law enforcement partners to go after these criminal networks that are fuelling this public health epidemic, as well as increasing public awareness of the risks associated with this illicit drug use. The RCMP’s federal policing program is leading a national operational approach to target synthetic opioid importers, distributors, manufacturers and traffickers. The approach is in partnership with CBSA, Canada Post, and domestic and international law enforcement partners. Our goal is to detect, disrupt, dismantle and support the prosecution of criminal networks, so it’s multi-faceted. The key activities to your approach: gathering information and data to identify national trends and enforcement opportunities; raising awareness among law enforcement agencies and the public; collaborating with the Ministry of Public Security in China to combat illegal drug trafficking networks and disrupt the flow of fentanyl into Canada; and coordinating the information between all of our partners. To protect our members and the Canadian public, the RCMP has also equipped its front-line officers with naloxone nasal spray, which can temporarily reverse the effects of an opioid drug overdose. So we continue to work with other law enforcement and government agencies at all levels to raise awareness of the risks associated with the use of the drugs. With respect to China, the RCMP recently renewed a memorandum of understanding with the Chinese Ministry of Public Security that enhances law enforcement cooperation between the two law enforcement agencies. It strengthens cooperation on crime prevention and criminal investigations involving illegal drugs, tri-national crime, and smuggling. China has committed to cooperate with Canada and other international partners to disrupt the export of fentanyl, including classifying a number of fentanyl analogues as controlled substances under Chinese law and investigating leads provided by Canadian law enforcement.

SUPERVISED INJECTION SITES

Conservative Senator Paul E. McIntyre:

In its 2011 Insite decision, the Supreme Court of Canada made it clear that the minister has the discretion to grant exemptions. However, that discretion must be exercised in accordance with the Charter. Now, citizens also have a right to security and protection, and the bill would allow consultations of less than 90 days but without a minimum. Mr. Zarins, would you agree that some consultations should be allowed, at least a minimum of weeks or months? Under the bill, a consultation could be done, for example, in one day.

Acting Chief Superintendent Andris Zarins, RCMP:

I can’t comment on legislation. We will enforce whatever laws are in place, but for me to comment I don’t think would be appropriate.

Conservative Senator Paul E. McIntyre:

Well, what do citizens who are opposed to drug consumption sites tell you about their worries? I’m sure they tell you something. Do you consider their worries legitimate?

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Acting Chief Superintendent Andris Zarins, RCMP:

The police of jurisdiction would be the ones that would be consulted, sir, and, whatever they tell us, we would listen to it and factor it in. But, again, we’re not part of the decision-making process on these sites, sir.

DRUG TRAFFICKING

Conservative Senator Paul E. McIntyre:

This question is for the CBSA. Drugs also enter the country through means other than envelopes. What other trends do you see at the border in terms of drug trafficking and what are some of the techniques used to bring in these drugs?”

Lisa Janes, Canada Border Services Agency:

Yes, you are correct that drugs unfortunately are arriving in Canada through all of our modes. CBSA is responsible for all modes coming into Canada, whether it is air, land, rail, marine, which are all modes that people will take advantage of and attempt to exploit. Whether it is through packages or secretion on the individual, it arrives back in Canada with their bags, or they will use it as an importation with a large company. So they will use different methodologies to bring the drugs into Canada.

LAW ENFORCEMENT AND ORGANIZED CRIME

Independent Senator Patricia Bovey:

My question is really around the law enforcement aspect, particularly when you see what has occurred in the opioid crisis in the past couple of years and how the legislation frames up. From an enforcement perspective, does the legislation contain enough to actually work with to make a difference? I’m assuming you had some input into that. Second, have you anticipated what the next inevitable move will be by organized crime and others to circumvent this in some other way in terms of importation?

Acting Chief Superintendent Andris Zarins, RCMP:

We are very supportive of any tools that can be given to us to ensure public safety and help us in our enforcement efforts. With respect to your question of whether it is enough, we welcome whatever we can get. As to the next thing coming, this is also addressed in this bill by allowing the Minister of Health to have that flexibility to put in things, as these opioids get changed in their molecular structure, so it’s giving us time to keep up with what’s happening. If we have intelligence that says, “This is the next opioid coming in here,’’ at least we have the mechanisms now that we can feed into the Minister of Health and have that already listed as an illegal substance. That gives us and the CBSA the tools to go after this.

SUPERVISED INJECTION SITES AND LAW ENFORCEMENT

Conservative Senator Pierre-Hugues Boisvenu:

I’ll go back to the issue my colleague, Senator McIntyre, discussed with you. In many regions of Quebec, your police force plays the role of the local police, so you’re in direct contact with the citizens. You need to know the citizens’ concerns. You work with them each day. We know the establishment of sites — which you overlooked in your brief — raises concerns for citizens. On that note, you’re on the front line when it comes to organized crime. If, tomorrow morning, for example, a site were established in a local community and a day were set aside to consult you or the citizens or mayors, would you find this normal? I have a second question for you. In terms of transparency, does the bill give you all the answers regarding the substances that will be used, the target clients and the site’s management? Does this bill fully ensure that, when you’re in contact with the citizens, you’ll be able to give them all the answers?

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Acting Chief Superintendent Andris Zarins, RCMP:

We are concerned with what the community has to say. The supervised injection sites, that’s a process that has been established. We don’t control that process. We’ll abide by whatever legislation Parliament sees fit to be in place. We are focused on the safety of our citizens, and we are also focused on the organized criminal groups bringing these substances in. That’s where our focus is, sir. Whatever system is put in place with respect to approving these supervised injection sites, it is a concern for us; however, we don’t control that process, sir.

Conservative Senator Pierre-Hugues Boisvenu:

If a site were established in a high-risk area, would your police force react by informing the authorities whether a certain area represents a higher risk than another area? My view is that you seem to be leaving this to the politicians and that you’re not concerned about the safety of the communities. I find this response worrying.

Acting Chief Superintendent Andris Zarins, RCMP:

We are very much interested in the safety, sir. But this is where the police of jurisdiction know the local crime trends. Speaking for the police as a whole, we always respond and provide resources to where we see the criminality occurring. If there were criminality occurring in an area related to where these sites would be placed, the appropriate resources would be allotted to that particular area. As the national police force, we’re concerned about these illegal substances coming into the country and the groups bringing them in. The police of jurisdiction are the police agencies that will be addressing the local crime. I can’t give you more of an answer than that, but we constantly evaluate the threats and then provide appropriate resources to address those threats.

CUSTOMS ACT AMENDMENTS AND CANADA BORDER SERVICES AGENCY

Liberal Senator Serge Joyal:

I want to come back to clause 52 of the bill, the Customs Act amendments, which proposes to remove subsections 99(2) and (3). My concern is that it’s now a blanket authorization for opening mail of less than 30 grams, for any reason. The bill doesn’t specify to fight drugs, organized crime or the illegal proceeds of organized crime; it is just a blanket authorization. It means that you can now open the mail for whatever reason you believe. In practical terms, how does it work in your system to avoid the kind of over-exploitation of that power by an officer who feels he has all the grounds to do that?

Lisa Janes, Canada Border Services Agency:

Earlier I spoke about the importance of privacy. Our officers do receive training, and there is oversight from superintendents, chiefs and senior management regarding when officers are opening mail or boxes — or whatever items they are — that the reasonable grounds to suspect are present. There is oversight on that as well, and our officers do receive training on the importance of respecting privacy. As I mentioned in my earlier response, we see hundreds of thousands of pieces of mail that are presented to us on a daily basis. We use non-intrusive technology, like X-ray, to facilitate the movement of the mail. For our job, we don’t want to hold things up; we want to be able to specifically look at those items that, as I mentioned, would be of risk to the health and safety of Canadians. That’s why we’re here. We’re not here to open up letter mail to just gather intelligence or, as you say, it’s a pink envelope and we want to look at it. We have to follow the fact that we need to have reasonable grounds to suspect that before we move forward on any of those actions. That’s why we have the oversight as well, and our officers receive the training.

Liberal Senator Serge Joyal:

I understand that, from then on, mail that I receive will be opened and the content will be checked, but I will never be notified that in fact they have looked into it.

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Lisa Janes, Canada Border Services Agency:

Yes, you will. When we open up any type of packet or envelope over 30 grams, current procedures are that tape is applied to close up the item, and it says the item was opened by CBSA.

Liberal Senator Serge Joyal:

In other words, you open the item on the basis of your own criteria. What are those criteria?

Lisa Janes, Canada Border Services Agency:

As I said, the officers have to have reasonable grounds to suspect that the mail and the goods contained therein are related to a customs tariff or that the items are prohibited, controlled or regulated by an act of Parliament.

RCMP AND ORGANIZED CRIME

Independent Senator Renée Dupuis:

My question is for Mr. Zarins. If I understood correctly, you said that, as a federal police force, you’re interested in organized crime, which is involved in 89 per cent of illicit drug market activities. I want to fully understand this statistic. The police are interested in organized crime, and not in any other sector that manufactures, produces or prescribes this type of product. Is that what you meant?

Acting Chief Superintendent Andris Zarins, RCMP:

No, ma’am. We’d like the entire criminal network, from the point of where it’s coming from, who’s manufacturing it, how it’s brought in and delivered to the Canadian public. The entire network is what we’re interested in. Criminal organizations are involved every step of the way, so it’s the entire organization that we are trying to dismantle.

Independent Senator Renée Dupuis:

Your work doesn’t consist only of monitoring or taking action when it comes to organized crime. It could also involve taking action in cases of doctors who prescribe or over-prescribe opioids.

Acting Chief Superintendent Andris Zarins, RCMP:

Anybody that would be involved in the chain. We don’t target the prescribing or over-prescription, but if somehow they’re connected to these organized crime networks that are bringing this in and distributing it and it comes to our attention during the course of our investigation, we’ll definitely not turn a blind eye to it. But we’re not targeting that.

Independent Senator Renée Dupuis:

I have a quick question. I simply want to understand your statistic. About 89 per cent of organized crime groups are involved in the illicit drug market. The remaining 11 per cent comes from other sources, such as manufacturers or importers. Regarding the 89 per cent, do you have data — I don’t know whether this exists — on organized crime’s involvement in importing drugs rather than in manufacturing them on site?

Acting Chief Superintendent Andris Zarins, RCMP:

For clarification, the Criminal Intelligence Service of Canada, CISC, has estimated that 89 per cent of the Canadian-based organized crime groups it assessed in 2016 are involved in some aspect. It could be any aspect of the illicit drug market. That includes production, import, export and distribution. These groups seek profits anywhere they can. It doesn’t matter where the profit is coming from; anywhere along the chain. So 89 per cent of all of the organized crime groups in Canada are somehow involved in the illicit drug trade. It means that 11 per cent might not have their hands on illicit drugs but they are still organized crime. So it’s anywhere in the chain.

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Independent Senator Renée Dupuis:

So we don’t have a breakdown of the data, in those 89 per cent of cases, on importation in relation to on-site manufacturing.

Acting Chief Superintendent Andris Zarins, RCMP:

Do you mean of the illicit product? It comes in different stages. It can come as a product that is already completed or as a precursor. This is where this legislation is extremely helpful for us, because it can be manufactured and put into pill form here in Canada. There are all different variations that are crossing our borders, and we’d like to have the tools to address all of it, which is what we’re getting.

PILL PRESSERS AND ENCAPSULATORS

Independent Senator Murray Sinclair:

The definitions of encapsulators and tablet presses, for example, are listed in the schedule. They essentially seem to refer to anything that you can use to make tablets and that you can use in order to fill capsules. If that particular aspect of the legislation is found to be too vague, it strikes to the heart of an important provision in this legislation. Do you have any concerns about the vagueness of that, or were you consulted with respect to those definitions?

Acting Chief Superintendent Andris Zarins, RCMP:

It’s the Ministry of Health that will designate what a device is. We’ll enforce the definition that is given to that, and if we’re unclear, we’ll seek clarity of what it is. I think it’s more that these devices will need to be registered with Health, so we’ll have to defer that question to the ministry to decide.

Independent Senator Murray Sinclair:

That could include a spoon. I was curious whether you had been consulted, but obviously not. How about your force (CBSA)?

Lisa Janes, Canada Border Services Agency:

My response is consistent with the chief superintendent’s.

FENTANYL MAILED THROUGH CANADA POST AND CANADA BORDER SERVICES AGENCY

Conservative Senator Bob Runciman:

You’re talking about 30 grams. To folks like me, that’s about an ounce, I gather. If you’re explaining this to Canadians generally, that sounds like a modest amount. Could you expand on the implications because it sounds, on the surface in any event, that this is not a serious problem. Perhaps you could elaborate with respect to the need for this?

Acting Chief Superintendent Andris Zarins, RCMP:

We’ll both address this one. I believe it was addressed because the stuff that is coming over now, one gram can kill you. A minute amount of fentanyl and its derivatives is enough to cause serious harm, if not death. So the 30 grams might seem very small, but the quantities coming in and that can cause serious injury to our citizens is tiny. This is why the 30 grams would be a level that’s not unreasonable.

Lisa Janes, Canada Border Services Agency:

I would echo my colleague’s comments. As I mentioned in my opening remarks, we understand that 2 milligrams is a lethal dose, and this is 30 grams. You can multiply that out and see what the potential impact could be. By being able to put it in the letter mail, it’s very inexpensive, easy to do, and it is anon- ymous. So there are a lot of positives for people who want to use the legitimate mail system for this purpose. 113 The Federal response to the Opioid Crisis

LAW ENFORCEMENT AND INFORMATION SHARING

Conservative Senator Bob Runciman:

Chief, I think you mentioned, in one of your comments, operational crime agreements with China. I was curious about that. How does that work with respect to this issue? Does it include information sharing?

Acting Chief Superintendent Andris Zarins, RCMP:

We’re always aware of the care that we take when we share information with any country, not just China. We are cognizant of what can be shared and what can’t. Things are moving forward, sir. An example of that is that on March 1, 2017, China added four more analogues of fentanyl to its list of controlled substances: carfentanil, furanylfentanyl, acrylfentanyl and valerylfentanyl. So they’re listening to us. We’re working very hard to get a better handle on precursor issue with them. So they are cooperating with us, and we are moving forward. We’ll see as it happens. We will be engaging them in the near future in face-to-face meetings, and we are hopeful that things will work out.

Conservative Senator Bob Runciman:

You said you’re cautious about information sharing. That’s wise, I would think. You didn’t say it’s not occurring, so I assume to some degree it is occurring.

Acting Chief Superintendent Andris Zarins, RCMP:

Yes, sir. In police ongoing investigations that happens, but we’re still very careful with what we share. It’s like every country, sir. We have to know where it’s going and it has to be for consistent use. So as we move forward, as the trust level carries on, the more sharing can happen. Again, it’s on a case-by-case basis and under a very controlled environment.

PILL PRESSERS

Conservative Senator Vernon White:

I have two quick questions. One is on pill making and capsule making. Just to be clear, this legislation won’t outlaw them. It just means you have to have a permit to own one. It will not take away a legitimate veterinarian who makes pills for animal care.

Lisa Janes, Canada Border Services Agency:

That is correct. The pill presses or encapsulators would have to be registered with Health Canada, absolutely.

REGULATIONS

Conservative Senator Vernon White:

One of the challenges with listing precursors right now is that we have a 90-day gazetting process. Does that change with this legislation, or do we still end up knowing today that something is going to kill people but have to wait until June or July to have it unlawful to possess?

Acting Chief Superintendent Andris Zarins, RCMP:

My understanding is that the Minister of Health will now have the ability to go and have them listed. The timeline, sir, I couldn’t answer for you. At least he or she now has the ability to get that listed.

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Conservative Senator Vernon White:

But the Minister of Health does that now. They listed all of the fentanyl precursors, all eight of them, last September, but they didn’t take effect until December because of the gazetting. I didn’t see anywhere in the legislation that removes the requirement for gazetting. Do you know?

Acting Chief Superintendent Andris Zarins, RCMP:

I don’t know, sir; I can’t comment on that.

CANADA POST AND CANADA BORDER SERVICES AGENCY

Independent Ratna Omidvar:

This is a question to Ms. Janes. I know that you already have the authority to open packages and now you’re going to get the authority to open letters. Do you have the capacity to do that?

Lisa Janes, Canada Border Services Agency:

Thank you very much for the question. When we look at letter mail under our current process, right now we have the ability under the Customs Act to examine all mail that is coming to Canada. Where we have limitations is in our ability to open up mail that is 30 grams or less and where we have to go to a secondary process and seek permission. When the mail is presented, as I mentioned earlier, we work very closely with Canada Post on identifying, based on risk assessment and the information, the letter mail or mail that we would like to see Canada Post present to us, because there are hundreds of thousands of items of mail. We work on a risk assessment basis because there’s a lot of mail in the system, so we want to better target and we want to rely on non-intrusive technology to help us do our job.

Independent Ratna Omidvar:

Currently, when you are looking at packages, because that’s where your authority lies, can you give us a sense of how many warrants are currently issued in any given time period?

Lisa Janes, Canada Border Services Agency:

I am unable to answer that question. I do not have that information at this time.

Independent Senator Rosa Galvez:

I believe that when you say “risk assessment,’’ it includes where these letters are coming from. I believe that you will concentrate on the mail that is arriving in the provinces where the problem exists. I am in Quebec. I don’t know how many of the letters in Quebec you will be opening compared to the ones that you will be opening in B.C. Based on your experience and your conversations with the other places where this problem has been seen, what percentage of the problem are you going to solve and in what time frame? What are your hopes? What will you attain and achieve in terms of mitigating the problem by these measures?

Lisa Janes, Canada Border Services Agency:

Thank you very much for the question. I think what’s important is that we’re trying to close a gap in the sense that we have mail that is more than 30 grams that we can immediately open, and then we have mail that is less than 30 grams that we have to follow a process to do because people are taking advantage. There’s abuse there. We’re trying to create a level playing field across all modes, as well as within the mail itself, that there’s no opportunity to abuse the “30 grams or less”. By doing that, as we’ve mentioned earlier, because there are such small amounts of the product, whether it’s fentanyl or other opioids, this is the challenge. They’re using this as an avenue for that. They’re taking advantage of the fact that we don’t have the ability to automatically open the mail. 115 The Federal response to the Opioid Crisis

IMPORTED OPIOIDS (CHINA)

Independent Senator Renée Dupuis:

Regarding your discussions with China and the United States, I was wondering whether you had data on the percentage of the importation of opioids or other illegal substances by country of origin. In other words, more specifically, how much comes from China in terms of what we receive here and what you intercept, in relation to other countries, and do we have data on those countries?

Acting Chief Superintendent Andris Zarins, RCMP:

I don’t have the exact percentages. However, our focus is on China, both for precursors and for the finished product. It fits into my colleague’s answer earlier. We, as CBSA and RCMP, strive to be intelligence-led. We have liaison officers and analysts deployed abroad. We try to develop the intelligence to know where they’re coming from, and this helps us to target, whether that’s letters or organizations. We really use our footprint abroad to find out where it’s coming from so we can be ready to receive it when it comes here. In relation to the percentage, right now our focus is on China, but I’m not saying it’s the only place it’s coming from.

CANADA POST AND CANADA BORDER SERVICES AGENCY

Liberal Senator Mobina S.B. Jaffer:

At the moment, for less than 30 grams you have to get a warrant; is that correct? And the sender has to get a warrant? No? They can just give permission?

Lisa Janes, Canada Border Services Agency:

For less than 30 grams, we have to get permission from either the addressee or the sender. No, we would have to seek written permission from either the addressee or the sender in order to open up an item.

Daniel Therrien opening statement:

Let me start by acknowledging the importance of addressing drug abuse and addiction in a comprehensive manner. While Bill C-37 touches upon a number of matters, I’ll comment only on the clauses that amend the Customs Act and the Proceeds of Crime (Money Laundering) and Terrorist Financing Act. These clauses concern the mail inspection powers of different government agencies. As the law stands now, customs officers are permitted, on suspicion, to examine mail that is being imported or exported and weighs more than 30 grams. However, when mail weighs 30 grams or less, consent must be obtained. If I understand correctly, this longstand- ing limitation has been in place to protect the privacy of correspondence. While Bill C-37 would repeal the requirement for consent, I want to say a few things on the matter. First, prior to any examination of mail, customs officers would need reasonable grounds to suspect the presence of prohibited, controlled or regulated goods. This is in contrast to the general customs examination of goods, which in most circumstances requires no grounds. Second, assessing the reasonableness of the amendments to the Customs Act and the Proceeds of Crime (Money Laundering) and Terrorist Financing Act requires a balance between privacy and public safety interests. The government says it has evidence demonstrating that the international mail system has been used to import, in small quantities, drugs that have been responsible for the death of a large number of Canadians. Third, I’ve also been informed that customs officers don’t systematically open all mail. Before examining or opening mail, they use a range of risk assessment techniques to determine whether any contraband is being imported or exported. In light of these factors, I believe the amendments to the Customs Act and the Proceeds of Crime (Money Laundering) and Terrorist Financing Act are justified. However, I think these amendments should be accompanied by additional measures to protect Canadians’ privacy, more specifically to ensure that correspondence isn’t read in cases when no contraband is found. These measures would ideally take the form of additions to the bill. Otherwise, a government policy on the implementation of these amendments could be sufficient. In a free and democratic society, the opening of mail by the government is generally prohibited and must be carried out with the greatest possible restraint. The recent Supreme Court of Canada decision in R. v. Fearon may be helpful to us in finding the right balance between the objectives of Bill C-37 and the protection of privacy. In that case, police searched an individual›s cellphone after arrest, without a warrant. The majority of the court held that such warrantless searches serve valid law enforcement purposes, that the search in question did not violate the individual›s Charter rights, and that the evidence obtained was admissible.

116 The Federal response to the Opioid Crisis

While the context was different than Bill C-37, which contemplates searches at the border, and those have been referred to in the case law as a unique context, R. v. Fearon also addressed the unique context of warrantless searches upon arrest and may therefore prove useful in navigating this issue. While it upheld the search as constitutional, the majority in Fearon clarified that a balance must be struck between the legitimate objectives of enforcing the law and privacy interests. To ensure that searches upon arrest comply with the Charter, the majority outlined four conditions that must be met. First, the arrest must be lawful. If we apply this to Bill C-37, examination of mail must be conducted with reasonable grounds to suspect, in accordance with the provisions of the Customs Act or the PCMLTFA. The second condition is that the search must be truly incidental to arrest. In the case of Bill C-37, this would mean that the examining officer must have a valid reason to conduct the search, such as the discovery of prohibited or controlled goods, currency or monetary instruments. The third condition, and of highest interest in my view, is that the nature and extent of the search must be tailored to its purpose. In the case of Bill C-37, any search of correspondence after an examination and opening of mail should be tailored to the initial purpose of the examination: the discovery of prohibited or controlled goods, currency or monetary instruments for the purpose of enforcing the Customs Act or the PCMLTFA. This condition is useful in that it is a flexible standard that could be applied in the case of all mail in -or der to balance privacy rights with the examination of mail at the border. For example, reading correspondence would not be permitted if opening the mail was justified by a suspicion that it contained drugs, and no drugs are found in the envelope. However, if the justification for opening the mail is that it contains correspondence, which itself is something the importation or exportation of is prohibited — say, terrorist propaganda — then reading the correspondence would be authorized. The fourth and final condition of the Supreme Court Fearonin is that the police must take detailed notes of what they had examined on the device and how they examined it. Likewise, I would suggest that officers should document the steps they take when examining and opening mail, the reasons for their suspicion, and if correspondence is read, why they believe that the correspondence itself was contraband.

MAIL SEARCHES AND THE CANADA BORDER SERVICES AGENCY

Liberal Senator Mobina S.B. Jaffer:

I have a weird question for you. After your presentation, when you, whose opinion we respect, say there isn’t much to be worried about, that this is the right way and you can justify it, the only concern I have and the only way I can say it is “mail profiling,’’ in the sense that we heard from the CBSA that there are lots of concerns about material being sent from China. My concern is that not everything that comes from China should be seen by them. They have a job to do; I’m not being critical of them. But for your job, how do you assure that anything that comes from X country, everyone’s mail has to be looked at? How do we prevent that kind of generalization?

Daniel Therrien, Privacy Commissioner of Canada:

The CBSA would need to have reasonable grounds to suspect — To me, country of origin in itself would likely not be reasonable grounds to suspect. You would need something other than the simple country of origin, but country of origin may be relevant among other factors in providing reasonable grounds to suspect.

Conservative Senator Bob Runciman:

I’m curious about country of origin and China. The evidence, and we heard testimony as well, is that it is a primary concern of the RCMP. I’m curious why you would not consider that a justification.

Daniel Therrien, Privacy Commissioner of Canada:

I said not likely would that in itself provide reasonable grounds to suspect. I don’t have the evidence. I don’t know the amount of mail that comes from that country or other countries. I suspect it is extremely large. I would suspect as well, but I don’t have the evidence, that the CBSA would not be in a position to examine all mail from a given country and will want to have other factors than the mere country of origin. Maybe of more direct relevance to your question, many people will correspond from a given country, say China, with Canadian citizens for extremely legitimate reasons. So again, the mere country of origin of the mail I would suspect would not generally be sufficient in itself, but it could be a factor, among others.

117 The Federal response to the Opioid Crisis

Conservative Senator Bob Runciman:

Given the current situation with respect to the ability to open mail, do you receive many complaints over the course of the year? What has your experience been?

Daniel Therrien, Privacy Commissioner of Canada:

About the searches of mail by the CBSA?—No, we do not see many complaints about this.

Conservative Senator Vernon White:

When we’re talking about items coming from another country, and we understand that we’re protecting personal information in relation to what has been written inside, if we’re searching for drugs as an example, we also understand that in the mail system they are already going to scan, X-ray those items. Do we require more clarity around the fact that they’re searching for a substance and not written material? Or do you think this already covers that what we’re searching for is drug material, precursors or ingredients? Realistically, they’re not picking up an envelope and saying, “I want to open it.’’ They are actually going through another process that would have already generated some form of lawful grounds. Wouldn’t you agree?

Daniel Therrien, Privacy Commissioner of Canada:

The law itself requires that customs officers have reasonable grounds to suspect very specific things: that things are in the package, whether it’s mail under 30 grams or bigger packages over 30 grams, that the package contains goods, the importation of exportation of which is prohibited. That is a finite series of goods, so they need to have suspicion that that contraband is in the package in order to open it. The historical distinction between packages of less than 30 grams versus over 30 grams I think is based on the privacy concerns that less than 30 grams is more likely to only include correspondence. And correspondence, even in that border context, is entitled to some expectation of privacy. But I take notice of the fact that nowadays, mail under 30 grams is viewed, as I heard this morning, to import illicit drugs. At the end of the day, I think we need to balance privacy and other considerations. Here there is importation of drugs that lead to death, and we need to recognize that, but it should be done in a way that is privacy protected, which is why I am recommending certain privacy protection measures. To start with, customs officers need reasonable grounds to suspect that the package contains something illicit.

Conservative Senator Vernon White:

The second piece for me is an item arriving from another country. Does it have the same expectation of privacy when, for example, there is often no name and there is no return address on the envelope? Who has that expectation of privacy on an envelope that has no other name on it other than Vern White’s and it’s coming to my house? Is it my expectation?

Daniel Therrien, Privacy Commissioner of Canada:

The recipient would have some level of privacy expectation, but here we’re at the border, and the case law is clear that at the border, the reasonable expectation of privacy is much less than in other contexts. But “much less’’ does not mean “not at all”.

RCMP AND FENTANYL

Independent Senator Rosa Galvez:

I work in a chemical lab, and when the RCMP says they’re going to use non-intrusive instruments or mechanisms and they mention X-rays, an X-ray doesn’t tell you whether or not a chemical product is in there. What you have to do is take out the compound and send it to a lab, and lab will say it is a drug or not. So in reality, what they will use is the intelligence they gather and the risk assessment. I’m saying that they won’t be able to know whether the drugs are there, so they will open it. Do they press charges when it is directed to the drug issue specifically, or can they relate it to another crime, such as immigration or another drug offence not related to fentanyl?

Daniel Therrien, Privacy Commissioner of Canada:

Customs powers are not limited to drugs. They extend to any goods that are regulated or something that is prohibited in terms of exportation or importation. So the impetus for this bill is particular drugs, but the customs powers that we’re discussing now extend to anything that is illicit, the importation or exportation of which would be illicit. 118 The Federal response to the Opioid Crisis

MARCH 29, 2017

ON THE AGENDA Consideration of Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts Main Topics Discussed: supervised injection sites, prevent and treatment, prescriptions, amendments to the Controlled Drugs and Substances Act, fentanyl and marijuana, Customs Act and Canada Border Services Agency, role of Health Canada.

WITNESSES Cabinet • Health Minister Jane Philpott (Markham-Stouffville, Ont.) Health Canada • Hilary Geller, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch; • Diane Labelle, General Counsel, Health Canada Legal Services. Public Health Agency of Canada: • Dr. Theresa Tam, Interim Chief Public Health Officer.

TRANSCRIPT HIGHLIGHTS

Health Minister Jane Philpott opening statement:

Good afternoon, everyone. I am pleased to be appearing before your committee to discuss Bill C-37 and update you on actions we are taking to address the opioid crisis. As the chair said, accompanying me today are: Hilary Geller, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch; Theresa Tam, Interim Chief Public Health Officer, Public Health Agency of Canada; and Diane Labelle, General Counsel, Health Canada Legal Services. I certainly appreciate the committee’s interest in this very important issue and I look forward to your feedback and questions on our discussion this afternoon. As you know, Bill C-37 offers concrete solutions to many challenges that we are facing as a country, particularly as it relates to an ongoing crisis of overdose deaths associated with opioids. Our government has been eager to expedite the passage of this bill through the parliamentary process to help protect both the health and safety of Canadians and their communities. The speed with which parliamentarians have addressed this legislation demonstrates the collective sentiments for a need to swiftly act in the face of an opioid crisis. Our country is facing a public health crisis in relation to opioids, especially fentanyl. First responders have seen with their own eyes the devastation caused by that crisis. Last year in British Columbia, as many of you are well aware, more than 900 people died from drug overdoses. That was an 80 per cent increase over the year previously. The data from 2017 shows that there are few signs of improvements and in fact we are on track for that number to continue to grow. There were 102 suspected drug overdose deaths in February 2017 and that is a 73 per cent increase over the number of deaths in February 2016. The scale continues. British Columbia is not alone. In Alberta, 257 people died from fentanyl overdoses in 2015, and that number jumped by a third in 2016 to 343. That is just the number of deaths associated with fentanyl. There would be other overdose deaths in addition to that. We are facing a period of time in the country where there are more people dying as a result of overdoses, let alone overdosing itself, than there are Canadians dying from motor vehicle accidents. We see signs that the opioid crisis is expanding throughout the country. Problematic substance use can affect people of all ages and from all socio-economic groups. It has devastating consequences on individuals, families and communities. I have visited with those who face this crisis on a daily basis. That includes first responders who are facing repeated overdoses, many times on a single shift. I have met with family members and friends who are grieving the loss of loved ones. Our government’s approach to drug policy is compassionate, collaborative, comprehensive and evidence-based. We are using the same approach to address the opioid crisis. We need to take a public health approach, while ensuring that law enforcement entities have the tools they need when addressing problematic substance use. We need to turn the tide on this crisis as quickly as possible. The government’s new Canadian drugs and substances strategy in which Bill C-37 plays a fundamental role will help us to turn that tide. The new Canadian drugs and substances strategy replaces the previous approach by addressing problematic substance use as primarily a public health issue. We have restored harm reduction as a key pillar in Canadian drug policy alongside prevention, treatment and enforcement. These pillars are supported by a strong evidence base. 119 The Federal response to the Opioid Crisis

Bill C-37 is a legislative proposal that supports this strategy. It would do so by updating legislation to focus on harm reduction measures, while continuing to reduce the flow of illegal substances into Canada. It proposes to amend the Controlled Drugs and Substances Act, the Customs Act and other acts to: improve the government’s ability to support the establishment of supervised consumption sites, as a key harm reduction measure; address the illegal supply, production and distribution of drugs; and, finally, reduce the risk of controlled substances used for legitimate purposes being diverted to the illegal market by improving compliance and enforcement tools. Streamlining the application process for supervised consumption sites is a central piece of this bill, and for good reason. The evidence is abundant that when properly established and maintained supervised consumption sites save lives without increasing drug use and crime in the surrounding area. Specifically regarding the application to supervised consumption sites, Bill C-37 would amend the Controlled Drugs and Substances Act in order to establish a more streamlined application process for these sites that aligns with the five factors that were set out for us in 2011 by the Supreme Court in the decision of Canada (Attorney General) v. PHS Community Services Society. The bill also seeks to improve transparency by requiring the decisions made about supervised consumption sites to be made public, including the reasons why an application would be denied. For those communities that want and need these sites, we want to create an environment that encourages applicants to come forward. Of particular note the bill proposes that we include the five factors I referred to in the legislation, one of which it is important to note is community support or, on the contrast, community opposition. The government is absolutely supportive of community consultations. In fact, it is critical to the ongoing success of this important harm reduction tool that communities be supportive. Bill C-37 also includes a number of other amendments to the Controlled Drugs and Substances Act that would modernize the legislative framework. Improving the compliance and enforcement tools would reduce the risk of controlled substances that are used for legitimate purposes from being diverted to the illegal market. Proposed legislative measures would prohibit the importation of unregistered pill presses or pill encapsulators. It would allow border officials to open international mail of any weight, should they have reasonable grounds to suspect that the item may contain prohibited, controlled or regulated goods. It would grant the Minister of Health the necessary powers to quickly schedule or control a new and dangerous substance. Bill C-37 balances public health and public safety and is based on the best available evidence. Removing components of the bill such as the provisions related to supervised consumption sites would upset this balance and significantly delay access to an important harm reduction tool for communities that need and want them to address the opioid crisis. Bill C-37 is one of many important federal actions that have been taken to date to address the opioid crisis. To give you an idea of the other things we have done over the past year, we made naloxone, the antidote to overdoes, available without a prescription. We expedited a review of naloxone nasal spray and ensured an emergency supply of that spray. We granted a four-year exemption to Insite, the supervised consumption site in Vancouver that I suspect you are familiar with, and we granted an exemption to the Dr. Peter Centre in Vancouver. We reversed the prohibition on physician access to the important treatment option of pharmaceutical-grade heroin to treat the most severe cases of addiction. We supported the Good Samaritan Drug Overdose Act, Bill C-224, which offers immunity from simple possession charges for people who witness an overdose and call 911. We finalized new regulations to control chemicals used to make fentanyl, making it harder to manufacture illicit substances. I co-hosted a joint national conference and summit on opioids with the Ontario Minister of Health. We produced a joint statement of action from nine provincial and territorial health ministries and more than 30 organizations. In collaboration with our provincial and territorial partners we have established a special advisory committee on the epidemic of opioid overdoses that includes the Council of Chief Medical Officers of Health. In 2016-17, the federal government transferred $36.1 billion through the Canada Health Transfer to provinces and territories for their overall health services, including treatment of addictions. In Budget 2017 we recently announced $100 million in funding to address the ongoing crisis. This includes $65 million over five years for federal initiatives, an additional $10 million in emergency funding for British Columbia, and $6 million in emergency funding for Alberta. To address some of the causes and factors associated with the crisis, the federal government offered the provinces and territories $5 billion over 10 years for mental health and addiction supports as part of our new health accord. In addition, Health Canada is improving access to and information as it relates to a number of medication-assisted therapies. We funded the Canadian Research Initiative in Substance Misuse to provide better evidence-based guidelines for medication-assisted treatment. We supported McMaster University’s update to the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Can- cer Pain, developed by a group of clinicians, researchers and patients. That gives you some idea of the work done so far. Unfortunately, while we cannot end this opioid crisis immediately, we have taken swift and decisive action. We will continue, and I look forward to working with you on this, to make sure we have a comprehensive and balanced approach to deal with problematic substance use for the long term.

120 The Federal response to the Opioid Crisis

Making Bill C-37 law is an important step to support this approach to drug policy. I would take a moment to respectfully urge this committee to work as expeditiously as you possibly can. Your role in this matter is critical. As you know, people are dying in Canada every day and there are measures in this legislation that will save lives. This legislation was so important that in the other place, for the first time in its political party’s history, the New Democratic Party supported time allocation to move this bill as quickly as possible through the legislative process. The health committee in the other place conducted a thoughtful study on the opioid crisis. I would be happy to circulate the government’s response to honourable senators once it is tabled. Because of this investigation and the hearings with witnesses that had already been completed, the health committee in the other place was able to complete their study on this bill quickly. I know many of you have been pressed with this issue and have already taken a number of steps to prioritize this legislation. I want to personally thank you for that. We need to do everything at our disposal to save these lives that are being cut short. This proposed legislation would equip the federal government and law enforcement with stronger tools to address problematic substance use and the ability to support communities fighting this crisis on the local level. We will continue to work with our party partners, including the provinces, territories, municipalities, indigenous communities and civil society to address this opioid crisis. This will allow us to better protect Canadians, save lives and address the root causes of a major issue that affects our entire country. Thank you for asking me to join you today. We would be happy to take questions.

BILL C-37

Conservative Senator Denise Batters:

Minister, it is my understanding that a number of the measures in this bill were tabled by our Conservative government’s Bill C-70 in June 2015. This included measures like giving Canada Border Services Agency increased powers to inspect suspicious mail and allowing Ottawa to limit the importation of devices like pill presses. We are in the midst of an opioid crisis and have been for many months. Children are dying. Knowing that, why did you wait 18 months to introduce legislation containing measures that were already drafted and ready to go in 2015?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

You are absolutely right. There are pieces of this legislation that had been previously introduced in the previous government. They were not the areas where we were being most pressed but they were areas where people were concerned. When we came to government the area I was immediately asked about most frequently was the matter of supervised consumption sites. We took some time to consider the process that had been put in place by the previous government. We had hoped it would be workable to allow access to supervised consumption sites as quickly as possible, but it proved onerous and I was under tremendous pressure to address that. As we moved forward in putting in place measures to expedite the process for application of supervised consumption sites, we looked to these other measures that had been in the previous government’s Bill C-70 and added those in. In retrospect, things take time and one can never move quickly enough in a process like this. However, as soon as we recognized that we needed to put legislation in place on drugs and substances we added these additional measures.

SUPERVISED INJECTION SITES

Conservative Senator Denise Batters:

Like you referred to, you have significantly altered the requirements put into place by the former Conservative government for the applications of drug consumption sites. Some of the criteria that Bill C-37, your bill, now abandons include letters of opinion and concerns from significant community stakeholders such as the local government and the head of effective policing services. Instead, your legislation requires only the vague “expressions of community support or opposition.’’ Without the input of the local government or police services in an area, what would qualify as an “expression of community support or opposition’’ for the purposes of your bill? Would one positive letter, for example, from a supportive community organization or leader suffice?

121 The Federal response to the Opioid Crisis

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

My officials may want to add to this, as well, but the reality is that the approach that we went to in this puts a significant amount of discretion in the hands of the Minister of Health to make a decision based on the particular circumstances of that community. We wanted to include the measures that the Supreme Court indicated needed to be taken into consideration, including community support. On a case-by-case basis the Minister of Health may choose to look to require additional items like that to be able to document the community support. The Minister of Health, especially in turning down an application, would be required under this legislation to explain, for example, that there were members of the community who were opposed to it. I have certainly been impressed with the reality we are facing on the ground from the beginning of the time that I took office. Many cities and communities across the country desperately want to be able to open supervised consumption sites. The community support is overwhelmingly pushing for us to be able to allow that authority to provide an appropriate exemption. People are dying in the streets on a daily basis and people are looking for every possible mechanism. Within the Minister of Health’s discretion, assuming that there is support in the community, the burden of pressure and need was to be able to provide support for these in communities that need them. You will see included in the five factors that there has to be a demonstration not only of community support but also of community need.

Liberal Senator Mobina S.B. Jaffer:

Minister, the last legislation that in the previous government put in place there were 27 conditions. It was very onerous and very difficult, especially in my province of B.C. We heard from many people that it was virtually impossible to open another site. You now have five. I looked at them. This is something people can do, but people need time to do this. I would like to hear from you as to why you did not consider that in an emergency, in a case where a 56(1) exemption cannot apply because there isn’t the time to empower the provincial minister to open a temporary site, for example in B.C. with all the problems that are happening, why couldn’t the minister of health provincially open for a short time to deal with this issue? Did you consider that provision?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

That is an excellent question and it is indeed something that we considered. You are absolutely right that the process under the current legislation as it exists is tremendously onerous. The binders my department received to meet the 26 criteria are quite remarkable, considering the fact that the people who are filling these out are dealing with the front lines of the overdose crisis at the same time. I have urged my officials to be as helpful as possible in helping people to fill out the application process. That will continue under the new criteria, so that even though we have moved it to five factors I will encourage them to be as helpful as possible. In fact they have sought to do that to support communities that are feeling this desperate need. We felt that the idea of passing on his responsibility to the provinces and territories would put us at risk where there may be inconsistency across the country. When we are dealing with a matter of drugs and substances and dealing with prosecution, for example, it made sense for there to be some cohesiveness and coherence across the country. Yes, indeed we did discuss that. I have made it very clear to those communities crying out for help that we will make sure we do everything within our power to work with our provincial partners to be able to support the communities that want these.

Liberal Senator Mobina S.B. Jaffer:

All the five, according to the Supreme Court of Canada, I accept those. The one requirement that I have a bit of concern with and think will be time consuming is the resources available to support the maintenance of the site. I believe it is vague. How long? Is it for a year? Is it for six months? Could you elaborate on that?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I may not be able to go into specifics in a short answer, but a good example of this is in Ontario where Toronto and now Ottawa have applications in process. In Toronto’s case, for example, they had three sites where they were enthusiastic to get sites open to people. One of the pieces that held us at bay, as it were, in approving those was that we needed to make sure they had the resources to be successful. We were thankful when the provincial government announced they would put the resources behind and announced that money would be there. We put this in there because the Supreme Court had put this in as a factor to consider, but I think it is a reasonable factor. So far, these sites have been highly successful. They have been able to save lives, make sure there is no increased crime and make sure there are no challenges in the surrounding area. We have to make sure they continue to be successful and having the resources to function well will be important in that. 122 The Federal response to the Opioid Crisis

PREVENTION AND TREATMENT

Conservative Senator Paul E. McIntyre:

I have to admit I am concerned that your bill would reduce from 26 to only 5 criteria, which severely weakens Bill C-2, the current regime under the Respect for Communities Act. You have explained the rationale behind reducing considerably those criteria. Hope- fully, it will tackle the present national crisis we are facing today. My question has to do with the drug treatment centres. In reading your bill I note that it does not contain provisions on drug treatment centres that are considered as being an important part of the solution. Could you enlighten us on why Bill C-37 does not contain provisions on drug treatment centres?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I may need some further elaboration on whether I am getting at the right point, but let me make an attempt. If I haven’t got your question quite clear, maybe you can clarify it for me. I think you are asking about treatment for problematic substance use and medication-assisted therapy to go along with the supervised consumption sites. This is an incredibly important question. As you may have heard me say, the response to drug policy and the response to this overdose crisis have to be comprehensive. It requires all of those pillars. Prevention is incredibly important. We need to talk about why people end up with problematic substance abuse to begin with. It is often related to unresolved trauma, mental illness and a whole bunch of other social issues. We need to make sure they have harm reduction facilities, including that supervised consumptions are available, but you are absolutely right that treatment has to be an essential part of this. Treatment involves things like counselling, mental health care, housing support and social support. It also includes medical treatment and medication-assisted therapy in many cases that may take the form of opioid substitution therapy like Suboxone, for example. Sometimes in certain circumstances it will involve things like access to pharmaceutical-grade heroin. There is nothing in this bill that would prevent a provincial government from being able to associate a treatment centre with a supervised consumption site. In fact it’s a very good idea in many cases. One thing that grieves me tremendously is that people will come into a supervised consumption site. Their life will be saved if they overdose and they will be introduced to the health care system, but very often they are sent right back out into the street. They have a recognized opioid dependency. In order to maintain that dependency and deal with the health condition they are associated with, they will often seek more drugs. Those will be drugs that they will seek on the streets and commit crimes sometimes in order to access those. Being able to find ways to introduce people to treatment in connection with these sites is a fantastic idea, and I’m certainly encouraging my provincial partners to consider that.

SUPERVISED INJECTION SITES

Conservative Senator Paul E. McIntyre:

Overall, as you know, minister, three models of drug consumption rooms are operational in Europe: integrated, specialized and mobile facilities. Are mobile injection sites covered by this bill? If not, are you considering mobile injection sites?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mobile supervised consumption sites would certainly be able to apply under this bill. In fact we have two applications that are in process. They are slightly more complicated applications in order to demonstrate that they would meet the criteria, but as you’ve indicated in Europe these have been found to be helpful. We’re open to considering those according to the appropriate legislation.

123 The Federal response to the Opioid Crisis

DESIGNATED SUBSTANCES AUTHORITY

Independent Senator Renée Dupuis:

I have a question about the minister’s new authority to make an order that would add a designated substance to the list for a maximum of two years, even though the legislation already grants the Governor in Council the power to make an order and even though we — lawyers — generally do not like to resort to ministerial discretion, as that means both adding an element and removing it. Can you enlighten us on the justification for using that particular process?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I think I will turn to my officials to clarify the specifics. You are absolutely right. In many cases the Governor-in-Council authorities can allow for these products to be listed or delisted. Hilary or Diane can respond to that.

Hilary Geller, Health Canada:

The section that we refer to as allowing for temporary accelerated scheduling is similar to authorities that exist in a number of other countries. It’s designed to address an emerging problem of new psychoactive substances. Where in the past you might see one or two new substances a year, over the last number of years that has increased rapidly to where we are now seeing one or two a week in some cases. Instead of going through the normal regulatory process, as you indicated, senator, this authority allows the minister a much quicker scheduling. If it runs its typical course it can take between 18 and 24 months. That’s a long period of time when dealing with a dangerous substance. We’re thinking possibly as quickly as eight weeks, depending on the circumstances, but that would be limited to cases where a substance poses a significant risk or alternatively may pose a risk and we know it has no legitimate purpose. It’s a renewable authority. It can’t continue for more than two years. We anticipate that at the same time this process is used we would also be going through our usual regulatory analysis to replace it with that process for its long-term scheduling.

PRESCRIPTION OPIOIDS

Independent Senator Renée Dupuis:

Do the offences designated in the bill include physician-prescribed opioids? There is talk about possession for purpose of consumption, but is there talk about what is partially causing the opioid crisis — prescription by health care professionals?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

You are right. Some of the roots of the crisis are related to prescription opioids but that’s not the matter being addressed in the particular bill. We are responding to that in our more broad strategy, including the work that we did at the opioid summit where we brought together national stakeholders, including regulators of doctors and pharmacists, et cetera. That’s not the subject of the particular legislation.

ON HEALTH CANADA BEING PROACTIVE WITH IDENTIFYING DRUGS

Conservative Senator Vernon White:

My first question will focus on the work of Health Canada and whether or not they are proactive enough in identifying what drugs are coming and what other possibilities we would have. I appreciate that you need the new legislation to be able to be proactive, but I do think that we are behind most countries if we look at Australia. The U.S. listed precursors for fentanyl in 2006. We did so in 2016. With bath salts we were behind most of the countries. I guess I’m asking what we anticipate seeing going forward from Health Canada when it comes to being proactive. Eight weeks is a long time in Vancouver. It probably means about 175 people have died. That’s a long time for some of these issues. Do we anticipate seeing activity happen more quickly?

124 The Federal response to the Opioid Crisis

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

This requires our working closely with our partners in public safety, including law enforcement officials who are doing a large part of the work on this. Some of the new resources we are providing through even the money that I talked about earlier are around laboratory testing and toxicology, to be able to get better information about the substances that are being intercepted on the street. That also allows us then to be able to identify the new substances, as this is a rapidly changing environment. I don’t know whether you want to add to that at all, Hilary.

Hilary Geller, Health Canada:

I guess I would just add that this new provision will work in concert with an existing provision under the Food and Drugs Act, which is perhaps not as well understood as it could be. It means that any substance sold that is not approved under the Food and Drugs Act and that alters a mental process is in fact illegal right from the beginning. Even before something is temporarily scheduled law enforcement can move against it. I think one of the things we need to do is work with our colleagues at public safety to ensure that is better understood.

Diane Labelle, Health Canada:

There is an additional tool being proposed with the amendments to section 7.1 where we capture anything being used with the intention that it will produce a controlled substance. Between the accelerated scheduling, the backstop offered by the FDA prohibitions on selling and 7.1, I think there is a much enlarged capacity to deal with new substances.

SUPERVISED INJECTION SITES AND TREATMENT

Conservative Senator Vernon White:

I spent last Sunday night and Monday night in East Hastings with police officers and health officials walking up and down those streets and visiting some of the facilities. The biggest concern raised by community members who aren’t addicts and by police officers and health officials is the use of illegal drugs. I notice that we did see a regulatory change that will allow for the use of medical-grade heroin, but we did not see any regulatory changes that will allow for the medical use of other than medical-grade heroin. My perspective and that of most people around supervised injection sites is that they move to the relationship between a doctor and an addict, not organized crime, a drug dealer and an addict who is committing crimes but an addict and the doctor which is where it is now. Will we see regulatory change that will allow for greater use of prescriptive pharmaceuticals rather than illegal and illicit poison? I don’t want to call them drugs because they’re not that.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I encourage honourable senators to work with us in ensuring that access to all range of treatments and responses to this health problem are there. Some of this requires the decisions of provinces and territories as well as medical practitioners who obviously make decisions about what appropriate treatments are. There is nothing in the bill and nothing in the law that would prevent provinces from expanding a treatment centre associated with a supervised consumption site to be able to allow these kind of treatments to which you are referring to work closely. I think it is an outstanding model and it’s a model that we have to perhaps talk about a little more in public. I know, senator, you are well aware of the work done in other countries. Switzerland is perhaps the best example of that. When people are determined to have opioids use disorder and/or have legal problems associated with their substance use disorder they are introduced to the possibility of being able to be prescribed medications. It certainly has been effective in decreasing crime rates in those areas, very dramatically decreasing overdose rates and treating this as a health issue.

CUSTOMS ACT AND CANADA BORDER SERVICES AGENCY

Liberal Senator Serge Joyal:

I am concerned with section 52 of the act that amends the Customs Act. The purpose of the legislation is to abolish two sections of the Customs Act, one of which provides for the exception. I am concerned because I think the bill could be challenged on Charter 125 The Federal response to the Opioid Crisis grounds because you totally eliminate the exception without qualifying that you have used the least intrusive means. You have not taken means other than giving blank authorization for any opening, invading the privacy of citizens. In my opinion that could be challenged on Charter grounds because there is no nuance on the reason why the postal agent would be able to do the operation of opening. I have not gone through all the implications of this but since it also removes the possibility for somebody to file a declaration according to the universal postal convention you might be in breach of the postal convention in doing so. I am really concerned about that. I know the objective is sound. It is to prevent trade through mail but on the other hand I think that you move too much on the ground without the safeguards to protect the privacy of citizens in specific circumstances.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

It was discussed earlier that this was also part of previous legislation. As we came forward it was something that the provinces were very much interested in. Diane may want to comment on this now, but I would urge you to bring this up specifically with the folks from Canadian Border Services that will be here with you I believe tomorrow. They will be able to give detail as to how they propose to address this. I absolutely respect your concerns in terms of making sure this does not impose on people’s rights and privacies, but it is felt to be extremely important and that the risks of that can be appropriately dealt with.

Diane Labelle, Health Canada:

I can confirm that the Department of Justice did scrutinize the bill for consistency with the Charter and privacy legislation. Had there been an inconsistency a report would have been tabled with the clerk at the time of tabling the legislation. Having said that, I think that tomorrow’s officials will be in a better position to explain the implications you have raised with the international agreements.

Liberal Senator Serge Joyal:

I realize the minister is not responsible for that and I totally respect that. Now the authorization is for fighting drugs through mail, but once you give a blank authorization it could be open to anything and there is no longer protection. That’s why I have a real concern about it. The intention is good, but its impact and the way it could be used without balance is open to challenge.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

It is certainly one of the issues where we have to find the balance between making sure we protect the security and safety of Canadi- ans while not infringing inappropriately on the rights and privacy of individuals.

COMMUNITIES AND SUPERVISED INJECTION SITES

Conservative Senator Pierre-Hugues Boisvenu:

I have a question about communities. I spent 20 years with the department of the environment. Every time decisions had to be made, including for establishing water treatment centres, when the citizen consultation period was shortened, as the case seems to be with this bill, local communities’ reluctance increased. Canadians become very concerned when we talk about drug consumption and about creating supervised consumption sites. We are faced with citizens who are very opposed to those issues. In the context of this bill, why did you not include a transparent consultation process with Canadians, mayors and police forces to ensure that the decision is not being made strictly by Ottawa, but rather by local communities, as they will have to deal with those issues? It’s the communities and not the federal or the provincial health department that will have to manage very serious problems. Why did you not consider a highly structured and, most importantly, highly transparent consultation process in the context of this bill?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I certainly agree with you that it’s absolutely essential the community be consulted. This is very much a part of this bill. It is one the requirements that the Supreme Court put in place and it’s absolutely essential. The Minister of Health will be required to document that there has been appropriate community consultation. 126 The Federal response to the Opioid Crisis

I urge honourable senators to consider looking at the history of supervised consumption sites in Canada, particularly in communities where they have been successful in the past. Of course Vancouver is the best example where communities have been highly supportive of this. In fact when there have been documentations in the process of opening injection sites such as Insite some people were somewhat skeptical but agreed to move ahead with approval of an exemption for Insite. If you go to those communities now you will hear widespread support for what it has done to improve the safety of the community, to decrease crime and to decrease the drug paraphernalia that might be found in hallways and parks in the area. Another piece of assurance I can give is that in the communities most severely affected by the opioid crisis, including in the western part of the country in particular, I would encourage you to speak to chiefs of police and mayors, including the mayor of Vancouver, the mayor of Calgary and the mayor of Edmonton. All of the big city mayors that are most severely affected by this are highly supportive of making sure that we have the facilities available and that their communities are safe, not in spite of these but because of these measures that are available.

Conservative Senator Pierre-Hugues Boisvenu:

You are confirming that the obligation to consult communities will not be ignored in your bill.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

The duty to consult communities is deeply written in this bill. As long as I’m the Minister of Health community consultations will be an essential part of this process and it’s written into the bill.

FENTANYL AND MARIJUANA

Conservative Senator Betty Unger:

I have a separate but related concern that fentanyl is being mixed with marijuana. The marijuana at parties is used to convince young people that this safe drug can be used and then fentanyl-like substances are being mixed in. I understand the government is doing this rapid response to the crisis but I’m concerned that legalizing marijuana will create another crisis. We know that marijuana seriously and adversely affects the brains of young people up until the age of 25. My question is: Why would you still be considering legalizing marijuana when we know that there is a direct correlation here?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I would appreciate the opportunity to clarify that there have been rumours of the possibility of cannabis that has been laced with fentanyl. In fact there is zero evidence. It is very important that everyone understands that. We have confirmed this with chiefs of police and law enforcement officials across the country. There is zero documented evidence that cannabis has ever been found laced with fentanyl in this country. It is important that we make sure that message is clear. I will tell you that there are cases where cocaine, for example, has been found to be laced with fentanyl and that fentanyl has been sold in a way that it’s disguised to look like OxyContin tablets, for instance. You are on the right track in terms of the fact that other drugs may be laced with fentanyl, and that is why the public education portion of our approach is extremely important. However, I think we need to make sure that we don’t perpetuate the somewhat widespread stories related to this being connected to cannabis.

AMENDMENTS TO THE CONTROLLED DRUGS AND SUBSTANCES ACT

Independent Senator Murray Sinclair:

I have a little concern about the categorizing of offences as minor, serious or very serious as set out in various provisions of the bill. Can you explain to me why that approach was taken and what you wish the consequences to be by doing that?

127 The Federal response to the Opioid Crisis

Diane Labelle, Health Canada:

The proposed amendments to the Controlled Drugs and Substances Act will introduce a system of violations and penalties known as administrative monetary penalties. These will be applied mostly to regulatory non-compliance as opposed to what we call the Part 1 offences. These monetary penalties do not apply to trafficking, possession, illegal production, import or export. It is in the context where a regulated entity has a certain compliance history that these degrees of severity will be examined. That is where the criteria will be applied.

SUPERVISED INJECTION SITE

Conservative Senator Denise Batters:

Minister, how you answered my earlier question made me wonder if it is actually more onerous to turn down the approval of a safe injection site under your bill than it is to approve a safe injection site.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I’m not sure. There is a requirement within the legislation for transparency. The requirement is that the minister will have to be accountable for a decision that’s made as to whether it is turned down or whether it is approved. One would assume that when an application comes forward that there has to be evidence for that need in the area as is outlined here. I don’t know that there is anything in this bill which would indicate that the requirement to turn it down would be any heavier than the requirement to approve it. I think it depends a bit on what perspective the interested party has in seeking this, but I can certainly tell you that the overwhelming desire from these communities where overdoses are a daily reality is that they are urgently desirous of having all resources available to respond and to save lives.

PRESCRIPTIONS

Conservative Senator Denise Batters:

Minister, there was a front page The Globe and Mail story this week that stated: “Despite a national epidemic of opioid abuse and overdoses, prescriptions for painkillers — as well as therapies for treating dependency — have increased, new figures show. . . . Overprescribing is behind the epidemic. . . . A Globe and Mail investigation found that Ottawa and the provinces have failed to take adequate steps to stop the indiscriminate prescribing of opioids.” Minister, why isn’t your department taking adequate measures, then, to address this major part of the opioid puzzle?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

I will say it is very important that we recognize the overdose crisis has many roots. There are a whole range of reasons how we got ourselves to where we are. Some of them are related to laws and policies; some are related to prescribing practices; and some are relate to how prescription opioids were marketed, for example. Many of the roots that we don’t talk enough about are roots in social challenges that people are faced with. I hope that all honourable senators are pressed with the fact that people use substances like opioids because they are in pain. Many times it is physical pain that got somebody started, but very often it is emotional pain, it is unresolved trauma, it is history of domestic violence or it is adverse childhood experiences. People do not desire to become addicts. They develop an opioid dependency because of issues in their lives which are beyond their control. We need to respond to that in a compassionate and comprehensive way. We need to respond to this. I heartily agree with you that overprescription of drugs is one of the roots of this crisis but there are many other roots including social issues, untreated mental illness, and all kinds of things.

Conservative Senator Denise Batters:

What are you doing to address this? 128 The Federal response to the Opioid Crisis

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Yes, we are doing this. We brought together 30 organizations from across the country. We brought together regulatory colleges, colleges of nursing, colleges of pharmacy, and colleges where people are training, regulating and teaching doctors, nurses and all other health care professionals. We brought together people who deal with chronic pain. I think about this day and night. I work on this and try to ensure that we bring a comprehensive response to this. Bill C-37 is an essential part of that response but only one part of an extremely broad response.

SUPERVISED INJECTIONS SITES

Liberal Senator Serge Joyal:

There were 26 conditions. When you put all the conditions together it was almost the equivalent to negating the intention that the Supreme Court expressed in relation to section 7 of the Charter, which is the right to security and life. Which one of those 26 conditions are you reviewing in this bill to lighten the approach to getting authorization to open an injection site?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

You are absolutely right. There were 26 criteria under the previous legislation. Many of them in and of themselves made sense but put all together they became incredibly daunting and far too onerous. We’ve been in government 15 months or something like that and we were able to move along and finally approve three sites in Montreal, I believe. However, they were in that process for 18 months to be able to work through those criteria. I am hearing every single day about people dying. It became impossible. I had to force people to continue to work with that legislation. We looked at a number of possibilities and how we could do this best. We went to the Supreme Court decision. The Supreme Court laid out quite succinctly five factors that the government, the Minister of Health, had to take into consideration to provide an exemption. What we have done is that we repealed the 26 and put in the five factors. Many of the things it will take to prove those five factors have been considered. They will be some of the same kinds of things that were in the 26 criteria but it will be in a much more cohesive way. The minister will be able to take into consideration, as Senator Jaffer said, the circumstances those communities are facing on a daily basis to say, “Given the emergency that you are facing and given that I have considered all five of those factors, I will provide an exemption under the circumstances.’

Conservative Senator Paul E. McIntyre:

Minister, the Supreme Court specified five criteria that you must take into consideration in considering an application. I note that the bill modifies the wording of the third criteria. In other words, it replaces the words “the regulatory structure’’ with the words “administrative structure.’’ That said, are you satisfied that this modification is in accordance with the Supreme Court of Canada decision?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

This was actually an amendment that was made in the other place. If I am not mistaken, and my officials can clarify it, we went in with the exact wording of the Supreme Court including regulatory structures. There was an amendment made in the process in the other place where they felt that a clinical site like that might not have regulations but might have administrative policies. In describing this as administrative structure, maybe Hilary can give examples of the kinds of things. I would need to see that a particular site had appropriate policies in place in terms of how hazardous products like needles would be dispensed of and did they have rules that meet the requirements.

Independent Ratna Omidvar:

This is a brief question relating to the fifth of the five criteria, which is the requirement to show an impact on crime rates.

129 The Federal response to the Opioid Crisis

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Many of the advocates of supervised consumption sites have said the evidence is there. There are academic papers that have documented this. There is already lots of evidence that these sites do not increase crime rates. Because it was one of the Supreme Court factors we felt that it made sense for it to continue to be in place. Given the abundance of overall evidence that crime rates are not adversely affected, the Minister of Health should have no reason to believe that it might be otherwise in this particular circumstance.

Hilary Geller, Health Canada:

Simply put, we would anticipate that in the context of describing the model of the supervised consumption site they would point to local conditions, for instance. What are the crime rates like now? What are the patterns of overdose and of drug use? Then they would point to studies, to which the minister has referred, where it’s clear that if it’s established in a certain way it has no negative effect on the crime rates. We would anticipate a description to the extent that they are able of what the environment is like now and probably references to studies about what they anticipate the effect would be based on previous studies. The applicant would get information on the crime rate from the police.

130 The Federal response to the Opioid Crisis Press Releases

December 11, 2017 – Canadian Institutes of Health Research

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.) met with researchers at the Quebec and Maritimes Node of the Canadian Research Initiative in Substance Misuse in Montreal. This research team is working to advance the Government of Canada’s response to the ongoing opioid crisis. Petitpas Taylor recently announced $7.5 million in funding to support the important work of CRISM. This funding is being divided equally among the four regional nodes. Of this funding, more than $1.8 million is being provided to the Quebec and Maritimes Node, based at the Centre de recherche du Centre hospitalier de l’Université de Montréal. Call 613-957-0200.

December 8, 2017 - Canadian Pharmacists Association

The Canadian Pharmacists Association issued a statement on the federal response to the opioid emergency: “We commend the Federal Minister of Health for her leadership in identifying additional measures or powers that would address the current crisis and any similar crisis in future. In response to her statement, we would strongly recommend that Health Canada amend the Controlled Drugs and Substances Act to enable pharmacists to review, adapt and taper opioid prescriptions,” read the statement. “We further recommend that the federal government support the remaining provinces that have not yet made naloxone freely available to all residents to do so as quickly as possible.” Call 613-293-7223.

December 8, 2017 – Health Canada

Health Canada held a Scientific Advisory Panel on Opioid Use and Contraindications to consider whether the current contraindications for opioid use are sufficient, or whether labelling updates and other actions may be needed to reduce risks to Canadians. Health Canada is working with manufacturers to update the Canadian labelling of all prescription opioid products. The labelling updates for all prescription opioids are expected to be completed in January 2019. In total, 508 prescription opioids are affected, representing approximately 211 submissions. Call 613-957-2983.

November 15, 2017 – Health Canada

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.), Justice Minister and Attorney General of Cana- da Jody Wilson-Raybould (Vancouver-Granville, B.C.) and Public Safety Minister Ralph Goodale (Regina-Wascana, Sask.) issued the following statement on National Addictions Week: “We are in a national public health crisis, and we are taking a whole of government approach to tackle the issue of substance use. By the end of 2017, it is estimated that over 3,000 will lose their lives to apparent opioid-related deaths, which is an undeniable tragedy. The Government of Canada is taking a proactive and collaborative approach to reduce opioid-related deaths and harms. This year, Health Canada collaborated with Justice Canada and Public Safety Canada to establish the Canadian Drugs and Substances Strategy, a new evidence-based and health-focused approach. We also passed the Good Samaritan Drug Overdose Act, which encourages people to seek emergency medical help during a drug overdose by providing certain legal exemptions for people who call for help and remain on the scene.”

November 15, 2017 – Health Canada

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.) announced new federal activities as part of the federal government’s strategy to address the opioid crisis. These new activities include: • Supporting a pilot project that would provide a safer pharmaceutical alternative (such as hydromorphone) to illegal drugs, • Authorizing supervised consumption sites to offer drug checking services, • Supporting innovative harm reduction pilot projects to provide drug checking services, and • Working with provinces and territories to establish a streamlined protocol for temporary overdose prevention sites should the province or territory indicate urgent public health need. She also announced the release of the Government of Canada Actions on Opioids: 2016 and 2017 report. Call 613-957-0200.

131 The Federal response to the Opioid Crisis

October 20, 2017 – Federation of Canadian Municipalities

Vancouver Mayor Gregor Robertson, Chair of Big City Mayors’ Caucus’ Task Force on the Opioid Crisis, issued a statement on the federal-provincial-territorial Health Ministers meeting: “Despite some progress on opening harm reduction services and improving data and reporting, this overdose crisis is escalating. We’ve seen almost no national progress to improve access to treatment, minimal awareness and education campaigns, and there are no established timelines or evidence-based targets to end opioid overdoses and deaths, as recommended by the Mayors’ Task Force earlier this year,” he said. “We urgently need a co-ordinated, pan-Canadian response led by the federal government - that sets clear targets and timelines for solving the overdose crisis, sharing information, and coordinating action across all orders of government. Canada must build and track evidence-based solutions and ensure that federal dollars urgently save lives through the Four Pillars - treatment, education, harm reduction and enforcement.” Call 613- 907-6395.

October 3, 2017 – Canadian Nurses Association

Canadian Nurses Association president Barb Shellian issued the following statement concerning the ongoing national opioid crisis that is adversely affecting the lives of thousands of Canadians: “In advance of the first ministers meeting taking place today in Ottawa, CNA is calling on the federal government to lead efforts for a more coordinated approach between all levels of government and to also work with stakeholder groups to take concrete steps to stem the national opioid crisis. Equitable access to health and social services is at the heart of this public health epidemic. Despite the devastating nature of this continued national public health crisis, it is an opportunity for Health Minister Ginette Petitpas Taylor to show courage by taking concrete actions to save lives. All governments must work together to implement a comprehensive approach to addressing the opioid crisis including harm reduction and better strategies for prevention and treatment.” Call 613-266-8230.

October 3, 2017 – Canadian Nurses Association

The Canadian Nurses Association welcomes the Canadian Institutes of Health Research announcement of Canadian Health System Impact Fellowship recipients. We are excited that Chantelle Bailey, M.Sc., PhD, will join CNA for the coming two years as a research fellow on this timely new project: Enhancing Nurses’ Role in Opioid Stewardship. This prestigious award is jointly supported by CIHR, Mitacs and CNA. CNA has long advocated that registered nurses and nurse practitioners be given appropriate prescribing privileges. Call 613-266-8230.

September 27, 2017 – Health Canada

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.) and Dr. Theresa Tam, Chief Public Health Officer of Canada, held meetings in Washington, D.C. with health leaders and government officials from the United States and other countries in the Americas. Petitpas Taylor attended the 28th Pan American Sanitary Conference, a high-level event held every five years by the Pan American Health Organization. Petitpas Taylor and Ricardo Barros, Brazil’s Minister of Health, signed a Memorandum of Under- standing for health sector collaboration between the two countries, signalling a shared value and willingness between the two countries for continued cooperation in the field of health. The shared crisis of opioid overdoses in the U.S. and Canada was a key topic of discussion in meetings with U.S. officials. Call 613-957-0200.

September 14, 2017 - Public Health Agency of Canada

Co-Chairs of the Federal, Provincial and Territorial Special Advisory Committee on the Epidemic of Opioid Overdoses, Dr. Theresa Tam, Chief Public Health Officer of Canada, and Dr. Robert Strang, Chief Public Health Officer of Nova Scotia, issued the following statement: “The opioid overdose crisis has been devastating for Canadian families and communities in many parts of the country. Sadly, newly compiled data paints a national picture where overdose deaths continue to rise, with some parts of Canada continuing to be harder hit by this public health crisis than others. The numbers released today represents more than just data and statistics. Behind every number is a person, a life lost and loved ones forever impacted by their loss. Today, on behalf of the federal, provincial and territorial Special Advisory Committee on the Epidemic of Opioid Overdoses, we are releasing an update to the preliminary national data on apparent opioid-related deaths in 2016 that were published in June. The updated preliminary 2016 data provide, for the first time, more detailed information on age and sex of the individuals and the type of opioid(s) involved in the apparent opioid-related deaths. We are also providing new preliminary data for the first quarter of 2017.” Call 613-957-2983.

132 The Federal response to the Opioid Crisis

September 14, 2017 - Canadian Institutes of Health Research

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.) announced an investment of $7.5 million from the Canadian Institutes of Health Research to support practical research interventions to prevent opioid overdoses, treat those living with opioid dependency, and promote harm reduction. The Canadian Research Initiative in Substance Misuse will use this funding to study how to best integrate evidence-based interventions into practical settings. Call 613-957-0200.

August 31, 2017 - New Democratic Party of Canada

NDP Health Critic Don Davies (Vancouver Kingsway, B.C.) issued the following statement on International Overdose Awareness Day: “Conservative leader Andrew Scheer’s (Regina—Qu’Appelle, Sask.) rejection of a harm reduction approach to the opioid crisis reveals an outdated, unscientific and dangerous ideology. His failure to understand that addiction is a health issue, and not one of crime or morality, represents the kind of thinking that leads to unnecessary injury and death.” He continued “To be clear, the Liberal government has not done nearly enough to make real progress on the opioid crisis. Inexplicably, the Liberals continue to refuse to declare this clear health crisis a national emergency which would open up more resources and support for communities that are facing this deadly epidemic. I call on them to do so once again today.” Call 613-222-2351.

August 30, 2017 - Conservative Party of Canada

Conservative MP Marilyn Gladu (Sarnia—Lambton, Ont.) announced that she has been invited by Conservative leader Andrew Scheer (Regina—Qu’Appelle, Sask.) to serve as the Shadow Minister of Health. She stated: “I’m honoured to play a leading role in our Shadow Cabinet, and look forward to working in a cooperative, productive manner with my counterparts on the critical issues facing our Canadian Healthcare system. This appointment recognizes my advocacy on issues important to health, such as my private member’s legislation C-277 on palliative care (which received unanimous support in the House of Commons,) my support for mental health issues, and my strong voice on the opioid drug crisis impacting our nation.” Call 519-383-6600.

August 3, 2017 – Health Canada

Health Canada granted an exemption to the Vancouver Island Health Authority to operate a supervised consumption site in Victoria’s Pandora Community Health and Wellness Centre. This fixed site is the first in Victoria and, once operational, will provide supervised injection services along with additional harm reduction and counselling services to its clients in Victoria. The Gov- ernment of Canada is taking action to address the public health crisis related to opioid overdoses and deaths across the country. Call 613-957-0200.

July 20, 2017 – Canadian Nurses Association

Barb Shellian issued a declaration following the Council of the Federation’s 2017 summer meeting in Edmonton: “The Canadi- an Nurses Association is encouraged by Canada’s premiers’ continued discussions to strengthen the long-term sustainability and the innovation within our health-care system. As the new mifegymiso abortive medication lacks access at this time, it is an example of how outdated regulation and legislation prevents Canadians from accessing the quality services they deserve,” she said. “Premiers have a lot to do to ensure that they can practise to full scope and therefore CNA is calling on the federal, provincial and territorial governments to eliminate these and other barriers to timely access to quality care. We were also very pleased that the opioid crisis is still on top of their agenda. Given that supervised consumption sites have a positive impact on community safety, there is a lot more that can be done in Canada to support the development of many more.” Call 613-222-5389.

July 19, 2017 – Canada-U.S. Inter-Parliamentary Group

NDP MP Brian Masse (Windsor West, Ont.), Vice-Chair of the Canadian Section of the Canada–United States Inter-Parliamen- tary Group, led a delegation to the 72nd annual meeting of the Council of State Government’s Midwestern Legislative Conference in Des Moines, Iowa. The other members of the delegation were Liberal MP Fayçal El-Khoury (Laval—Les Iles, Que.), and Conservative MP Larry Maguire (Brandon—Souris, Man.). “The MLC’s meetings are extremely useful,” said Masse. “They allow legislators from the MLC states and provinces to establish and strengthen their relationships, and to build consensus on issues that are important to both the Midwestern region of our countries and our nations more generally. Certainly, the discussions on economic development, the opioid crisis and the next U.S. Farm Bill are among those that were informative for both Canadian and American legislators who attended the MLC’s annual meeting.” Call 613-995-1866. 133 The Federal response to the Opioid Crisis

July 19, 2017 – Canada-U.S. Inter-Parliamentary Group

The Canadian Section of the Canada–United States Inter-Parliamentary Group was represented at the annual summer meeting of the National Governors Association by Senators Art Eggleton and Bob Runciman, Conservative MP Mike Lake (Edmonton—Wetask- iwin, Alta.) and Liberal MPs Salma Zahid (Scarborough Centre, Ont.) and Brenda Shanahan (Châteauguay-Lacolle, Que.). The meeting was held in Providence, Rhode Island. “The delegation was very pleased to continue the participation of the IPG’s Canadian Section at the NGA’s most recent meeting,” said Senator Michael L. MacDonald, Senate Co-Chair of the IPG. “I know that members of the delegation enjoyed both their time with the governors and the opportunity to hear very informative presentations on such topics as the opioid crisis, cybersecurity and the importance of technological innovation, and from such notable individuals as Tesla’s Elon Musk and Steve Ballmer, former CEO of Microsoft.” Call 613-995-1866.

June 28, 2017 – Health Canada

Health Canada published an initial list of drugs for an urgent public health need that are authorized for sale in the United States, the European Union or Switzerland, but are not yet authorized in Canada. Health Canada will now permit these drugs to be imported into Canadian jurisdictions that have notified Health Canada of an urgent public health need. Drugs to treat opioid use disorder (addiction), and for the treatment of tuberculosis, have been identified by public health officials for immediate access and have been included on the initial List. Other drugs that could be approved drugs to treat pandemic viruses or other public and military health emergencies. Call 613-957-0200.

June 6, 2017 – Public Health Agency of Canada

Dr. Theresa Tam, Interim Chief Public Health Officer of Canada and Dr. Robert Strang, Chief Public Health Officer for Nova Scotia, issued the following statement on the Epidemic of Opioid Overdoses: “Every day, there are Canadians and families impacted by the devastating outcomes associated with problematic opioid use. To address the crisis and stop the deaths, data is a necessary foundation. Today, on behalf of the federal, provincial, territorial Special Advisory Committee on the Epidemic of Opioid Overdoses, we are releasing national data on apparent opioid-related deaths in Canada in 2016. Together, we have estimated that at least 2,458 Canadians died from an opioid-related overdose in 2016. This equates to almost seven people a day dying from opioid use. Western Canada is being hit the hardest.” Call 613-957-2983.

May 31, 2017 – Health Canada

The Canadian Centre on Substance Use and Addiction released its first report, which demonstrates key achievements made since the Opioid Summit, as well as the continued need to work together to fight the opioid crisis from all sides. Call 613-957-0200.

May 25, 2017 – Federation of Canadian Municipalities

The Federation of Canadian Municipalities’ Big-City Mayors’ Caucus released its report on the opioid crisis, calling for coordinated, pan-Canadian action by all orders of government to solve the opioid crisis, which has already claimed thousands of lives and continues to escalate. Our first responders and community workers are on the front lines of this crisis, and cities are working together to save more lives—but we can’t do this alone. We need a coordinated, pan-Canadian response involving all orders of government,” said Vancouver Mayor Gregor Robertson, who chairs the BCMC Mayors’ Task Force on the Opioid Crisis. “The federal response so far isn’t reaching the frontlines in the way we need to save lives and tackle this crisis.” Call 613-907-6395.

May 15, 2017 – Canadian HIV/AIDS Legal Network

Scientists, medical professionals, policy makers, activists and people who use drugs gathered in Montréal for the 25th Harm Reduc- tion International Conference 2017. The world is looking to Canada to show leadership and replace criminalization with drug policy that is rooted in harm reduction principles, human rights standards and scientific evidence. The Canadian HIV/AIDS Legal Network calls on all levels of government to work together to: Scale up overdose response measures to create a robust response to the ongoing opioid crisis; Improve access to treatment for opioid dependence; Rapidly expand access to life-saving safer consumption services; Im- plement comprehensive harm reduction in prisons; Strengthen harm reduction, including community-based responses, by increasing funding under the Canadian Drugs and Substances Strategy; and End the “war on drugs”. Call 416-595-1666 x 236.

134 The Federal response to the Opioid Crisis

May 8, 2017 – Health Canada

Health Canada and the Canadian Institutes of Health Research provided McMaster University with $618,248 in funding to update the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain and associated training tools for prescribers. The updated guideline, released in the Canadian Medical Association Journal, recommends that patients with chronic non-cancer pain first try non-opioid options to manage pain before considering a trial of opioid therapy. Call 613-957-0200.

April 28, 2017 – Canada Border Services Agency

On April 27, there was an incident involving Canada Border Services Agency officer working at a Canada Post’s Léo-Blanch- ette Postal Facility in Montreal, Que. The border services officer was hospitalized as a result of exposure to an opioid contained in a package the officer was examining. In accordance with the Canada Labour Code, a Hazardous Occurrence Investigation is being conducted locally by the CBSA. Call 613-957-6500.

April 21, 2017 – Health Canada

Health Canada is proposing to allow the importation and use of medications that have been authorized for sale in the United States, the European Union or Switzerland, but are not yet authorized in Canada. Once this process is implemented, the most immediate need is expected to be for drugs to treat opioid use disorder (addiction); however, drugs for pandemic use or other public health emergencies could also be approved for importation through this new process. To access a drug through this new process, public health officials would send a request to Health Canada and provide key information on the drug, the urgent public health need, and how the drug is expected to help those in need in jurisdiction. Call 613-957-0200.

April 11, 2017 – Health Canada

Health Minister Jane Philpott (Markham-Stouffville, Ont.) was in Surrey, B.C., to highlight additional federal support for the opioid crisis announced in Budget 2017. Philpott highlighted $116-million in federal funding to help address the ongoing opioid crisis, $100 million of which will be invested over the next five years in national measures associated with the new Canadian Drugs and Substances Strategy. Call 613-957-0200.

March 23, 2017 – HealthCareCAN

HealthCareCAN also applauds the $100-million federal commitment to address the opioid crisis; the strategic investment in Canada Health Infoway ($300 million), the Canadian Foundation for Healthcare Improvement ($51-million) and the Canadian Institute for Health Information ($53-million). Call 613-241-8005 x 205.

March 10, 2017 – Health Canada

The Government of Canada announced an additional $6-million in urgent support to the Province of Alberta to assist with its response to the growing effects of the significant crisis in that province. The Government of Canada has already taken numerous steps to address the opioid crisis, including $75-million in previously announced funding to address this crisis. Call 613-957-0200.

Feb. 21, 2017 – Health Canada

The Government of Canada announced an additional $65-million over five years for national measures to respond to the opioid crisis and implement the government’s Opioid Action Plan. In addition, the federal government will provide $10-million in urgent support to the Province of British Columbia to assist with its response to the overwhelming effects of the emergency in that province. The Government of Canada has already taken numerous steps to address the crisis, including making naloxone readily available, over- turning the ban on the use of prescription heroin to treat the most severe cases of addiction, and introducing Bill C-37 to simplify and streamline the application process for supervised consumption sites. Call 613-957-0200.

Feb 21, 2017 – Health Canada

Health Minister Jane Philpott (Markham-Stouffville, Ont.) issued the following statement: “Reducing the harm associated with problematic use of opioids requires a comprehensive response that involves health professionals, law enforcement, and all levels of government. In addition, we must take steps to better inform Canadians about the potential risks associated with the use of these medications. Today, Health Canada announced that it will put forward a regulatory proposal to make warning stickers and patient information handouts mandatory with all opioids dispensed in Canada. This commitment to raising awareness is a component of Health Canada’s Opioid Action Plan.” Call 613-957-0200. 135 The Federal response to the Opioid Crisis

Feb. 6, 2017 – Health Canada Health Minister Jane Philpott (Markham-Stouffville, Ont.) issued the following statement on Health Canada’s Authorization of Three New Supervised Consumption Sites in Montreal: “The Government of Canada is committed to doing its part to address the public health crisis related to opioid overdoses and deaths across the country. Our approach must be comprehensive, collaborative, compassionate and evidence-based. Cer- tain communities across Canada have decided that supervised consumption sites are an appropriate tool for the realities they face. At these sites, people who use drugs are supervised by qualified staff who can provide immediate treatment in the case of an overdose.” Call 613-957-0200.

Feb. 3, 2017 – Federation of Canadian Municipalities The Federation of Canadian Municipalities’ Big City Mayors’ Caucus launched a task force to tackle an epidemic of fentanyl overdose deaths. The Mayors’ Task Force on the Opioid Crisis has two main objectives. First, to share frontline experiences and best practices among cities addressing the crisis. Second, to work with all orders of government to better coordinate a full national response. “Cities are dealing with the fentanyl opioid crisis on the front lines, but the tragedy is escalating and we’re at a breaking point,” said Vancouver Mayor Gregor Robertson, chair of the task force. “We urgently need a nationwide emergency response as opioid addiction devastates families and communities and overdose deaths reach an even more horrific toll. In Vancouver, our front-line workers are tireless in their heroic efforts to save lives, but the intensity of overdose response is overwhelming.” Call 613-907-6346.

Jan. 20, 2017 – Conservative Party of Canada Conservative MPs Cathy McLeod (Kamloops—Thompson—Cariboo, B.C) and Dianne Watts (South Surrey-White Rock, B.C.) released the following joint statement echoing B.C. Health Minister Terr y Lake’s plea for the federal government to declare the opioid crisis a National Public Health Emergency: “With over 900 deaths in our province in 2016, the call is loud and clear for the federal Liberal government to take action and declare this crisis a National Public Health Emergency. December was the deadliest month, with 142 deaths from illicit drug overdoses and there is no end in sight to this epidemic. We are calling on Health Minister Jane Philpott to: • Declare a National Public Health Emergency; • Enhance border security measures to stop the flow of fentanyl and carfentanil into Canada; • Immediately undertake a National Fentanyl and Carfentanil Education Awareness Campaign; • Support detox and treatment facilities and mental health in our communities and provinces; and • Create a national strategy for tracking opioid overdoses. Call 250-573-0001.

Jan. 18, 2017 – Health Canada Health Minister Jane Philpott (Markham-Stouffville, Ont.) has concluded a successful visit to the Organisation for Economic Co-operation and Development (OECD) in Paris, France, where she took part in the Health Policy Forum and Health Ministerial meeting. The OECD Health Policy Forum on the Future of Health brought together health ministers, senior policy makers, health system experts, and stakeholders from around the world to discuss how health systems can support patient-centred care. Philpott also took the opportunity to meet with her counterparts from other countries and international organizations — including the U.K., Switzerland and the World Bank — to discuss topics of shared interest, in particular mental health and problematic opioid use. Call 613-957-0200.

Dec. 13, 2016 – New Democratic Party of Canada NDP MP and Health Critic Don Davies (Vancouver Kingsway, B.C.) issued the following statement: “Canada’s New Democrats believe that legislation to remove unnecessary barriers to opening new supervised injection sites is long overdue. When the Liberals were in opposition, they said that Stephen Harper’s Bill C-2 was deliberately designed to prevent new facilities from being established. It’s a shame that it took over a year and the announcement of unsanctioned overdose reduction sites in British Columbia before the Liberal government tabled legislation.” He continued, “The Liberal government must immediately declare the opioid crisis a national public health emergency.” Call 613-222-2351.

Dec. 13, 2016 – Canadian Nurses Association Barb Shellian, President of the Canadian Nurses Association, issued the following statement on the introduction of Bill C-37: “We are very pleased today to see the Canadian government is taking action to support harm-reduction policies and repeal the previous government’s Bill C-2. In order to face the current opioid crisis in Canada, it is essential to take an approach that ensures swift and effective access to safe consumption sites and a linkage to quality health services.” She continued “The current prohibitive approach doesn’t help our most vulnerable people get the care they need, many of whom may be living in poverty, homeless or under-housed and may be living with other health conditions, including mental health issues. Access to this type of care without judgement or bias is imperative. The alternative is im- practical, creating additional healthcare costs and longer wait times for our universal and public health system.” Call 613-237-2159 x 543. 136 The Federal response to the Opioid Crisis

Nov. 30, 2016 – Health Canada

As part of the federal government’s commitment to address the national opioid crisis, regulations were published controlling six chemicals used in the production of fentanyl. Changes to control these six chemicals, originally put forward by Senator Vern White as Senate Public Bill S-225 support Health Canada’s Opioid Action Plan announced by Health Minister Jane Philpott (Markham- Stouffville, Ont.) in June 2016 and updated through the Joint Statement of Action to Address the Opioid Crisis signed at the Opioid Summit in Ottawa on November 19, 2016. The plan focuses on better informing Canadians about the risks of opioids, supporting better prescribing practices, reducing easy access to unnecessary opioids, supporting better treatment options, improving the national evidence base, and reducing the availability and harms of street drugs. Call 613-957-0200.

Nov. 21, 2016 – Health Canada

Health Minister Jane Philpott (Markham-Stouffville, Ont.) and Dr. Eric Hoskins, Ontario Minister of Health and Long-Term Care, released a Joint Statement of Action to Address the Opioid Crisis setting out priority actions to address the opioid crisis and a commitment to public reporting on progress. The statement was developed with input from 42 partner organizations during the national Opioid Summit. The statement identified key action items to address the root causes and reduce the harms associated with opioid use, including: empowering healthcare professionals with new tools and guidance on opioids; increasing access to Suboxone® in First Nations communities; improving addiction services; increasing access to Naloxone; and, increasing critical monitoring and surveillance activities across the country. Call 613-957-0200.

Nov. 18, 2016 – New Democratic Party of Canada

NDP MP and Health Critic Don Davies (Vancouver Kingsway, B.C.) issued the following statement: “Today, New Democrats are calling on the federal government to declare Canada’s opioid overdose crisis a national public health emergency. Additionally we urge the government to create a national multi-sectoral taskforce on opioid overdose, and repeal or significantly amend Bill C-2 to remove unnecessary barriers to opening new harm reduction facilities.” He continued, “The House of Commons Standing Committee on Health has been conducting an emergency study on the opioid overdose crisis and will be releasing a detailed list of recommendations in anticipation of Health Canada’s upcoming summit on opioid overdose. Expert testimony at Committee showed a clear consensus that leadership and effective coordination at the federal level would have a major impact on reducing overdose deaths in Canada.” Call 613-222-2351.

Nov. 18, 2016 – Canadian Medical Association

The Canadian Medical Association issued a statement regarding the opioid situation: “The Canadian Medical Association (CMA) commends the federal government for convening key stakeholders to develop a collaborative action plan to address Canada’s opioid crisis. The CMA also thanks the co-chairs of the summit, Federal Health Minister Jane Philpott and Dr. Eric Hoskins, the Ontario Minister of Health and Long-Term Care, for inviting the CMA to participate in this important meeting. One of the major recurring themes of the discussions over the last two days has been the complex nature of the current opioid crisis in Canada.” Call 613-806-1865.

Nov. 17, 2016 – Canadian Pharmacists Association

CPhA is calling for a multi-pronged action plan that addresses the root causes of opioid abuse or misuse, ensures appropriate prescribing, and supports addiction management therapy for those struggling with dependency. “A fully integrated system would ensure that pharmacists and prescribers have access to the information they need to help patients manage their use of opioids,” said Alistair Bursey, Chair, Canadian Pharmacists Association. “It would flag inappropriate prescribing and greatly reduce prescription “shopping” which occurs when those who are addicted visit multiple prescribers to obtain the same prescription.” Call 613-292-6070.

Oct. 3, 2016 – Health Canada

Health Minister Jane Philpott (Markham-Stouffville, Ont.) announced that Health Canada has authorized naloxone nasal spray for non-prescription use, following an expedited review. Philpott had previously signed special Interim Order on July 5, 2016, to allow for the importation of a version of the product from the United States while Health Canada was conducting the expedited review. Nalox- one can save lives when used promptly, by temporarily reversing a potentially fatal opioid overdose, and the nasal spray is considered to be easier to use than the injectable version, particularly by those who are not healthcare professionals. Call 613-957-0200. 137 The Federal response to the Opioid Crisis

Sept. 22, 2016 – New Democratic Party of Canada

NDP Health Critic, Don Davies (Vancouver Kingsway, BC) has secured a key study of the opioid crisis in Canada. Davies won unanimous support from his colleagues when he put forward a motion calling on the Standing Committee on Health to make recommendations for dealing with the growing opioid crisis. “Canada is going through a deadly opioid crisis so severe and widespread that few Canadians are untouched by it,” said Davies. “It is imperative that Parliament looks into this crisis and proposes concrete steps the government can take to address the situation,” he added. Call 613-222-2351.

August 31, 2016 – Health Canada

As part of the federal government’s commitment to take action to address the national opioid crisis, Health Canada is proposing to move forward with plans to restrict six chemicals used in the production of fentanyl, originally put forward by Conservative Senator Vern White’s Senate Public Bill S-225, An Act to Amend the Controlled Drugs and Substance Act (substances used in the production of fentanyl). This regulatory proposal would achieve the intent of Senator White’s Bill in an expeditious fashion, and add these substances to the Controlled Drugs and Substances Act (CDSA) and the Precursor Control Regulations (PCR), meaning that their unauthorized importation and exportation would be illegal. “Thanks to the work already done by Senator White, we are able to quickly take this step to restrict chemicals used in the production of fentanyl,” said Health Minister Jane Philpott (Markham-Stouffville, Ont.). “Our government is taking a comprehensive, collaborative, compassionate, and evidence-based approach to addressing this public health crisis.” Call 613-957-0200.

July 28, 2016 – Health Canada

Health Minister Jane Philpott (Markham-Stouffville, Ont.) issued a statement: “Canada is facing a growing crisis related to opioid overdoses and deaths across the country, and our government is committed to addressing this issue,” she said. “Today, recognising the severity of the problem in that province, the Premier of British Columbia announced a Joint Task Force on Overdose Response, which will seek to provide expert leadership and advice on additional actions to prevent and respond to overdoses. Our government applauds B.C.’s work in this area and its swift response to what has become a public health crisis, and we want to assure the province we will work with them as they advance their efforts to combat this crisis.” Call 613-957-2983.

July 28, 2016 – Health Canada

Health Canada is taking new action to improve the safe use of two prescription opioid drugs, codeine and hydrocodone, to help further address the rare but potentially life-threatening risk of breathing problems in children and adolescents. Serious breathing problems known as respiratory depression (slowed breathing) are a known risk with the use of any opioid, particularly when too much is taken. Specifically, the reviews determined that: • codeine should no longer be used (contraindicated) in patients under 18 years of age to treat pain after surgery to remove tonsils or adenoids. Codeine (prescription and non-prescription) is already not recommended for children under the age of 12, for any use. • hydrocodone is no longer recommended in patients under six years of age. Call 613-957-2983.

July 6, 2016 – Health Canada

As an emergency public health measure in response to the current opioid crisis, Health Minister Jane Philpott (Markham- Stouffville, Ont.) has signed an Interim Order to temporarily allow naloxone in nasal spray form to be imported from the U.S. and sold in Canada. Until now, only the injectable format of the drug has been available in Canada. Health Canada received an application for a nasal version of naloxone in May 2016, and is currently conducting an expedited review for authorization in Canada. The Interim Order allows the product, which has been approved by the U.S. Food and Drug Administration, to be temporarily sold in Canada.

June 1, 2016 – Health Canada

The Government of Canada announced it has published final amendments that add the synthetic opioid W-18 to Schedule I to the Controlled Drugs and Substances Act, and to the Restricted Drugs section of the Food and Drug Regulations, rendering unauthorized activities such as production, possession, importation or exportation and trafficking illegal. “Substances like W-18 are dangerous and have a significant negative impact on some of the most vulnerable people in our society. I am pleased with the swift action that Health Canada has taken to regulate this substance,” said Health Minister Jane Philpott (Markham-Stouffville, Ont.). Call 613-957-0200.

138 The Federal response to the Opioid Crisis

May 12, 2016 – Health Canada

Health Canada announced that the department will propose a regulatory amendment to allow access to diacetylmorphine under Health Canada’s Special Access Programme (“SAP”). A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine. Call 613-957-0200.

Feb. 16, 2016 – Canadian Institutes of Health Research

Health Minister Jane Philpott (Markham-Stouffville, Ont.) announced funding for research aimed at improving the health of people who abuse prescription drugs. More and more Canadians are putting their health at risk by intentionally taking medication, such as opioids, in a way that hasn’t been recommended by a doctor. The Government of Canada, through the Canadian Institutes of Health Research (CIHR), is investing $4.4 million to support four large regional teams comprised of researchers, service providers, and decision makers to tackle this public health issue. The teams based in British Columbia, the Prairies, Ontario, Québec and the Maritimes collaboratively developed the first national study Optimizing patient centered-care: a pragmatic randomized control trial comparing models of care in the management of prescription opioid misuse (OPTIMA), conducted through the Canadian Research Initiative in Substance Misuse (CRISM).

139 The Federal response to the Opioid Crisis Debates in the House of Commons

SEPTEMBER 21, 2017 The House resumed second reading debate on Bill C-338, an act to amend the Controlled Drugs and Substances Act (punishment).

NDP MP Matthew Dubé (Beloeil-Chambly, Que.):

Mr. Speaker, it brings me no pleasure to have to speak to this bill, because it has to do with a crisis Canada is currently facing, the opioid crisis. The United States is also grappling with the same crisis, which has been the subject of many discussions. Unfortunately, Bill C-338 fails miserably in its approach. As the NDP public safety critic, I want to point out that the opioid crisis is not so much a public safety issue as it is a public health issue. It is important to make that distinction with respect to Bill C-338, since all it does is propose heavier penalties, like the infamous mandatory minimum sentences we saw so often when the Conservatives were in power. So far, anywhere you look around the world, mandatory minimums have failed completely in terms of their intended objective, that is, to put an end to the scourge facing our society. Every policy, medical, and legal expert tells us the same thing: the solution to this crisis is to provide more mental health and addiction treatment services and more resources to the hardest-hit communities that are dealing with the consequences daily. For example, the mayor of Vancouver has had a lot to say about this, since the statistics coming out of British Columbia on the number of deaths caused by this crisis are terrifying, especially for a province in a country like Canada. For nine years we had a Conservative government that said that the solution to drug trafficking and public health problems was to impose harsher sentences, the infamous mandatory minimums. Even in the American states that are commonly referred to as “red states,” where Republicans share many of the ideological opinions of our Conservative colleagues, it was determined that such sentences were a failure. This approach does not work, and it does not prevent the tragedies we are currently seeing. To see why this is more a public health issue than a public safety one, we can look at supervised injection sites. All across Canada, especially in big cities that are grappling with this crisis and that want to protect citizens struggling with addiction issues, people have pushed for supervised injections sites and other solutions. During the previous Parliament, the federal government kept plugging its community consultation line as an excuse to pass legislation making supervised injection sites even harder to set up, even though municipal and provincial elected officials representing those very communities were asking it to authorize them. Rather than solve the problem, the government created conditions that endangered public safety. People’s lives were put at risk because they did not have the resources to get help if they were dying of an overdose in some alleyway. I do not want to get into too much detail here. The Liberal government took way too long to move on this, but at least it moved, and while that is commendable, there is still more work to do. The member for Vancouver Kingsway, our health critic, represents one of the first provinces to face this problem, a region with some of the most terrifying opioid statistics of all. He asked the question again today: when will this government recognize that this is a national health crisis and declare this to be a pan-Canadian crisis? This has yet to be done, even though it is such an easy step to take so as to ensure that governments could begin taking appropriate action to protect Canadians. I would go so far as to say that for 30, 40, or even 50 years, the approach taken by the right in the war against drugs has always been to take aim at the criminal element. In the meantime, the ones who were truly forgotten were the Canadians who unfortunately are among these statistics and who lost their lives because we, the legislators, were unable to help them. Having considered Bill C-388, we oppose it, because we believe that the solution does not lie in putting more resources into fighting crime and putting people in jail. The solution is to help them. We must help these people face their substance abuse problems. We must help those who suffer from a mental illness by ensuring that we provide the care they need and want. We must help protect these citizens. If we want to discuss public safety, we must first discuss public health. That is what the crisis is about. That is what is being neglected in the approach set out in this bill, which, unfortunately, is similar to the approach that prevailed for many years, especially in the years when there was a majority Conservative government. It was a failure. We are not the ones saying so. The statistics on recidivism and substance abuse are clear. Today’s statistics on this problem indicate that this is not just happening in Vancouver, British Columbia. As people know all too well, this problem is unfortunately affecting the entire country. The problem is moving eastward and is starting to become a reality in the maritime provinces and Atlantic Canada. This should be unacceptable in a society such as ours.

140 The Federal response to the Opioid Crisis

Statistics aside, this is also a legal issue. The Supreme Court has found that minimum mandatory sentences are not going to help us prevent recidivism and protect Canadians. The most vulnerable victims of the opioid crisis and other crises related to drug use and drug trafficking are the users themselves. The government says they are proposing legislation to protect victims and vulnerable populations, but in a drug crisis like this, the real victims, the real vulnerable population, are the Canadians dying from opioids before our very eyes. What this tells us is that, as I have said many times before, this is a public health issue. Let us stop talking about how long we can put people in prison for. Let us stop thinking that rehabilitation is what is really going to help people recover from their mental health problems. Let us take their needs seriously, along with the needs identified by local authorities, such as the health and justice ministers in the provinces dealing with these tragedies, and municipal officials, such as the mayor of Vancouver, who is asking for help and more authority to develop tools like supervised injection sites to help these people start to heal. That is the approach we should be promoting. I would like to close by saying that we have concerns about this approach. We recognize that it is a step in the right direction, but there is still a lot of work to be done to eliminate this problem, which is no longer just a regional issue. It is affecting all of Canada and even North America. These problems are being raised in discussions with American counterparts and between ministers. That proves that we need to take the issue seriously. Let us declare it to be a pan-Canadian health crisis. That would allow the government to do what is necessary. I have said it many times, and the NDP will continue to repeat it, that this is first and foremost a public health issue. Let us help and protect these individuals, for they are the victims.

Conservative MP Len Webber (Calgary Confederation, Alta.):

Mr. Speaker, it is my pleasure to rise today to speak to Bill C-338. This private member’s bill has been brought forward by my Conservative colleague, the member for Markham–Unionville. The member has an obvious genuine concern for his own community and those across Canada. He recognizes the harmful effects that drugs have had in his own city and he has stepped up to do something about it by bringing forward this legislation, so I thank the hon. member for the work that he has done on this bill. Drugs have been around for as long as anyone can remember, so why the urgency now? The reality is that the drug scene today is nothing like it was in the past. The Internet has made drugs far more accessible. International shipping has made drug distribution both more efficient and more difficult to stop. The growth in the highly addictive and extremely deadly drugs like fentanyl and carfentanil has made drugs more deadly than ever. As I have said in this House before, the best way to combat our drug and opioid crisis is to stop the illicit supply from coming into this country and trading on our streets. Before the House of Commons Standing Committee on Health, the RCMP testified that 98 per cent of the illegal opioids in this country are coming from China. This is not a new problem. Work was started under the Stephen Harper government to stem this tide of drugs flowing onto our streets. It culminated recently in an agreement with China that should have some effect—at least; we hope it will have some effect. The Public Health Agency of Canada reported that almost 2,500 Canadians died from opioid overdoses in 2016. This year, that number is expected to exceed 3,000 deaths. That is eight people a day dying from drugs, eight families a day dealing with an unexpected death. Bill C-338 would target those who are working to bring drugs onto our streets and into our neighbourhoods. Unfortunately, even if we do catch those responsible for shipping these deadly drugs, the punishment that awaits them is insufficient and hardly a deterrent for protection of our communities. As proposed section 1 states in the bill, if the amount of drugs involved is less than one kilogram, the offender would be subject to a maximum of life in prison with a minimum of a two-year sentence. This would increase the minimum sentence from one to two years. Proposed section 2 in the bill states that if the amount of drugs involved is more than one kilogram, the offender would be subject to a maximum of life in prison with a minimum of a three-year sentence. This would be an increase from two to three years in this minimum sentence. One of the most dangerous drugs on the street today is carfentanil. It can kill in the smallest amounts. The equivalent of less than a grain of salt can kill. Simply touching the drug can potentially kill. First responders are at a high risk of death. I am not trying to be an alarmist here; I am just reporting the reality. Young children are dying after coming into contact with this drug. Even just the residue on clothing can be deadly to a small child. In June 2016, Canadian border services intercepted one kilogram of carfentanil en route to my city of Calgary. RCMP Inspector Allan Lai said, “One kilogram of carfentanil can produce approximately 50 million fatal doses.” That is enough to kill every man, every woman, and every child in Canada one and a half times over. If we are going to turn this tide, we need to equip our courts with the tools that they need to remove these dealers of death from our streets. Alberta Health Services, in my province, has found that 343 people died from fentanyl overdoses in 2016. This is a whopping 33 per cent increase over 2015, and a horrifying 110 per cent rise from just two years ago. A doubling of the death rate in just two years is incredible. It is disgusting. Calgary experienced the worst of it. Half of the province’s deaths were in Calgary. Of those 343 deaths in Alberta in 2016, 22 were linked to carfentanil. In the first five months of this year, more Albertans died from carfentanil than in all of last year, and the body count continues to grow. Albertans are dying at a rate of more than one a day from opioid overdoses alone. 141 The Federal response to the Opioid Crisis

We need to give our courts the tools and the willpower to keep the drug pushers and traffickers off our streets where they cannot do harm. We need to show our law enforcement that their tireless efforts and risky work was worth it. We need to show our first responders that we recognize the dangers they face, and we are looking to reduce potential harm. We need to show our overworked medical staff, those who see the damage daily, that we are trying to save lives as much as they are. We need to show our communities that their safety and security is under threat, and we are taking action. Most of all, we need to show Canadian families we are doing what we can to better protect their children, their brothers, their sisters, and in some cases, sadly, their parents. The reality is that the Liberals will not support our efforts to make these changes set out in Bill C-338. The Liberal government is working hard to expedite legislation that would make it legal for children to carry up to five grams of marijuana, while defeating Conservative attempts to jail drug dealers. The NDP members are even worse. Some of them are suggesting we legalize all drugs. This cavalier attitude toward drugs has consequences, and eight times a day; we are reminded of what is at stake. I am not naive. I know we cannot simply increase all penalties and think it will magically make everyone follow the law. However, we are talking about people who cruise our streets, literally handing out death pills. I know we are all safer if they are in prison, and not on our streets or in our communities. I encourage all my colleagues to vote in support of this legislation, and let it go to committee for further review. We need to tackle the importing and trafficking of drugs to stop this problem from getting any worse. If my colleagues across think the bill can be -im proved, then let us do it. Let this proposal go to committee. Let us hear from experts, and let us just do something. Voting down this legislation is tantamount to doing nothing as Canadians increasingly die around us. Let us do something. Let us do the right thing. Let us vote in favour of the bill.

Parliamentary Secretary to the Minister of Justice and Attorney General of Canada Marco Mendicino (Eglinton-Lawrence, Ont.):

Mr. Speaker, I am pleased to participate in the debate on Bill C-338, which proposes to amend the Controlled Drugs and Substances Act to increase mandatory minimum penalties, or MMPs, of imprisonment for offences relating to the importation and exportation of certain drugs and substances. I would like to begin by commending my honourable colleague across the way for bringing forward this private member’s bill. It will encourage and foster an ongoing and important discussion regarding how we best regulate controlled substances. Let me also say that I have been listening carefully to the debate on Bill C-338 and I would like to echo the political and legal concerns that have already been raised, including the constitutional implications of this bill. To start, it strikes me as inappropriate to provide the same MMP for substances that have vastly different levels of potency and danger. It is exactly this type of situation that the Supreme Court of Canada has raised concerns about in recent cases in which it struck down MMPs. I refer the House to the Supreme Court of Canada case in Regina v. Muir, in which the court cited R v. Lloyd in stating that “mandatory minimum sentences that...apply to offences that can be committed in various ways, under a broad range of circumstances...are vulnerable to constitutional challenge.” Although the bill targets the importation of powerful opiates like fentanyl and carfentanil that are lethal in very small quantities, the increased MMPs would also apply to other substances like cannabis. Hon. members will recall that the government has introduced Bill C-45 and Bill C-46 to address and introduce a new comprehensive regime so that we can keep cannabis out of the hands of our youth and vulnerable communities. Although a highly regulated substance, cannabis simply does not share the devastating qualities of fentanyl for instance. Suffice it to say that such differences are material from a sentencing and charter perspective, so it does not make sense to treat these two substances in the same way. That said, there is no doubt that the increasing prevalence of potent opioids in our communities has sparked a public health crisis in Canada. The onslaught of this deadly epidemic in Canada is twofold. First, the overdose crisis has been driven by the emergence of these powerful illicit opioids on the black market, leading to an unprecedented number of deaths among illegal drug users. This unfortunate reality is exacerbated by vile and deceitful drug dealers who mix these incredibly cheap yet highly addictive and potent substances with other more expensive drugs, for instance heroin or cocaine, in an effort to maximize their profits. The relative ease with which these opioids can be produced further compounds these problems. A secondary contributing factor has been the high levels of addiction to legal opioids across Canada. This trend has been caused in part by inappropriate prescribing practices and poor education on the risks associated with opioid use. Unfortunately, once prescription renewals expire, many individuals turn to the black market to supply their addiction. The demand that emanates from legal opioid addiction helps fuel the demand for such substances on the black market. To effectively respond to the opioid crisis in Canada both contributing factors must be addressed. This is partly why I have strong reservations about the approach proposed in Bill C-338. It proposes an unnecessary, costly, and likely ineffective approach to a complex drug problem. The bill is focused on increasing MMPs for offenders engaged in importing and exporting instead of focusing on the root causes of this epidemic.

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Evidentiary support is simply lacking to suggest that increasing MMPs in the way proposed by the bill will reduce the influx of these lethal drugs into Canadian communities. In fact, research on the “war on drugs” in the United States reveals that increased penalties do little to deter high-level drug traffickers from engaging in this lucrative criminal conduct, nor do they do anything to help those battling addictions. Health and criminal justice experts assert that addressing the demand side is critical to comprehensively responding to complex social problems like these. The import and export offences targeted by Bill C-338 are already punishable by a maximum term of life in prison. In Canada, this is the highest penalty a judge can impose. In my personal experience as a drug prosecutor, our judges consistently use their discretion to impose stiff penalties if and when they are warranted. In fact, courts around the country are already treating fentanyl trafficking very seriously. For example, in a recent decision this year, Regina v. Fyfe, the judge imposed a total sentence of five years’ imprisonment on a low-level first-time fentanyl trafficker. I would point out that this is two more years than the mandatory minimum jail sentence proposed by this private member’s bill. In the decision, the court noted that an appropriate sentence for fentanyl trafficking must be more serious than other hard drugs, for example cocaine, given the substantial risks posed by this and similar opioids. Moreover, appellate courts across the country are revisiting sentencing ranges for those who traffic in these dangerous substances, noting that previous ranges are “out of sync” with the dangers these substances pose to society. I offer and commend to the House the case of Regina v. Smith, decided by the British Columbia Court of Appeal in 2017. I will pause to note that it is important that we reaffirm the fundamental principle of the independence of the judiciary as that -im parts a high degree of confidence among the public that the judiciary will do their job. Let me be clear. We are talking about an unprecedented number of fatal drug overdoses in Canada. Our government fully understands the gravity of the situation, and we continue to take action to address the problem. The policies put in place to deal with this crisis need to be guided by performance measurement standards and evidence. These policies must have an immediate impact in order to reduce the number of tragic deaths. That is why I am so pleased that our government has introduced a new Canadian drug and substances strategy. The strategy focuses on prevention, treatment, and enforcement, but it also reinstates harm reduction as a core pillar of Canada’s drug policy. The strategy champions a comprehensive, collaborative, compassionate, and evidence-based approach to drug policy. To further advance this strategy, the Minister of Health introduced Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments under other acts. Together, these will address the serious and pressing public health issues related to opioids. That bill has now received royal assent, which is something all members in the House should celebrate. This legislative response is one important part of our government’s comprehensive approach to drug policy in Canada. Bill C-37 will simplify and streamline the application process for supervised consumption sites, clamp down on illegal pill presses, and extend the authority of border officers to inspect suspicious small packages coming into Canada, which is precisely the object of what this private member’s bill tries to address. In relation to this last point, extending the inspection powers of the CBSA officers is important, because one standard-sized envelope can contain 30 grams of fentanyl, potent enough to cause 15,000 overdoses. These numbers will increase exponentially where the substance in question is carfentanil. In addition, our government is also investing over $100 million to support the new Canadian drugs and substances strategy. This is in addition to $10 million in emergency support that the federal government has provided to the province of British Columbia to assist in responding to the overwhelming number of overdoses. While the private member’s bill is well intentioned, its objectives will not be accomplished through the provisions set out in it. This is for all the reasons I have stated in my remarks. I therefore encourage all members to vote this private member’s bill down and continue to support all the good work our government is doing with regard to controlled substances.

Conservative MP John Barlow (Foothills, Alta.):

Mr. Speaker, it is an honour to rise today and speak in favour of the private member’s bill put forward by my colleague, the member for Markham–Unionville. I want to thank the other members who have risen in the House today to speak on this important piece of legislation to amend the Controlled Drugs and Substances Act in order to increase sentences for offences related to the importing and exporting of controlled drugs and substances. I want to be very clear. We have an opioid crisis. It is plaguing our communities. As legislators, we must take some sort of action. We heard from some of my colleagues earlier today on Bill C-37, which would give our border services agents additional tools to address things like illegal pill presses and to search small packages. Those are all steps to address what I think all of us in this House would agree is a plague that is impacting communities across the country. Bill C-338 is another step for us as parliamentarians to give our law enforcement officers, as well as the judicial system, the tools they need to fight this opioid crisis that is unfortunately taking away our friends, neighbours, and, in some cases, our family. I want to talk a little about what is going on in my home province of Alberta. My riding is almost completely rural. We have never seen something like this affect the communities in my riding for as long as most of us have been there. For example, in 2016 there were 338 accidental opioid deaths, and the 2017 numbers are predicted to be much worse. 143 The Federal response to the Opioid Crisis

I have a first nations community in my riding, the Kainai Blood first nation, which had to declare a state of emergency in 2016 because of the number of deaths they were facing in their community. Many of those were young people. About 80 per cent of the deaths in Alberta were people 20 to 35 years old. These were young people who had their entire lives ahead of them. We have to understand that we have to get away from that stereotype that these are somehow down-and-out people or those who have long-term drug addiction problems. Some of them may, but what is most frightening to me and to many of my colleagues in this House is that a large number of those who have died from these opioid overdoses were trying opioids for the first time, or had taken something else that unknown to them was laced with fentanyl or carfentanil. My colleague across the floor was talking about trying to take marijuana out of the hands of children and out of the black market. Unfortunately, many of these deaths are from people smoking marijuana that has been laced with some of these very dangerous opioid products. It is disingenuous to say that the legislation brought forward by the Liberal government is going to take marijuana out of the hands of children. That is what concerns me on the approach to fentanyl. If people are allowed to have four plants, three feet high, in their house, how is it possibly going to make it less accessible to children? For example, in Ontario the provincial Wynne government is saying it is going to look at the LCBO as the avenue or vehicle to sell marijuana. The odds of the LCBO selling marijuana at a cheaper price than what is available on the street is probably slim to none. We have to take stronger action to address some of these issues. What is attractive in Bill C-338 is that it takes a hard line on those who are importing and exporting fentanyl and carfentanil and these other very harmful opioids. These products are flooding our communities. I would attest that there is not a community, not a constituency, not a riding anywhere in Canada that is immune to this opioid crisis. I think those of us who are in western Canada, in B.C. and Alberta, felt it a little sooner than maybe the rest of the Canadian provinces and territories. It is certainly making its way across Canada. There are massive numbers of these fentanyl and carfentanil pills. I know some of it is from prescriptions, from pharmacy patients who are distributing or reselling these products, but the vast majority of it is being imported from out of the country. A lot of it is from China. We have to take some very strong steps as parliamentarians to ensure that those who import these products face some very harsh punishment, as well as those who export them, even though we do not have as much control over that aspect of it. I have been to far too many funerals over the last two or three years for young people who have overdosed on fentanyl. The last one I was at was for a young man who was 26 years old. I had known him for most of his life. I coached him in hockey. I certainly never expected something like that to happen. This is a life that was taken much too soon. I know the bill does not address some of the consequences of fentanyl and opioid abuse, but it certainly addresses some of the root causes of it. I am not saying we cannot focus on funding for mental health. That is a key part of this issue as well. Certainly access to counselling, access to addictions counselling and recovery, those things are also very critical. I hope we have those discussions in Parliament moving forward. However, a big part of this is also on the justice side. What tools can we as parliamentarians give to our law enforcement and justice to ensure they can take hard action against people who import these products and then sell them in our neighbourhoods, schoolyards, and in communities across the country. That is why as Conservatives we have taken such a hard stance on ensuring we have safe communities, mandatory sentencing, being tough on crime. As Canadians, we want to ensure we have safe communities, safe streets. I want to feel comfortable that my children are safe in my community. That is why it is so critical to do everything we can to stop the illegal importation of these drugs, methamphetamines, ecstasy, fentanyl. Again, we must provide our health services with the tools they need for mental health, resources on counselling, but we must ensure that those who import and sell these drugs face the harshest of punishments. They must be severely held accountable when they import these types of products. I want to emphasize the fact that Bill C-338 does not talk about substance misuse. I do not want our friends across the floor to think we are not focusing on the consequences of drug addiction. That was a large issue with Bill C-37, which we talked about in the last session. We are talking about people who are bringing in these illegal substances into our country and making them available for sale and distribution in our communities. I recognize the importance of mental health services, but it is also to ensure we have the tools in place so those who import and sell these drugs face the most severe consequences. The bill from my colleague from Ontario is one step, one tool in taking action against drug dealers. We are facing an emergency. Drugs do not discriminate. It does not matter what age, gender, or how much money people make. These drugs are dangerous and unfortunately for many of us in the House we have seen they can kill our friends, neighbours, or loved ones. It is important as parliamentarians that we take action. Canadians are looking to us to take strong action on the opioid crisis. I believe Bill C-338 brought forward by my colleague from Markham—Unionville is a key part of that strategy. It is one tool we can take to ensure our communities and our families are safe.

Conservative MP Bob Saroya (Markham—Unionville, Ont.):

Mr. Speaker, I rise again today to address a serious issue that is causing thousands of deaths in Canada each year. The importing and exporting of dangerous drugs and substances is a serious threat to Canadians. More must be done. 144 The Federal response to the Opioid Crisis

I introduced Bill C-338, an act to amend the Controlled Drugs and Substances Act with regard to punishment in order to increase sentences for offences related to the importing and exporting of controlled drugs and substances. Bill C-338 indicates that if the subject matter of the offence is less than one kilogram of a substance included in Schedule I or in Schedule II, he or she is guilty of an indictable offence and is liable to imprisonment for life, with a minimum sentence of two years. It also indicates that if the subject matter of the offence is a substance included in Schedule I and is in an amount that is more than one kilogram, the person is guilty of an indictable offence and is liable to imprisonment for life, with a minimum punishment of three years. The current sentence is too light. This is unacceptable. It does not deter drug traffickers from continuing to import, export, and profit at the expense of society’s most vulnerable. The reality is that criminals who import and export deadly drugs and substances are responsible for thousands of lost lives. Canadian families expect safe and healthy communities in which to raise their children. Canadians are especially concerned about crime, which is why the former Conservative government introduced and passed over 30 measures aimed at strengthening our justice system, standing up for victims, and keeping our streets safe. Canadians lose faith in the criminal justice system when they feel that the punishment does not fit the crime. We make no apologies for strengthening penalties for drug trafficking or other crimes. We must ensure that sentencing still reflects the desire of Canadians to get tough on drug dealers and other criminals. We are in the grips of a deadly fentanyl epidemic. In Ontario, about two people a day die due to opioid overdoses, and most involve fentanyl. A few months ago, the former health minister claimed that Canada needed more data on the opioid overdose crisis. I was shocked. The reality is that fentanyl is on our streets and people are dying. We do not need more research; we need action now. Bill C-338 will do that. In 2016, opioids claimed the lives of at least 2,458 Canadians, according to a new estimate released by the Public Health Agency of Canada. Light sentences make it appealing for drug dealers to produce illegal substances in basements, labs, and kitchens. These dangerous drugs are produced in such conditions that it is impossible to predict the strength of each dose. In my riding of Markham— Unionville, a drug lab was discovered in the heart of an upper-middle-class residential neighbourhood. This forced residents to evacuate their homes. From coast to coast to coast, no community in any member’s riding is immune to this epidemic. I truly understand the need for robust prevention and treatment options for addicts, but we cannot rehabilitate dead bodies. As it stands, the Controlled Drugs and Substances Act provides inadequate and unintimidating punishment for criminals who import and export lethal drugs and substances. Those who import and export these drugs and substances must be brought to justice and must face increased mandatory minimum sentences. Our constituents expect us to do more to keep our children and communities safe. A vote was held on September 27, 2017, receiving 81 yeas and 204 nays. The bill did not pass second reading. MAY 9, 2016 The following debate was part of Adjournment Proceedings, health

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

I want to begin by taking a moment to commend the minister for her decision to visit Insite, Vancouver’s life-saving safe injection site, in January. This visit was an important symbol of the welcome and necessary change in tone from the Liberal government with respect to evidence-based, harm-reduction policy within our health care system. I myself have visited Insite and can attest first-hand to the incredible work that it does to reduce overdoses, lower the transmission of infectious diseases, provide essential health services, including addictions treatment, and most importantly, save lives. However, words are not enough. Communities with individuals suffering from addictions, serious mental illness, and infectious diseases need a better, more responsive and more caring health care system. Therefore, I was shocked by the minister’s statement in March that she has decided not to repeal Bill C-2. This harmful legislation runs diametrically against progressive health policy, and erects unnecessary barriers to the opening of new life-saving safe consumption sites in communities that need them across Canada. Upon the passage of Bill C-2 in June 2015, a coalition of 65 health, patient and harm-reduction advocacy groups from across Canada issued a public declaration condemning this legislation. They broadcast a clear warning to the Canadian public about the serious problems with this legislation. The following are a few quotes that sum up their position:

“Bill C-2 will put the lives of...vulnerable Canadians at risk by establishing excessive and unreasonable requirements for health authorities and community agencies looking to open or continue operating supervised consumption [sites].... This bill...establish[es] 26 new requirements applicants must meet before the federal Min- ister of Health will even consider an approval to operate a [supervised consumption site]. The barriers this bill...presents to accessing [supervised consumption sites will] allow a public health emergency to [be treated] under a law-and-order agenda...expos[ing] patients and communities to infection, suffering, and death.”

145 The Federal response to the Opioid Crisis

Among the prominent signatories to this declaration are Toronto Public Health, the BC Centre for Excellence in HIV/AIDS, the Association of Ontario Health Centres, the Canadian HIV/AIDS Legal Network, and the BC Centre for Disease Control. Calls for more harm-reduction facilities are only growing as overdose deaths continue to rise across Canada. Just last month, British Columbia provincial health officer Dr. Perry Kendall declared a public health emergency after more than 200 overdose deaths were reported in my province in three months. Nearly 300 Albertans died of overdoses in 2015, more than double the 2014 death toll. Similarly, Ontario has seen a 72% increase over the last decade. Health authorities in Montreal, Toronto, and Victoria are now working to open life-saving harm reduction facilities as they struggle to save lives. Unfortunately, the onerous provisions of Bill C-2 continue to delay the opening of new safe consumption sites. It is time for the minister to move from symbolism to action in harm reduction and commit to repealing Bill C-2 once and for all. Will she do so?

Parliamentary Secretary to the Minister of National Revenue Kamal Khera (Brampton West, Ont.):

Drug use is a significant public health and safety issue in Canada that can have wide-ranging impacts on individuals, their families, and communities at large. One of the most devastating impacts is losing a family member or friend to a preventable drug overdose. That is why our government strongly supports a comprehensive public health approach to addressing problematic drug use, one that is based on compassion and collaboration, and is guided by scientific evidence. In this case, the evidence is absolutely clear: such an approach must include harm reduction. Our government is working hard to ensure that harm reduction measures are part of our approach to drug policy, to help prevent the transmission of infectious diseases, overdose deaths, and stigma. We have also shown support for supervised consumption sites, which provide a controlled space whereby people who use drugs can bring their own substances to consume under the safe supervision of health care professionals, and at the same time gain access to other health and social services, including drug treatment. In January of this year, after a thorough and rigorous review, Health Canada granted an exemption from the Controlled Drugs and Substances Act for the Dr. Peter Centre, a leading HIV/AIDS treatment centre, to provide supervised consumption site services as part of its programs. On March 16, Health Canada granted lnsite an unprecedented four-year exemption. Insite is one of the most established and well researched supervised consumption sites in the world. It is an excellent example of what an integrated public health approach to problematic drug use can look like. Earlier this year, the Minister of Health had the privilege of visiting lnsite and speaking to the staff and clients there. There is a reason why people from all over the world look to lnsite for advice on implementing their own sites. Yes, lnsite provides a clean and supervised space for injection drug use, but it is so much more than that. It offers a holistic program where disease is less likely to spread, overdose deaths are averted, and individuals are more likely to access health and social services including immunizations, counselling, and drug treatment. Our government anticipates receiving more applications for supervised consumption sites in the future. We will ensure that they are diligently assessed, so that informed and evidence-based decisions can be made. In closing, it is our government’s belief that effectively addressing problematic drug use requires a comprehensive and compassionate public health approach that is inclusive of evidence-based harm reduction measures, including supervised consumption sites.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, as drug overdoses continue to kill more and more Canadians, the minister has failed to act proactively on another serious issue. In recent weeks, the minister decided to abandon new regulations to require tamper-resistant forms of powerful opioid prescription drugs. The minister has stated that she believes these regulations will not solve the problem because they are only applied to a single opioid drug, OxyContin. However, the solution to that is obvious: we need to bring in tamper-resistant regulations across the entire class of opioids, as the U.S. FDA has done. Canada is in the midst of an opioid overdose crisis. Hundreds of people are dying, and British Columbia has declared a public health emergency. More people will die, so why will the minister not introduce tamper-resistant regulations to the entire class of opioid drugs and help save lives?

Parliamentary Secretary to the Minister of National Revenue Kamal Khera (Brampton West, Ont.):

Madam Speaker, to operate legally, a supervised consumption site requires an exemption under the Controlled Drugs and Sub- stances Act, Canada’s drug control framework. The purpose of the act is to protect public health and maintain public safety, and it is the federal government’s responsibility to ensure that this is upheld in all circumstances where activities with controlled substances are taking place. 146 The Federal response to the Opioid Crisis

Health Canada requires sufficient information upon which to base any decision allowing an exemption. For this reason, requirements to demonstrate that a supervised consumption site will be properly established and managed pre-date the Respect for Communities Act. I acknowledge the concerns being voiced by the member. However, the recent approval of exemptions for the Dr. Peter Centre and lnsite demonstrate that existing legislation does not preclude sound and evidence-based decisions regarding supervised consumption sites.

JANUARY 31, 2017 This debate was part of Government Orders. The health minister moved that Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, be read the second time and referred to a committee.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I am pleased to begin debate today on Bill C-37 to address a serious and pressing public health matter, to improve public safety, and to protect the health of Canadians. This legislation is introduced in the context where Canada is facing a national public health crisis related to opioids, characterized by ever-increasing rates of harm, overdose, and death. The opioid crisis raises many concerns, and the one we hear about perhaps most often is the rapid rise in the numbers of deaths from accidental overdose. Last year, in British Columbia alone, more than 900 people died from overdose. That is an 80% increase from 2015. The majority were linked to the swift spread of powerful drugs like fentanyl. Alas, the situation is getting worse. Last week it was reported that there were 20,000 overdoses in British Columbia alone. At a national level, deaths from overdoses are now more numerous than deaths caused by motor vehicle accidents. Before I continue, I would like to extend my condolences to the families and friends who have lost a loved one. We share their grief. We are aware of the pressing need to turn the tide of this crisis as quickly as possible. I would also comment at the outset that while the focus of the legislation is on immediate action to address the opioid crisis, we must bear in mind that lasting solutions require an understanding of the roots of the opioid crisis, which are messy, but not mysterious. It should be acknowledged, for example, that pain is a central theme at the heart of the drug crisis. Sometimes, problematic drug use begins with physical pain, but we must also admit that emotional pain is a factor in substance use. To fully resolve the opioid crisis we must address the multiple social drivers, including poverty, social isolation, childhood trauma, sexual abuse, and mental illness. Addressing the roots of the crisis demands a whole of society response. It means calling out stigma and discrimination as barriers to accessing care. It means building a society where children receive tender attention and adults are not isolated and lonely. It means an international search for effective answers and being willing to discuss bold policy alternatives and the evidence associated with them. We must deal with this crisis comprehensively, collaboratively, and compassionately. We must assess what works and what does not work, and then we must do what works. The crisis is moving eastward in Canada, with more drug seizures of fentanyl and carfentanil. Canadians are increasingly aware that problematic substance abuse spares no one—people of all ages and from all socio-economic groups—and that it has devastating consequences on individuals, families, and communities. In the past year, I have met with bereaved parents, people who use drugs, first responders, addiction specialists, mental health experts, indigenous leaders, health educators, and others to learn their perspective on the challenges we face. A complex, multi-dimensional social challenge of this nature demands timely, coordinated, and effective action. Before I discuss the details of this proposed legislation, I would like to thank many members of this House who have been outspo- ken on the urgent need to respond together. I thank the member for Vancouver Kingsway for his support and advocacy on the issue, and especially for his calls to pass this legislation by unanimous consent. I would also like to thank the Standing Committee on Health. Its members are actively working on this issue, and they made a series of recommendations that we reviewed carefully. We have acted on that. I look forward to responding formally to the committee report in due course. There are many important components of this proposed legislation that would support communities and enhance public health and public safety when it comes to the use of drugs and substances. Bill C-37 would save lives. It needs to be passed without delay. At this point, please permit me to outline some of the federal actions to date on the matter. Early last year we made naloxone, the antidote to overdose, available without prescription. We arranged an expedited review of naloxone nasal spray and ensured an emergency supply for Canadians. We granted an exemption to the Dr. Peter Centre in Vancouver to operate Canada’s second supervised consumption site, along with an unprecedented four-year renewal of the exemption for Insite in Vancouver. Last summer, we announced Health Canada’s opioid action plan to improve education for the public and prescribers, to expand access to treatment, and to build the database.

147 The Federal response to the Opioid Crisis

In September, we overturned a ban on the use of prescription heroin, so that it is available to treat the most severe cases of addiction. Our government has supported the good Samaritan overdose act to remove the fear of drug possession charges for individuals who call 911 when they witness an overdose. We added regulations to schedule fentanyl precursors as controlled substances, making it harder for illicit substances to be manufactured in Canada. In November, along with the Ontario Minister of Health, Eric Hoskins, I hosted a national conference and summit on opioids, which led to a joint statement of action to address the opioid crisis. That statement includes 128 separate commitments made by Health Canada, nine provincial or territorial health departments, and over 30 other organizations. In February we will provide Canadians with an update on the progress made so far regarding those commitments. In work led by the Minister of Public Safety and Emergency Preparedness, the RCMP now has an agreement with China to combat the flow of illicit fentanyl. Because this is a national crisis, we activated additional supports. In collaboration with the provinces and territories, we have established a special advisory committee on illicit opioids that includes the Council of Chief Medical Officers of Health to advance information among jurisdictions related to the opioid crisis. We have built a task force within the federal health portfolio to work with other federal departments in a comprehensive response to the crisis. We funded McMaster University to produce new evidence-based guidelines for prescribing opioids for chronic pain. They are now available for consultation. We funded the Canadian research initiative in substance misuse to provide evidence-based guidelines for medication-assisted treatment; and with the support of the Prime Minister, we identified new federal funding of $5 billion over the next 10 years to address mental health and addictions. We know that untreated mental illness is a common cause of addiction, and early intervention is key. We introduced the new Canadian drugs and substances strategy, to reinstate harm reduction as a pillar in Canadian drug policy and return the lead for drug policy to the Minister of Health. In December, I introduced Bill C-37, which proposes to amend the Controlled Drugs and Substances Act and other acts. This legislative framework is an important part of our comprehensive approach to drug policy. It aims to accomplish three important goals: one, to provide support for harm reduction, in particular the establishment of supervised consumption sites; two, to reduce the supply of illicit substances; and three, to reduce the risk of diversion of other legitimate controlled substances. Evidence shows that, when properly established and maintained, supervised consumption sites in communities that want and need them will save lives and improve health without increasing drug use or crime rates. Last year, I visited Insite in Vancouver to witness the important work it does to help vulnerable people and communities. I was moved by what I saw. Facilities like Insite promote health-seeking behaviour by introducing people who use drugs to the health system in a non-judgmental and non-stigmatizing manner. They have hygienic facilities and sterile equipment, and are supervised by qualified health professionals who provide advice on harm reduction and treatment options as well as prevention of overdose. Under the Controlled Drugs and Substances Act, the Minister of Health has the ability to provide exemptions to allow supervised consumption sites, but the Respect for Communities Act from the previous government introduced unnecessarily onerous requirements that must be met by communities before the Minister of Health could even respond to the request for an exemption. We have heard desperate cries for help from communities most affected by the opioid crisis. They have indicated that the current requirements are burdensome and hinder their ability to offer services needed to reduce harm and to save lives. Currently there are applications being reviewed by Health Canada from across the country from communities such as Vancouver, Toronto, and Montreal. Proposed legislation would simplify and streamline the application process for communities that want and need to establish supervised consumption sites. It would replace the current 26 application criteria with the five factors outlined in the Supreme Court of Canada 2011 decision regarding Insite. In fact, the criteria in the proposed legislation are exactly those written in paragraph 153 of the Supreme Court decision. A vital criterion that Bill C-37 retains is the requirement for community consultation. It would improve transparency by adding a requirement for decisions on applications to be made public, including reasons for denial. To support these proposed changes, Health Canada would post new information online about what is required in applications, how to process works, and the status of applications. To help keep opioids and other illicit substances off the street in Canada, we need to make sure that they are not easy to produce. To that end, the bill proposes to prohibit the unregistered importation of pill presses and encapsulators. This measure has been included in part because certain jurisdictions, such as British Columbia, have asked for it. While it is true that those devices do have legitimate uses, they can also be used to manufacture counterfeit drugs that contain dangerous substances, including fentanyl. This legislation would also give Canada Border Services officers greater flexibility to inspect suspicious mail, no matter the size, that may contain goods that are prohibited, controlled, or regulated. Protecting the privacy of Canadians is of the utmost importance. The measure would only be for incoming international mail where the prevalence of illicit drugs is greater. In fact, just one standard size mail envelope can contain 30 grams of fentanyl, enough to cause 15,000 overdoses. 148 The Federal response to the Opioid Crisis

Lastly, the bill updates a number of provisions regarding compliance and enforcement of the Controlled Drugs and Substances Act in order to modernize that piece of legislation. These legislative measures allow over 600 licensed dealers to manufacture, purchase, sell, distribute, import, export, and transport controlled substances for legitimate purposes. The proposed amendments will allow Health Canada inspectors to conduct inspections in a variety of situations, especially in any location where it is suspected that any activities involving controlled substances are taking place. These amendments will help prevent the diversion of controlled substances to the illegal market. Bill C-37 supports our government’s new Canadian drugs and substances strategy, which the Minister of Public Safety and Emergency Preparedness and I announced on December 12. In the past, federal drug strategies aimed to balance public health and public safety objectives through key pillars of prevention, treatment, enforcement, and at times, harm reduction; but in 2006, under the national anti-drug strategy of the previous government, the harm reduction pillar was removed. Our government will pursue an evidence-based approach to drug policy. Accordingly, this new strategy would formally reinstate harm reduction as a key pillar, in addition to prevention, treatment, and enforcement. It should be noted that the reintroduction of harm reduction does not diminish the importance of the other pillars. In particular, we must not let up on our efforts for prevention and treatment. I will continue to encourage the expansion of access to a broad range of treatment options, which are essential to reducing the number of overdose deaths. In reframing problematic substance use as the public health issue that it is, it returns the lead to the Minister of Health from the Minister of Justice. In conclusion, the opioid crisis has taken a toll on many communities across Canada. It requires swift action, as well as a more balanced approach to deal with problematic substance use. Our renewed evidence-based approach would allow the government to better protect Canadians, save lives, and address the root causes of this crisis. Canada needs this action now. While our focus must be on the current crisis, we must also pursue a balanced approach over the long term to address the upstream causes of problematic substance use. We will continue to work with our partners, including the provinces, territories, municipalities, and indigenous communities. While we cannot end this crisis immediately, we can markedly reduce its impact and set ourselves on a path to health for all. Mea- sures proposed in Bill C-37 aim to take swift action to address the opioid crisis. I call on hon. members of the House to support the passage of Bill C-37 without delay.

Conservative MP Colin Carrie (Oshawa, Ont.):

Madam Speaker, I would like to ask the minister about the current injection site application requirements versus the proposed requirements. For example, the current requirements explicitly state, as far as consultation is concerned, that there needs to be the provincial health minister’s opinion, the provincial public safety minister’s opinion, the local government’s opinion, letters from the head of the police force in the area, letters from health professionals in relation to public health, and consultations with professional licensing authorities for physicians and nurses. In addition, they require that the public have 90 days after the day on which notice is given to provide the minister with comments. The current bill states that there is only a need to have an expression of community support or opposition, and that is about it. It further states that the minister may give notice, and it indicates a period of time not to exceed 90 days in which members of the public may provide the minister with comments. Therefore, under the new regulations, theoretically, a one-day consultation would suffice, and as long as one advocacy group was in favour, the minister would approve the site. I am wondering if the minister could clarify what she means by community and community consultation.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

When it comes to making decisions about supervised consumption sites, consultation with communities is absolutely essential. I hear from communities almost every day, people who are living in places like the Downtown Eastside in Vancouver and communities like Victoria. The member for Victoria is here today. If members speak to people who go into these communities and speak to business owners, first responders, and law enforcement officials, they will hear their cries of desperation. These communities are saying that people are dying in their streets and that they need to find a way to save people’s lives. Of course the community has to be consulted. There will always be questions, and they are absolutely legitimate. What Bill C-37 allows is for the Minister of Health to be able to make a reasonable decision and to make sure that all the appropriate people are consulted. Communities are desperately crying out for these kinds of facilities to be available. We have deep, abundant scientific evidence that they save lives, and we have seen that in communities where they have been introduced, the public has in fact come to see that they are highly effective in allowing public safety and making sure that people are safely introduced to the public health system.

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NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, I am glad to hear the minister acknowledge the comprehensive roots and causes of substance use disorders. I agree with her, very much, that addiction is a complex psychosocial disease. I think we all agree in this House that addiction is, first and foremost, a health issue. Taking all of these facts together, it is clear that we need to provide Canadians with a full range of treatment options if we are really to help people recover, if we are really going to stop overdoses, and if we are really going to reduce the deaths being caused in cities across this country. However, it is also a fact, and I think the minister knows this, that there is a shocking lack of detox and treatment facilities in this country that are publicly available, affordable, and free. A lot of families want to get help for a family member. It costs $10,000 or $20,000 a month to access treatment. It takes an average of eight days in British Columbia to access detox. We all know that with addiction, if someone does not get into treatment today, they may not be ready tomorrow. Will the minister assure this House that in the upcoming budget, there will be significant new federal funding to help create detox and treatment facilities for Canadians across this country, which is the only real way to actually deal with this health issue?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

He is absolutely right that harm reduction alone will not solve the opioid crisis. It requires a range of pillars, and that includes access to treatment. I would absolutely agree with the member that there is a tragic shortage of treatment facilities in this country. When I speak to mayors of big cities, people who work in emergency departments, and people who are first responders, they decry the fact that people can have their lives saved, but then they go back out onto the streets. They need treatment. When those people need treatment and are ready for treatment, they should have access to treatment. That is why I am very pleased that we were able to offer to the provinces and territories $5 billion in new money for mental health and addictions. I certainly hope that my colleagues, the ministers of health, particularly in the provinces where this is the greatest challenge, will use some of those resources to expand access to treatment facilities so that people will be able to get, possibly, opioid substitution therapy, for example, and will be able to have their social issues addressed and live healthy lives.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Madam Speaker, today we see the abuse that program has undergone. We can look at the sale of prescriptions for methadone. We can look at the people using methadone, along with other drugs. I am just wondering if the minister can speak to the review of that program and the costs it has borne over the years to end up with the results we see today.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Madam Speaker, I am pleased to answer this question, which raises again the issue of treatment, which is clearly an important part of the response to the opioid crisis. The member raises the issue of medication-assisted therapy, and that includes opioid substitution therapy, products like methadone and another product called buprenorphine/naloxone, which is also known as Suboxone. These are absolutely essential parts of the solution to the opioid crisis. People who have been identified as having a severe addiction are in many cases, unfortunately, accessing drugs that are laced with much more powerful drugs, like fentanyl, and that is causing many of the overdose deaths. We are looking to work with provinces, territories, and communities including indigenous communities, to make sure that treatment options are available. There are challenges in accessing some of these opioid substitution therapies across the country. There are challenges with cost. There are challenges with making sure that prescribers can use them in a proper way. However, we know, and I know from having talked to the parents of people who are suffering with problematic substance use, that they want their children to be able to access these kinds of treatments and to find good health.

Liberal MP Chris Bittle (St. Catharines, Ont.):

Madam Speaker, during the break I had an opportunity to meet with a friend of mine who is a firefighter in Niagara. I asked him how work was going, and he said that it was terrible. He was going from call to call with the opioid crisis and overdoses. We hear a lot about the opioid crisis related to British Columbia, but my question for the hon. Minister of Health is how the government is going to address this issue from coast to coast to coast.

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Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Madam Speaker, I am very grateful for this question. It does emphasize the tremendous toll this places on first responders in many of the cities across the country, and even in rural areas. It is heartbreaking for them to see people die of overdoses and to have to try to get to them to respond. The member also raises the matter that there is a shortage of good data, and that is one of the things I am very concerned about. In fact, it has been raised by the health committee and others. We have tasked the chief public health officer of this country to work with the medical officers of health across the country, with Stats Canada, and with the Canadian Institute for Health Information to find a way, and I will continue to push on this, to get access to good, rapid, up-to-date data across the country so that we can recognize where there are pockets of substance use challenges that are not adequately being addressed.

Conservative MP Colin Carrie (Oshawa, Ont.):

Madam Speaker, I am happy to finally get the opportunity to rise in the House to debate bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts. I think all members of the House and all Canadians would agree that the ongoing opioid crisis is absolutely tragic. I know that the Premier of British Columbia and a few of our colleagues from B.C. have asked the minister to issue a national public health emergency as the overdose numbers continue to rise in the province. This is a very complex issue. There is not just one solution. I was fortunate to have been part of the opioid study recently conducted at the health committee. It allowed me, and I think all my colleagues on the committee, to truly learn and empathize with struggling addicts, communities, first nation health professions, and families that have had to endure an opioid-related death. We had the opportunity to hear many first-hand stories, something that I am so grateful to have had the opportunity to be part of. We heard from parents who lost their children. We heard from recovered drug addicts, government officials, and the first responders who are reviving these people hourly. We sometimes seem so focused on those battling drug addictions that we forget about the first responders who are working so hard to ensure that our streets and our citizens are safe. I would like to personally thank everyone who appeared as a witness. I truly believe that their testimony has played a huge role in encouraging all levels of government and Canadians to work together, and of course, to take action. With that, I would now like to get to the bill itself. The bill aims to achieve five main things. First, it would grant increased powers to the Canada Border Services Agency. Second, it would regulate the importation of unregistered devices, such as pill presses. Third, it would increase prohibitions against certain actions related to controlled substances. Fourth, it would give the minister authority to temporarily schedule and control new dangerous substances. Fifth, it would streamline the application process for approving and opening supervised injection sites. We know that there are many factors that have contributed to the opioid crisis. While one cause of the crisis results from illegal substances and organized crime, many are battling addiction because of the over-prescribing of painkillers. This bill seeks to address one aspect of the crisis: illegal activities and organized crime. I look forward to seeing what measures will be taken to address prescription drugs and over-prescribing, as I think we must acknowledge that it is a key contributor as well. We know that China has been a primary source of fentanyl, carfentanil, and other dangerous opioids. It has been reported over the last year, and by the CBSA itself, how easy it is to import illicit substances into Canada with the current regulations. My Conservative colleagues have been pushing the government to finally acknowledge the flaws at our borders and grant officers the authority to search and seize suspicious packages weighing less than 30 grams. While border agents already intercept dozens of these packages, exporters have found a way to hide illegal substances in toys, silica packages, and products that ultimately could not be searched without permission. Removing the “30 grams or less” exemption from the Customs Act is a much-needed step in combatting the opioid crisis facing our country. Another weakness that has been recognized by many of my colleagues, but most passionately by Senator Vern White, is the need to target devices, specifically pill presses. These devices are capable of turning out thousands of deadly pills per hour, and under the current law, anyone can import one legally. That is not okay. Abbotsford Police Deputy Chief Mike Serr stated:

“Right now, they are not regulated and the importation of them—there really is very little from an intelligence perspective the police can do.... To have these machines registered would be at least one step for us.... We could then have a better sense for ensuring they are for legitimate purposes.”

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Again, granting the Canada Border Services Agency the authority to detain unregistered pill presses is something that must be done. It is important that all information obtained at the border be available to law enforcement agencies across the country so that they can take the appropriate steps in ensuring the safety of all citizens. Ultimately, that is what we are trying to ensure here: that all Canadians are protected and that access to illicit, dangerous substances is avoided any way possible. That is what I find quite contradictory. The government is so quick to encourage the approval of supervised injection sites. Injection sites are known to give access to illicit and dangerous drugs, yet the government appears to want more of them. This is where there are some major inconsistencies in the government’s policies. The minister’s mandate letter states, “Canadians need to have faith in their government’s honesty and willingness to listen. I expect that our work will be informed by performance measurement, evidence, and feedback from Canadians”. Yet, the bill would severely weaken the Respect for Communities Act, which was put in place to ensure that feedback from Canadians was taken into consideration before a supervised injection site was approved. Under the previous Conservative government, we took steps to ensure there was a robust consultation process which included residents, local law enforcement agencies, and elected officials to be on board with an injection site in their community. Bill C-37 proposes to significantly change those requirements. While the expression of community support for opposition is a requirement, the specific requirements have been removed to allow the Liberals to easily change them as they see fit.This is a way to completely avoid parliamentary oversight. The minister’s attempt to avoid community approval will fail. We heard from numerous witnesses in the health committee that an injection site could not be successful without the support of the entire community. I will use the city of Ottawa as an example. The mayor, the chief of police, and the former chief of police all have openly stated that they are opposed to an injection site in their community. Yet, under this bill, there is no assurance their views would even be taken into consideration. The minister has given herself the power to approve a site, regardless. What the minister does not realize is that not all communities want injection sites. Usually there are a few advocacy groups that are in support of a site, and no other legitimate stakeholder. The Prime Minister’s own parliamentary secretary for justice stated, “They have been doing it in Vancouver for some years and there have been issues that have arisen there. I don’t know of any place in Toronto where that couldn’t have a significant negative impact on the communities.” The Liberals are using harm reduction strategies as temporary solutions, band-aid solutions, and are refusing to offer any long-term solutions such as treatment and prevention. This is concerning. In the minister’s mandate letter, the Prime Minister states, “When Canadians are in good physical and mental health, they are able to work better, be more productive, and contribute more fully to our economy while living healthier, happier lives”. I agree with this statement, which is why injection sites should not become the norm. These sites are not helping people become productive. They are not encouraging good physical and mental health; in fact, they are doing the complete opposite. All injection sites are doing is providing a safe place for addicts to get their fix and if they overdose, someone will revive them.This is not a life. Injection sites do not save lives. They revive people who, from what I have heard from meeting with many recovered addicts over the year, do not want to be alive if drugs, crime, and overdosing is all they have to look forward to. The parliamentary secretary for justice also said, “the ambiguous messaging that comes out from a society that says you can’t use these drugs, they’re against the law — but if you do, we’ll provide a place [for you] to do it in.” This is exactly the type of conflicting message Canadians do not want children to be raised with. Drugs are dangerous. They are illegal because they ruin lives. The Prime Minister and the Liberal Party are simply building a co-dependent relationship with drug addicts. To elaborate on what I mean, a co-dependent relationship is a dysfunctional relationship in which one party enables and supports another’s addiction such as drugs. That is what the Liberals want society to become: an enabler as opposed to a preventer. The president of the Canadian Police Association, Tom Stamatakis, said, “We should be treating addiction as a health issue and if harm reduction is part of a holistic approach to dealing with this issue, there should be a treatment pillar that focuses ultimately on how we get people away from engaging in harmful activities.” Injection sites simply provide a place for drug users to get high, but offer no treatment. I will use Insite as an example. In 2015, 6,531 people visited the injection site and only 464 were referred to Insite, the site’s apparent detox treatment centre. Only seven per cent were referred to or offered detox treatment at Insite. To elaborate on the statistics, when I went for a visit, I was basically told by an employee that it was not in the business of treating these people. The site was there to provide them with needles and ensure that they would wake up. These sites are not saving lives; they are enabling and giving up on people whose lives have taken a bad turn. The government’s desire to quickly approve these sites without community support, especially law enforcement, is absolutely outrageous. We cannot support the government’s attempt to improve these dangerous enabling sites without knowing and being assured that residents, law enforcement, and elected officials are 100% on board. Once the minister approves the site, the responsibility to ensure the safety of all residents rests in the hands of local police. Crime rates do not drop as the government keeps stating. Addicts are still illegally obtaining these drugs through break-ins, robberies, prostitution, etc. As Toronto Police Association president Mike McCormack said, “They’re (VPD) seeing more of what we’d call street disorder—more people using drugs on the street, smoking drugs, congregating, minor thefts.” 152 The Federal response to the Opioid Crisis

I worry about my community of Oshawa. Oshawa is an up-and-coming area with many new businesses and new residential areas for families to settle into. Oshawa and Durham region continue to work to improve the crime rates, and we have seen a drastic decline in assault, robberies, and drug crimes since 2009. This is thanks to the community as a whole working together to make it a better and safer place to raise our families. I worry that the approval of an injection site in my riding would lead to people looking for somewhere else to live, which ultimately would negatively affect these thriving businesses. It would cause alarm if local residents, the mayor, and local police were not consulted prior to an approval. This is something my local community would not be in favour of, and that is why I cannot support this portion of the bill. Another issue we heard quite a bit about throughout the opioid study was the fact that new dangerous and deadly substances were constantly being made. This causes serious concerns. As the current rules stand, new psychoactive substances that are designed to mimic illegal drugs are chemically different enough not to be considered illegal. I was happy to see that that the bill proposed to grant the Minister of Health the authority to temporarily and quickly schedule and control a new and dangerous substance under the Controlled Drugs and Substances Act. This will allow the minister to take immediate action for the public good, while launching a thorough review of the new substance. This means action is being taken while a decision on whether to permanently schedule the substance is warranted. I think all members agree that the opioid crisis must be addressed. I also think that all members are in agreement on the severity of the issue. The right steps are being taken to address security concerns at the border. Acknowledging that an international source is massively contributing to the opioid crisis is the first beneficial step the Liberals have taken to combat the issue. Ensuring that the Canada Border Services Agency can now open any suspicious package under 30 grams will stop the inflow of illegal substances dramatically. Unregulated devices such as pill presses are another massive contributor to the opioid crisis, and that is acknowledged in the bill. These devices are allowing organized crime to produce mass amounts of deadly drugs. Giving the CBSA authority to share information with law enforcement agencies will allow police forces to do their jobs and shut down these illegal activities. The bill also acknowledges the notion that new dangerous substances are constantly being manufactured. In order to control the quick turnaround of newly designed psychoactive substances, under new regulations, the minister would be able to temporarily and quickly schedule control of a dangerous substance. These are public safety measures that look out for the best interests of all Canadians. These measures look to negatively affect organized crime and make it harder for organized crime to produce and sell dangerous drugs. However, severely weakening the consultation process with Canadians before the approval of an injection site is the exact opposite of these other measures. Approving these sites all around the country will normalize substance abuse. Drug addicts will still be committing extreme numbers of crimes to obtain these drugs. They will still be contributing to organized crime, and they are all to use freely in a government-sanctioned facility. I acknowledge that every province has different needs. What is happening in British Columbia is not the same as what is happening in Prince Edward Island. However, I cannot acknowledge that injection sites save lives. I heard the analogies from a medical addiction specialist who said that, “If I was a lifeguard and saw someone drowning, I would run in and pull them out of the water. Once they started breathing again, I would not throw them back into the water”. That is exactly what injection sites do. Streamlining the application process for approving injection sites is irresponsible. It would put communities at risk and it would put individuals with severe drug dependencies at risk. Drug addiction should be seen as a treatable illness. Until I see the government take appropriate steps to help these people get off these dangerous and deadly drugs, I cannot, and will not, support this harm reduction band-aid solution.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Madam Speaker, although I appreciate the member speaking to the legislation, I do not necessarily agree with a number of the points and conclusions that he has brought to the chamber. The Vancouver Insite injection site has received overwhelmingly positive feedback since its creation. Its creation was based on consultation and had a federal minister working with the provincial entities and different stakeholders, including first responders and the community as a whole. I recall when the Conservatives brought in legislation to try to expand the area. There was a great deal of concern and scepticism toward the Conservatives back then because they did not support these injection-type sites, even though science and statistics clearly indicated that society benefits from these sites. I take it from the member’s statements that we will no doubt have to agree to disagree on the validity of the injection sites, but that we do agree on the crisis of opioids. This legislation will assist in dealing with that crisis. Given the urgency of the opioid crisis in Cana- da, at the very least, would the member not agree that we should attempt to get this to committee as soon as possible?

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Conservative MP Colin Carrie (Oshawa, Ont.):

Madam Speaker, I think everyone in the House agrees this is urgent. When we look at addiction as a health problem, it is clear we would treat no other health condition like this. Even if we were to define the harm in the term “harm reduction” as an addict putting heroin into his or her arm, I think the approach would be to try to help that addict so he or she would not do that. We have seen statistics. I remember talking to Vernon White. He said that the average addict committed four to eight illegal crimes every day to get his or her fix. Therefore, by allowing addicts to go into one of these injection sites to inject an illicit substance, which as far as we know could be filled with kerosene, and then giving them a little shake and letting them go back out again saying that we have saved their life, we are enabling them to go out in that community and commit four to eight crimes again. Whether it is break and enter or prostitution, let us imagine that happening four to eight times per day and all we are saying is, “Come back in again. We’ll see what we can do to help you.” My colleague from Vancouver was adamant and passionate. This was a band-aid solution. We need to work on long-term detox programs. I find it uncomfortable that the minister just finished renegotiating the health accord and did not get a firm commitment from the provinces and territories to open up these detox centres. That is what really saves lives.

NDP MP Linda Duncan (Edmonton Strathcona, Alta.):

Madam Speaker, what is stunning to me is that the member appears to be saying that he agrees that we are facing an opioid epidemic. We have been told by the minister that there has been an 80% increase in deaths from overdose since 2015. There have been huge increases in deaths from overdose in my city alone. More than 87 organizations that work with the homeless, the HIV-infected, and the addicted came forward to oppose the legislation of the member’s government. They said that safe injection sites were proven to decrease overdose, death, injury and risk behaviour, that access to health care for the marginalized increased, that it saved health care costs, and that it decreased open drug use and publicly discarded equipment. Therefore, given the member supports the fact that there is an opioid epidemic, will he support our call for a national public emergency to be declared so federal resources will be made available immediately, and at least temporary safe injection sites?

Conservative MP Colin Carrie (Oshawa, Ont.):

Madam Speaker, what my colleague says is quite true. The crisis is getting worse. Sometimes people get caught up in thinking they need to do something. However, as I said in my speech, if only 7% of the people who attended what some people call this “safe” injection site were offered treatment, why would we be repeating that around the country? As the minister said herself, there are no good statistics being collected to determine the proper way of to move forward. Is it injection sites or needle exchanges? Therefore, before we move forward, it is important that we maintain the rights of communities to provide their input where these injection sites have been proposed. That is the most disturbing thing I find with the bill. It would remove a lot of the safeguards we had put in place as a government. The basic fact is this. We should not be normalizing these injection sites. They should be rare and should not be made the go-to way of treating these addictions. Rather, it should be detoxification treatment.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, it is a privilege to work with my hon. colleague on the health committee. I very much respect his contributions to that committee, but with the greatest of respect, I must vehemently disagree with a number of the theses he is advocating here today. If health policy is to be based on evidence and not on ideology, then we must look to the best evidence we have. The validity and accomplishments of safe injection sites was exhaustively examined by the Supreme Court of Canada when it ruled on the Insite case back in 2011. In that case, mountains of evidence were placed before the court, including from The Lancet, which is one of the world’s most respected medical journals. Evidence gathered around Insite itself showed that it results in fewer overdoses, and in fact, no deaths. There has not been a single death at a supervised injection site in this country ever. As my colleague from Edmonton Strathcona said, it results in there being less open drug use in the streets, less crime, and fewer discarded needles in our communities as well. His own government brought in legislation that did permit safe injection sites to open, albeit it made it extremely difficult to open them. His own government must have acknowledged that there was some value to this, or perhaps it was just forced to do so by the Supreme Court of Canada. Why did his government do nothing about the CBSA’s prohibition on opening envelopes under 30 grams, which it took the present government to fix, so that we could stop the flow of fentanyl into this country? Why did his government not catch that and do something about it?

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Conservative MP Colin Carrie (Oshawa, Ont.):

If [my colleague] looks at the community where Insite is, Vancouver’s Downtown Eastside, I think he would agree with me that it is an exceptional neighbourhood. Before Insite was put into that neighbourhood, it was a horrible situation. The injection site was put there basically as an experiment. We had to do something. In that particular community, there was a lot of support for it. I think he is very aware of the strong support among all stakeholders. That is one exceptional neighbourhood. I do not see any neighbourhood in Canada as bad as that one is or was in the past. If we look at the evidence, and he was there in health committee, unless communities are actually supportive and on side with these facilities, they do not have a chance of being successful. There is not a lot of evidence to support taking this template and just moving it across the country. As he said, there has only been one. To duplicate that based on that one experience is not the responsible thing to do. Some things have been brought up over and over again, such as saving lives. I would suggest that if someone is injecting in front of them, that is to be expected, but to send them back out without proper treatment and moving them into a treatment program, as we would with any other disease in Canada, is that the best we can do? If that was our child or our friend, is that really the best we could do? I look forward to working with my colleague on seeing what we can do to move that agenda forward, because I think that is something all Canadians in all communities can agree on.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, Canada is currently in the grips of an unprecedented opioid overdose crisis. According to David Juurlink, one of Canada’s leading drug safety experts:

“This is the greatest drug safety crisis of our time, and it’s not hyperbole to say that every one of you knows somebody with an opioid use disorder. Whether you realize it or not, you do, and it’s quite possible that you know someone who’s lost a loved one to these drugs.”

He went on to say:

“The scope of the problem in Canada is completely unknown. We know that in the U.S., the CDC estimates that over the last 20 years, about a quarter of a million people have died from opioids, more than half of them from prescription opioids.... We have no corresponding numbers in Canada. I speculate that somewhere in the order of 20,000 Cana- dians have died over the last 20 years from these drugs. The fact that no federal politician can tell you that number is a national embarrassment.”

In my home province of British Columbia, illicit drug overdoses claimed the lives of at least 914 people last year, making it the deadliest on record for overdoses. This places it at the same level as Alabama, the worst state in the United States in terms of overdose rates. Last year two Ontarians died every single day from drug overdoses, with one of every eight deaths of young adults due to opioids, and 338 Albertans died last year. Quebec overdose deaths have increased by 140% over the last 10 years. Although Canada does not track overdose deaths at the national level, which again is an inexcusable deficiency in national health policy, it is estimated that in 2015 alone, 2,000 Canadians died from overdoses. That number is certainly much higher for 2016 due to the rapid proliferation of extremely potent illicit opioids throughout Canada. It is patently clear that drug overdoses and deaths are increasing in every region of the country and will continue to do so without extraordinary and effective action. The significant increase in overdoses in 2016 prompted B.C.’s provincial health officer, Dr. Perry Kendall, to declare a public health emergency last April for the first time in the province’s history. Notwithstanding this extraordinary step, the crisis has deepened. December saw another record spike in deaths in B.C., with Vancouver alone now registering 15 overdose deaths per week. This is truly a crisis of epidemic proportions. Fentanyl, an opioid 100 times more potent than heroin, has been called a game-changer for drug overdose deaths in Canada, and now we are seeing overdoses caused by carfentanil, an opioid so powerful that it poses overdose risks to those exposed to it simply through inhalation or contact with their skin. These drugs are so dangerous that a dose the size of a grain of salt can cause overdose or death. I think we can all acknowledge that there are many aspects to this complex crisis. Fentanyl is strong, cheap, easy to transport, and small amounts can be made into thousands of doses. For $10,000 or $20,000, manufacturers can obtain a kilogram of fentanyl, an amount so compact it can fit in a shoebox, and turn it into $20 million in profit.

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Many overdoses are being caused by inexperienced young people experimenting with non-opioid recreational drugs, unaware that they are contaminated with fentanyl. For example, this past fall in Vancouver, there were nine overdoses recorded within 20 minutes in people who were using cocaine that was unknowingly laced with fentanyl. Opioids have been overused and over-prescribed by doctors for pain management, leading to many patients becoming dependent and addicted. Canada has among the highest per capita volume of opioids dispensed in the world, totalling 19.1 million prescriptions in Canada in 2015, up from 18.7 million the year before. That is about one opioid prescription written for every two Canadians. Even though there are no credible peer-reviewed studies that demonstrate that opioids afford more benefit than harm for chronic pain, opioid use has been marketed beyond palliative and cancer patients for regular use for people experiencing back pain and other common ailments. Prescribers were incorrectly taught that addiction was a rare consequence of using prescription opioids long term, that less than 1% of patients would become addicted. In reality, the addiction rate is estimated to be 10%, with 30% suffering from opioid use disorder. This misuse of opioids reveals the absence of broad and effective treatment for chronic pain in Canada. Critically, there is an alarming lack of public detox and treatment facilities available across Canada, caused by underinvestment for decades at both provincial and federal levels, and even less resources dedicated to education and prevention. Bluntly, our health care system has an appalling lack of publicly covered treatment options for Canadians suffering from substance use disorder, a pox on both Liberal and Conservative governments over the last number of decades. In indigenous communities, inconsistent federal support for community governed and culturally based treatment has made addressing the opioid crisis a particular challenge. Nurses employed by Health Canada do not possess the scope of practice to support indigenous people in addressing opioid addiction in their own communities beyond 30 days by federal edict. As Dr. Claudette Chase, a family physician at the Sioux Lookout First Nations Health Authority recently told our health committee:

“I tear up every time I think about this, because our workers are putting themselves on the line to hear the stories of incredible trauma. We have little funding to train them. These are community members who, because Health Canada has refused to step up, have stepped up themselves. They do this and they get traumatized daily, and I have little or no means to support them other than being their family doctor. It’s not acceptable.”

Addiction is a complex psychosocial disease with genetic, environmental, and social determinant influences of every type. Although this crisis has been garnering increased media attention in recent months, make no mistake that it has been allowed to escalate for years, recently under a Conservative government blinded by superficial ideology and now under a Liberal government paralyzed by timid expediency. What both Conservative and Liberal governments have in common, however, is a refusal to act on evidence in a timely fashion, and decades of history of failure to make the investments necessary to provide Canadians with essential health options to treat substance use disorder. Over the last 10 years, the previous Conservative government slashed Health Canada’s addiction treatment budget, removed harm reduction as one of the four pillars of Canadian drug policy, and spent nearly a decade trying to discredit the clear and overwhelming evidence that supervised consumption sites save lives. Indeed, this crisis has undeniably been exasperated by barriers erected by a Conservative government that prevented supervised consumption sites from opening across Canada. Despite an abundance of research that conclusively established that Vancouver’s supervised consumption facility, Insite, significantly reduced overdose deaths, the Conservative government obstinately refused to accept that evidence. In 2011, it took the Supreme Court of Canada to rule that Insite and other supervised consumption sites must be granted a section 56 exemption from the Controlled Drugs and Substances Act because they “decrease the risk of death and disease, and there is little or no evidence that it will have a negative impact on public safety”. In response, in 2015, the Conservative government introduced Bill C-2, which sets out a lengthy and arduous list of criteria that supervised consumption site applicants must meet before the minister would grant them an exemption. In practice and by design, these criteria made it effectively impossible for organizations to open new supervised consumption sites in Canada. For example, Montreal has had applications pending Health Canada approval since May 2015, almost two years, for three fixed services in three neighbourhoods and one mobile service. Indeed, not a single supervised consumption site has opened in Canada since Bill C-2 was passed. Of course, that was exactly the Conservatives’ intention. Only an hour after Bill C-2 was initially introduced, in a move so vile it would impress Donald Trump, Conservative campaign director Jenni Byrne issued a fundraising letter stating that the Liberals and NDP wanted addicts to shoot up in the backyards of communities all across the country. This went beyond a juvenile refusal to accept evidence that ran contrary to their moralizing ideology. It was a clear and utterly disgraceful attempt to campaign on the backs of the most vulnerable Canadians, sick Canadians. 156 The Federal response to the Opioid Crisis

For those Conservative MPs who now claim to have found religion on the issue, who have recently echoed the NDP’s long-standing call to declare a national public health emergency, I must remind them that it was Conservatives who blocked my attempt to move this bill swiftly through the House in December, to save lives faster. Though the Liberals claim to support the expansion of supervised consumption sites, their government has not approved a single new facility since coming to office. In fact, the Minister of Health initially and stubbornly argued that legislative changes to Bill C-2 were not even necessary, since she had directed Health Canada officials to facilitate the application process under the existing law. She refused to acknowledge that the problem was the act itself with its 26 separate requirements acting as effective barriers to any new sites, as had been consistently pointed out by stakeholders, the NDP, and even some of her own colleagues. This tepid response stood in stark contrast to the view espoused by the member for Vancouver Centre, the Liberal member for Vancouver Centre, when she was the Liberal health critic in opposition. When Bill C-2 was introduced, the member for Vancouver Centre publicly stated that the bill was deliberately written in a way that would ensure no supervised consumption sites were approved in Canada. She also questioned the constitutionality of the bill. It has frequently been observed that Liberals campaign from the left and govern from the right, that they talk progressively in opposition, but act conservatively when in power. I am afraid their conduct on the opioid crisis is yet one more example of this unfortunate truism. Unacceptably, it took a mounting death toll and universal pressure from medical experts, public health officials, provincial governments, municipal leaders, and the federal NDP before the Minister of Health finally relented and outlined legislative changes she was willing to make to Bill C-2, on December 12, 2016. This came on the heels of an announcement from the B.C. government that it was no longer willing to wait for federal approval and would take the extraordinary measure of signing a ministerial order making the provincial operation of temporary overdose prevention sites legal. This was in turn a response to the unsanctioned, makeshift supervised consumption sites that were being established throughout B.C. by activists like Ann Liv- ingston and Sarah Blyth, who founded the Overdose Prevention Society last September with crowdfunding, due to the severity of the crisis. While the current government was waiting, while people were dying, people in British Columbia and on the street were acting. Thus, the bill is an overdue acknowledgement that this is, in fact, a crisis and contains some important steps to address it. I do want to credit the government for taking some positive measures. The Liberals hosted an opioid summit, where they committed to better informing Canadians about the risks of opioids, supporting better prescribing practices, and improving the evidence base. They made naloxone available in a non-prescription status. They reversed the federal prohibition on the use of pharmaceutical heroin for treatment. They scheduled fentanyl precursors. They reinstated harm reduction as one of the four pillars of drug policy. Now the government has introduced amendments to the Controlled Drugs and Substances Act and other acts, to streamline supervised consumption site applications. These changes are all welcome, if overdue, and New Democrats are in agreement with all of them. However, they do not go nearly far enough, fast enough. There is much more that we can and must do. That is why I must take serious exception to comments made by the Minister of Health in a recent interview. The minister said:

“I would argue with the fact as to whether or not there’s been progress made. I know that the number of deaths are rising, but we have been extremely active on this file....”

I do not know how the minister measures progress, but I do know one thing. When Canadians are dying at unprecedented rates, when month after month we see increased death tolls from opioid overdoses, there can be no legitimate talk of progress. We in the New Democratic Party will measure progress by one factor and one factor only: when the death toll of Canadians goes down, not up. How- ever by that standard, the crisis is getting dramatically worse, not better. Annually since 2012, the number of fatal overdoses in B.C. has increased significantly: 273 deaths in 2012, 330 in 2013, 366 in 2014, 510 in 2015, and now 914 in 2016. Last month alone, we recorded the highest number of overdose deaths in B.C.’s history, with 142 lives lost. That is more than double the monthly average of overdose deaths since 2015 and a sharp increase from the fall. There were 57 overdose deaths in B.C. in Septem- ber, 67 in October, and 128 in November. That is not progress. To understand the scale of this epidemic, I would remind the House that during the SARS crisis in 2003, 44 people died in an outbreak of the disease across all of Canada. We are losing that many people every week to opioid overdoses. I would suggest to members of the House that if 40 to 50 Canadians were dying every week from SARS, Ebola, or any other infectious disease, the House would not rest until it saw a response from the federal government that matched the severity of the crisis. Every life lost to overdose is a heart-wrenching tragedy that leaves devastated loved ones in its wake. The lives cut short by overdose matter just as much as anyone’s, and this epidemic deserves the same attention and urgency as any other disease. Moreover, we must remember that the consequences of inaction are felt severely by those on the front lines of this crisis. As Chris Coleman, a firefighter who works on Vancouver’s Downtown Eastside, told the health committee:

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“...it takes a toll on an individual’s mental health to see such helplessness and suffering up close on a daily basis; to work extremely hard but to feel that you are having little or no impact on a problem that is growing exponentially, like a tidal wave, on the streets of your city. There is mental strain in watching a population repeatedly harming itself and in ultimately witnessing death and deceased persons who have succumbed to this human tragedy.... I must stress that our brothers and sisters who work in the Downtown Eastside are in trouble.... In conversations with these firefighters, I hear a lot of “It’s driving me nuts” and “I can’t take it”. I’m told stories of their being in an alley with 20 or 30 drug users. They’re unprepared and untrained for that. Part of their hopelessness comes from having to deal with the same particular overdose patient who has a needle in their neck, who’s rolling around in urine and feces, more than once on the same shift. They feel abandoned and they feel hopeless.”

We must not condemn our courageous first responders to the fate of Sisyphus, rolling an immense boulder up a hill over and over again for eternity. They need the Government of Canada to have their backs. Indeed, the federal government’s failure of leadership on the opioid crisis has led to renewed pleas for help from public officials from all across Canada. These include the mayors of Calgary, Toronto, Ottawa, and Vancouver, B.C.’s health minister, and health professionals from every discipline. I know that the Minister of Health has repeatedly stated in public that the federal government is doing everything it can. Of course, that is utter nonsense. There are literally dozens of measures and recommendations made by health experts and stakeholders across Canada that remain unimplemented by the government. Recently, the City of Vancouver sent a list of nine recommendations to the federal government to help address this crisis, including calling for a central command structure, daily meetings with Health Canada, and improved treatment services. A coroner’s jury in British Columbia recently issued a list of 21 recommendations for action, and the Standing Committee on Health in December issued a report detailing 38 recommendations for the government alone, most of which remain unimplemented. To demonstrate this leadership and illustrate the federal government’s understanding of the scope of this crisis, the New Democrats have been calling on the federal Minister of Health to declare a national public health emergency for months. We are now joined in this call by municipal, provincial, and federal politicians of all stripes, including, recently, the Conservatives. A declaration of a national public welfare emergency under the Emergencies Act would empower Canada’s top doctor with the authority to take extraordinary measures to coordinate a national response to the crisis. This could include an allocation of emergency funding on the scale required to actually address the mounting death toll, as well as sanctioning the operation of temporary supervised consumption sites on an emergency basis. Inexplicably, the minister continues to claim that a national public welfare declaration is unnecessary and untimely. With respect, she is utterly and demonstrably wrong. For example, such a declaration would allow overdose prevention sites across the country to open and operate legally, something they cannot do now. Not only are such sites needed desperately in every major city in Canada, but they would start saving lives today. New Democrats have worked in good faith with successive federal governments to address the crisis with the urgency it deserves. We led the fight against the Conservatives’ Bill C-2 from the day it was introduced, and then pressed the Liberal government to repeal or amend it. Last fall, we moved a motion at the standing committee to conduct an emergency study on the crisis. We tried to expedite this bill through the House in December; and we were the first to call for a declaration of a national public health emergency to address the crisis. The New Democratic Party will support this bill and work in committee to improve it. We will continue to press the government to take every action it can to address this national public health crisis.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Madam Speaker, I support many of the comments the member made in reference to Bill C-2, especially his reflections on the Con- servative government at the time. I was here, like him, and I like to think it was not only the NDP. The Liberals were also in great opposition to Bill C-2 and made commitments to look at making changes. What we are talking about today addresses some of the issues that were raised during the debate on Bill C-2 by both opposition parties. I agree, in good part, with the beginning of the member’s comments. Where I take some exception, and where the member needs to get a better appreciation, is on the statement that the national government has not demonstrated leadership. The Minister of Health and the Prime Minister have demonstrated leadership on the opioid crisis here in Canada.

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The Minister of Health has been very proactive. The member himself made reference to a series of things the Minister of Health has done. We have to take into consideration an enormous amount of work with the different stakeholders, whether they are provincial administrations, indigenous people, first responders, and so forth. It has to be a coordinated approach. My question for the member is this. Does he not recognize the importance of working with others, since it will not be just Ottawa that resolves this particular problem? Maybe he could comment further on how the House today can assist in expediting the passage of this legislation.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, sometimes Liberals say that the New Democrats are Liberals in a hurry. The corollary to that is that Liberals are New Democrats who will not take action. My hon. colleague brings up something that I made a central point of my speech, which is that when Liberals were in opposition, they stood in the House and told Canadians that they opposed Bill C-2, that they believed that supervised consumption sites save lives, and that Bill C-2 was deliberately designed to prevent the opening of supervised injection sites in this country. In fact, the member for Vancouver Centre, the senior Liberal in British Columbia and the Liberal critic for health at the time, called the bill unconstitutional. That is why New Democrats, as soon as the Parliament changed back in October of 2015, at first opportunity, called on the government to introduce legislation to amend or repeal Bill C-2. New Democrats started the call in February of last year. Why? It was because we saw that there was a crisis. People were dying every week. What did the Liberals do? They told the NDP they did not think, while in government, that there was any problem with the legislation, that they just thought it was an administrative problem. Every month, New Democrats stood in the House and told Liberals they had to act to change it because supervised consumption sites save lives and the bill was a barrier. Month after month, Liberals stalled and did nothing while Canadians died. It took them until December, after over a year in office, before they actually introduced legislation, which will now take months to pass. I am going to give the Liberal government no credit for its inaction and delay on introducing legislation that is so critical to saving lives in this country, and New Democrats will continue to push the government to take the dozens of recommendations that are necessary to continue to do so.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Madam Speaker, I am looking at some of the embedded criteria regarding injection sites. I was not here at the time, but as I go through this, I see they include support from local government with respect to health and safety, a letter from the head of the police, a letter from health professionals in relation to public health, information on the vicinity of the site, information on the inappropriate discarding of drug-related paraphernalia, a number of issues on data gathering, drug treatment, and trends. All of those things were embedded, and I am wondering which piece was a roadblock to establishing a consumption site. Insite has been there for 13 years and was established under the Conservative government. I am wondering what piece of the consultation he is not supporting.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, the legislation that the Conservative Party brought in was forced upon that government after fighting Insite in the Supreme Court of Canada. Instead of listening to the evidence and working with health professionals, a decision by that member’s government forced Insite to spend millions of dollars going to the Supreme Court of Canada to establish that supervised consumption sites save lives. In that decision, the Supreme Court identified five factors that ought to be met before a community permitted the opening of a supervised consumption site. The Conservatives took that Supreme Court decision and they exploded those five factors to 26, and a number of those factors have absolutely nothing to do with health. For those of us who view addiction as a health issue, for those of us who view the operation of these clinics as being pivotal to saving lives, I will point out that not a single person has died in a supervised consumption site facility in this country. As my former colleague Libby Davies used to say, “dead addicts don’t get recovery”. From a health point of view, when a community wishes to have such a site we should focus on criteria that would help to address the health issues there. It is not a question of finger-pointing; it is a question of establishing facts. The previous Conservative government slashed Health Canada’s budget for addictions treatment by 15%. It did nothing about the CBSA’s problem in being unable to open 30-gram or under envelopes. The Conservative government fought supervised consumption sites in this country right to the Supreme Court of Canada.

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NDP MP Murray Rankin (Victoria, B.C.):

Nine hundred and fourteen people died last year in my province of British Columbia. In my riding of Victoria, dozens of people have died, while we watched the government take no action over the last year on this issue. I am delighted to hear the minister make commitments today. This is very personal. I know people whose family members have died as a consequence of inaction over the last while. I would ask my colleague to elaborate a bit on what this national health emergency means and what the Emergencies Act might allow by way of powers. My colleague talked about the 38 recommendations from the health committee. He talked about recommendations from the City of Vancouver and in coroners’ reports. If we have a crisis, which we do, I would ask the member what powers would be available to the government were it to trigger that?

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

A piece of federal legislation called the Emergencies Act permits the declaration of a public welfare emergency when one of two situations exists. The first is if a province is experiencing a problem that is so serious and severe that it overwhelms its own ability to deal with it. The second situation is when an issue affects more than one province across the country. It is the latter situation that is clearly the case in Canada right now. All provinces across this country are experiencing problems with the opioid overdose crisis. There are a number of extraordinary powers that would be given to Canada’s top doctor under the Emergencies Act were the government to declare a public welfare emergency. There are two in particular. The act would allow the flow of emergency funds commensurate with the emergency without having to go through this process in the House. Second and most important, the act would allow the government to open emergency hospitals or clinics, for example, if a disease was spreading across this country and we needed mobile units immediately. The overdose prevention sites that are really currently operating against the law right now would be deemed legal were the government to declare a public welfare emergency and cities across this country could open those up today and start saving lives today. The Liberal government will not do it and I have no idea why it will not.

Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.):

My private member’s bill, Bill C-224, the good Samaritan drug overdose act, is currently in the other place. Just like Bill C-37, it is just one piece in the harm reduction tool kit that would help to save lives. Protecting the health and safety of Canadians is a key priority for this government. That is why on December 12, 2016, the Minister of Health, with support from the Minister of Public Safety and Emergency Preparedness, introduced Bill C-37 in the House of Commons. This bill makes several amendments to the Controlled Drugs and Substances Act and the Customs Act in support of the government’s efforts to respond to the current opioid crisis and problematic substance abuse in general. This comprehensive bill aims to balance the important objectives of protecting public health and maintaining public safety. It is designed to better equip both health professionals and law enforcement with the tools they need to address the issue. Over the last decade, the harms associated with problematic substances abuse in Canada have become more complex and have been changing at a rapid pace. The line between licit and illicit substances has blurred with the opioid crisis, prescription drug misuse, and the rise of new designer drugs. The government has committed to helping Canadians affected by these problematic substances and their use. Legislative and regulatory controls are certainly an important part of this approach. However, as we know, drug use and dependency pose significant risks for individuals, families, and communities. Our approach to addressing problematic substances abuse must include preventing and treating addiction, supporting recovery, and reducing the negative health and social impacts of drug use on individuals and their communities through evidence-based harm reduction measures. This must also be a part of our approach to addressing problematic substances abuse. Harm reduction is viewed by experts as a cost-effective element of a well-balanced approach to public health and safety. Harm reduction connects people to other services in the health and social systems related to treatment and recovery. It recognizes that individuals and whole communities benefit when people with substance misuse and addiction issues can obtain the support and services they need rather than being marginalized or stigmatized. The evidence regarding harm reduction is absolutely clear. Harm reduction measures are a critical piece of a comprehensive approach to drug control. That is why the government is determined to take a balanced, evidence-based approach that supports rather than creates obstacles to harm reduction. To that end, on December 12, 2016, in addition to introducing Bill C-37 in the House, the Minister of Health announced that a national anti-drug strategy would be replaced with a new, more balanced, and health-focused approach, called the Canadian drugs and substances strategy. The new strategy will strengthen Canada’s approach to drug policy by providing a comprehensive, collaborative, compassionate, and evidence-based approach to the protection of public health and safety and the reduction of harm from misuse of licit and illicit substances. To reflect the new health-focused approach, the strategy will be led and co-ordinated by the Minister of Health, in close collaboration with her colleagues.

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Canada has had successive drug strategies in place since 1987 that have aimed to balance public health and public safety. In 1992, the government launched Canada’s drug strategy, which was intended to reduce the harms associated with alcohol and other drugs to individuals, families, and communities. In 1998, harm reduction was added as a pillar alongside prevention, treatment, and enforcement. However, the balance between public health and public safety in Canada’s approach to drug policy shifted in 2007, with the release of the national anti-drug strategy. This strategy reflected the previous government’s priorities of public safety, crime reduction, and safe communities. The national anti-drug strategy focused primarily on youth and illicit substance use and did not retain harm reduction as a pillar. This shift brought Canada out of step with other like-minded countries, most of which include harm reduction in addressing problematic substance abuse. The new strategy will retain and build upon the aspects of the national anti-drug strategy that worked well and, specifically, the new strategy will maintain the existing and well-established areas of prevention, treatment, and enforcement. These pillars, respectively, aim to prevent problematic drug and substance use, support innovative approaches to treatment and rehabilitation, and address illicit drug production, supply, and distribution. However, perhaps the most important aspect of the new strategy is that it will improve upon the national anti-drug strategy by formally restoring harm reduction as a pillar. This shift to a more health-focused approach has been welcomed by stakeholders, including the Centre for Addiction and Mental Health, and our provincial partners. Our government is committed to ensuring that its policies under the new strategy will be informed by a strong foundation of evidence, including data related to harm reduction policies, programs, and interventions. This will enable the government to better identify trends, target interventions, monitor impacts, and support evidence-based decisions. It will help ensure that Canada has a comprehensive national picture of drug use and drug-related harms and can fully meet our international reporting requirements. Even before the new strategy was announced, our government included harm reduction measures in our efforts to reduce the negative health and social impacts associated with problematic drug use, including the transmission of infectious diseases, overdose deaths, and stigma. For example, under federal legislation, we have improved access to naloxone, an overdose reversal drug, by making it available without a prescription specifically for emergency use in cases of opioid overdose outside of hospital settings. This important measure broadens access for emergency workers and will help address a growing number of opioid overdoses. We have also demonstrated our support for the establishment of supervised consumption sites, a key harm reduction measure. After a thorough and rigorous review, in January 2016, Health Canada granted an exemption from the Controlled Drugs and Sub- stances Act for the Dr. Peter Centre to operate a supervised consumption site. Not long after, on March 16, 2016, Health Canada granted Insite an unprecedented four-year exemption. If passed, Bill C-37 would go further to support the implementation of evidence-based harm reduction measures. In particular, it would reduce the burden on communities that wish to apply for an exemption to operate a supervised consumption site. The proposed amendments would streamline and simplify the application criteria, while ensuring that community consultation continues to be an integral part of the process. By streamlining the application and renewal process and adding a new transparency provision, applicants could be assured that the process would not cause unreasonable burden or delay. In conclusion, our government’s approach to drug policy strives to balance the important objectives of protecting public health and maintaining public safety. The Canadian drugs and substances strategy will restore harm reduction as a pillar, alongside prevention, treatment, and enforcement, and will formalize our commitment to a comprehensive, collaborative, compassionate, and evidence-based approach to Canada’s drug policy. It would mean that harm reduction-focused policies, such as support for properly established and maintained supervised consumption sites and increased access to naloxone, would now officially be part of Canada’s drug strategy. Implementing measures proposed in Bill C-37 would be a key step in realizing the objectives of the Canadian drugs and substances strategy.

NDP MP Anne Minh-Thu Quach (Salaberry—Suroît, Que.):

Madam Speaker, the Liberals have been in power for more than a year now and we have been asking that the Conservatives’ Bill C-2 be withdrawn and reworked in order to consider the possibility of opening injection sites to help reduce the number of overdoses and overdose-related deaths. We know that it is often the young, inexperienced users who end up overdosing. Some do not know that certain drugs contain fentanyl. Why have the Liberals still not reinvested in awareness and prevention? There is a desperate lack of resources for this. Front-line workers are saying that they need more resources to work on prevention. What is the Liberal government doing to save lives and ensure that young people are not the primary victims of its inaction?

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Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.):

Madam Speaker, it is plain that the Liberal government is taking meaningful action on this matter. We have undertaken a number of initiatives such as the conference, bringing together all provincial and territorial stakeholders involved in this crisis. We have also committed $5 million for support of mental health and addictions issues. I certainly urge all provinces that have not done so to step up and make use of this.

NDP MP Peter Julian (New Westminster—Burnaby, B.C.):

Every day, two people die in the Lower Mainland. Every day in Ontario two people die. Every day in Alberta a person dies. This is a health crisis of an unimaginable extent. It is something that should be calling the government to take immediate action. Instead, for over a year, we saw the government drag its feet and refuse to do anything as the death toll rose, doubling and tripling. We are now talking about thousands of Canadians dying over the past couple of years. The implications are enormous if nothing much happens. The government has moved very slowly on legislation. It has waited 15 months now. We are coming up to February tomorrow. The Liberals took office and could have moved something in December 2015. They have done nothing really to in any way fight to put in place the addiction treatment programs that are needed across the country, and they have refused to call a public health emergency. Why is the government moving so dreadfully slowly in the midst of this crisis?

Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.):

Madam Speaker, I see no profit in fighting old battles and worrying about who did or did not do what when. What remains a fact at this time is that we are taking definitive and meaningful action, and moving forward in a substantive way on this issue. This bill shows that very well. We have taken action all through our time in office, such as improving access to naloxone to controlling the availability and the supply of the precursors to the manufacture of things like fentanyl, all of which are meaningful actions. However, we are moving forward. It is time we all move forward and solve this problem together in a meaningful way, as we are setting about to do.

Liberal MP Randy Boissonnault (Edmonton Centre, Alta.):

Bill C-37 confirms once again our government’s continued commitment to ensuring that our legislative frameworks for public health and safety are modern and effective. Bill C-37 is further evidence of our government’s continued commitment to ensuring that our legislative frameworks related to public health and public safety are both modern and effective. Protecting public health through efforts to prevent disease, prolong life, and promote health is a key priority for the government. The recently announced Canadian drugs and substances strategy and the proposed legislative changes to streamline the application process for supervised consumption sites are just two ways the Government of Canada is demonstrating this commitment to public health. This new strategy is comprehensive, collaborative and compassionate. It is comprised of four key pillars: prevention, treatment, harm reduction and enforcement, which are built upon a strong foundation of evidence. While the new strategy places an increased emphasis on public health, our government recognizes that effective drug policy must balance both public health and public safety. Therefore, not only does Bill C-37 address harm reduction measures such as supervised injection sites, it also proposes new ways to deal with controlled substances that are obtained through illicit sources. Therefore, not only does Bill C-37 address harm reduction measures such as supervised consumption sites, it also proposes new ways to deal with controlled substances that are obtained through illicit sources. Bill C-37 would amend the Controlled Drugs and Substances Act, or the CDSA, Canada’s drug control statute. The CDSA provides a framework to control substances that can alter mental processes and that may produce harm to health and to society when diverted or misused. It has the dual purpose of protecting public health and maintaining public safety. We know that the use of illicit substances can increase the risk of harm to health. The CDSA maintains public safety by restricting the activities such as import, export and trafficking of controlled substances and precursors. The Controlled Drugs and Substances Act has been in effect for two decades now and some of its regulations, enacted under previous legislation, have been in place much longer. While the CDSA serves us well in many areas, there has been a significant evolution in both the legitimate controlled substances and precursors industries as well as the illicit drug market. The CDSA has been in force for two decades now, and some of its regulations have been in place for much longer, having first been enacted under old statutes. While the CDSA serves us well in many areas, there has been a significant evolution in both the legitimate controlled substance and precursor industries as well as the illicit drug market.

162 The Federal response to the Opioid Crisis

As we all know, problematic substance use is a serious public health issue. Our government is very concerned about the increasing rates of opioid-related overdose deaths occurring across Canada right now, and the devastating impact this crisis is having on individuals, families and communities at large, including in my own riding of Edmonton Centre. Opioid-related overdoses in British Columbia and Alberta have reached a crisis point and urgent action is needed to protect public health and safety, and disrupt illegal production and trafficking. It is becoming increasingly critical to ensure that the CDSA is modernized in order to better protect Canadians, their families, and the communities in which they live. The Government of Canada is taking concrete action that will help address the current crisis and keep deadly drugs such as fentanyl and carfentanil out of Canadian communities. If the proposed amendments in Bill C-37 were adopted, they would further strengthen and modernize the tools available to the government to combat the illegal production and distribution of drugs and reduce the risk of controlled substances being diverted to the illegal market. The Government of Canada is taking concrete actions that will help to address the ongoing crisis and keep deadly drugs like illicit fentanyl and carfentanil out of Canadian communities. If passed, these amendments will further strengthen and modernize the tools available to the government to combat the illegal production and distribution of drugs and reduce the risk of controlled substances being diverted to the illegal market. One such action would prohibit the import of unregistered pill press and encapsulator devices. Pill presses and encapsulators can be used legitimately to manufacture pharmaceuticals, food and consumer products as well. However, they may also be used to make illegal counterfeit drugs that look like legitimate pharmaceuticals. These counterfeit pills can contain dangerous substances such as fentanyl and W-18. Pill presses can produce thousands of illegal pills in a short period of time, which poses significant risks to the public health and safety of Canadians. Currently these devices can be legally imported into Canada without specific regulatory requirements. Bill C-37 would require that every pill press and encapsulator imported into Canada be registered with Health Canada. This would serve as a tool to better equip law enforcement to reduce the supply of illicit opioids and other drugs in Canada. Proof of registration would have to be shown upon importation and unregistered devices could be detained by officials at the border. The devices captured under this provision are aligned with those for the import and sales that must be reported in the United States. A new schedule to the CDSA would be created, allowing additional devices to be controlled in the future to respond to changes in illicit drug production. The proposed legislation would enable better information sharing about imports of pill presses and encapsulators with border officials and police forces during an investigation. The proposed legislation will enable better information sharing about imports of pill presses and encapsulators with border officials and police forces in the course of an investigation. Bill C-37 would also make amendments to expand the offences and punishments for pre-production activities of any controlled substance. Pre-production includes buying and assembling the chemical ingredients and industrial equipment that are intended to be used to make illicit drugs, but are not specifically listed in the CDSA schedules. These activities are not currently controlled under the CDSA unless the intent is to produce methamphetamine. Members of the House may recall that concerns about the growing popularity of methamphetamine prompted private member’s bill, Bill C-475, An Act to amend the Controlled Drugs and Substances Act (methamphetamine and ecstasy), in 2011. The passage of this bill made it illegal to possess, produce, sell, or import chemicals with the knowledge that they would be used to produce or traffic methamphetamine. Given the growing opioid crisis and the evidence of illegal production of other drugs in Canada, including fentanyl, we must go further. The amendments proposed in Bill C-37 would extend the provisions that were added in 2011 so that penalties would apply to the illegal production, distribution, import, export, and transport of anything used to produce or traffic any controlled substance. Given the growing opioid crisis and the evidence of illegal production of other drugs in Canada, including fentanyl, we must go further. The amendments proposed in Bill C-37 will extend the provisions that were added in 2011 so penalties will apply to the illegal production, distribution, import, export, and transport of anything used to produce or traffic any controlled substance. The government recognizes the complex challenges faced by individuals who are involved in problematic substance use. We remain committed to working with our territorial and provincial partners to address the issues related to illegal drug use. The government recognizes the complex challenges faced by individuals who are involved in problematic substance use. We remain committed to working with our territorial and provincial partners to address the issues related to illegal drug use. Bill C-37 is one part of our government’s response to Canada’s growing opioid crisis. The legislative changes proposed in the bill will make the CDSA a more robust act and increase law enforcement’s ability to take early action against suspected drug production operations, and better equip enforcement to respond to the evolution of the illicit drug market. I encourage all members of this House to support this bill.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

I agree there are some very important features in the bill. He talked about pill presses and encapsulators. Back in April 2016, British Columbia declared a state of emergency over the fentanyl opioid crisis. Why is it taking until 2017 to take action when we have a state of emergency, with 900 people who have died in British Columbia? It will be almost a year later before the bill is passed. The member should be ashamed.

163 The Federal response to the Opioid Crisis

Liberal MP Randy Boissonnault (Edmonton Centre, Alta.):

Mr. Speaker, Bill C-37 is part of a comprehensive strategy of the Government of Canada to address this opioid crisis. The Minister of Health has been very clear in her meetings with territorial and provincial counterparts from coast to coast to coast that this is a crisis. We see it in Alberta as well. We take every life that has been lost due to this crisis seriously. The changes in Bill C-37 are part of a comprehensive strategy. It is a whole-of-government approach. We take this issue seriously. We are moving as a government, and that is our commitment, to save the lives of Canadians.

NDP MP Linda Duncan (Edmonton Strathcona, Alta.):

Our party has a long-standing call for his minister, who has the powers under the Emergency Act, to declare this a public emergency. The member is aware, as I and my city are, of the crisis we are facing with deaths from opioid addiction. Will the member support our call for a declaration of an emergency so the minister can demand more funds be made available, and to at least have temporary injection sites? More than 87 organizations in Edmonton are desperately calling for immediate action, not for waiting until the bill finally passes through the House and Senate.

Liberal MP Randy Boissonnault (Edmonton Centre, Alta.):

Our government clearly understands the crisis that Canadians and marginalized populations are facing when it comes to the use of illicit substances. We are taking all action and all steps to make sure that our work not only in Bill C-37 but with our provincial counterparts is moving apace. We are looking at how to make sure we have controlled use substance sites in place where wraparound supports can be made available. That is the kind of federal, provincial, and territorial partnerships we see not only in this proposed legislation but in our approach as a government to address this very serious issue not only in the city of Edmonton but in all cities and communities across the country.

NDP MP Anne Minh-Thu Quach (Salaberry—Suroît, Que.):

Mr. Speaker, the Standing Committee on Health conducted an emergency study of the opioid crisis. Of the 38 recommendations set out in the report, the very first recommendation, which has the support of all parties, calls on the government to declare the opioid overdose crisis a national public health emergency. However, the Minister of Health has refused to do so, despite the fact that experts, municipalities, and even provinces have been calling on her to do so. If a national public health emergency were to be declared, funds would be allocated, which would make it possible to invest more in helping victims and to urgently approve the creation of safe injection sites. How is it that, a year later, a public health emergency still has not been declared despite the fact that British Columbia has never before seen such a high rate of overdoses and deaths from overdoses? The problem is only getting worse. How many people have to die before Canada will say enough is enough, declare a national public health emergency, and do something to save lives?

Liberal MP Randy Boissonnault (Edmonton Centre, Alta.):

What is clear about this matter in Bill C-37 is that it is only one part of our comprehensive strategy to combat the use of illicit substances. In terms of the opioid crisis, the work of the Minister of Health with her provincial and territorial counterparts is clearly very important. Bill C-37 provides us with other tools to prevent the production and trafficking of these illicit substances. It is important to note hatt we take very seriously the deaths caused by the use of illicit drugs. We have a comprehensive strategy. We will continue this fight to safeguard the lives of all Canadians.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

I am rising to speak to Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts. As we all know, addiction issues have been a challenge throughout the history of mankind. As noted by the Canadian Centre on Substance Abuse, addiction touches everyone. As of 2013, one in five Canadians, or six million people, met the criteria for substance use disorder, causing harm and heartache among families and communities throughout the country. Today, however, we are facing an unprecedented crisis: the casual or addictive use of drugs now includes a much higher risk of death. I would note there were some questions in the previous exchange where the government talked about how it worked very hard with the provinces in terms of moving forward, but what the Liberals did not say is that they worked hard with the opposition.

164 The Federal response to the Opioid Crisis

There are many pieces of the bill that are very supportable and should move forward in a rapid and timely way, but the Liberals know very well that there is one component that we have a few concerns with, and I will articulate the reasons a little later. If the Liberals are talking about being concerned about this crisis, they should have proposed something that would allow us to immediately move forward with all the things we know we can agree on, and take a little bit more time for the conversation over the one piece that is giving us a bit of a challenge. This is a big concern. The other big concern which people who are listening and watching need to be aware of is that on April 14, 2016, B.C. declared a public health emergency in response to this rise in drug overdoses and deaths. Now it is months later, at a time when pill presses and encapsulators, and border issues have been identified, but what did the government first talk about in its call for debate yesterday? It was a bill on Statistics Canada. It is absolutely shameful. The government had the opportunity to move forward on some important issues, but Statistics Canada was more important on our first day back. They presented a bill that the Liberals knew there were some challenges with instead of presenting something that we could all immediately support and move forward in a timely way. I think the Liberals should look at how they have dealt with this issue. An emergency was declared in April, and it was recognized. Maybe it has not hit some of the other provinces, but it is interesting that it was a Liberal member, the member for Vancouver Centre, who said that if this crisis was happening in Ontario or Quebec, action would have been taken much sooner. That was said by a Liberal member, a family physician, who called out her own party on how it responded to this particular crisis. That is absolutely shameful. The recent epidemic is characterized by an increasing proportion of death related to fentanyl, which is an illicit opioid substance. Back in 2012, fentanyl was seen in about 5% of the illicit drugs, and in 2016 it was seen in 60%. Fentanyl is dramatically increasing in use. In British Columbia in 2016, there were 914 deaths, with 142 in December alone. Many might have read the Facebook page of the grandmother who was grieving for her young granddaughter saying that she just needed some help. She felt that maybe she could have dealt with her granddaughter who died a couple of days before Christmas. In Kamloops, a community I represent, there were 40 deaths over the year. It typically had 10 deaths, steady over years and years, but in 2016, 40 people died in Kamloops from a drug overdose. With SARS, there were 40 deaths across Canada, and H1N1 had 400 deaths across Canada. I was on the health committee when H1N1 was happening. I remember that we had daily briefings from the chief public health officer of Canada. It was Dr. Butler-Jones at the time. He kept parliamentarians up to date every day on what was happening. That was for 400 deaths across Canada. We are talking about 900 deaths in British Columbia alone. We do have in Bill C-37 a partial response to this crisis. As I indicated earlier, there are measures in the bill that are very supportable, such as the prohibition of designated devices, encapsulators, and adding to the schedule of substances reasonable grounds to represent health risks. There are more powers proposed for Canada Border Services Agency. We knew a year ago those were some of the things that could have been done to avert this crisis. The addition to broaden the prohibition and penalties to now apply to the possession, sale, importation, or transport of anything intended to be used is an important measure. However, if the government had been concerned, it could have dealt with this many months ago instead of debating a bill about Statistics Canada. This is about people who are dying in British Columbia, and soon across the country. I want to talk about the areas in which I have what I think are reasonable concerns. That is the part we need to be debating as parliamentarians. There is one area where there is a bit of a difference of opinion and it has to do with the process that should be in place for what they call safe consumption sites, or what are more commonly known by the public as injection sites, to move forward. That is a reasonable discussion. Our Conservative government brought in the Respect for Communities Act. Certainly, there are some people who felt it made it too difficult, but it is a valid place for us to talk about what that should look like. We originally had 26 criteria that were to be addressed when people applied for a safe injection site. This bill changes it from 26 criteria to five factors. That is a little vague. When I talked to the minister at committee, I tried to go through the 26 criteria. I asked her what objection she had to them, but I really did not get an answer. None of them said they were really concerned about any one piece, “I don’t think the RCMP should be able to have a say”, or “I don’t think municipal council should have a say”. Those are the criteria that are in place. What is being proposed now is a few factors. The other thing the government has done is there were six principles that should be part of the thinking around whether the minister would approve a site or not. These principles have been totally removed and there are no principles left. Those are principles that recognize the issue of crime profits or criminal activity that is supported with illicit substances. We have gone from 26 criteria to five and there are no other checks and balances. Using Kamloops as an example, the mayor and council voted unanimously to support a safe injection site. They have talked to the RCMP. They are having a consultation process under former Bill C-2, which is now the Respect for Communities Act. That process allows the mayor and council to have input. They supported the safe injection site. I am not sure how they would feel if they were told they would not even be talked to about it, that it was just going to happen. They can write a letter and say whether they like it or not. They endorsed it unanimously. Interior health will be looking at it. That is important. As we know, Ottawa has not endorsed it. Those are pieces of public consultation that the government is looking to replace with vague references to talking to the community, but it re-

165 The Federal response to the Opioid Crisis ally does not matter because communities do not tend to like these things. Kamloops council voted 100% for it. Why does the government not trust the community process that is specific and methodical? There are some good pieces in the bill. We should move forward on those important pieces immediately. We should have done it a year ago. We should have a reasoned and appropriate debate around the changes to the safe injection sites. However, there are some pieces that are missing when it comes to the government’s response to the crisis. My colleague from South Surrey—White Rock and I both have said to listen to British Columbia. Let us call a state of emergency to raise the elevation so that people know about what is happening, because it is happening in B.C. now, and it will be going across the country. Youth councils are saying that there should be a national education campaign. Moms and dads need to be having that conversation. They will not have the conversation if they do not know. In conclusion, let us look at the pieces, move forward on those critical ones, then look at doing those additional recommendations.

Liberal MP David Graham (Laurentides—Labelle, Que.):

Mr. Speaker, I listened to the speech from the member for Kamloops—Thompson—Cariboo with great interest. I heard her talk at length about the need to do this quickly. I agree with her. I wonder, if the member is so excited to get this done quickly, if she is willing to pass this through at all stages immediately.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, I think I was very clear that there are pieces that should pass at all stages quickly. It is interesting. Kamloops looked at having a safe injection site. We went to the coroner to find out how many of the 40 deaths had been from the casual ingestion of pills and whether people would actually use a safe consumption site. That data is not available. There are pieces of information that need to be part of making decisions. We have to be very thoughtful as we move forward on these measures. Let us move forward on some of the important pieces, but let us have a good debate and a good conversation about where we disagree.

NDP MP Pierre-Luc Dusseault (Sherbrooke, Que.):

I have trouble understanding the Conservatives’ stance on the fundamental issue of supervised injection sites. Do they support the establishment of more than one site, a site other than the one we already know in Vancouver? When the Conservatives were in power, they passed a bill allowing the establishment of supervised injection sites, but it was clear that the unstated objective was to make it as difficult as possible to create and open new sites. I have a hard time understanding their position today. My colleague talked about the benefits of supervised injection sites. I would therefore like to know whether the Conservatives are now in favour of opening and setting up additional supervised injection sites.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, we created Bill C-2. There are 26 criteria, which include things like the mayor and council having consultations, the chief of police knowing what is going on, and letting the community know. In Kamloops, I had someone come to me who would have really liked to have had some input in terms of Kamloops and the locations. Under even the current system, the comment period had already closed. What I am saying is that the Liberals have gutted a lot of reasonable processes around community decision-making on consumption sites. Something that really needs a good conversation in this House is Bill C-2, the Respect for Communities Act, and those 26 criteria. Maybe one or two were overdone, but there were a whole bunch that were great, and the current government has gutted those.

NDP MP Tracey Ramsey (Essex, Ont.):

Mr. Speaker, I appreciate my colleague for her speech today on such a critical, important issue, certainly for her riding in B.C. but also across all of Canada. I can say that in my riding of Essex, in southwestern Ontario, we also see this impending crisis coming our way. People and families are very concerned, very worried. We are going to be holding a round table this month to address the issue to prevent possible deaths, to prevent addiction, and to provide all of the contacts and the outreach the member is talking about. Would the member not agree that the best way to do this is to declare a national health crisis so that we can have the funding find its way down to these levels and have the education set from a national directive, as opposed to right now municipalities and provinces trying to patch together things to help those who are impacted by the crisis?

166 The Federal response to the Opioid Crisis

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, I know my colleague from South Surrey—White Rock and I are on record as supporting the British Columbia minister in this call. Again, I have to contrast the response to H1N1, where there was a massive, quickly activated national education program. There were regular briefings. There was a focused effort, in terms of a public health perspective, in dealing with that particular crisis. In this case, I am seeing delay and no sense of urgency. As I noted before, we were talking about Stats Canada before talking about Bill C-37. The Liberals should look at what their priorities are in terms of dealing with what is a horrific crisis in Canada.

FEBRUARY 1, 2017 The House resumed consideration of the motion that Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, be read the second time and referred to a committee.

NDP MP Marjolaine Boutin-Sweet (Hochelaga, Que.):

Before I get into the substance of Bill C-37, I would like to remind the House of some of the events that occurred before it was introduced. In 2011, the Supreme Court of Canada ruled that the federal government must grant Vancouver’s safe injection site, Insite, and other such sites section 56 exemptions under the Controlled Drugs and Substances Act in order to uphold the fundamental right of all people to life and security. The Supreme Court added that safe injection sites will “decrease the risk of death and disease, and there is little or no evidence that [they] will have a negative impact on public safety”. In response to this decision by Canada’s highest court, the then Conservative government finally tabled Bill C-2 in 2015. With the thinly veiled intent of not allowing new supervised injection sites to open, the government put in place 26 conditions for obtaining a legal exemption, making it virtually impossible to open new centres. As if that were not enough, the bill also gave discretionary power to the minister responsible to refuse to grant the legal exemption even if the 26 conditions were met. I always maintained that it would not be possible to obtain an exemption given the number of requirements already imposed by the law. However, this discretionary power proves that the Conservatives were not going to allow, under any circumstances, new centres to open. I sat on the committee and heard witnesses, with supporting evidence, describe the benefits of injection sites, including harm reduction and public health, and tell us that public safety would not be jeopardized. By refusing to consider clear and compelling evidence that supervised injection sites save the lives of many very vulnerable people, the Conservatives and their ideological approach only continued to marginalize and criminalize people suffering from addiction. This unfortunately also resulted in overdoses and deaths that could have been prevented. A serious opioid crisis is plaguing the country, particularly the west coast, as my colleague, the member for Vancouver Kingsway, our health critic, has repeatedly stated here in the House. In 2016, in British Columbia alone, opioid overdoses took the lives of 914 people, 80% more than in 2015. In April, the situation prompted B.C. public health authorities to declare a state of emergency for the first time in the province’s history. Although we do not have statistics for the number of overdose-related deaths in Canada, it is estimated to have been over 2,000 across the country in 2015. It is easy to imagine the death toll in 2016 being much higher because of the rapid spread of extremely powerful opioids across the country. Overdoses and drug-related deaths are on the rise in every part of the country, and the crisis is expected to hit Ontario and Quebec this year. The opioid crisis in Canada is now officially out of control. One of the main reasons the crisis is mounting is that fentanyl is cheap and easy to transport, and just a small amount can be used to make thousands of doses. Because this drug is so cheap, and because too few resources are invested in raising awareness and prevention, young and inexperienced users are overdosing. In many cases, they do not even know that there is fentanyl in the drug they are using. In February 2016, when the crisis was emerging, the New Democratic Party called for the repeal of Bill C-2 to make it easier for organizations to get legal exemptions to open supervised consumption sites. Last fall, the NDP got the Standing Committee on Health to study the opioid overdose crisis. In its report, the committee made 38 recommendations to the federal government. We were also the first to request that a national public health emergency be declared in order to give the Chief Public Health Officer of Canada the authority to take extraordinary measures in order to coordinate a response to the opioid crisis, including the creation of injection sites on an emergency basis. Last December, after Bill C-37 was introduced, we also tried to have the bill fast-tracked in order to resolve the crisis as quickly as possible.

167 The Federal response to the Opioid Crisis

The Liberals say they support supervised injection sites, and yet their government has not approved a single new facility since coming to power. In fact, the Minister of Health initially argued that legislative changes to Bill C-2 were not even necessary, even though the real problem was with the bill itself, with its 26 separate requirements acting as effective barriers to any new sites, as had been pointed out by stakeholders and the NDP. Faced with the growing crisis across the country and mounting pressure from stakeholders and the NDP, the Minister of Health finally gave in and, on December 12, 2016, introduced Bill C-37, which we are debating here today. Specifically, the bills seeks to simplify the process for applying for a legal exemption so that communities dealing with the opioid crisis can actually open supervised injection sites. In the preamble, the bill states:

“Whereas harm reduction is an important component of a comprehensive, compassionate and evidence-based drug policy that complements prevention, treatment and enforcement measures;”

It is in the context of harm prevention that the City of Montreal and the public health authority officially submitted their application for legal exemption in May 2015 for three fixed services in three neighbourhoods and one mobile service. They are still awaiting. It is not surprising. Not a single supervised consumption site has opened in Canada since Bill C-2 was passed. We are not the only ones calling for the government to move forward with implementing injection services. In summer 2015, the mayor of Montreal, Denis Coderre, who wanted to get moving on this by the fall, said the following to The Montreal Gazette.

“What are we waiting for? People are dying”.

One year later, in July 2016, Sterling Downey, municipal councillor and Project Montréal critic, asked the mayor a question:

“How do you go into the media and announce over a year ago that you’re going to open these sites and back off and go radio silent?”

Then, concerned organizations also tired of waiting. Jean-François Mary, executive director of the Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues, had this to say to the Montreal Gazette.

“The organizations that are supposed to host the sites don’t even dare set opening dates anymore. We’re stuck in a grey area where, every year for the last three years, we’re told they’ll be open in the spring. But it doesn’t happen.”

We need to move forward quickly. Many groups, such as Anonyme and Dopamine in Montreal, have been waiting for too long to establish services that have been proven to save lives. In the meantime, in Montreal alone, 70 people on average die every year as a result of drug overdoses. As I have already said, the crisis in western Canada will be coming to Quebec this year. Even without this crisis, and if only for the sake of harm reduction and public health, the services provided by supervised injection sites are vital. In Montreal, 68% of injection drug users have hepatitis C. Opening these centres could do much to decrease the incidence of disease related to the use of syringes. Speaking of syringes, Hochelaga, the riding I represent, is the second largest area in Montreal after the downtown area, which has the largest number of injection drug users. A supervised injection site could help get needles out of parks where our children play. I will support this bill in the hope that it will come into effect quickly.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

As we have seen, different levels of government and many different stakeholders are coming together to advance the issue. That is really what it is about. It goes beyond the legislation. What Canada needs most at this point is to recognize that we are in a national crisis. Would the member not agree that when we talk about the opioid crisis, one of the things we need to do is recognize that there are many players who need to get involved? If we are successful, we will minimize the harms and the tragic deaths that are occurring every day in Canada. That means working with our provincial counterparts, municipal counterparts, first responders, and the many other stakeholders that can make a difference. It is time for us in Ottawa to continue to show strong leadership on this file. Where we can advance, let us move forward. Would the member agree?

168 The Federal response to the Opioid Crisis

NDP MP Marjolaine Boutin-Sweet (Hochelaga, Que.):

Mr. Speaker, in my riding, we have been working for years with the authorities, including the mayor of Montreal, the chief public health officer, and the police. Everyone agrees that safe injection sites are necessary. There is going to be one in my riding. We have known for a long time that everyone has to work on this, and everyone agrees. What is more, we have been calling on the minister for at least a year to finally introduce a bill that would allow for the creation of safe injection sites. We are anxious for that to happen. That is why we are asking that this bill be passed as quickly as possible.

FEBRUARY 14, 2017 The following debate on Bill C-37 at Report Stage in the House of Commons preceded two votes on two proposed amendments to Bill C-37 (to remove Clauses 42 and 53). Both amendments were voted on after debate, and both were defeated.

Conservative MP Colin Carrie (Oshawa, Ont.):

Mr. Speaker, I have already had the opportunity to speak to Bill C-37, and I have made it clear that my colleagues on this side of the House and I are very much in favour of the majority of the bill. Saving lives and tackling the production, distribution, importation, and consumption of these dangerous and deadly drugs needs to be made a priority. The bill seeks to allow the Canada Border Services Agency, CBSA, the authority to seize unregistered pill presses and allows CBSA to open suspicious packages weighing less than 30 grams. The bill also seeks to grant the Minister of Health more powers to quickly and temporarily class and schedule new synthetic and dangerous drugs. It also seeks to severely weaken the Respect for Communities Act, which has been called onerous on the applicant and impossible to meet the criteria. Yet just last week, three injection sites, I repeat, three injection sites, in Montreal were approved under the previous legislation, so I am not sure if “impossible” and “onerous” are the words that should be used here. As stated, I have had the opportunity to speak to the bill already, but I have not had the chance to speak to how the government has pushed the bill through both the House of Commons and the health committee. I know that the response to this argument is that this needs to be pushed through in order to start saving lives. I could not agree more that saving lives is our priority and primary goal, but there are many Canadians who are worried that an injection site will appear in their neighbourhood without community support. As parliamentarians, it is our job to listen to our constituents and ensure that we represent them in the House. That is why on February 1, 2017, I proposed splitting the bill. This would have allowed the majority of the bill to pass unanimously through the House and likely through the Senate. This would have granted the CBSA the authority and powers it has been asking for to combat the inflow of illegal substances and seize unregistered devices. This would have granted the minister the power she is seeking when classing new substances. Splitting the bill would have also given members more opportunity to debate the importance of community engagement in the consultation process when applying and approving injection sites. Splitting the bill would have started to save lives immediately while allowing parliamentarians to do their job and represent Canadians. Instead, the Liberals moved closure, with the support of the New Democrats, who had previously complained about the use of time allocation. They said Canadians want vivid debate, a government that actually listens to the improvements that can be made to the bill, and for their members of Parliament to have the ability to speak out. What this means is that the Liberals used a procedural device to ultimately bring debate on this very important issue to an end, and the NDP, unfortunately, agreed. The NDP agreed to move closure and silence members of Parliament, which is surprising considering the NDP is the party which time and time again accused the previous Conservative government of stifling debate. Both the Liberals and the NDP silenced parliamentarians who were scheduled to speak and represent their communities. Again, ministers are not following their mandate letters. The mandate letter to the Minister of Health clearly states the following:

“As Minister, you will be held accountable for our commitment to bring a different style of leadership to government. This will include: close collaboration with your colleagues; meaningful engagement with Opposition Members of Parliament, Parliamentary Com- mittees and the public service....”

It says, “meaningful engagement with Opposition Members of Parliament“ and “close collaboration with your colleagues”. When it comes to Bill C-37, the Minister of Health has done anything but engage with opposition members and work collaboratively both in the House and committee.

169 The Federal response to the Opioid Crisis

Once debate was shut down in the House, the Liberals then moved to shut down debate in committee. Shutting down debate in committee meant that no witnesses could appear on Bill C-37and suggest their own amendments. It meant opposition members did not have the chance the ask the Minister of Health, the Minister of Public Safety and Emergency Preparedness, or the Minister of Jus- tice questions that their communities had for them. The Liberals know there are concerns and questions from this side of the House when it comes to weakening community consultations with regard to injection sites, just as the Conservatives know that the Liberals’ agenda includes harm reduction strategies. That is why we proposed reasonable amendments at committee. We proposed two amendments. The first would ensure that there was at least a 45-day consultation period, which is in line with all the other consultations put in place by the government. The second would give the mayor and the head of police the right to be part of the application process by including their opposition or support for an injection site in their community. These amendments would not obstruct the minister’s authority to approve the site; they would just ensure that the people who are ultimately responsible for the success of an injection site are properly consulted and informed. These amendments were reasonable. It is disappointing that, unlike what the minister’s mandate letter sets out, there was no chance for meaningful engagement with the government on making this bill stronger for all Canadians. That is why I am asking that clause 42 of Bill C-37 be deleted. As the bill stands today, injection sites could be forced on communities that do not want or need them. My NDP colleague stated that the application process should be made easier for applicants, and it seems that the Liberals agree. Again, I ask the minister why consultations for pipelines are entirely on the applicant, yet for injection sites, the application process should be made simpler? When it comes to pipelines, community consultation is the pillar of approval, yet for injection sites, the community does not matter. It is a double standard that I do not agree with, and it is another inconsistency within the government’s policies. I already know the Minister of Health’s response. She will tell Canadians that these sites will save lives and perhaps that is true. How- ever, truly saving a life is offering an alternative to committing crimes, getting high, and potentially overdosing. Saving a life is ensuring the option to get proper treatment is available the moment it is requested. We know the lack of detox treatment around the country is a huge problem and a huge discouragement for addicts looking to treat their treatable disease. We also know that those who are overdosing from these dangerous drugs are not only injecting them, they are also snorting them and taking them orally. Not all those who have overdosed are struggling addicts. Some are recreational users. This is a complex issue, an issue that all parties can agree needs to be addressed, and needs to be addressed immediately. That is why, as I stated earlier, I had proposed splitting the bill in two. We could have ensured the CBSA had the powers it has been asking for while clause 42 was further debated. This is entirely reasonable. We are not trying to play politics. We are not trying to be insensitive. In fact, I think all members are working hard to protect all Canadians. I would ask the minister to reconsider clause 42 and take into consideration the importance of community consultation and, of course, community support, because we know that without community support, the chance of success is almost nil. I would ask the minister to further allow debate on injection sites before the bill gets passed as it. I know I speak for many Canadians that injection sites do not belong in every single community. We know that the current process in place for the approval of injection sites is not impossible to meet, as three injection sites were recently approved by the Min- ister of Health. For this reason, I ask all of my colleagues to agree to remove clause 42 and allow proper and full debate on the consultation process when approving a supervised injection site. That is what Canadians expect of us: to have full and proper debate.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, I could not agree more with the member when he said that this issue of the opioid crisis in Canada needs to be addressed immediately. Safe consumption sites, unlike what he said, do not perhaps save lives. They do save lives. That is why we are moving forward with the bill. He mentioned the approval of three safe consumption sites in Montreal. Would he inform the House how long it took for this community, where it is needed and appropriate to have these safe consumption sites and which has been asking for these consumption sites for a long time, to get these sites approved under the previous Bill C-2 of the Conservative government?

Conservative MP Colin Carrie (Oshawa, Ont.):

Mr. Speaker, the reality is that under the Respect for Communities Act, there were certain criteria that had to be fulfilled, and one of the arguments to put this bill forward and change it was that it was impossible and onerous for these sites to be approved. What I am saying to my colleague is that obviously, that is incorrect. We know that right now, as the member said, there are three sites in Montreal. It took a number of months to get them through the application process, but it allowed the mayor, the police, and community members to be involved in the process. When that happens, the likelihood of these things being successful is greatly improved.

170 The Federal response to the Opioid Crisis

The member talked about saving lives. He missed it in committee because he was not there yet, but we had a specialist come who said that addicts are dying. The witness said it was like being a lifeguard who saves someone in the water. As soon as the lifeguard gets that person breathing again, he or she does not throw the person back in. I would ask the member and his colleagues to remember that we need proper detoxification treatment. This is not just about band- aid solutions, which is what many have called these injection sites. We would like to see the government take action and make sure that proper treatment is available for addicts, because this is a treatable condition. That is what we are all in favour of. We want to make sure that these injection sites, if they are put in a community, are wanted and have the greatest likelihood of success.

Green Party leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Mr. Speaker, I think the answer to the hon. parliamentary secretary’s question is that it was something in the order of 16 months, or perhaps even longer, for the groups in Montreal to get the safe consumption sites. I wanted to point out for the hon. member for Oshawa that the so-called Respect for Communities Act was an attempt to do indirectly that which the previous Conservative government could not do directly. In other words, it wanted to defy the Supreme Court of Canada, which found that safe injection sites are a matter of law, and on the evidence, save lives. The response from the previous Conservative government was to create 12 conditions, which I am amazed any facility managed to get through, because they required such things as the curriculum vitae of staff who would work at a site that was not yet built. The kind of criteria we would get rid of with Bill C-37 were there for the purpose of stopping the facilities from even being available for the people who need them.

Conservative MP Colin Carrie (Oshawa, Ont.):

Mr. Speaker, unfortunately, what my colleague from Saanich—Gulf Islands just said is hogwash. The Respect for Communities Act was compliant with what the Supreme Court said. The member talked about the criteria. There were 26 criteria that needed to be fulfilled. Now what the Liberals would do is basically take away all of that. The consultation period would be non-existent. It used to be up to 90 days. The Liberals would get rid of that. Fun- damentally, the minister could choose to have no consultation or give approval within a day. This is clearly unacceptable. If the member was paying attention in committee, it was quite clear from our experts that they need to have community support, so this is reasonable. I made amendments in committee. The mayor of a community and the head of the police where one of these sites would be placed would likely want to have a bit of input as to where they would be located. These are only reasonable things we ask. At the end of the day, all of us have to think about this entire situation in a compassionate way. We should be pressing the government for solutions instead of band-aid solutions that are really not getting rid of the cycle of repeat, repeat, and come back every single day. What does the member think the addicts are doing in the 24 hours if they are coming back to an injection site every day? We need to be compassionate and work for long-term solutions, not just these band-aid solutions. The current government wants to be seen to be doing something without really making a big change.

Green Party leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Mr. Speaker, I rise to present an amendment to the bill, but I want to say that it is extremely important that this legislation be passed and that we move expeditiously on the fentanyl crisis. The opioid crisis is a national public health crisis, and for the first time in my life as a parliamentarian, I actually voted with the government on time allocation, because it is critical that we get the bill passed. There were things said just moments ago in this chamber to which I must respond. This is not hogwash. It is based on the evidence. I was part of this Parliament when we debated the attempts by the Conservatives to bring forward conditions that were not reasonable. They were not put there in the interests of public health and safety. They were explicitly and clearly part of an ongoing effort by the -pre vious Harper government to fight against the existence of Insite in Vancouver or its application as a model for safe consumption sites, which worked in saving lives, and to make them unavailable to people in the other jurisdictions. I support Bill C-37, but I would have wished, as I moved at committee and as the member for Vancouver East also moved at committee, that there would have been more effort to streamline the approval of safe consumption sites where they are desperately needed to confront the opioid crisis. I am bringing forward an amendment. It is difficult, I have to say, to bring forward an amendment at this stage. However, it is often the case that when there is an urgent circumstance and our attention is focused in one area, it is easy to say yes, it will be okay, because the need is so great that we can ignore other concerns. This amendment has been brought forward by both the Canadian Civil Liberties Association and the British Columbia Civil Liberties Association. There is concern about clause 53 of the bill. Clause 53 of the bill allows suppression of excerpts in the Proceeds of Crime (Money Laundering) and Terrorist Financing Act. Again, when focusing on one thing, such as terrorism, concern for civil liberties can be lessened, and that is definitely the trend. In the Proceeds of Crime (Money Laundering) and Terrorist Financing Act, 171 The Federal response to the Opioid Crisis

Canada Border Services agents and employees of Canada Post are allowed to open packages in a way that would not have previously been allowed. Packages that weigh 30 grams or more are not to be opened, but if they are larger, and they constitute packages, they are routinely now opened. It is critical that we examine the practicality of this. If a civil liberties organization said that in the case of fentanyl, which we know can be absolutely lethal in tiny grains of an amount, we are going to turn a blind eye and say that no one should be allowed to open letters, that would be an unreasonable position. What the Civil Liberties Association is saying is that if a letter is identified and there are reasonable and probable grounds to open that letter, then get a warrant. This is not cumbersome. This is why we have the rule of law and protections for privacy and for civil liberties. Once law enforcement agencies have extreme and sweeping powers to open any letter, it does not take much imagination to imagine the ways in which this power can and will be abused. I want to draw the attention of the House to this amendment. It would suppress just one clause of the bill. It would not have the effect of saying that border services agents and Canada Post could not open letters that they suspected contained fentanyl. That is not the purpose of my amendment. The purpose of my amendment is to underscore that if they are going to open letters, they need to have a warrant. It is very clear that these broad and sweeping powers will be in the future misused. Letters will be opened by people who are suspecting something else and not necessarily because of the fentanyl crisis. I do not need to use all the speaking time I have available to speak to the amendment. I support Bill C-37. I want to see it passed, but it should not pass with our focus exclusively on the opioid crisis without taking a moment to consider whether we are making a mistake here. Should we not require at least a warrant before border services agents and postal officials have the right to open very small packages? I dedicate my commitment to Bill C-37 and to working on the opioid crisis to one of my constituents, Leslie McBain, a founder of Moms Stop the Harm, because she lost her son in this crisis. It is not just downtown Vancouver that is seeing an unreasonable and extraordinary number of deaths from this crisis. Within in my own riding, and on the remote Gulf Islands, we have seen people die from the fentanyl crisis. We need this piece of legislation. I will agree with my friend, the member for Oshawa, on one thing. We need more. We need these safe consumption sites, but we also need programming for mental health. We need programs for addiction counselling. We need ongoing support so that people who have gone through addiction crisis counselling and are clean of the drug have the support they need so they do not go back to it. This is a very large problem. It will, I hope, be a focus in the 2017 budget and we will see money for mental health, money for addiction counselling, and money targeted particularly to adolescents. They are very often not in the right place when they have addiction counselling with older people with addictions and a lifestyle that may scare a younger adolescent. We need to think about how we target our mental health and addiction counselling. We need Bill C-37. I support the bill. This one amendment would ensure that we do the right thing to respond to the fentanyl crisis without doing the wrong thing for civil liberties.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, I would like to thank the member for Saanich—Gulf Islands for her support of Bill C-37 as well as for her tireless efforts and advocacy in responding to the opioid crisis in Canada. She raises an interesting point. Our goal, of course, is to balance privacy with responding to the crisis we are seeing. I would like to simply highlight that the provision, as stated in Bill C-37, would allow customs agents to open only international mail. The reason for that disposition is that we know that only 2 mg of fentanyl can cause an overdose. This means that a 30-gram package could contain as many as 15,000 fatal doses, which is why we have included this in the bill. The goal is to strike a balance, but we think that a 30-gram package that can cause 15,000 overdoses is out of proportion. That is why the disposition is in the bill.

Green Party leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Mr. Speaker, if I omitted to say that it is only international mail, I apologize. I do not write my remarks out. It is clearly intended to deal with letters that are mailed internationally. However, those letters mailed internationally could be from Canadian citizens. It is a question of getting the balance right. I respect what my hon. colleague just said. We understand. Certainly, I am very concerned about the fentanyl crisis, but to me, it is not a step too far to say that if a suspicious piece of international mail has been identified, at that point get a warrant.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, Bill C-37 is the government’s response to the opioid, fentanyl, and carfentanil crisis. I hear of young kids who have died in their 20s. They are 21, 23, 24, and 25 years old. Some are leaving behind small children. However, the bill is silent on the treatment aspect. These kids would not go to a consumption site. There has to be another strategy. I want to ask the member if she would not have liked to have seen the bill be more expansive and broader in strategy to deal with the issue of these young kids taking pills, not injecting. 172 The Federal response to the Opioid Crisis

Green Party leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Mr. Speaker, I understand that we need a broader strategy. When we had the previous bill, Bill C-2 at the time, the Respect for Communities Act, so branded by the previous government, we needed to get rid of a lot of the provisions that were making it extremely difficult, close to impossible, to open a safe consumption site. We may even have consensus on all sides of the House that safe consumption sites in Bill C-37 are not the whole answer to the fentanyl crisis. A lot more needs to be done, particularly for facilities designed, as the hon. member just said, for an adolescent who might not go to a safe consumption site, and we are looking at better education. I hope we are using the best diplomacy we have with the People’s Republic of China in asking it to do more to stop the flow of fentanyl coming into Canada. There are many steps: going from the full range of mental health and addiction counselling, supports in communities, helping law enforcement, yes, with safe consumption sites being available, and other steps as needed. They do not all have to be in this piece of legislation. This piece of legislation is likely to pass more quickly by focusing on only one aspect of what I hope will be a much broader strategy.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

This legislation is long-awaited and evidence-based, and it can save lives. I wish to thank the Standing Committee on Health for its timely and helpful review of Bill C-37. As everyone knows, our government is deeply concerned about Canada’s ongoing opioid crisis. Over the last year, we have seen an unprecedented number of deaths in this country. In British Columbia and Alberta, opioid-related overdoses are overtaking motor vehicle accidents as a cause of death. While some parts of the country have been more severely hit than others, no part of the country is immune. Sadly, many Canadians have lost friends or family members, or know someone who has. The government is therefore committed to addressing this complex public health crisis, and problematic substance use more generally, through a comprehensive, collaborative, compassionate, and evidence-based approach. That is why on December 12, 2016, the Minister of Health, with the support of the Minister of Public Safety and the Minister of Justice, announced the new Canadian drugs and substances strategy. This new strategy formalizes our government’s commitment to taking a health-focused approach to addressing problematic substance use by restoring harm reduction as a core pillar of Canada’s drug policy. It also aims to strengthen the evidence-based underpinning of Canada’s drug policy. At the same time, the minister introduced a comprehensive bill in the House of Commons that would support the new strategy, Bill C-37, a bill that strives to address certain gaps and weaknesses in the existing legislation by better equipping health professionals and law enforcement with the tools they need to protect the public, protect public health, and maintain public safety. The provisions contained in Bill C-37 would help to address the ongoing opioid crisis, and for this reason I encourage all members of the House of Commons to support the bill’s quick passage. Addiction is a complex issue. Not everyone will respond to treatment the same way, and not everyone is willing or able to enter treatment. Unfortunately, evidence demonstrates that individuals who are outside of treatment are at an increased risk for major health and social harms, including overdose and death. This is why the government recognizes that we must be pragmatic in our approach to problematic substance use. As Canadian communities struggle to respond to the opioid crisis, it is essential that evidence-based harm reduction measures, including supervised consumption sites, be a part of that response. Concrete evidence demonstrates that, when properly established and maintained, these sites save lives and improve health. However, in 2015, the previous government passed the Respect for Communities Act, which required applicants interested in establishing supervised consumption sites to address 26 criteria in their application before the minister of health could consider it. On top of that, to renew an exemption for an existing site, applicants have to submit information to address the 26 criteria as well as information related to two additional criteria before an application can be considered. As a result, this legislation is widely viewed by public health experts as a barrier to establishing new supervised consumption sites, which is unfortunate. As I have already stated, the evidence shows that supervised consumption sites save lives. As we work to stem the crisis of opioid overdose deaths, facilitating the establishment of these sites in communities where they are wanted and needed is a priority. That is why Bill C-37 proposes to relieve the administrative burden on communities seeking to establish a supervised consumption site, without compromising the health and safety of those operating the site, its clients, or the surrounding community. Further, with respect to renewals, existing supervised consumption sites would no longer require a new application. Instead, under Bill C-37, a renewal would simply be requested by informing Health Canada of any changes to the information that was submitted as part of a site’s last application. Last week, the Standing Committee on Health adopted Bill C-37 with one amendment to clarify the information requirement for an application for a supervised consumption site. This is an amendment that our government fully supports.

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Now at report state there is a motion from the member for Oshawa to delete clause 42 of Bill C-37. This would remove from Bill C-37 all of the amendments designed to streamline the application process for a supervised consumption site. The government cannot support this motion. Supervised consumption sites are a key element to responding to the opioid crisis, and our government has heard that the current legislative framework is a barrier to their successful implementation in communities that want and need them. An important aspect of this crisis is the extraordinary potency of the drugs being consumed, often unintentionally. Fentanyl, a powerful synthetic opioid, is one of particular concern. While it has legal pharmaceutical use for severe pain relief, it can be misused for its heroin-like effects. Fentanyl is often disguised as other opioids, such as oxycodone or heroin, or added to other drugs. A pilot drug checking project at Insite, a supervised consumption site in Vancouver, found that 91% of drugs reported as heroin or containing heroin were also positive for fentanyl. Disguising fentanyl in other drugs leads to overdoses, as individuals are not aware of the potency of the substances they are using. We know that pill presses and encapsulators, which can be used for legitimate purposes, are also being imported to manufacture illegal pills containing opioids. According to the United States Drug Enforcement Agency, a single pill press can turn a kilogram of raw fentanyl worth a few thousand dollars into hundreds of thousands of pills worth millions of dollars on the black market. Currently, these devices can be legally imported into Canada by anyone, with no regulatory requirements. Under Bill C-37, every bill press and encapsulator imported into Canada would need to be registered with Health Canada. The most illicit fentanyl is produced in other countries illegally and imported in small packages. Pure fentanyl is an extremely powerful opioid where even a few milligrams can cause a fatal overdose. A small package of pure fentanyl smuggled into Canada through international mail can contain the equivalent of thousands of fatal doses. Currently, all mail entering Canada may be examined by an officer at the border prior to being allowed into the domestic postal stream, if the officer has reasonable grounds to do so. However, mail weighing 30 grams or less may only be opened if consent is obtained from the sender or the addressee. If no consent is given, suspicious mail is simply returned to the sender. It is believed that this exception is being exploited by drug smugglers and resulting in the proliferation of trafficking via international mail. Bill C-37 would address this by enabling officers at the border to open all items in the international mail stream if they have reasonable grounds to be suspicious that the mail contains illicit goods. Finally, we know that the opioid crisis has introduced very real workplace health and safety concerns for front-line staff, including border agents, law enforcement officers, and others who may be exposed to fentanyl and carfentanil during the course of their duties. This concern is only made worse by the current rules related to the handling and disposition of seized controlled substances; precursors and other offence-related property are cumbersome and complex and include requirements for agencies to store materials until a court order can be obtained. This results in large quantities of controlled substances, potentially dangerous chemicals, and other offence-related property sitting in police evidence holdings for long periods, increasing the risk of exposure to these dangerous substances and increasing the risk of their being diverted to the illicit market. Among the many provisions included in this bill to modernize the Controlled Drugs and Substances Act to keep pace with changes in the licit and illicit drug market, there are provisions that would introduce a new expedited process for the disposal of seized controlled substances, precursors, and chemical offence-related property. In conclusion, I would say that Bill C-37 would address gaps and weaknesses with existing legislation in order to better respond to the opioid crisis. This bill is another example of our government’s commitment to establishing a comprehensive, collaborative, compassionate, and evidence-based approach to drug policy in order to reduce the harms currently being experienced by individuals and communities, caused by drugs. I strongly, therefore, encourage all members of the House to support this bill, as amended by the House of Commons Standing Committee on Health.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, I listened to the parliamentary secretary’s words about safe injection sites very carefully and he said, “properly established and maintained”. I also want to note that in committee there was an amendment suggesting, among other things, that the mayor and council formally endorse the proposal, that the police also support the proposal, and that within two kilometres of the planned area, there be some community dialogue. That, to me, is absolutely part of a proper establishment. I would like the parliamentary secretary to stand and defend to people in those municipalities why that is not part of the process, in terms of the proper establishment of safe injection sites.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, there is definitive evidence that supervised consumption sites save lives. What we are doing with Bill C-37 and what people need to understand is that we are complying with the Supreme Court’s 2011 ruling in Insite, by allowing access to these supervised consumption sites in communities where they are necessary and useful. As Mayor Coderre said in Montreal, we have a responsibility to protect Canadians, even from themselves at times. 174 The Federal response to the Opioid Crisis

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Mr. Speaker, the question I have for the parliamentary secretary is, basically, whether he thinks the government is doing enough. New Democrats have been calling on the government to declare the opioid overdose crisis a national public health emergency since last November. It is going on four months now. Such a declaration under the Emergencies Act would give the government emergency powers to flow emergency funding and, more importantly, provide legal sanction to what are called overdose prevention sites, which are popping up in my home city of Vancouver and operating illegally right now, but are saving lives. Does the parliamentary secretary agree with New Democrats that such a declaration is necessary to get the sites, which he acknowledges save lives, up and running now, instead of forcing the people working there to work, essentially, against the law?

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, I think the government is doing all it can to respond to this crisis. The question allows me to point out a few things that this government has done. Health Canada has issued a necessary exemption to Centre intégré universitaire de santé et de services sociaux to provide three supervised consumption sites in Montreal, which took nearly two years under the previous government’s 26 criteria in Bill C-2, and now we are moving forward with Bill C-37. We have made the overdose antidote naloxone more widely available. We have provided an emergency interim order to allow the importation of bulk stocks of naloxone nasal spray from the United States. We have scheduled W-18 under the Controlled Drugs and Substances Act. We have scheduled precursors to fentanyl. We have supported Bill C-224, the good Samaritan drug overdose act. We have enabled access to diacetylmorphine via Health Canada’s special access program. In addition, we have launched a five-point action plan to address opioid misuse, which focuses on better informing Canadians about the risk of opioids, supporting better prescription practices, reducing easy access to unnecessary opioids, supporting better treatment options, and improving the national evidence-based strategy. We also held a summit on opioids, resulting in 42 organizations bringing forward 128 concrete commitments to address the crisis. Also budget 2016 provides $50 million over two years, starting in 2016-17, to Canada Health Infoway to support short-term digital health activities in e-prescribing and telehomecare. That is just to name a few. We have done a lot to respond to this opioid crisis, and Bill C-37 is one of the steps we are taking to respond to this crisis. I appreciate the member’s support and work on Bill C-37.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Mr. Speaker, I think all members of the House approach this debate with a very trenchant and acute sense of the crises gripping communities across the country. The opioid overdose crisis is not restricted to any one province or territory. It is affecting communities from British Columbia to Newfoundland and Labrador, from Inuit territories all the way down to the border with the United States, and in every major city, from Vancouver to Edmonton to Calgary to Winnipeg to Toronto to Montreal. I am told that even Cape Breton is having a serious problem with opioid overdoses. This is not restricted to any one place. It is touching communities and families across our country. We are here debating Bill C-37 because the Conservatives have put in amendments at report stage which they could not get passed at committee. We are dealing with an amendment from the member for Saanich—Gulf Islands as well. It has been the consistent position of the New Democrats, going back over a year now, that the opioid overdose crisis is a national public health emergency, and we need action now. It has been our position that this political issue is different than many other issues and, in fact, almost every other issue that comes before the House. It is an issue that affects life and death. The consequences of the decisions we take in the House and the consequences of the decisions we do not take have the effect of perhaps meaning someone lives or dies on the streets of Canada today. We cannot say that about every issue in the House. It is that seriousness, that sober reality the New Democrats bring to this debate, and have brought to the debate from the beginning. The previous speaker, on behalf of the Liberal government, felt that the government had been doing everything possible that it could be doing. That is demonstrably false. The government has failed to take into account many factors and many actions it has not taken up to now, and they remain before us. There are literally dozens of actions that are open to the government to take to respond to the overdose crisis, which it seems reluctant to do. Interestingly, the last speaker talked about taking 16 months for three supervised consumption sites in Montreal to be approved. He blamed that on the previous Conservative government. It is true that this application was dealt with under Conservative legislation introduced in 2015, but 16 months is about the length of time the Liberal government has been power. Therefore, it unjust for the Liberals to blame that on the previous government. The New Democrats stood in the House a year ago and told the government that it should introduce legislation to repeal or amend Bill C-2, the legislation that made it virtually impossible to open safe consumption sites, and to act on that immediately. What was the response at that time? It did not think it was necessary. 175 The Federal response to the Opioid Crisis

The Minister of Health publicly stated that she did not see the problem with the act and if she did eventually see a problem, she would act at that point. She felt that the remedy for dealing with the problems of Bill C-2 were administrative. She did not acknowledge or understand that the problem was the 26 separate criteria that were in the act. It is funny, because my hon. colleague, the member for Vancouver Centre, former Liberal health critic, at the time the Conservatives brought in their bill in 2015, nailed it on the head, as did the New Democrats. She identified that Bill C-2 was specifically brought in by the Conservatives to prevent the opening of safe consumption sites. Yet, when the Liberals came into power, suddenly they changed. Suddenly, they could work with the act. In the year we have waited, finally dealing with Bill C-2, finally bringing in Bill C-37, which would streamline the act, how many Canadians have died? Approximately 2,000. Now, not all of those deaths would have been preventable. However, when we know safe consumption sites save lives, we know the sooner we can get safe consumption sites open across the country, the sooner lives will be saved. Therefore, we know Canadians died unnecessarily because of the delay of the government, and that is a fact. The thing about the Conservative amendments are that the Conservatives, with great respect, still remain stuck in their ideological perspective that they want to slow down the introduction of safe consumption sites. I believe the vast majority of Conservatives do not support safe consumption sites. The only reason they brought in legislation was because they fought Insite all the way to the Supreme Court of Canada, when the Supreme Court of Canada ruled, based on evidence, that the government had to grant a section 56 exemption. Therefore, the Conservatives reluctantly brought in legislation to do so, but they did so with poison pills, 26 of them in fact. The legislation had the desired effect. In the time that the Conservatives brought Bill C-2 to the House, not a single safe consumption site was opened in the country. Therefore, I think that is not a coincidence. What we have done here, and this legislation tracks this quite well, is restore the process and the criteria for opening a safe consumption site back to the criteria identified by the Supreme Court of Canada. The Supreme Court of Canada said that the minister must grant an exemption to an applicant who wanted to open a safe consumption site if he or she was satisfied that six criteria had been satisfied. The applicant would need to provide evidence of the intended public health benefits of the site, the local conditions indicating the need for the site, the resources available to support the site, the impact of the site on crime rates, the administrative structure in place to support the site, and expressions of community support or opposition. I want to stop for a moment because I continually hear the Conservatives misrepresent this issue. All parties in the House believe that the expressions of community support or opposition are important and, in fact, must be taken into account by any health minister. That is in the legislation. I hear some Conservatives say that it is not there. It absolutely is in the legislation, If they have read it, it says that expressions of community support and opposition is one of the factors that must be taken into account. Perhaps the Conservatives can read the legislation on which they want to vote. While I am on the topic of the Conservatives, I have to say this. While we were at the health committee last week, one of the most bizarre interventions I have ever heard was made by the member for Calgary Confederation. In opposing the position of the New Democrats that we supported legislation to make safe consumption sites easier to open in the country, with an appropriate regulatory structure mirroring the six criteria set down by the Supreme Court of Canada, he said to me:

“I think [the member for Vancouver Kingsway]’s intention here is to try to make the application process for safe injection sites easier. Would you be in a similar position...if we were sitting around the table here talking about application processes for pipelines in Alberta? To apply for a pipeline is extremely onerous. It’s extremely burdensome and time-consuming. It can often take years. We fought hard as Conservatives to try to make it easier to get pipelines built throughout this country, but we’re not talking about pipelines here today; we’re talking about safe injection sites. ...I don’t support what you’re doing here...in your motion or your amendments. However, I am making again the comparison between pipelines and safe injection sites. ...If you’re willing to make it easier for us in Alberta, we can make it easier for you to put in safe injection sites throughout the country.”

That was the most offensive intervention I have ever heard from any member in the House or at committee. To draw a comparison between moving fossil fuels through pipelines and a process that saves Canadian lives is about the most offensive, dishonourable comment I have heard made by anybody in the House. To actually suggest that there is a comparison between the regulatory process for approving pipelines and the regulatory process to open up health facilities to save Canadians is offensive. To suggest that there could be a trade-off, that if one party supported an easier approval process for pipelines in exchange for an easier approval process for opening safe consumption sites, is also offence. This does not surprise me. However, what I am surprised by, and where I will conclude, is the Liberal government’s refusal to entertain the two amendments of the New Democrats. 176 The Federal response to the Opioid Crisis

First, the New Democrats moved to amend the act to better apportion the burden on an applicant for these sites to make it more appropriate. We believe that the six criteria of the Supreme Court ought to be taken into account by the Minister of Health, but that it is only the local conditions, the resources available, and the need for the local community that applicants should have the burden of meeting. The impact on crime rates, the expression of opposition or support for the site, and the regulatory structure are matters for the minister to use her discretion. We should not burden the applicants for that. Our second amendment would have allowed provincial health ministers to bypass that process on an emergency basis and ask the Minister of Health for a section 56 exemption in order to open up temporary emergency overdose prevention sites, which are operating in Vancouver today against the law. I am disappointed the Liberal government rejected those amendments, but the New Democrats will continue to work to move this act swiftly through Parliament so we can start saving lives as soon as possible.

Liberal MP Frank Baylis (Pierrefonds—Dollard, Que.):

Mr. Speaker, everyone knows that there is a nationwide opioid crisis. We know that the government must take immediate action. We understand that there is a great need for supervised consumption sites. What impact does the hon. member for Vancouver King- sway think that Bill C-37 will have in terms of promoting the introduction of these sites in communities where the need is great?

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Mr. Speaker, there is no question that section 37 would restore the balance to the law in this area and respect the Supreme Court’s direction to Parliament in instructing a health minister and a government as to when or when not an application for a supervised consumption site ought to be approved. As I mentioned in my speech, there are six criteria set down by the Supreme Court, each and every one of them important. What will happen is when section 37 becomes law, it will ease the burden on applicants who are seeking to open safe consumption sites. It will streamline the process and make it quicker. Those communities that want safe consumption sites, where there is a need for that, will open them more quickly and we will start saving lives. It is a fact that not a single person has ever died in safe consumption sites in Canada, and they have been operating, I believe, for 12 years now. As my former colleague, Libby Davies, used to say, “dead addicts don’t get treatment”. The very first principle of harm reduction, while nobody here is countenancing the use of drugs, is to help people get off substance use and we want them to get treatment. While they are doing so, we can ensure that at least the community is protected, disease is not spread, lives are saved, sterile equipment is provided, and there are medical personnel around in case of an overdose. Those are the facts around supervised consumption sites. They save lives and they are better for our community as well.

NDP MP Pierre Nantel (Longueuil—Saint-Hubert, Que.):

All Canadians and all Quebeckers have seen in the news something that they had already heard about. However, over the holidays, we started seeing for ourselves, through television cameras, teams responding to real situations. This is a tragedy of huge proportions. I would like to thank the member for pointing out the staggering number of victims. We would have addressed this some time ago except that this is a subject that elicits strong reactions, sometimes very unreasonable ones, from the Conservative Party. Can my colleague explain why in the last 16 months the Liberal Party lost touch with what is happening? This is not a new issue; it has been brought up many times. We knew and said in advance that it would be a major problem if we did nothing. They did nothing. Why does he think that they lost sight of the issue even though many members are from that part of the country?

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Mr. Speaker, those are very powerful comments. Fundamentally, this issue occurs at the grassroots level in our communities, affecting real people. As we sit here debating this, people in Vancouver, Montreal, Toronto, all across the country are injecting opioids in an unsafe manner and are overdosing. Our first responders are dealing with these situations on the ground right now, in very stressful circumstances. Brave nurses and medical personnel are operating right now to try to get a handle on this. I really think the answer is that substance use disorder is not a moral failing. It is not an issue of character. It is a health matter. Ulti- mately, we need to respond compassionately to ensure that the people who are suffering from substance use disorder have access to the best health care they can get. We have to quit looking at them as if they are criminals. We must look at them as if they are patients. Once we start doing that, we can move beyond the dark decade of Conservative rule in the House, when the Conservatives substituted their ideology and their disrespect for evidence, and finally return to an evidence-based, compassionate, health perspective on what is fundamentally a health issue. I am happy to work with the government in every respect to accomplish that.

177 The Federal response to the Opioid Crisis

Liberal MP Hedy Fry (Vancouver Centre, B.C.):

Mr. Speaker, I would like to congratulate my colleague from Vancouver Kingsway for a very excellent presentation. I think he understands the issue very well. This is an issue about health. This is, as the minister has said and as we have acknowledged, now a national public health crisis and steps are being taken to work across the country with resources, as we heard the minister saying, as well as working with all of the public health officers in every province to deal with this issue on the ground. As a physician, the first thing I look at in any kind of public health emergency, whether it is a virus, whether it is a bacteria, whether as we see now overdose deaths from tainted opiates, is the immediate, urgent means of stopping the problem and of saving lives, of looking at a medium set of policies and legislation that would help us look at longer term solutions to the problem. I want to congratulate the New Democratic Party for helping to move this so quickly through the House. It means that members get it; for most of us in the House, saving lives is paramount. We can put nothing else before saving lives. I want to congratulate the Minister of Health for bringing about this change in repealing Bill C-2, which I consider to have been a very tragic and heinous, cruel bill that stopped people from doing what was necessary to save lives. If I may paraphrase something that was said by the Conservative health critic earlier on today, it was that yes, indeed, safe consumption sites save lives, but they help people to stay on drugs. I want to ask anyone who has any ounce of common sense, which would they put first, saving a life, or saying that people should be able to stay on a drug that they are addicted to. We know all of this is a public health issue and all of this has to do with patient care and understanding the issues of public health. I want to congratulate the minister because when the Supreme Court brought down its ruling, the Liberal Party was very adamant that we should listen to what the Supreme Court had said. I was the health critic at the time. The Supreme Court had exactly word for word the five criteria that the minister has put in the bill. At the time I remember most of us were absolutely concerned that the Conservative Party brought in what was then called the Safer Communities Act, which no one saw the irony in because it certainly was not about safer communities at all. Therefore, what we see now is that since 2011 when the Supreme Court made the ruling, until 2015, four years had passed before the Supreme Court’s decision had been considered by the government. I think that is a pity and it was sad because it stopped safe injection sites from being set up across this country. It stopped harm reduction, which is about bringing down the mortality rates of any disease, of any condition, of any public health problem, and bringing down the disease rates as well, not just saving lives, but bringing down disease rates. We saw the safe injection sites. I am proud to say I was the minister responsible for the Downtown Eastside, setting up the Vancouver agreement and agreeing with the harm reduction principles that were set out in the four-pillar approach by the then-mayor of Vancouver, Philip Owen. During that time, we had the UBC Centre of Excellence for HIV/AIDS, which did the actual project by 24 peer bodies around the world that was accepted as being well done and the evidence was completely accepted. At that time, we had 90 safe injection sites around the world, in Switzerland, the Netherlands, Scandinavian countries, Australia, and Portugal. This was happening. People had seen that evidence and this was when we were concerned about 234 overdose deaths in the Downtown Eastside. We saw that once a safe injection site had been set up, evidence showed that there were no overdose deaths from anyone who came into that safe injection site. We had in fact stopped deaths. The other thing that was noticeable was that the crime rates had gone down in that area, so public order was restored. We also saw that these very high-risk people who had actually started to use Insite at the time suddenly decided that they wanted to go into treatment. These were high-risk addicts. They went into treatment at OnSite, which is above the Insite site. There were 25 beds there for people who wanted to go into treatment. This was an important piece of the evidence as well. It not only saved lives, it also helped people to go into treatment. We saw that it had restored order, and fulfilled another criteria; it allowed people to have hope and to begin to want to build new lives. These are some important things when we look at harm reduction. When I heard the Conservative health critic say in the House this morning that evidence shows it may save lives, but it helps them stay on the drugs, I wonder why ideology should take human life so lightly. These are human beings, and just because they happen to be addicted to a drug does not mean they are unworthy. Who should say what lives are unworthy and what lives are worthy? That is what we are talking about here. I am pleased to see the minister moving forward, calling this a national public health crisis. I am pleased to see the extra pieces with regard to opening of suspicious mail that may contain up to 30 grams of fentanyl. We know that 30 grams of fentanyl can actual cause 15,000 deaths. This is a huge number. We are talking about deaths in the thousands. After Insite, we not only saw the deaths were stopped, we also saw that the rate of HIV reduced. There had been 2,100 new cases of HIV/AIDS at the time Insite opened. That went down to 31. We are talking about the need to look at this as something that is essential. I am pleased to see the New Democrats supporting the bill. I am pleased to see everyone in the House determined to move it forward, because it is essential if we are going to have safe injection sites, and all the evidence has proven safe injection sites save lives and bring down mortality and morbidity. I understand when the leader of the Green Party talked about not wanting to intervene in civil liberties by opening these envelopes, but in the case of lives being saved, it is an essential thing we must do. 178 The Federal response to the Opioid Crisis

I am glad to see the minister bringing up precursors in the bill, to stop precursors. They are important in many instances, but at the moment we have to decide that stopping precursors from being given without going through a prescription and being approved, is actually one way of saving lives. As a physician, I can say that lives will be saved as a result of the action the minister has taken with this bill, and by making naloxone widely available. As the member of the NDP said, it is important that the mobile units that are helping to save lives at the moment in Vancouver Centre, which are infringing on the law, should be able to give this. It should not simply be given in a buffer zone, but should be considered across the country if we see this as a national crisis. There are other things we can do. We were asked what those were. The minister has moved very swiftly to do some of the things that are necessary, but we need to look at a public awareness campaign for all the young people, the young professionals, and youth who are not necessarily addicted, but who are recreational drug users, to let them know that using drugs off the street is a dangerous thing to do. When the minister first became minister, she moved to allow for the SALOME project, which had also been done under the Chrétien government, to show whether or not the use of substitute pharmaceutical grade heroin was important to save lives. It was shown that allowing hydromorphone, which is being used in the heroin assisted treatment in Europe and Scandinavia with a great deal of success, is saving lives and helping people to manage their addiction so they do not have to buy off the street anymore. They can go to the clinic and get a pharmaceutical drug, which costs pennies, to be able to save their lives and move them off the street drugs. We have to stop the illicit trafficking. That is of key importance. If we continue to only look at the demand side of the problem and do not look at the supply side of the problem, illicit opiates will continue to not only kill people but damage lives for a long time. A lot of the work that has been done in New York gives us the ability to truly look at evidence-based solutions to this problem, to act as quickly as we can, and to make these decisions not based on ideology, but based on clear evidence and science.

Conservative MP Pat Kelly (Calgary Rocky Ridge, Alta.):

Mr. Speaker, the previous speaker as well as the member for Vancouver Kingsway both grossly mischaracterized the earlier comments from the Conservative health critic, the member for Oshawa. When the member for Oshawa acknowledged that supervised injection sites may save lives at the moment but do not address the issue of addiction, that is exactly what he meant by that. An injection site is not a panacea, it is not a solution in and of itself to the opioid crisis, it may be part of a solution. It is not ideological to merely point out that preventing a person from overdosing in the moment is not to solve the problem of addiction. Addiction is an enormous problem that encapsulates many parts of society, far beyond street-level addiction. I wanted to clarify and say there is nothing ideological about acknowledging the complexity of the problem—

Liberal MP Hedy Fry (Vancouver Centre, B.C.):

Mr. Speaker, yes, there is something ideological about preventing when we know that safe injection sites on evidence have saved lives. Saving lives alone is not an answer, but saving lives is an immediacy. People go to emergency rooms when they have an accident. They want their lives to be saved so they can move into other areas such as keeping healthy and fixing the problem. The minister and our government have been very clear. We have moved into the medium-term and the long-term problems but we need to deal with the immediacy of saving lives. If a person’s life is saved, that person can then move on to treatment, that person can then move on to rehabilitation, and as has been shown in Europe with the advent of safe injection sites, that person can live a meaningful life. No one has denied that. The minister has put in place all of these things. We set an opioid summit to talk about how we can move forward to the longer and the medium term. If the member had been listening he would have heard me say at the beginning of my presentation that public health deals with immediacy, medium and long term. No one is suggesting that a harm reduction strategy is the only thing we need to do, but it is the thing we need to do now to—

NDP MP Pierre Nantel (Longueuil—Saint-Hubert, Que.):

Clearly, given the work that we are doing together on various committees, my colleague understands that we sometimes need to work on the most obvious common denominator, or the thing that everyone agrees on, in order to take action on what matters most. However, I would like to ask her if there are any other complementary measures that could be taken. Are there other options that are not included in this bill that we could eventually look into to resolve the problem, since it seems to be growing so rapidly?

Liberal MP Hedy Fry (Vancouver Centre, B.C.):

I am a physician, and in the government of Jean Chrétien, I was responsible for the Downtown Eastside because of the problem that was happening with overdoses, so I was there from the very beginning. 179 The Federal response to the Opioid Crisis

I look at evidence-based solutions. There are other things that we need to do not so much with respect to this legislation, because the bill must be passed now to get moving on this. We need to do things such as analysis at certain mobile units, at safe injection sites, and in other areas and on the street of whether or not a drug that is being used is tainted with fentanyl or carfentanil. It is because of the safe injection sites in Vancouver that we first found out that there were tainted opioids. We need to do that. There is a clinic in Vancouver that is giving hydromorphone to a small group of very high-risk addicts. The people who were in the SALOME trials are now getting hydromorphone, which is important for saving their lives and keeping them off street drugs or from buying on the street. There are some things the minister is working on but this legislation hits the nail right on the head of what we need to do right now.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

All of us in the House agree that we are facing a very real crisis. The casual or addictive use of drugs is now including a much higher risk of death. Indeed, many people have compared it to playing Russian roulette with what is out on the streets and what is being mixed into drugs. It is truly a risk for everyone. Bill C-37 represents a partial response to the crisis. There are many measures in the bill that are important and supportable, but there are some areas which obviously we still have some concerns about. Even with the supportable measures, I think we need to talk a bit about the time it took to get us to this point. It was 10 months ago today, April 14, when British Columbia’s provincial health officer declared a state of emergency in relation to the rising death rate being seen every day. It was related to fentanyl being laced into drugs. Back in 2012, it was in about 5% of drugs and it was reaching up to 60% in 2016. It was recognized that we had a crisis and B.C. declared a state of emergency. That was 10 months ago. Meanwhile, we know that carfentanil has been confirmed on the streets as well. It is very important that we have a public awareness campaign, because many parents, children, youth, and young adults have no idea what is out there on the street. Carfentanil is for use on large animals like elephants. It is 100 times more potent than fentanyl, 4,000 times more potent than heroin, 10,000 times more potent than morphine. People can actually order it by mail from China, and it can be delivered. In the fall of last year, a man in Calgary was arrested, and I believe he had a kilogram of carfentanil, which had the potential to kill 50 million people. We have all agreed that we need to give additional powers to our border security folks. How long has that taken? We had a state of emergency 10 years ago. We finally got a bill that would do this, right before Christmas when there was no time to debate it. The bill was sort of packed with a number of different measures, many of which are supportable, but the government had to know here was one area that was going to create debate. First of all, the government should have had this bill on the table way back in the fall. Second, let us get that piece that is non-controversial through the House, and then spend a bit of time debating the issues that we are concerned about. The bill also includes the prohibition of designated devices, such as pill presses. We know that in Canada there is no reason for anyone to have a pill press without it being registered. I understand that this change could have been done in the regulatory framework, but instead, we waited months and months and it was put into the bill. Instead of a quick, simple process that would have been an appropriate response to an emergency, we have gone at a pace similar to that for many of the bills in the House which are not critical. However, this is a bill that is critical, and these items should have been acted on a long time ago. As I have indicated, we really do support many of the measures in the bill, but it should have been here 10 months ago. It should have been here eight months ago. I was very disappointed that the Liberals did not support moving it through at all stages. We offered to move it through at all stages and it could have been law right now. Our border services agents could be opening those small packages and capturing some of these illicit substances in the mail as we speak. I think the government has been negligent. It was interesting to hear the member for Vancouver Centre talk about how important this bill is, but even she recognized last summer that her government was moving too slowly. Unfortunately, I did not get a chance to ask her a question about that so that she could articulate more clearly what her concerns were at that time. There is a section of the bill we do have some problems with. The Liberals are gutting community consultation and there is truly a lack of rigour. They talk about complying with the Supreme Court, but they have taken all the rigour out of the compliance. They have some very undefined statements and principles. There is no definition around them. I do have big concerns that they have taken some of those items out. On November 16, the Minister of Health was at the indigenous affairs committee. I want to refer to a couple of comments she made at that time. We talked about a lack of proper data. She said:

“The point you’ve raised brings up one of the real challenges on the opioid crisis, which is that there is actually not the kind of data and surveillance we would like to have, even in terms of the total overall number of overdoses and overdose deaths.”

180 The Federal response to the Opioid Crisis

Having a solution means we need to have data, and I do not see us making much movement toward having good data, in terms of informing the proper solutions for different communities. In response to some questions I was asking about the availability of detox and rehabilitation, she said:

“I think it would be accurate to say that there is a shortage of treatment facilities and programs.”

The government has no trouble putting criteria around home and mental health care. It is very happy to say to the provinces that we have to have some criteria around home and mental health care, but the requirement for associated detox and rehab at safe community injection sites has been taken away. That is something that was attached because, to be frank, there are a lot of priorities for dollars to be spent within our provinces and our health authorities, and there is a huge and extreme lack of detox and rehabilitation facilities. In spite of the minister’s acknowledgement that there is a shortage, she actually chose to remove that from the bill. Again, at the meeting on November 16, we talked about the importance of community consultation. She said:

“I’ve made it clear that for communities that need them, where they’re appropriate and where there’s a community desire to have those programs, we need to find mechanisms to make them more available as one of a range of tools. Of course, this is the kind of thing where there would be collaboration with the community and with provincial health authorities.”

Then she went on to say “community consultation is absolutely essential.” Let us take those quotes and look at the very reasonable amendment. There were some concerns from the current government that the process was too onerous, so my colleague, who is the critic for health, made what I thought were very appropriate suggestions for amendments. He suggested that what was needed was mayor and council to support a safe injection site. Many of us have a local government past. We would agree that mayor and council can have critical, absolutely critical, insight in terms of what, where, and how. They talked about the RCMP having some input. They talked about a public consultation process that includes notices to the people who live within two kilometres of the area. The minister talked about community consultation. It is very nebulous and unclear in the existing legislation. What was proposed was something that was very reasonable, very sensible, but the government chose to ignore putting any sort of framework around community consultation. I think it has made a big mistake. Our concern is very important. It is valid. We cannot take the community consultation process away. We need a bit of rigour, and they have taken that rigour out of the process. I look to members opposite to reconsider that particular element, because anyone who has ever been in local government knows how important it is to have a framework around the local community consultation process. In my final comments, another really important gap we see that perhaps is not part of legislation, is there has been no commitment at all on the part of the government for a national education and awareness campaign. That is something to which the government should give very serious consideration.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

I want to make it very clear that this has been a priority issue for this government. Our Minister of Health and others have indicated it as being a national health care crisis and the government is moving forward. It has met with many different stakeholders, including at the provincial level. It is working with many different stakeholders who are involved in trying to come up with ideas. I do take some exception in the sense that we did introduce the legislation late last year, and that is because there is a lot that needs to be done in the lead-up to legislation. The Conservative Party was provided the opportunity back in December to pass the bill and chose not to do it. I appreciate the fact that the New Democrats did. Could the member indicate when the Conservative Party first raised the issue inside the House of Commons in the form of a question during question period? Question period often reflects the priorities of the opposition. Does the member have any sense of when it was first raised by the official opposition in the House?

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, we are on the coal face, and certainly as far back as shortly after the state of emergency in British Columbia was declared, I know my colleague from South Surrey—White Rock, and certainly a number of us did express our concerns. 181 The Federal response to the Opioid Crisis

My bigger point is there are measures. When there is a strike and it is determined we need to have back-to-work legislation, it happens immediately. We knew carfentanil was coming in from China. We knew it was coming in in small packages. It has taken 10 months to get a piece of legislation on the table that gives some additional powers to our border guards to seize and intercept packages containing something that has the capability of killing thousands.

NDP MP Pierre Nantel (Longueuil—Saint-Hubert, Que.):

Mr. Speaker, I am reassured to hear a Conservative Party member use that tone when speaking about this bill, and I appreciate it. However, I cannot resist asking her to explain her position, since, to date, her party has been extremely sceptical about supervised consumption sites. When the Conservatives were in power, they even passed a bill that limited the establishment of these sites and made it extremely complicated to do so. As part of its partisan campaigns, this party even sent emails to its supporters saying how frightening and appalling it was that the Liberals and the NDP wanted safe consumption sites in their backyards. How can my colleague explain her current pragmatism given her party’s attitude when it was in power in the previous Parliament?

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, I think it is important to note that there has been approval given to new injection sites under the existing process. In Kamloops we have a mayor and council who have endorsed 100% moving forward with a safe injection site. We had 26 criteria which created some rigour around the process, and because of that rigour, we have a community like Kamloops where the downtown business association has been engaged. Its members have made suggestions in terms of locations. Council is voting 100% unanimously to support it because there was rigour around the process in moving forward. What the government is suggesting and what the bill does is it guts all the rigour of the process. I think we will be heading down a very bad path in terms of having that support and that good advice from communities on how to do things and where to do things.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, certainly the member’s community has been hit very hard with an over 200% increase in deaths. This comes back to the data. I have a list here of 12 deaths, which is a very small snapshot, of kids in their mid-twenties, the deaths of just a dozen young kids who would not use a consumption site, who are not injecting. We are very concerned about saving lives, whether it is an individual who has been an addict on the street for a very long time, or whether it is our young adolescents. The bill is so vacant in dealing with our adolescent population, and I am wondering if the member can comment on that.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, I talked about the lack of data, What was very surprising was that when I looked at the data in Kamloops, we had 40 deaths in the last year. Those are mothers, daughters, and sons. It is horrific. Was that through ingestion or related to addiction? How does it break down? We really need to target our support and resources, and that information is not there. Our ability to understand the problem in all its complexity is not actually helped by the data that is currently available. Regardless of the reason, we need to have strategies for the different issues we are dealing with, and we simply do not have that.

Parliamentary Secretary to the Minister of Canadian Heritage (Multiculturalism) Arif Virani (Parkdale–High Park, Ont.):

We have a national public health crisis in Canada right now. Last year, in British Columbia alone, more than 900 people died from drug overdoses, an increase of over 80% from the previous year, and the situation is getting worse. Deaths from drug overdoses, including fentanyl and carfentanil, are now predicted to exceed deaths by car accidents. Thousands have died, and thousands more will die unless we, as parliamentarians, take decisive action. Bill C-37 represents decisive action. This bill would address our public health crisis and help save lives in a few important ways. It would simplify and streamline the application process for communities that wish to open supervised consumption sites to limit drug overdoses. It would put stronger measures in place to stop the flow of illegal drugs into our communities. Bill C-37 represents a vitally important step and necessary shift in the treatment of drug addiction from a framework of punishment and strict law enforcement, practised by the previous government, to one focused on health care and based on scientific evidence.

182 The Federal response to the Opioid Crisis

I am proud to support this bill on behalf of my constituents in Parkdale—High Park. The care and compassion of the people in my community, coupled with their political engagement and depth of knowledge on these issues, has translated into overwhelming support for a shift in how we treat people experiencing drug addiction. My constituents want a federal government that responds to health crises, like the tragic deaths of thousands of Canadians from accidental opioid overdoses in 2016, with a compassionate strategy based on evidence, not the knee-jerk ideological responses that characterized the previous government’s zero tolerance approach. This past July in Toronto, the city where I live and serve the people of Parkdale—High Park, city council approved plans for three future safe consumption sites. In Toronto, there are already 50 such locations that offer harm reduction services and access to clean syringes and needles, including the Parkdale Community Health Centre and the Breakaway Addiction Services Satellite clinic in my riding. Both of these organizations provide an invaluable service in my community. They help save lives in Parkdale—High Park by treating addicts with care and compassion, not punishment and stigma. Bill C-37 would help by expanding the harm reduction network that already exists in my community and across the city of Toronto. I want to explore the idea of harm reduction a little more. At its core, the principle of harm reduction is about taking a realistic approach to drug use and addiction and thinking practically and respectfully about the best options for treatment. As we all know in this chamber, drug addicts do not desire or choose to continue using substances that put them at risk of harm. Addiction is a brain disorder; it is not a choice. People experiencing addiction compulsively engage with rewarding stimuli, despite the harm it does to their health, their relationships, and their very lives. While prevention and treatment are the central pillars of any drug strategy, we acknowledge, on this side of the House, the reality that people who are experiencing addiction will use drugs for a period of time until they are in treatment. Harm reduction strategies and treatment goals are not incompatible. To the contrary, they are actually mutually reinforcing. Harm reduction strategies assist by helping to keep addicts alive and moving them toward treatment. Harm reduction strategies are the best alternative for people for whom prevention or criminal sanctions have not been effective. Harm reduction does not mean that we are giving up on these people or enabling them to use. It is quite the opposite. Through harm reduction, we are refusing to give up on these very people. We are refusing to let them die. The contrast to harm reduction initiatives are the zero tolerance policies favoured by the previous government. Zero tolerance policies aimed at criminalizing addicts do not work. We have seen the negative effects of these strategies on marginalized communities, especially among those who are over-incarcerated, like the indigenous and black communities. We have seen the negative stigma. We have seen misinformation based on anecdotes instead of scientific facts about drug addiction. People who are suffering from a condition they cannot control are treated as criminals instead of patients. This is fundamentally the wrong approach. By contrast, harm reduction not only serves individuals affected by their own addiction but helps friends and families of addicts, and society as a whole. When we stop pushing addicts out onto the street and into alleyways, our communities become safer. When we provide a safe space for consumption, equipped with medical professionals, parents of addicts do not have to bury their children. When we shift our narrative to focus on providing health care for Canadians afflicted with a difficult condition, our society, as a whole, begins to heal. This basic idea that harm reduction, in the form of safe, supervised consumption sites, can promote public health and safety was recognized by the Supreme Court in the Insite case. With members’ indulgence, I am going to put on my constitutional lawyer hat for a moment and discuss the Vancouver safe injection site that was at issue in the Insite case. I will not go into all the details, much as I would love to, but it is important to note that, in short, the Supreme Court of Canada unanimously found in that case that the denial of a ministerial exemption by the previous government under the Controlled Drug and Substances Act was a violation of the charter, specifically the section 7 right to life and security of the person of Insite’s clients. The Supreme Court, by way of remedy, unilaterally reinstated the exemption, allowing Insite’s doors to remain open so the facility could continue to prevent unnecessary deaths on Vancouver’s Downtown Eastside. The previous government’s response to that decision, after some negative reaction on the part of the previous government, was to ramp up the number of conditions that had to be met for supervised consumption sites to be permitted to operate. The government cannot do through the back door what it is not permitted to do constitutionally through the front door. The old Bill C-2, which is called, and we know the Conservatives had a penchant for these catchy names, the Respect for Communities Act, was an ideological response, not one based on evidence. It prompted observers, like the HIV/AIDS Legal Network, to note:

“...Bill C-2, imposed near-insurmountable obstacles for supervised consumption services (SCS), such as Insite in Vancouver, despite ample evidence of the benefits of these health interventions. Not only have [supervised consumption sites] been shown to save lives, they are also cost-effective, as revealed by a new study conducted by the Toronto-based St. Michael’s Hospital”

If the members opposite want evidence of that study, I am happy to provide it. We have heard such critiques, and we have responded as a government. Through Bill C-37, our government is taking the number of criteria that must be met to open a supervised site from 26 conditions, which to my mind is not intensive community involvement 183 The Federal response to the Opioid Crisis but is actually a barrier to providing authorization, and reducing it to five. We did not just dream up this list. We are using the very five criteria entrenched in paragraph 153 of the Supreme Court’s unanimous decision, lest we be accused of perhaps not taking community consultation seriously, as some of the members opposite have opined. Through Bill C-37, our government has responded to calls for a change in the legislation from organizations and people on the front lines who care for and treat drug addicts. They see the negative impact of a system imbalanced between public safety and public health. Criticism of the bill has suggested that the government’s new approach would turn society into an enabler of drug addiction, as opposed to a preventer. On the contrary, we will not stand idly by and enable Canadians to fatally overdose because we failed to act to provide them with safe spaces to receive health treatment. We will prevent more people from dying by shifting our approach from criminalization to treatment with compassion. While we are shifting our approach, we are not diminishing the ability of law enforcement and the criminal justice system to enforce the law. We are shifting the treatment of addicts from punishment to treatment by treating addiction as a health issue. Critics of the bill forget that we are also increasing law enforcement’s ability to prevent illegal substances from making it onto Canadian streets with changes to the Customs Act. Bill C-37 would also further reinforce the commitment to consult with communities before making decisions that would directly impact them, such as the opening of safe consumption sites. Law enforcement, first responders, business owners, and residents down the street would all be consulted before the health minister delivered an evidence-based decision. This bill is not revolutionary. We heard this in some of the earlier speeches. There are already over 90 safe consumption sites -op erating effectively worldwide, including two sites right here in Canada. The Centre for Addiction and Mental Health has completed extensive research, in collaboration with other prevention programs, on the effectiveness of harm reduction. Researchers discuss drug addiction as a continuum, “where harm may occur at any level”. Drug addiction is not black and white. It is not an all-or-nothing disease. If we continue to impose the rigid standards of Bill C-2, passed by the previous government, we will continue to deny communities and addicts the help, support, and life-saving services they desperately need and deserve. Balancing public safety and public health is not easy, but I am confident that Bill C-37would help do just that. I am very proud to support legislation that puts the health and safety of Canadians at the forefront of our strategy, and I urge all members of the House to do the same.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

First, I agree with the CBSA opening the mail, but we have a lot of drugs coming in from China. I would like to know what the strategy of the government is to stop that flow. Second, I would like the member to outline and maybe point out in the legislation where the process of community consultations is laid out. My third point, and I said this earlier to another member who had spoken, but I have list here of 12 adolescents who have died, and they were all in their early twenties. They were not addicts. They were adolescents who had taken fentanyl, and they have all died. I wonder what that strategy looks like.

Parliamentary Secretary to the Minister of Canadian Heritage (Multiculturalism) Arif Virani (Parkdale–High Park, Ont.):

In terms of what we are seeing with the transport by mail of substances like fentanyl and carfentanil, it is shocking and dramatic, and it demonstrates to us that there are new types of drugs that are being used and coming into our communities in vastly different ways. We are responding to that through this legislation by implementing changes to the Customs Act, which would allow the seizure and inspection of those types of mail packages, including packages as small as 30 grams. We know that a 30-gram standard letter envelope can contain enough fentanyl to kill 15,000 individuals, which is staggering by any stretch of the imagination. In terms of what the community consultation looks like, we have heard debate in this chamber already. We have heard the response from the minister. It is important to note that one community consultation is one of the five factors that must occur. Second, the way that it would roll out is in a robust way, including first responders, residents, and individuals in the law enforcement community, so that it is comprehensive. With respect to youth, the third part of the member’s question stated that we need to be addressing the needs of youth in particular. I agree wholeheartedly. This government is focused on youth, including youth who are suffering the impacts of substance abuse. This will be a focus of our strategy going forward.

NDP MP Tracey Ramsey (Essex, Ont.):

We are talking about lives. Every day that we sit here and debate, every day that we hold back on this decision, we are potentially impacting the lives of Canadians. We cannot sit any longer and not declare a national state of emergency. This is something that has been widely called for. We see that it has been called for by David Juurlink, who was the keynote speaker at the health minister’s own opioid summit. B.C. health minister Terry Lake has also called for this, as well as stakeholders across Canada.

184 The Federal response to the Opioid Crisis

Canadians need access to funds for clinics in their region to address this. The only way we can do this is to declare a national state of public health emergency. I want the member’s opinion on whether or not he feels his government should declare it so that we can address this crisis and prevent any more Canadians from losing their lives.

Parliamentary Secretary to the Minister of Canadian Heritage (Multiculturalism) Arif Virani (Parkdale–High Park, Ont.):

What we are dealing with is an absolute crisis. We are dealing with levels of death not seen before, which are staggering. As I mentioned in my opening statement, the number of deaths from overdose may exceed the number of deaths from automobile accidents, which is a staggering figure for us to understand and analyze. On this side of the House, we are acting. We are firm in our commitment to take action as quickly as possible, which is why we have moved quickly to have this debate occur. We have moved quickly to have this legislation steered through committee, which is why the bill is now at third reading. We want to take concrete actions that will address the crisis in a manner that is as robust as possible. As to whether this should be declared a proper emergency under the Emergencies Act, there is no precedent for that thus far. However, I am comforted by the actions, responses, and the leadership shown by the Minister of Health, herself a physician, in terms of taking actionable steps to implement a strategy that will help to save lives.

Conservative MP Mark Strahl (Chilliwack-Hope, B.C.):

We are here to talk about a very serious piece of legislation, Bill C-37, an act to amend the Controlled Drugs and Substances Act. First of all, Canadians should be aware that this debate is now taking place under time allocation, which means the government has decided it does not want to hear from any more members of Parliament on this issue. Not only does it not want to hear from affected communities on the issue of safe injection sites or safe consumption sites, as they are now being described, but it does not even want to hear from parliamentarians on this issue. That is a real shame. We are sent here to represent our constituents. We are sent here to speak out on behalf of the people who elected us, and now the government has said it does not want to hear from us anymore. It only wants one more day of debate. It tried to have no debate whatsoever on the bill. Teaming up with the NDP, it tried to have the bill passed at all stages with no debate from any single member of Par- liament. It is outrageous that this sort of important issue would be treated in that manner where not only do Liberals not want to hear from affected communities anymore, but they do not even want to hear from members of Parliament. I think that is the real issue here. I heard today, and we all agree, that this is a health crisis. There are components of the bill that deal with the health crisis. The official- op position, the Conservative Party, advocated splitting the bill and passing those sections of the bill immediately. Again, this was rejected by the Liberal government and the third party, the NDP, because apparently they want to score political points on this issue. That is a real shame. The points of the bill that all parties agree on include giving the Canada Border Services Agency more powers to search packages weighing less than 30 grams and ceasing the import of pill presses. We agree. The Conservative Party has agreed. Our health critic has spoken eloquently about that, and so have many on this side. This is a real measure that can be taken immediately to address this issue, but again, the government rejected our attempts to have this dealt with quickly. We agree that we should grant the minister the authority to quickly and temporarily schedule and class new substances. That is a good idea. We could have done that in a single day with a single voice vote, had the government agreed to split the bill and move forward on the issues on which we could all agree, had the Liberals really wanted this to move ahead quickly, if they actually cared. We heard this again and again today from the government side: we need to act immediately, we need to act quickly, this is a health crisis. We agree. Why did they not agree with the Conservative amendment to split the bill and move forward those important measures immediately? It shows that there is politics at work here. What we are concerned about is the community consultation. Quite frankly, I find it shocking that the government talks about consultation. It consulted on every other measure it has brought in. Whether it actually listened to that consultation, I think is a matter of debate. However, whether it is on new pipelines or any number of other pieces of legislation, the Liberals have delayed the pipeline decisions that would have got energy workers in Canada back to work, by up to a year. They said the consultations that were done previously were not enough; they needed to set up a whole new process and double down on consultation because they needed social licence to move forward, whatever that means. So they draw out that process on and on and ignore the consultation that they actually had. They went with the Conservative process entirely when they made those decisions. However here, on something that affects communities, there is no consultation. I heard it again. The minister has declared it a barrier. The previous Liberal speaker said that community consultations are a barrier to safe injection sites and we need to get rid of them. Quite frankly, I think it is reasonable to expect that, when a safe injection site is proposed for any community, the chiefs of police are consulted, crime statistics are consulted, the mayor and council are consulted, the residents in the area where the site might be opened 185 The Federal response to the Opioid Crisis are consulted. As the member for Oshawa said, who is the official opposition health critic, the only way that safe injection sites are successful is when they have community buy-in, and we do not get community buy-in when we refuse to consult with the people who will be directly impacted. We have heard many times about Insite in east Vancouver. Members of that community have said this is where they want this; this is okay in their community; they have integrated it into their community. Not all communities are east Vancouver. Some are going to take some time to get there, if they ever do. However, we do not build consensus by refusing to consult with affected individuals. We do not build consensus by refusing to talk to the community. As a member of Parliament, I am glad I had the opportunity to speak. I am sorry for the many dozens of MPs who will not be afforded the opportunity because of the heavy-handed tactics of the government. However, seeing this coming, seeing that the government was abandoning community consultations, I took the opportunity to consult with my community. I sent a brochure to every single household in my riding and asked two questions. The first question was whether they think communities should be consulted before a safe injection site is proposed in a community. Do they think that’s reasonable? The second question was whether they think there should be a safe injection site in Chilliwack—Hope. I had an extremely robust response. Nearly 1,000 people have taken the time to respond, which is a very high number. It is more than double the number I usually get in responses. To the question whether they believe that, without consultation, the government should be able to approve these, 76% of respon- dents said, no, they do not believe that should be possible to do. They do not see that as a barrier. They think it is essential that they be consulted before a safe injection site goes through. To the second question, whether they believe safe injection sites should be located in Chilliwack—Hope, 68% said no and 32% said yes. I will be sharing that information. I share it with the House. Once the final results are in, I will share that with the Minister of Health, with the government, because my constituents deserve the right to be consulted and heard. The real tragedy here is that we had an opportunity to act immediately on those measures that we could all agree on, but the government refused to do so. The safe injection site model is what the debate is focused on here, but there is another great example that I want to highlight from British Columbia, as well, and again B.C. is on the leading edge of this. It certainly was troubling to hear the member for Vancou- ver Centre indicate in the media earlier this year that, maybe once this issue reaches the Manitoba-Ontario border, then this Liberal government will start to pay attention. Right now, it’s just an issue for B.C., so they are not too worried about it. This is the most senior member of that caucus, I think. She has been here since 1993. She indicated that maybe when this becomes an issue in central Canada, then the government will start to pay attention. That is a pretty sad state. I want to talk about the St. Paul’s Rapid Access Addictions Clinic. It has been set up in a hospital setting where, when people come in and say that they want to kick their addiction, they are immediately walked upstairs and started on the process of detox right then and there. That is what we have not talked about enough today. Harm reduction is one of only four pillars in dealing with drug addiction. We have enforcement, we have treatment, and for too long the balance has shifted only to harm reduction. Until we have adequate treatment and detox beds for people to access, I think we are merely treating the symptom and not the underlying problem. It is unfortunate that the government is cutting off debate on this issue. It is unfortunate it does not want to consult with communities. It is a real shame, and it is not the way the government should move forward on this important issue.

Liberal MP Mike Bossio (Hastings—Lennox and Addington, Ont.):

Mr. Speaker, I respect the member’s concerns over safe injection sites. This is not just going to pop up tomorrow, that all of a sudden the bill will pass and we will have 100 safe injection sites across the country. It is not to infer that the minister will not consult with the communities where these sites may end up being necessary. Let us face it, we are in a crisis situation right now in Vancouver. It is starting in Calgary and moving to Toronto. Who knows how many centres will be impacted by this existing crisis within our society. It behooves us to move as quickly as we can to deal with the crisis. Therefore, I do not accept the member’s premise that no consultation will take place. That is just not the way things work. They never have and they never will. Of course consultation is going to occur in order to make these sites beneficial to their communities. I imagine we will also consult with the municipal governments as well as the public safety officials within those centres to ensure these sites are established in a proper manner. Does the member agree that a crisis exists, that we need to deal with this issue as soon as possible, and that this does not necessarily infer that consultations will not be conducted?

Conservative MP Mark Strahl (Chilliwack-Hope, B.C.):

Mr. Speaker, the member will forgive me if I do not put a lot of weight in what he says. He says that he imagines there will be consultation. He asks us if we do not think there will be that consultation. The previous Conservative government, with the Respect for Communities Act, mandated it. We believed so strongly in consultation with communities on this issue that it was required. 186 The Federal response to the Opioid Crisis

When a government comes back and says that it will remove that requirement, to me it says it does not value that consultation. The Liberals have said repeatedly that they see this community consultation as a barrier to setting up future safe injection sites. If the consultations are to continue, why has the government removed the requirement to consult? We would have passed the portions of the bill that did not relate to community consultations without a debate, immediately, but the government refused to do that.

NDP MP Daniel Blaikie (Elmwood—Transcona, Man.):

Mr. Speaker, on the theme of consent, with respect to issues that are important enough, where there should be legally mandated consultation, does he think in those cases the consulted communities ought to have a veto over whether a project goes ahead?

Conservative MP Mark Strahl (Chilliwack-Hope, B.C.):

Mr. Speaker, certainly consultation should be required. The government needs to place a lot of weight on that. There might be cases where the health crisis itself necessitates certain action from the government. I am not arguing that. What I am arguing is that no matter what, we should be asking the police, affected residents, the mayors, and councils what their opinions are on this issue and what the data shows. If we truly believe in evidence-based decision-making, which we hear repeatedly from the government, then we should be collecting the evidence. We should not be backing away from that requirement. That is why we cannot support the bill in its current form.

Green Party leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Mr. Speaker, the Conservatives place emphasis on all the things that should be done before a safe consumption site is put in place, such as looking at the evidence. In Vancouver, there has not been an increase in crime rates anywhere around the safe injection site at Insite. We have evidence that shows it saves live More to the point, the so-called Respect For Communities Act was heavily loaded with conditions that were clearly put there for the intention of doing indirectly that which the Conservatives could not do directly, which was to defy the Supreme Court decision. The remaining conditions in the bill still require an assessment around crime. It still requires hearing from those who are for and against. The minister will look at all the factors in exercising discretion to allow this exemption.

Conservative MP Mark Strahl (Chilliwack-Hope, B.C.):

Mr. Speaker, it perhaps is not surprising that the member for Saanich—Gulf Islands places a lot more trust in the Liberal government than I do. I do not trust it when it removes requirements from the bill to continue to consult. That is a clear indication of its priority, which is that Ottawa and the Liberal government know best, that we should just trust them and they will take care of it for us. The Conservatives trust their communities, the police, and their own neighbours to intervene and share their knowledge before any type of safe injection sites go forward. That is how one builds support for this sort of thing. One does not do it by denying consultation with communities.

Parliamentary Secretary to the President of the Treasury Board Joyce Murray (Vancouver Quadra, B.C.):

As we have heard from other members in the course of this debate, the illegal production and trafficking of controlled substances continues to be a significant problem in Canada. Our government is profoundly concerned about the current opioid crisis and the growing number of opioid overdoses and tragic deaths across the country. Today, I will speak to the human aspect of this crisis, as well as some of Bill C-37’s proposals to help address the health and safety risks associated with the diversion of drugs from the legitimate supply chain to the illicit market, one important source that contributes to this public health crisis in Canada. It is critical that we ensure our drug control legislation, the Controlled Drugs and Substances Act, or CDSA, is modern, effective, and can better protect the health and safety of Canadians. This is an urgent priority for me and for our government. In that respect, on December 12, 2016, the Minister of Health introduced Bill C-37 in the House of Commons. This bill supports our government’s commitment to drug policy that is comprehensive, collaborative, compassionate, and evidence-based, and which balances both public health and public safety for Canadians. As you are all aware, this bill proposes significant changes related to supporting the establishment of supervised consumption sites as a key harm reduction measure. It also contains important elements which aim to ensure that controlled substances used for legitimate purposes are not being diverted to the illicit drug market.

187 The Federal response to the Opioid Crisis

We must work tirelessly to ensure that controlled substances used for legitimate purposes are not diverted to the illicit drug market, where they are deadly and have led to hundreds of tragic accidental drug overdose deaths, 914 last year in my province of British Co- lumbia alone. That is 80% more than the previous year, fentanyl being the major contributor to this awful statistic. The 914 are actually not statistics; they are people and they are us. There were 914 people who died in British Columbia from overdose deaths last year. They are human beings. Each life, in its own unique way, is interwoven with families and communities. They are mothers, fathers, sons, daughters, brothers, and sisters. They loved others and were loved, they belonged, they shared their aspirations, and they inspired their friends. They were people, like each of us, who, in their own way, enjoyed their lives, work, and challenges, who were powerful, contributing, and recognized, who were moved to make the world a better place. They are human beings. Donald Charles Alexander Robertson, known as Alex by his friends, was caught off guard by this crisis. He passed away just over two weeks ago due to an accidental death caused by the opiate fentanyl. I chatted with Alex the evening before. He was a close friend and work colleague of my son Erik over many years. His life was interwoven with ours, his community with our community. In the words of my son Erik, Alex really was an amazing, capable, wise, joyous, humble, grounded, passionate, brilliant young man. He was an innovator and emerging leader who loved and was loved by many. His memories, teachings, and legacy will inspire many of us for decades to come. Let us not detach ourselves in this debate and lose sight of the humanity of this crisis in the quotation of statistics. The victims of the fentanyl crisis, they are us. I want to express my deep condolences to Alex’s parents and his sisters, Chrissy and Leslie, to his extended family, friends and co-workers. I hope the passing of Bill C-37 will be one plank in the foundation that we need to build to help eliminate the unintended exposure to deadly illicit opioids and the harm they cause over the years to come. I would now like to focus specifically on how Bill C-37 would modernize Canada’s legislation to reduce the risk of controlled substances like fentanyl from being diverted from legitimate producers, importers and distributors and secured by the black market. The measures being proposed to address gaps in Canada’s drug framework are designed to respond to this evolving opioid crisis. First, while targeted amendments have been made to the Controlled Drug and Substances Act since it came into force in 1997, the provisions of the act have not kept pace with the quickly evolving licit controlled substances industry and the illicit drug market. Many of the legislative amendments being proposed in Bill C-37 will modernize the CDSA to strengthen law enforcement. They also enhance the government’s ability to monitor and promote compliance of the regulated parties who handle, buy, sell and transport controlled substances as legitimate products every day. These improvements will bring the CDSA into alignment with other modern federal legislation designed to protect public health, and these changes will reduce the risks of these drugs being diverted from the legitimate supply chain to the illicit markets that are creating havoc in the lives of the accidental victims. Professional tools are proposed within the framework of the CDSA to improve the government’s ability to incent compliance with the requirements for safe and secure procedures and practices under the CDSA and its regulations. Second, Bill C-37 would establish the legislative framework to support the development of an administrative monetary penalty scheme, or an AMP. Once the new monetary penalties are in place, it will allow Health Canada to fine a regulated party for a violation of the provisions of the CDSA or its regulations, as defined in the regulations required to bring the scheme into effect. Third, Bill C-37 proposes amendments which would allow military police to be designated as a police force under the CDSA. Currently, military police are not afforded the same protections as other law enforcement agencies in terms of handling controlled substances under the Police Enforcement Regulations. In the proposed provisions of Bill C-37, military police could be designated as a police force, in their respective areas of jurisdiction, which would allow them to exercise a full range of investigative tools in the course of the investigation of drug-related crime. These kinds of enforcement mechanisms are important to save lives. A fourth aspect of the bill includes improving inspection authorities under the CDSA to bring them in line with authorities and other federal regulations. Currently Health Canada inspectors are only able to inspect sites where authorized activities with controlled substances and precursors are taking place. Under Bill C-37, new authorities are being proposed to allow Health Canada inspectors to enter places where they have reasonable grounds to suspect that unauthorized activities with controlled substances or precursors are taking place. There are many more aspects to the bill to better control substances, like fentanyl, which are potentially dangerous chemicals. It is urgent that the bill go forward for public health and safety. Bill C-37 is a comprehensive package with many other aspects that have been debated today and in the previous days. There is more to be done but this is an important step along the way. It will make the CDSA a more comprehensive and compassionate act that encourages timely compliance, deters non-compliance, and ultimately contributes to the government’s objective of protecting the health, safety, and the lives of Canadians, valuable lives, the lives of people like a bright, fun, caring 29-year-old man his friends knew as Alex.

Conservative MP Pat Kelly (Calgary Rocky Ridge, Alta.):

Our caucus was willing to support this legislation but for one clause. We agreed to pass it through at all three readings but for that one clause. We remain concerned about community consultation on the placement of sites.

188 The Federal response to the Opioid Crisis

The operations committee recently heard from Liberal members that they were going to recommend that the minister de- volve the power of the final say over the placement of a community mailbox to a municipality. Why will the Liberals not agree that municipalities ought to be the final arbiters or at least have mandatory meaningful consultation on the placement of a safe consumption site?

Parliamentary Secretary to the President of the Treasury Board Joyce Murray (Vancouver Quadra, B.C.):

Mr. Speaker, I take the member’s expressions of care and compassion around the victims of this crisis in good faith but it was his government that over 10 years set up roadblocks in the guise of community consultation that prevented many communities from being able to go forward with safe consumption sites that would have saved lives in their communities. I am pained to hear that a clause is deemed a reason to not support this important law that needs to go ahead quickly as a foundational building block to save lives.

NDP MP Pierre-Luc Dusseault (Sherbrooke, Que.):

I would like to know if she thinks this measure is a happy medium between too many constraints and the total absence of constraints with respect to opening new supervised consumption sites. Obviously, we need rules around setting up supervised consumption sites. However, as we have seen in the past, too many constraints is not necessarily a good thing because that can get in the way of protecting public health. Can my colleague comment on the attempt to find a happy medium between the two extremes on this issue?

Parliamentary Secretary to the President of the Treasury Board Joyce Murray (Vancouver Quadra, B.C.):

We want a framework that prevents Canadians from dying accidentally because of illegal drug use. The provinces and communities have work to do. Bill C-37 must not be the end of the story. This is a very important initiative that will remove obstacles and support Canadians’ health and safety.

Green Party leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Mr. Speaker, I would like to extend my condolences to the hon. member for Vancouver Quadra for the loss of Alex, a young man she has known for many years and a young man who was friends with her own children. Does my hon. colleague feel that her government and the Minister of Health plan other measures to assist young people who are caught in this fentanyl crisis so that they can deal with their addiction and stay off drugs?

Parliamentary Secretary to the President of the Treasury Board Joyce Murray (Vancouver Quadra, B.C.):

Mr. Speaker, our government sees the need for continuous improvement. We are proposing measures in Bill C-37. The minister brought forward a six-point action plan in September 2016. We cannot stop and say this crisis is fixed as long as people are dying on the streets from these horrendous illicit substances. Our government will continue to act on this issue.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

As I stated in my speech on January 31, this is the government’s response to the fentanyl and opioid health crisis that is facing this country. Communities struggle to deal with this crisis. We just heard from a member whose son had lost a close friend who was 20 years old. I have a list here of young adolescents who are 21, 23, 25. A Delta mother lost two of her children within 20 minutes of each other, both in their twenties. I have also heard that this was the response to this crisis, and that it was comprehensive drug policy. However, I would suggest that this is not comprehensive drug policy, because it is silent on the issue of how the current government is going to deal with that aspect of the opioid crisis. First responders and medical personnel are overwhelmed and have difficulty trying to respond to the overdoses and the deaths. This is a very complex issue that deserves a multi-faceted approach. There is one strategy for those who are street-entrenched and will inject and use consumption sites, there is another strategy for those who use pills and prescription drugs, and another one for those whose use is recreational. Kids swallow a pill and do not realize what they are taking. Therefore, one size does not fit all.

189 The Federal response to the Opioid Crisis

Within the bill there are measures that are supported by all parties. We are happy to support the portion of the bill that gives the Canada Border Services Agency more authority to open international mail, and that prohibits the importation of unregistered pill presses. It is well known around the world that China has been a significant contributor to the growing opioid, fentanyl, and carfentanil problem in Canada and throughout North America. It is vital that the government work to ensure that the deadly chemicals used in manufacturing labs in China and the illicit drugs that can be ordered online and shipped overseas not be allowed in Canada. I would stress to the Prime Minister, as he goes forward with his trade negotiations with China, that this issue be dealt with first and foremost. We support the addition to broaden the penalties to now apply to the production, sale, importation, or transportation of anything intended to be used in the production of any controlled substance, including fentanyl. Clearly, there are many pieces of the bill that are supportable. I want to talk a little bit about the timeline of Bill C-37. Back in April, B.C. public health officer, Dr. Perry Kendall, declared a public health emergency. On December 12, two days before Christmas break, the government tabled Bill C-37 in the House. January 31 was the first debate. February 1, it was debated again, and the government moved time allocation to close down debate. On February 9, the health committee heard from no witnesses and moved straight into clause-by-clause. The singular issue I have with the bill is that it does not allow a process or criteria for public input before an injection site is located. We have heard that the Conservative government had one that was too onerous. Now, the current government is going in the exact opposite direction in having nothing. Our health critic moved amendments that called for letters indicating support or opposition from the municipality and the head of the police force. This amendment was voted down by the Liberals. There was the amendment that all households within a two-kilometre radius be notified with the ability to offer opinions in support or opposition. This was voted down by the Liberals. There was an amendment proposing that information be provided regarding schools, hospitals, businesses which include day cares, recreational facilities that were located within that two-kilometre radius be provided. That was voted down by the Liberals. There was an amendment proposed that no less than 45 days but no longer than 90 days be included for public input and consultation. That was voted down by the Liberal government. As a former mayor for almost a decade, I can say that we must consult with the community. We have to look at the community as a whole and support those in need as well as ensure that the community has a voice. I do not think it is unreasonable to request a minimum of 45 days in which to do this. I do not think that it is unreasonable to have an understanding of how many schools or how many day cares are in the vicinity of a proposed injection site. I do not think it is unreasonable to have a letter of support or opposition from the chief of police or the mayor in council. We need to have a multi-faceted approach to a very complex problem. We need to embark upon a national education awareness campaign and I was happy to hear that one of the Liberal MPs supported our initiative on that. We have to ensure that the general public, young adults, and students have the information and that they are well informed. We need proper data in each community. We need to know whether people overdosed by injection or taking pills. Were these people street entrenched? Were these people recreational users? As I pointed out earlier, the Liberal government’s response needs to be based on data that is gathered. With scarce dollars, Liberals have to identify where those dollars should be directed and where they will have the greatest impact. For those who are addicted and entrenched in that lifestyle, we need to have wraparound services that care for the whole person: mental health support as well as physical dependency and addiction support, a holistic approach that includes treatment beds, therapeutic communities, and detox. A place for those who want and need support because the window of opportunity in an addicted person’s life is fleeting and the response must be immediate and the resources must be available. Every community is different. In my community and as the former mayor, we worked with the province and with the private sector. We worked together and developed an addictions precinct adjacent to the hospital. We have a detox facility. We have two treatment facilities. We have a sobering centre as a point of entry, transitional housing, along with job and educational training. I have to say we have had some pretty incredible results. We also have a needle exchange and a mobile unit, but we still have issues that need to be addressed. Is locating an injection site the right answer? I do not know, but I know there must be a conversation and a consultation with the community, with the mayor in council, and the police chief, along with addiction specialists. This is a process that needs to be undertaken, but as I pointed out earlier, every single amendment we proposed to have some form of consultation was voted down by the Liberal government. This is not open. This is not transparent and it flies in the face of the very people who are on the front lines dealing with this health crisis.

Liberal MP Fayçal El-Khoury (Laval—Les Îles, Que.):

Mr. Speaker, I would like to ask my colleague about her knowledge of alternatives. As she probably knows, uncontrolled drug trafficking will increase the crime rate and will increase the death rates because of overdose and will bring no money to the government. What other alternatives would she propose and what are the solutions? 190 The Federal response to the Opioid Crisis

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, I am not sure what kind of money it brings the government, and I do not think that is a lens we want to look through. I will say this, though, and I just said it earlier in my speech. We know it is coming in from China. We know that, bar none. We know there are thousands of labs in China. We know that people can buy it online. That has to stop. As I said earlier, when the Prime Minis- ter goes forward and starts negotiating a trade agreement, this issue must be dealt with first and foremost. When we look at the multi-faceted piece, as I said in my speech as well, there are people who will use injection consumption sites; there are people who need treatment. Look at the ages of young people who have died. The parliamentary secretary’s son lost a friend who was 20 years old. I pointed to a dozen kids who are dead. They are not shooting up. They are not using a consumption site. We have to have another avenue to help these kids, and that is what is vacant in this legislation. They are dying, and it is not being addressed.

NDP MP Pierre-Luc Dusseault (Sherbrooke, Que.):

When I listen to the Conservatives, I sometimes think that they do not seem to recognize that establishing supervised consumption sites is at the very least part of the solution to today’s crisis. Although it is not the only solution to the opioid crisis, it is certainly one element of the response. Does my colleague recognize that supervised consumption sites, which also recommend ways to get off drugs, are part of the solution to the opioid crisis?

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, what I said in my speech is that it is a multi-faceted approach. There is not one element that fits all of it. The issue that I had and that I clearly articulated is that every amendment to have any kind of public consultation was removed. Within the legislation, there is no process and no criteria that lays it out. That was all removed. Therefore, when having common-sense consultation is voted down in a health committee, and when it is removed from legislation, clearly the government does not want consultation. That is the issue that I have; not the stream and not the piece of treatment that is going to work or not going to work in a community.

Conservative MP Alice Wong (Richmond Centre, B.C.):

Mr. Speaker, I appreciate my colleague’s holistic approach. In the city of Richmond, I already have parents and concerned community people wondering why there is no consultation and their views are not heard. Their representatives’ voice is not heard because the Liberals just shut down the debate. I have two concerns. First, are the safe consumption sites the only way that can help? Second, how important is it to consult the community?

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, as I said earlier, I was mayor of a community of 520,000 people for almost a decade, and I know that we need to have the voice of the community participate in everything that we do. If we do not have it, it is doomed to fail. Not everybody is going to support it and not everybody is going to be in opposition, but at least have a conversation about how many schools are in the vicinity, how many day cares are in the vicinity, is it the right location. All of those things were voted down. Having 45 days of consultation but not longer than 90 days was again voted down. Therefore, we have to have the element of openness and transparency and actually have a conversation about addiction because these are the people in the community. It is their kids, their husbands, wives, or friends and we have to speak to them. We have to have that conversation because we are all in it together.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Mr. Speaker, there are a number of things the Conservative Party has put on the record that I take objection to. The member who just spoke said that people are dying and this is not being addressed. Nothing could be further from the truth. No matter what the Conservatives want to mesh together as a conspiracy, the bottom line is that if there has been any negligence on this file, it can be rooted in the Conservative Party’s approach in dealing with what is a very important issue. To me, what it does, like many other issues, is reinforce that the Conservatives have lost touch with Canadians. They do not understand what good, sound public policy really is. It is demonstrated by what they have articulated on this legislation, not only at third reading of this bill but at second reading. It is somewhat disappointing.

191 The Federal response to the Opioid Crisis

We very much appreciate the supportive attitude by the New Democrats. In fact, I applaud the gesture they made back in December when they recognized that there is only so much the government is able to do and that we have attempted to deal with this issue on a number of fronts, one of which is, in fact, the legislation we are debating today, Bill C-37. Back in December, New Democrats suggested passing the bill in the House unanimously. What did the Conservatives say? It was obviously no, they did not want to do that. That is fine and I will respect that. I am a parliamentarian and appreciate why the Conserva- tives said no, but today they stand in their places and say that if the bill did not have the safe injection site issue in it, then it could have easily passed unanimously. There are others in the chamber who wanted that in the legislation. In fact, it was when Mr. Harper was prime minister that the whole issue of safe consumption sites was raised and fairly well debated. There could always be more debate, no doubt, but there was a debate back then. We knew back then that the Conservatives were going against science, that they were not listening to what the Supreme Court of Canada said, that they had a one-track mind in terms of legislation that would prevent consumption sites as much as possible, or at the very least discourage them. Now the Conservatives are saying they want more consultation. At the end of the day, Insite has been a huge success. There is not one stakeholder that I am aware of in British Columbia, particularly Vancouver, that is against Insite because it has saved so many lives. This came into being because the federal government at the time, under a Liberal administration, worked with the province, the municipality, first responders, and the community. People recognized the value of having a supervised injection site. Only the Conservatives say no to what makes sense and what different stakeholders want put in place. In order to prevent it from happening in the future, Conservatives brought in legislation to make it very difficult. The only reason they did was because the Supreme Court of Canada, in a unanimous decision, told the Conservatives that they were wrong, that people had the right of access. They were obligated to do it and then came up with this restrictive list in an attempt to prevent these sites from being created. They were very successful at downplaying it and preventing them from coming into being. The current government has taken a different approach than the Conservatives and, once again, the Conservatives are out on a limb. This is not only the Government of Canada saying it. The Green Party, New Democrats, and Liberals want to rush the bill through, applying time allocation. Even the New Democrats, who have traditionally not supported time allocation, recognize the importance of using this particular tool in order to pass this legislation, because who knows when the Conservatives will agree to pass it. I do not think the Conservative Party really understands what is happening within its caucus, because in the standing committee, the Conservatives actually passed unanimous support to get it through the Standing Committee on Health here in the House of Commons. Meanwhile, the critic says, “Well, we were roughshod. Why did it go through the committee so fast?” and being so critical of the committee. Some of that member’s own caucus colleagues recognized that it was beneficial to get it through the committee. The Conservative Party has in fact lost touch with reality, with Canadians, on this particular issue and, I would ultimately argue, so many issues. I would like to think, at the end of the day, that these supervised consumption sites, which are one part of the legislation, as has been illustrated by many inside this chamber, will in fact save lives. However, that is only one aspect. The legislation would do more than that. It would give more powers to the minister in working with others to ensure that we can, as much as possible, keep some of these deadly drugs out of our country, with Canada border control. It would allow, for this government to work with other governments and stakeholders to prevent more Canadians from overdosing. We have had thousands of Canadians who have died from accidental overdoses. It is a national crisis. It has been raised in the debates as to why it is that we do not invoke a state of emergency. There are three points on that aspect. We have responded to every request that the provinces have raised with our government in this crisis and we continue to work with them. In the event that a public welfare emergency under the Emergencies Act were declared, the chief public health officer would not have any new special powers. That is a very important point to recognize. The Emergencies Act is considered a tool of last resort and an emergency has never been declared under this act. The Government of Canada is committed to working with the provinces, with the municipalities, with the other stakeholders, in dealing with this national crisis. Building on that five-point action plan to address opioid misuse, the government has taken concrete, tangible steps forward. Let me highlight a few of them. We granted the section 56 exemption for the Dr. Peter Centre and extended the exemption for Insite for an additional four years. We made the overdose antidote naloxone more widely available in Canada, which is saving lives in a very tangible way. Last autumn, the Minister of Health co-hosted a summit on opioids that resulted in 42 organizations bringing forward concrete proposals of their own. That is what I mean, in terms of the government is working with the other stakeholders, because it is not going to be the Govern- ment of Canada that beats this issue. What we expect from the Government of Canada is strong national leadership, bringing people together, and that is actually what has been happening, on a number of fronts. The Government of Canada has responded to this crisis virtually from day one, contrary to what other members might try to imply. The Minister of Health and the Minister of Public Safety and Emergency Preparedness have been on top of this issue. We understand the terror that it is causing in many different regions of our country, if not all regions of our country. We are taking tangible actions in order to minimize the situation. We are working with the different stakeholders, whether they are the first-time responders, whether they are the different levels of government, or whether they are the communities that are trying desperately to look for answers and develop solutions that are going to save lives. This government has made a commitment to not only take those actions, but to continue to act, because we recognize the importance of it.

192 The Federal response to the Opioid Crisis

That is why we are very grateful to have the New Democratic Party’s support in bringing forward time allocation today. Ultimately, we hope to see the bill pass. It would be wonderful to see the Conservative Party get onside, stop looking for some reason not to be onside, understand what Canadians really want on this issue, get in touch with them and we could actually see the legislation pass quickly.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

[My colleague] said that everyone has come together and the government has done everything that the province has said, yet B.C. health minister Terry Lake said, “We haven’t seen the response that I think this type of epidemic requires on a national scale.” That was just a few weeks ago. To suggest that we are not on the same page on a number of these issues is categorically wrong, because we have said over and over again through the limited two days of debate that we have before debate is shut down, that we support many aspects of this. We have said it again that communities will determine if they support or do not support sites. There has to be a multifaceted approach to this, but also there has to be community consultation. As I pointed out in my speech, every single common sense amendment that was put forward was voted down. The member talked about community consultations. The Liberals removed it from the legislation and they voted it down at committee. Why did his party’s representatives on that committee do that? To have some sort of process and criteria for consultation is absolutely fundamental.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Mr. Speaker, the foundation of the argument presented from the Conservative Party seems to be strictly on the idea of consultation. When Insite came to Vancouver there was extensive consultation and that was pre-Conservative legislation. The member was a former mayor. I suspect that if a community were going in a certain direction, she would have some form of dialogue. I would think that any mayor would want to do that. To try to imply that no consultation is going to occur, that supervised injection sites are going to pop up all over the place is just hogwash. There will be consultation taking place.

NDP MP Alexandre Boulerice (Rosemont—La Petite-Patrie, Que.):

I am wondering about the following: why, once in power, did the Liberal Party drag its feet for 16 months before introducing a new bill to correct the mistakes made with the Conservatives’ C-2? Even the Minister of Health said at the start that it was not necessary and that they could work just fine with existing legislation. The Liberals are waking up, a bit late, now that we are facing an emergency and a national crisis and people are dying in the streets. Why did the Liberal government change its position at the beginning and then change it again? In the end, we have lost more than a year.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Let me remind the member that the legislation is only one aspect with respect to this national crisis. There are a number of other things on which the Minister of Health has been very diligent in reaching out and taking action, very tangible actions that have ultimately saved many lives in Canada. It is not just this one piece of legislation. When legislation is brought forward there is a process for doing that in itself. It would not be fair for me to say to the New Demo- crats that it was not a priority for them because I do not recall hearing them raise the issue in question period back in April and May of last year. Why is it only now when we have the legislation that they want to take a more proactive approach? I suspect that the NDP could have done more on raising the profile of this issue in April and May, but I will not criticize them on that because that would not necessarily be fair, just as it would not be fair for the New Democrats to imply that this government has not been taking this issue seriously. It is quite the opposite. We understand the issue. We are taking it seriously, and we are delivering for Canadians on what we believe is a national health care crisis.

NDP MP Alexandre Boulerice (Rosemont—La Petite-Patrie, Que.):

Simply put, it would have been nice if this issue had been resolved years ago because we are now dealing with an urgent situation in our municipalities, in our big cities, and on our streets. People are dying from overdoses of illegal drugs, particularly opioids, and this is a crisis. Hundreds of people are dying in our communities and on our streets because our facilities are not equipped to adequately respond to this serious substance abuse problem, 193 The Federal response to the Opioid Crisis particularly when it comes to increasingly dangerous and hard drugs. For example, fentanyl is 100 times more potent than heroin, and it is wreaking havoc on our cities and communities. There is even a fentanyl derivative that is so potent that first responders are now being advised to wear masks and gloves when helping people because, if the drug is inhaled or comes into contact with the skin, it can be deadly for the paramedics and nurses who are in contact with those who need help. Hundreds of people are dying every day in our streets and alleyways because we have failed to adequately respond to this situation. In all seriousness, this is one case where I am sad to say that our federal government dropped the ball and we have collectively failed. We could have taken measures that would have saved lives. There is a national crisis, and people are dying from lethal opioid injections because of the laws that we pass or fail to pass. This is serious. Indeed, we in the NDP are calling on the Liberal government to declare this a national emergency and give greater powers and funding to the chief public health officer of Canada, so that he can coordinate efforts to help these individuals. I find it extremely- un fortunate that the Conservatives did not respond appropriately to the Supreme Court decision and instead chose to stand in the way of public health stakeholders who wanted to set up safe injection sites to help addicts in crisis. As I reminded the parliamentary secretary a few minutes ago, I also find it unfortunate that the Liberal government dragged its feet for 16 months before introducing a bill to fix the mistakes of Bill C-2 passed by the Conservatives. I will come back to this point a little later. I would like to share some statistics. I am talking about people who are dying because of the lack of health facilities, that is, safe injection sites, particularly in our big cities. This is no joke. In 2016, there were 914 overdose fatalities in British Columbia. That represents an 80% increase over the previous year. Across Canada in 2016, there were about 2,000 fatalities. In December alone in British Columbia, 142 people died of drug overdose. In Vancouver, more specifically, there were between 9 and 15 deaths every week. In Ontario, there are two deaths per day. Our young people are dying in our streets because we do not have what we need to help them. Supervised consumption sites are proven to save lives. When Insite was finally given the go-ahead several years ago in Vancouver, community officials realized that the number of deaths dropped by 35% in the area surrounding the site. It works. It works in Vancouver, it works in British Columbia, and it works around the world. It has been proven. Why have we been unable to respond appropriately? The previous government spread all kinds of prejudices, which is a terrible shame. In 2011, a unanimous Supreme Court ruling authorized Insite and encouraged the government to change the law to define the process. The previous government was very right-wing and focused on repression, and it wanted to turn this into a partisan issue. When that government introduced Bill C-2, it was not to help people involved in public health; it was to create more barriers to setting up these very important sites. That is a terrible shame. What did the Conservatives do in their day? They added 26 eligibility criteria that had to be met before Health Canada could authorize a supervised consumption site. What was the outcome of that? How many sites were given the green light? Zero. Not one. We are years behind because of that. Health Canada was unable to authorize the opening of such sites despite the fact that the experts, the scientific community, municipal officials, and the groups that work with addicts every day all wanted them. Montreal had been asking for a supervised consumption site since May 2015. We can say that was a while ago. Every year, between 70 and 100 people in Montreal die of an opioid overdose. How many people could we have saved in that time? Communities approve of this type of measure. I want to share a few short quotes to that effect. The first one is from Gregor Robert- son, mayor of Vancouver. “Every month we lose because of Bill C-2, and an onerous process that’s totally unnecessary and overboard, means we’re losing dozens of people.” Denis Coderre, the mayor of Montreal, asked, “What are we waiting for? People are dying.” Adrienne Smith, health and drug policy lawyer at Pivot Legal Society, said that she feared that while we wait, while we set up working groups and give the Liberal government the benefit of the doubt, hundreds of people could die. Sterling Downey, a Montreal municipal councillor, asked, “How do you go into the media and announce over a year ago that you’re going to open these sites and back off and go radio silent?” According to another quote, the organizations that are supposed to host the sites don’t even dare set opening dates any more. They are stuck in a grey area where, every year for the past three years, they are told that the sites will open in the spring, but it doesn’t happen. I have pages and pages of quotes like that. For years, people have been anxious to help our young people, and the older ones too, but especially the street kids who fall victim to these opioids, these hard drugs. I think it is a shame that society has lost so much time because some people tried to score political points by holding fundraisers. I would remind hon. members that the director of the Conservative Party sent a fundraising email and used the politics of fear by accus- ing the NDP and the Liberals at the time of wanting to put our children in harm’s way, claiming there would be more syringes in our schoolyards and back alleys. They would have people believe that with injection sites comes increased risk, but the facts say otherwise. If a person enters a supervised injection site and is treated by a professional, that person will be given a course of treatment and drugs to help wean them off the hard drugs. That person will pull through. What does that mean? It means that thanks to supervised injec-

194 The Federal response to the Opioid Crisis tion sites, there will be fewer syringes in the streets, in the parks, and in the back alleys, not the opposite. For years, people have tried to convince us that this is more dangerous, but that is not true. The NDP moved a motion in the House a few weeks ago. My colleague from Kingsway wanted the debate to end and to send Bill C-37 to the Senate so that it could come into force as soon as possible. It is too bad that the Conservatives refused and blocked the NDP’s motion. That is why we would like to see this bill pass through all stages, intelligently and diligently of course, but as soon as possible. We have wasted enough time. We need to save lives.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

I agree with my colleague. We know that safe injection sites save lives and prevent the transmission of disease. In response to the Supreme Court ruling, the previous government unfortunately took a highly ideological approach, but at least now we are taking a facts- and evidence-based approach. With regard to the opioid crisis, which is killing too many people in Canada and needs to be addressed, earlier I listed a whole series of measures the government has already taken to deal with this crisis, Bill C-37 being one of them. I wonder if the member could talk about the advantages of coming back to the five criteria set out by the Supreme Court, rather than the 26 onerous and convoluted criteria required under Conservative Bill C-2.

NDP MP Alexandre Boulerice (Rosemont—La Petite-Patrie, Que.):

We need to get back to the basics, the five essential criteria set out by the Supreme Court. Obviously, the safety of our communities is an issue, but this is first and foremost a matter of public health. I also understand that Bill C-37 is not the whole solution but part of a bigger plan. We understand that. It is also very important to work on prevention. However, we need to speed up the process today. It is too bad that it has taken so long to get to the vote at third reading and move forward with this. I would also like to know why the Liberal government has not started implementing the 38 recommendations of the Standing Committee on Health, even though the Liberal members of the committee supported them.

Conservative MP Colin Carrie (Oshawa, Ont.):

I believe the member knows that the previous Conservative government set aside $500 million per year for an anti-drug strategy. That strategy was designed to keep needles out of the arms of addicts. The Liberal government cancelled that. Could he explain how important it is to not only maintain prevention but to implement the funds for detoxification plans? However we feel about injection sites, witnesses at committee were very clear that this was a stop gap measure, not a permanent measure. Could he please comment on the necessity for the Liberal government to set aside appropriate funds? Where did that $500 million go? Should it not be put into treatment for addicts? There is treatment for this condition.

NDP MP Alexandre Boulerice (Rosemont—La Petite-Patrie, Que.):

Most of what he said is correct. We have always wanted a government that bases its decisions on science, research, and facts. The facts show that supervised consumption sites work and that they are part of a process to help people overcome their addictions. There are programs that help people get out of this situation, which is extremely harmful to their health and potentially fatal. The programs offered in these centres reduce the rate of addiction and the number of related deaths. However, it is true that these are not the only programs out there. Broader drug treatment programs offered outside these centres are also required. I agree with the member on that. Together, we can do many things to prevent our children from being able to access drugs too easily, particularly really hard drugs like those we are talking about today, such as fentanyl and all of the extremely lethal opioids. The question is, where is the $500 million that my colleague mentioned?

Liberal MP Sean Fraser (Central Nova, N.S.):

Over the course of time that I have to address this issue, I want to give a very brief background on the scope of the fentanyl crisis facing our country and then tackle some of the things we can do, such as trying to undercut the illicit market for this devastating drug and ensuring we are treating addiction like a life-threatening chronic illness and not a crime. The scope of this crisis is extraordinarily widespread. We have heard hon. members from different parties address its widespread nature, but I specifically would like to draw the attention of members the fact that 947 lives were lost in British Columbia in 2016. By

195 The Federal response to the Opioid Crisis comparison, death from motor vehicle accidents in somewhere in the range of a little more than 300. In Ontario, I believe, on average, two people die a day from an overdose of opioids. In my home province of Nova Scotia, we are losing one life approximately every five or six days. This drug is migrating from the west coast to the east coast. Even though we know it is being manufactured and imported from parts of Asia and that British Columbia has borne the brunt of it so far, we need to act now so we can stem the bleeding that is happening on the west coast and prevent disaster to such extremes from affecting the rest of the country as well. I find that a few measures in Bill C-37 are very helpful and will help undermine the illicit market for fentanyl. One of the first things we can do is tackle the equipment that is being imported to help manufacture this drug locally, things like pill presses and encapsulators. Bill C-37 would ensure that we would not allow the importation of these devices, thereby helping to prevent the production of the drug locally in the first place. We are also planning on criminalizing the possession of any kind of equipment that can be used with the knowledge that it can be used toward trafficking in controlled substances, such as the law that currently applies to methamphetamines. This is a common-sense approach that will make it harder to produce and distribute this dangerous drug. Should this legislation pass, we plan on making changes that will allow border services agents greater latitude to inspect suspicious packages, even though they may be smaller than the current norm allows. Again, the reason for this policy change is simple common sense. The potency of this drug is so much stronger than even heroin or other drugs found on the streets today. This needs to be -ad dressed by ensuring that even the smallest amount can be detected and prevented from coming into Canada in the first place. In addition, Bill C-37 makes serious efforts to divert access of this controlled substance to the underground market by introducing a new scheme that is characterized by monetary penalties to ensure we have a better ability to enforce the laws on the books now. Ensuring that compliance is encouraged, non-compliance is deterred, and that we have an effective mechanism to enforce our rules is a key step in stemming the distribution and production of this drug in Canada. I would like to spend the remaining time I have on the importance of ensuring addiction is treated like a chronic life-threatening illness rather than a crime. This comes to the key feature of Bill C-37, which is the promotion of safe injection sites. Addicts would have a place where they could get the treatment they needed, rather than turn to the streets and bury themselves in communities where they would not have supports and the outcome of their use of the drug would be far more severe. In preparing for today’s speech, I consulted with medical professionals who had recently done research on this. They explained to me that the research was clear. The traditional approach of detox and abstaining is not one that works, particularly when people successfully try to get off the drug and have episodes of relapse. Their risk of overdose is so much higher because their tolerance is reduced. If we look at the benefits of harm reduction, there is a handful that, again, appeal to common sense and are borne out on the evidence. We know that the use of methadone prevents cravings and gives a different kind of high to help reduce addiction. We know that treatment in safe injection sites improves retention for people who do enter treatment. We know that it reduces needle sharing, which reduces the impact. Most important, it reduces death resulting from overdoses of opioids.

Resuming debate after a break for government business

Parliamentary Secretary to the Minister of Public Services and Procurement Steven MacKinnon (Gatineau, Que.):

This bill merits the support of all members of the House. I am particularly pleased that our friends in the New Democratic Party are in support of what is, essentially, a public health measure. There have been debates in this place and elsewhere across the country for over a decade and we saw some of the divisive community fights that ensued in Vancouver and other locales across the country on the issue of substance abuse, community health, and the measures for those who suffer from drug addiction. I applaud my colleagues in the House who support the measures that have now become more and more urgent, so that we may address the public health issues that are raised by the scourge of substance abuse in Canada. Whether we are talking about the measures taken in Vancouver or the ones taken in Montreal lately, measures that I know are being debated in communities across this country, the process outlined in the bill will be simplified, will take root in communities and among workers at the street level or across the spectrum of public health services who look after those who have substance abuse issues, and those who look to our communities and organizations to provide support.

Conservative MP Garnett Genuis (Sherwood Park—Fort Saskatchewan, Alta.):

Mr. Speaker, what the member has missed in the context of this debate is that there was an opportunity to expedite certain portions of this legislation, which I think we all agreed on, while, at the same time, giving proper debate to the one provision that is more controversial because it takes away effective opportunities for consultation from communities. 196 The Federal response to the Opioid Crisis

Conservatives proposed to expedite some of the necessary measures, but, instead, the government refused and has now brought forward closure when many members who were interested in speaking to this bill have not had an opportunity. I wonder if he would tell us why the government was not prepared to work in a non-partisan fashion, to move forward more quickly many of the essential elements of the bill, while still allowing proper debate on the government’s proposal to reduce community consultation. Why did Liberals have to make it a partisan issue, use closure, and slow down some of the vital portions of the bill? Why are they doing it this way and why did they not work with the rest of the parties in the House?

Parliamentary Secretary to the Minister of Public Services and Procurement Steven MacKinnon (Gatineau, Que.):

Over the course of the 10 years when people in Vancouver were trying to establish Insite, a groundbreaking service, where was the party opposite in listening to community voices, public health advocates, and, yes, evidence-based scientists? Where was that party in allowing the kind of debate required to establish that vital community service in Vancouver and other communities? We were having a debate in the chamber, as it should be, and that party wanted to shut down the debate.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, on such an important issue as safe consumption sites, which could, indeed, save lives, according to the vast majority of health experts, facts and evidence, and what we have seen in Vancouver, it has to proceed quickly. It became a partisan issue. The previous Conservative government responded to the Supreme Court judgment that set out five clear criteria on which to approve sites in communities where they are needed and, instead, provided 26 onerous, lengthy, complicated criteria that made it hard for communities to have the needed safe consumption sites, which prevent sickness and save lives. At this point, we should move forward with Bill C-37. I would ask the member, going back to what the Supreme Court clearly stated, if it would give more flexibility to provide safe consumption sites, to give exemptions where they are needed, where they save lives, and where communities demand it, like Montreal, which has just received approval after such a lengthy period. It had been asking for these sites for close to two years. Does he feel this would help protect Canadians, as Mayor Coderre said, even if it is sometimes from themselves?

Parliamentary Secretary to the Minister of Public Services and Procurement Steven MacKinnon (Gatineau, Que.):

As has been the case for a good number of issues, our approach has been based on science, evidence and, above all, jurisprudence. The bill as it stands is consistent with all these principles and is in rather stark contrast to the previous government’s approach, which opposed community activists and was contrary to the jurisprudence and, yes, to findings about public health.

NDP MP Gord Johns (Courtenay—Alberni, B.C.):

Mr. Speaker, medical experts have been clear that there is an alarming lack of access to publicly funded detox and treatment centres in Canada. Certainly as politicians we know this. The health committee’s recent report on the opioid crisis made three specific recommendations calling for significant new federal funding for public community-based detox and addictions treatment. Will budget 2017 contain significant new funding for addictions treatment?

Parliamentary Secretary to the Minister of Public Services and Procurement Steven MacKinnon (Gatineau, Que.):

This bill is a giant step forward. It ensures we listen to the people on the ground and helps provide greater access to infrastructure and community facilities. I believe this is a big step forward, but we must continue to work with the provinces, territories, and community stakeholders in order to solve what we both recognize is a major problem.

Conservative MP Karen Vecchio (Elgin—Middlesex—London, Ont.):

I have listened to many of the speakers in the last few debates on this, and everyone is pointing fingers, saying that the other government did not do this and we are doing this, but I am coming here as a mom. I am the official critic for families, children, and social development, and I am thinking about what we can do that is best for our families and best for our communities.

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Many people are giving information regarding safe injection sites and why they work, but I am looking at the communities. One of the most important things to me is having a safe community and having a good place to raise my children and all Canadian children. When we are talking about this, we have to go back to why we are putting in these laws. It is about the safety of Canadians, whether it is the safety of those people who are unfortunately addicted or the safety of the families that are living beside injection sites or living in areas where there is a huge drug issue. When this started being discussed in December, I sent an op-ed to The London Free Press, which is one of our local newspapers. Imme- diately following that, I set up an appointment with Dr. Christopher Mackie, who is the medical officer of health and the CEO of the mental health unit. Many people thought we would be on different sides. He comes at it in a more liberated way, and I come at it in a more conservative way, basically because of being a mom. At the end of the day, we had basically no things that were not in common. Our concerns were the same. It was all about making sure that when our children go to school, they are safe. It was about making sure that when people are dealing drugs, they are not interfering in our communities. We recognize that it happens, and it is extremely unfortunate that it happens. What is happening is that we are moving forward on things that we are really not comfortable with. As a mom, when l spoke to Dr. Mackie, I told him about my discussions with my own children regarding marijuana and about why it is so important for families to sit down and have these discussions. Things like marijuana, heroin, opioids, and all of these things are coming into our children’s paths much more frequently, and they are something we do not understand. I am a child of the eighties, and my teenage years were great in the eighties. We heard of cocaine and marijuana, but we did not see it in our small communities. Everyone is looking at the discussions we are having, but we have to look at them through a family filter. We talk about gender-based analysis. I want to ask every member of Parliament to look at this through the filter of a parent. That is what I am asking. In the city of London, when they were putting in a methadone clinic, there were discussions about where it would go. There were so many people concerned, because it was going directly across the street from a high school on Dundas Street in St. Thomas. To this day, five years later, it is still a huge concern, because in that pocket of the community, there has been a lot of turbulence, whether it is crime, increased drug use, or things of that sort. What is it teaching our children as they exit from the high school and there is a methadone clinic across the road? What signals are we sending to our children? Is it saying no to drugs or that we are there to assist them? We are failing our children. We are failing the next generation by not teaching them right from wrong and not teaching them that the use of drugs and hard drugs is difficult. They are going to have addiction issues. They are going to have problems with brain development. We are not starting at step one anymore. We are going to step 10 and saying, as one of the members said, let us legalize all drugs. I do not know if he was serious, because he was looking at drugs as not being a crime. Let us be serious. It may not be a crime to use drugs, but what does it lead to? I have a lot of personal experience in my community with my own family’s drug use. It is not me personally, but I have been touched intimately because of drugs. I have known people who have passed away. A person I grew up playing baseball with died right before Christmas, in our own community, from taking carfentanil. I knew this gentleman, Jeff. He died at the age of 46. He was a father with children. He had a son he loved like members would not believe and tons of friends. The problem was that he got mixed up with drugs when he was very young, and that is the life that led him down the path to his death. I think what is happening is that we are blurring what is right and wrong, and we are saying that this is how we are going to help. Why do we not start at the front end, which is education and letting people know how to speak to their children and letting people know that the use of heroin is not right? We give so many reasons for saying that we need to have this. Why do we not start at square one and make it right in the first place? I believe that we have to have places where we can help people rehabilitate. We know that there is a drug crisis, and we need to do better. Where do we start? I like 90% of this bill. I think it is really important that when packages come into Canada, they are tested, that we do not allow counterfeit companies that come in to manufacture pills, and that we do not allow pill presses or anything like that. I think it is really important to have legislation against that, because it is helping in the war against drugs, and we know that this is happening. However, when we start talking about the one piece, the safe injection sites and the fact that there would not be consultations in our communities, that is where I have to say stop. As I said, back in the city of London, where, across from H.B. Beal, they have a methadone clinic, there were many parents who came forward to the Thames Valley District School Board to state their opinions. In a letter I read last year regarding safe injection sites, a woman spoke about her daughter who, at the age of 13, became addicted to cocaine. The daughter, who went into one of these clinics, at the time said that the ability to get drugs was even easier once these clinics were available to her. We have to understand that it is not a fix. It is a band-aid approach unless we go into it full scale to help Canadians, whether it is Canadian families or Canadian youth at risk. We need to make sure that we are doing better, and we are not doing that. That is what makes me so concerned. We are talking about fentanyl. We know that in Vancouver, more than 950 people have died because of it. In my own community, we had six overdoses in one weekend right before Christmas, and unfortunately, one person died. 198 The Federal response to the Opioid Crisis

I was speaking to both the police chief of the city of St. Thomas, Darryl Pinnell, who will be retiring shortly, and the police chief of the city of London, John Pare. I wanted to discuss with them some of their concerns in their cities. To be honest, I thought when I went into this conversation with the police chiefs, we would be talking about prostitution, because we know that there has been some sex trafficking going on in our communities. I thought we would be talking about marijuana and the concern about people driving under the influence of marijuana, but the big issue for the two police chiefs was fentanyl. In the city of London, I know that there have been three different seizures of fentanyl that has come into our communities. I applaud them for doing their great work. However, we have to do more. We sit here and become so open and so allowing of things, whether we are talking about sexual expression or drug use. We have lost our innocence. As a parent, I can tell members that each and every time I have a conversation with my children, it is about talking about right and wrong. However, when we are watching television, when we are watching the news, when we are seeing things on the Internet, when we are having these discussions, do we not think we are also saying, “Drug use, well, you know, it happens”? It happens, but it has to stop happening. Our job is to change that. Maybe I am coming out here as a Pollyanna. A gentleman, many years ago, said that I was his Pollyanna. I like to see the positive side. When I look at this, we are starting the wrong way. We should be educating people. We should be having a program and educating people about the use of drugs. Instead, we are allowing it. We are even talking about legalizing all drugs. What the heck? What really concerns me is that we are going in the wrong direction. I am worried about what we are doing to the future of Canadi- ans. What are we saying? What is right and wrong? Those are some of my concerns. We can do better. I think we are all just kind of saying that opening these clinics will be fine. It is a band-aid approach. Unless we have wraparound services to allow people to rehabilitate and get off drugs, it is not going to help anybody. It is a short-term cure. Although I understand the need, it is just that, a short-term cure. When the municipalities and the communities are not involved in the decision on where these sites are going to go, we are in trouble.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

I often hear Conservatives on the other side of the House talking as though the communities were never consulted about the bill that we introduced. I would simply like to remind them that, under paragraph 42(2)(e), some of the information that will be requested by the Minister of Health will be expressions of community support or opposition. That is one of the criteria that must be considered, as set out in the Supreme Court ruling. With regard to what the member was saying about the importance of education, it is true that people need to stay far away from drugs. I think that everyone agrees on that. At the same time, we cannot stick our heads in the sand and pretend that there are no Cana- dians struggling with this problem, which is causing too many deaths. In British Columbia alone, 1,000 people died of drug-related overdoses in 2016. There has also been a major increase in the number of overdose deaths in Alberta. This is a problem in cities all across Canada. I believe we are taking a fact-based approach. We are trying to reduce the harm that this can cause while still cracking down on the problem. We are doing that by allowing authorities to open packages weighing less than 30 grams, which could contain as many as 15,000 fatal doses, while adopting an approach that seeks to reduce the devastation caused by drugs. My question is simple. Can the member see the balance that exists in Bill C-37, and can she comment on that?

Conservative MP Karen Vecchio (Elgin—Middlesex—London, Ont.):

Mr. Speaker, I appreciate the comments by the member, but I do not believe that the balance is there that once was. I was in Gastown, and I saw three people smoking crack. I knew I was not in Sparta anymore. It was that simple. The girl from southwestern Ontario had a total eye-opener. We have to recognize this. I believe that communities need to be more involved, and some of the members of the police force I have worked with are concerned that they are not. As I have indicated, we have seen some poor decisions made in the past that have resulted in teenagers having these things available to them, with schools across the street from methadone clinics and things of that sort.

NDP MP Jenny Kwan (Vancouver East, B.C.):

Mr. Speaker, I am a mother of two, and as the member for Vancouver East, we are in the centre of the crisis. Today it is fentanyl and carfentanil. Back in the day, when I got involved in lobbying for harm reduction initiatives, including Insite, it was heroin and heroin overdoses. In our community park, Oppenheimer Park, we planted 1,000 crosses back then to commemorate each person whose life was lost.

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I get it that we need a comprehensive approach. However, let me say that today, right here as we debate, people are dying in our communities, whether it be in my community, in Calgary, Alberta, Toronto, Montreal, or other communities. This is happening even in small communities. Dead people do not detox. Therefore, first and foremost, is it not incumbent upon us to do something to make sure that people survive the day? This is what the bill is about. It is what Insite was about and continues to be about. This is what we have to do so that people have a chance to succeed. Dead people do not detox. Would the member agree with that?

Conservative MP Karen Vecchio (Elgin—Middlesex—London, Ont.):

As indicated, during the voting, the Conservative Party put forward an amendment. We looked at all the clauses, and one clause we were not set with was to do with the injection sites. Everything else was fine, but this is where we have an issue. I understand where the member is coming from, because I am fortunate to sit with the member for South Surrey—White Rock, who is devastated about what is happening in her community. I will do what is best, but at the same time, I think we need to make sure that we have these honest discussions. What is happening in the member’s community is horrific, but it affects everyone, and it goes across the country. We need to make sure that all the communities are on board. We need to make sure that we have safe communities. As I indicated, walking on Vancouver streets, I did not expect to see people falling out of windows and smoking crack. It is a beautiful city, but that is what I saw. That is not what we want our communities to be about. We want safe communities, so we have to find a balance. The biggest thing for me is communication with communities to make sure that these injection sites are going in places that are best for their communities to keep them safe.

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Mr. Speaker, it is an honour to rise today to speak in support of Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts. The bill directly addresses the national public health crisis of opioid overdoses and provides measures to prevent increasing harm to Canadians and communities all across the country. I would like to speak to the importance of two key components of the bill: first, streamlining the process of supervised consumption sites; and second, providing additional enforcement capacities to the Canadian Border Services Agency, which would help prevent illicit opioids from entering Canada through international routes and therefore reduce the risk of controlled substances entering the hands of Canadians. These components of the bill are critical to Canada’s fight against the opioid epidemic currently sweeping across Canada. As we know, when the previous federal government decided it would not extend the legal exemption for Insite in Vancouver, advocates initiated a legal challenge, which reached the Supreme Court of Canada. In 2011, the Supreme Court ruled that the health evidence in support of Insite was substantial and opened up the possibility of establishing additional facilities in Canada if there was an appropriate balance between achieving public health and public safety. This balance was organized into five criteria: first, evidence, if any, on the impact of such a facility on crime rates; second, the local conditions indicating a need for such a supervised injection site; third, the regulatory structure in place to support the facility; fourth, the resources available to support its maintenance; and fifth, expressions of community support or opposition. Simply put, the legislation removes the burdensome 26 application criteria put forward by the previous government. Instead, it uses the five factors outlined by the Supreme Court of Canada in its 2011 ruling on Insite in order to streamline the process. It has been established that opioid addiction is typically chronic, lifelong, difficult to treat, and associated with high rates of morbidity and mortality. Our ultimate goal is to reduce, and ultimately help eliminate opioid addiction but we first have to stop people from dying. We know that supervised consumption sites work to do just that. Just a few of the organizations that support supervised consumption sites are: the Canadian Medical Association, the Canadian Nurses Association, the Canadian Association of Nurses in HIV/AIDS Care, the Public Health Physicians of Canada, the Canadian Public Health Association, the Registered Nurses’ Association of Ontario, and the Urban Public Health Network. Furthermore, international organizations, such as the World Health Organization and the Centers For Disease Control and Prevention, are in favour of harm reduction services. As a member of the Standing Committee on Health, I had the honour of assisting with the swift passage of Bill C-37 through the committee stage. With the current health crisis across Canada, the rapid passage of the bill is imperative. Time is of the essence to help save lives, and as I previously mentioned, a key outcome of the legislation is that the length of time required to process applications for supervised consumption sites would be significantly reduced, while still providing the necessary balance between public health and public safety. Many witnesses throughout the Standing Committee of Health’s study on the opioid crisis stated that there were significant barriers associated with the previous government’s Respect for Communities Act and its 26 criteria. The act created an onerous application process for community groups wishing to apply for a supervised consumption site, as evidenced by the lack of applications that have been successful since the legislation was put in place.

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For example, three supervised consumption sites were approved last month in Montreal under the previous government’s legislation. Although their approval is positive, the time it took to process the application was quite long, as it was submitted in May 2015. That is 17 months the city of Montreal had to wait to assist their vulnerable citizens with opioid addictions. That is too long. I agree the important criteria must be met before supervised consumption sites are established within communities, but the application process must reflect the urgency of the situation. I believe Bill C-37 would do just that. One significant statement made during the Standing Committee on Health’s clause-by-clause on Bill C-37 was by the hon. member for Vancouver Kingsway. He stated, “On the first day that Insite opened, they reversed 15 overdoses”. That is a staggering number of people saved in one day. By streamlining the application process, Bill C-37 would ensure applications would be approved in a timely fashion, paving the way to save more lives. For example, at Insite there have been over 4,922 overdose reversals, and not a single death has occurred at that facility. Supervised consumption sites save lives and help reduce the spread of HIV and other infectious diseases. I was shocked to hear that in 2016 in B.C. alone, a total of 914 people died from an overdose, an 80% increase from the previous year. This alarming statistic shows that it is our responsibility as federal members of Parliament to act now. Another key component of the legislation that I wish to speak to is how the bill addresses the illegal supply, production, and distribution of drugs. One of the key findings of the September 2016 report published by the RCMP regarding the current opioid crisis Canada faced was that China continued to be the pivotal source for illicit fentanyl and its analogues, precursors, other novel emerging opioids, and tableting equipment that supplied Canada-based traffickers. Bill C-37 addresses this issue by proposing to give Canada’s border services officers greater flexibility to inspect suspicious mail, no matter the size, that may contain goods that are prohibited, controlled, or regulated. The current legislation prohibits the CBSA from opening suspicious mail that weighs 30 grams or less. If the CBSA found such a package, it would have to seek the permission of the addressee, which would prove to be difficult. This gap in enforcement capacity is problematic as just one standard size mail envelope, 30 grams, can contain enough fentanyl to cause 15,000 overdoses. Given the prevalence of illicit drugs found in international packages is greater than domestic mail, this measure would only be for international incoming mail. Our border agents need to be given the clearance to inspect these packages to help stem the flow of illicit drugs entering into Canada. According to the same report by the RCMP, in May and June of 2016 the CBSA intercepted for the first time two separate shipments of carfentanil, which is estimated to be 100 times more potent and toxic than fentanyl and 10,000 times greater than morphine. Therefore, we know there has been an increase in trafficking and it is our responsibility to equip the Canada Border Services Agency with the tools needed to stop it. Bill C-37 would save lives, whether that would be by the seizure of a shipment of an illicit opioid by the CBSA or through the nurses at new supervised consumption sites, whose applications would be approved based on the new set of five criteria. This legislation is the next step in fighting the crisis we see across Canada, and I believe this bill is a step in the right direction to help Canadians today. Many Canadians are one overdose away from becoming another tragic statistic in the ever-increasing Canadian epidemic of opioid addiction. This evidence-based legislation could not be more timely. With these rising fatalities, it is now more important to act. It is my hope that Bill C-37 will be granted the same swift movement through the Senate as it is being granted in the House of Commons. It would enable Canada to tackle this nationwide problem and help to ensure the safety of vulnerable Canadians. The faster it is enacted, the faster it will help save lives.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

The member spoke about saving lives and said that the injection sites would do just that. I do not have any disagreement with that. However, I have before me just a random snapshot of 12 kids who are dead. They were aged 21, 23, 24, three at 21. A Delta mother lost two of her children within 20 minutes of each other, both kids in their 20s. We are talking about deaths, overdoses and adolescents. Could the member please tell me how Bill C-37 would address that issue for those adolescents who are taking pills and not using injection sites?

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Mr. Speaker, the Government of Canada and Health Canada’s action on opioid misuse does in fact address these problems, with improved public education and prescribing practices, a number of issues that will help to address this. Are these issues addressed in Bill C-37? No, they are not. Is Bill C-37 our only weapon in the fight against opioid misuse and overdose? No, it is not.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, this is fentanyl. They are all dead from fentanyl.

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Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

Mr. Speaker, to clarify, fentanyl is an opioid. However, the fact is that Health Canada has a strategy on opioid use, which is separate from Bill C-37. We are addressing that problem, and we are addressing a separate problem with Bill C-37.

NDP MP Gord Johns (Courtenay—Alberni, B.C.):

Mr. Speaker, this crisis is affecting people, even in rural communities. It is not just an urban issue. I live in a region with high child poverty. Unfortunately, we are seeing children who are experimenting with drugs and they are ending up in urban centres. They need help. When the health committee conducted an emergency study into the opioid crisis, the first recommendation it made, with all-party support, was to declare the opioid overdose a national public health emergency. This would give the public health officer of Canada extraordinary powers to act immediately, while the bill worked its way through Parliament. It has been echoed by provincial ministers across the country. In the face of a mounting death toll, why will the government not declare a national public health emergency so we can start saving lives today in rural and urban communities, and for the sake of our children?

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

We have responded to every request the provinces have raised with our government in this crisis and we have worked with them. If there were a public emergency under the Emergencies Act, the chief public health officer would not have any new or special powers to address this. Therefore, we thought this was a tool of last resort and with this bill, we would be equipping our health agencies with the proper tools with which to fight this crisis.

Conservative MP Len Webber (Calgary Confederation, Alta.):

During the member’s speech, he indicated that China was a main source of illicit opioids coming into our country, fentanyl and carfentanil. In fact, 98% of illicit drugs and illicit opioids, and fentanyl, comes from China. This is what was indicated to us by the RCMP during our committee hearings. Our Conservative caucus put a motion on the table during the discussion. We wanted to have the Chinese ambassador come to our committee to discuss what the Chinese government was doing, but the Liberal government turned down our motion. Why would the government be more concerned about being friends with the Chinese government than stopping the flow of deadly drugs on Canadian streets?

Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.):

In regard to the request, the reason the health committee did not grant this request was that inviting the Chinese ambassador to address our committee on a matter of China’s exporting, excise and criminal laws was completely outside the purview of the health committee.

Liberal MP John Aldag (Cloverdale-Langley City, B.C.):

The bill is part of the Government of Canada’s comprehensive approach to drug policy, one that strikes a balance between public health and public safety. Last year in my province of British Columbia, over 900 people died of drug overdoses. This was an 80% increase from 2015 and we now know that the opioid fentanyl was disproportionately responsible for these deaths. As the medical community has known for some time and as the general public is becoming increasingly aware, fentanyl is a difficult drug to combat. When used legitimately, it is a powerful pain suppressor which can help people who are suffering with acute and chronic ailments. However, when used inappropriately, incredibly small doses can be fatal. What has become evident to my community is that illicit fentanyl has become both widely available and far too easy to obtain, so today I stand in the House not only for my riding of Cloverdale—Langley City or even as a British Columbian, but for all Canadians who have been or may be affected by the opioid crisis. Central to the Government of Canada’s efforts to help individuals and communities affected by the current drug emergency is the reintroduction of harm reduction as an integral part of our country’s narcotics strategy. This bill includes changes to streamline the application process for new supervised consumption sites, which I believe is not simply a compassionate course of action but a responsible and evidence-based decision which has been proven to save lives.

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This important public health initiative will be partnered with the recently announced Canadian drugs and substances strategy. This strategy is built on four pillars: prevention, treatment, harm reduction, and enforcement, which will be grounded in a strong evidence base to bring about a decrease in both the manufacture and consumption of illicit opioids and the tragic incidence of overdose deaths across our country. This government knows that while we must address the public health perspective in dealing with the crisis at hand, we must also deal with the illicit drug supply issue. That is why Bill C-37 addresses problematic drug use from all sides and includes proposals to respond to controlled substances obtained through illicit sources. Canada’s drug control laws are centred on the Controlled Drugs and Substances Act, also known as the CDSA. This act serves the dual purpose of protecting public health and maintaining public safety. The CDSA provides controls over drugs that can alter mental processes and that may result in harm to one’s health and to society when misused. This is done by regulating the legitimate use of controlled substances and prohibiting unlawful activities, such as the import, export, and trafficking of controlled substances and precursors. As I discussed earlier, problematic and illegal substance use coupled with an illicit drug supply that has become increasingly more dangerous has led to a spike in overdoses and deaths. This risk is especially pertinent to fentanyl given its extreme potency and difficulty to detect in other so-called recreational drugs. Our government is committed to protecting public health and safety by curbing production and trafficking of banned substances. Bill C-37 would amend the CDSA to provide the necessary tools to do so. At the end of 2016, the Government of Canada added six fentanyl precursors to the list of controlled substances under the CDSA to help address the illegal production of fentanyl and related drugs. If passed, Bill C-37 would provide a wider array of effective tools to fight the illegal production and trafficking of all dangerous narcotics, including fentanyl and carfentanil. In addition, many overdoses have come as a result of ingesting drugs that appear identical to legitimately produced pharmaceuticals. These drugs are made without adequate controls and often contain unpredictable amounts of high potency and potentially lethal substances, such as fentanyl and carfentanil. Essential to making these illegal drugs are pill presses and encapsulator devices that allow illegal producers to turn out thousands of counterfeit pills or capsules in a very short time. This presents a significant risk to public health and safety. That being said, pill presses and encapsulators are also used in legitimate manufacturing processes in the pharmaceutical, food, and consumer product industries. This is why a registration system is being proposed. This new requirement would impose minimal burden on legitimate manufacturers. Importers of pill presses and encapsulators would simply have to register with Health Canada prior to bringing these devices into this country. Importation of these devices without proof of registration would be prohibited and border officials could detain those arriving without proper registration. Changes are also being proposed to help information sharing between Health Canada and the Canada Border Services Agency about the importation of pill presses and encapsulators, as well as with law enforcement agencies in the course of an investigation. In addition to the registration of imported pill press and encapsulator equipment, Bill C-37 would broaden the scope of pre-production activities associated with the production of illegal drugs. Pre-production activities include buying and assembling the chemical ingredients or industrial equipment with the intention of using it to make illicit narcotics. The offences and punishments would be extended to capture equipment and chemicals not currently listed in the CDSA schedules. Bill C-37’s proposed amendments to the Customs Act would also allow border officials to open incoming international mail weighing 30 grams or less if there are grounds to suspect it contains goods which are prohibited, controlled, or regulated under another act of Parliament. This would allow border officials to open packages that are suspected to contain substances intended for use in the production of illicit drugs. It is in response to substantial evidence that illicit drugs, such as fentanyl, are being brought into Canada through the postal system. As was noted by a member previously, 30 grams may seem like a small amount, but it is equivalent to approximately 15,000 lethal doses of fentanyl. The changes proposed in Bill C-37 are an important part of the government’s multi-faceted plan to address the growing opioid crisis in Canada. The bill would provide law enforcement agencies with the tools they need to take early action against suspected drug production operations and to respond to the ever-changing illicit drug market. At the end of 2016, news of over 10 overdose deaths in one night in British Columbia highlighted an already alarming and tragic situation, and the opioid crisis has not gone away since the beginning of the new year. Instead, it gets worse, as hard-working emergency responders and public health officials struggle to keep up with the increasing number of those afflicted. Unfortunately, I witness this challenge in my own riding of Cloverdale—Langley City, one of Canada’s communities most affected by the opioid crisis. Sadly, my constituents are not alone in facing this issue. As we in this House study legislation from day to day, we must often ask ourselves: What will be the direct result of this legislation, this action? With Bill C-37, we have an opportunity to pass legislation that would directly save lives. There is currently tremendous work being done to combat this issue, such as the RCMP’s Surrey outreach team, which has been effective in addressing addiction and homelessness issues in the local community. This team responded to 55 overdoses in just two weeks and has continued saving lives in the city of Surrey. While the individual efforts of police detachments and public health officials have resulted in positive results at the local level, these front-line responders need federal assistance and a national framework to tackle the issue. 203 The Federal response to the Opioid Crisis

The sooner Bill C-37 becomes law in Canada, the sooner it can help those most afflicted by this ongoing public health emergency. I trust that all members of the House understand the importance of this bill and hope that they will support it. I would like to close with a comment relating to an earlier speaker, who talked about needing to take a family approach to this crisis. I would like to remind all members that we have seen 900 deaths in B.C. in the last year. Those are 900 families affected by this tragic opioid crisis. It is only by working together across all parties that we will actually be able to make Canadians safe, focus on families, give them a safe and healthy upbringing, and deal with those who are facing crises in their lives.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, in Bill C-37, all language that articulated the process for public consultation has been removed. At the health committee, amendments were put forward to try to obtain letters of support or opposition within a two-kilometre radius of a site, which the Liberals voted against; to identify schools and day cares within a two-kilometre radius, which they voted against; a letter of support or opposition from the mayor and council, and the police chief, which they voted against; and a minimum of 40 days’ consultation, a maximum of 90 days, which they voted against. Could the member please tell me why the Liberals do not want any public consultation?

Liberal MP John Aldag (Cloverdale-Langley City, B.C.):

The member raises a good point, but the point of the bill is to deal with treatment measures that are effective. Being able to deal with safe consumption sites is absolutely pivotal in dealing with this crisis. We will have to talk to Canadians and neighbours but, ultimately, hopefully the bill will pass fairly quickly so that we can deal with the introduction of safe consumption sites into communities and to do it in a responsible manner with the communities to minimize the impacts, while also making sure that those who are in crisis have the opportunity to access those services.

Liberal MP Lloyd Longfield (Guelph, Ont.):

Mr. Speaker, I would like the member to build on his last comment in terms of what the medical community and law enforcement agencies think regarding the focus of Bill C-37 on harm reduction within communities and the need to provide not only safety for communities but also health care for individuals who need it.

Liberal MP John Aldag (Cloverdale-Langley City, B.C.):

Mr. Speaker, a pivotal part of this is the introduction of safe consumption sites, but there are so many other fronts to come at this public health crisis, which is why I am really proud to speak in support of Bill C-37. It would take a multi-faceted approach in dealing with this crisis. It would help communities across the country deal with the issue that we are facing.

NDP MP Gord Johns (Courtenay—Alberni, B.C.):

Mr. Speaker, during the study of the opioid crisis, the health committee heard that improved access to mental health services would also support people who use drugs. In addition, the committee heard that access to mental health services for front-line workers is critical to ensure their wellness and continued ability to provide support to others. Given the critical importance of these services, why is the Liberal government using funding for mental health as leverage in its divide and conquer negotiations over the health transfer escalator? We talk about mental health and we talk a lot about youth and children. In British Columbia, a lot of children end up on the street experimenting with drugs, and they end up getting into hard drugs. A lot of them have mental health issues. Right now, the highest risk residential care facility in Burnaby, British Columbia, the Maples facility, has a one-year waiting list. Youth cannot wait one year when they are high risk and need help. We know that they need urgent help. Our call is to call this a national emergency and to get new emergency resources. However, we heard a member across the way say that they would not get that. What can be done immediately to help these children?

Liberal MP John Aldag (Cloverdale-Langley City, B.C.):

Despite some of the challenges on the rollout of the health accords, we are seeing progress in negotiations in making mental health issues of importance to governments. It is something that I have spoken about. It affects so many members of society, and our government will continue to work on how we can improve mental health services within Canada.

204 The Federal response to the Opioid Crisis

Conservative MP Rachael Harder (Lethbridge, Alta.):

Mr. Speaker, though I stand in support of much of Bill C-37, there are a few issues I have trouble supporting. Whether we support supervised injection sites or not, one thing is certainly true, and that is that the placement of a site will impact the communities in which they are located. For this reason, I believe it is absolutely necessary for communities to adequately consult with members of the public and hear them out. As a member of the Standing Committee on Health, I was very troubled when the Liberals voted against my amendment that would ensure public consultation be carried out before the building of a site. “Social licence” was a phrase that we heard repeatedly used by the Liberals during the last federal election. We heard buzz phrases like “community input”, “consultation”, and “evidence-based decision making”. In the Prime Minister’s mandate letter to the health minister, he said, “I expect that our work will be informed by performance measurement, evidence, and feedback from Canadians”. The Prime Minister went on to say:

“Government and its information should be open by default. If we want Canadians to trust their government, we need a government that trusts Canadians.”

This begs a question then. Why do the Liberals not trust Canadians to have a voice when it comes to the placement of a safe consumption site? Under the current text of Bill C-37, the minister is under no obligation to issue public notice that a supervised injection site is being considered for a community. Further, the organization that is applying for the authorization is the only group required to demonstrate that local consultations have in fact taken place. This clearly undermines the impartiality of these consultations, since an applying organization can simply cherry-pick who it consults with. Let us imagine an alternate scenario here for just a moment: say, the construction of an oil pipeline. No one would be comfortable with a decision to go ahead with building a pipeline if the decision were based solely on the oil company’s report of its consultations with local environmentalists and first nations representatives. Moreover, no one would accept that a federal minister in Ottawa would have the facts to sufficiently decide where a pipeline should go, at least not without significant study by impartial experts and wide-ranging consultation with those who would be most impacted by the decision. Why then does the present Liberal government feel it is acceptable to trust that an applying organization has indeed consulted comprehensively when it comes to building a supervised injection site? In my riding of Lethbridge, Alberta, I have to say that I am incredibly impressed with the efforts to which my community has gone with regard to collaboration and consultation. The organization that is taking the lead on studying the need and feasibility of opening a supervised consumption site is going beyond the scope of this legislation in order to ensure that community members are respected and given a voice and that all levels of government are included. It is very concerned that community partnerships are formed and that comprehensive services are created that include a treatment model. Why is it doing so much work? It is doing this because it understands the importance of social licence, something the Liberals use as buzzwords but do not actually understand how to do. The organization in my riding understands that, while it could get the application approved without broad consultation, the suspicion and animosity that this would generate within our community would actually go against the very nature and purpose of the site. I believe that education, consultation, and collaboration are very key components to dealing with the crisis at hand. This is why I, as a member of the health committee, sought to amend this legislation. My amendment would have required the minister to provide 45 days’ public notice to communities where an application was being considered and that the feedback would then be made available to the public. Across government, it is typical for consultations of this sort to last between 30 and 90 days. For my efforts at the committee, I was accused by my Liberal and NDP counterparts of wanting to kill addicts who would overdose while consultations were taking place. Apparently they believe an application will be processed in fewer than 45 days, which is usually unheard of. It does, however, beg the question as to just how thorough this application process would be when it comes to considering whether or not a site should be opened. I believe it is not a simple process, but I wonder if the Liberals just plan on ramming them through. The health department will need to review the information provided, confirm the information is accurate, write its recommendation, brief the minister, and receive her decision. This takes time. If the government expects this process to take fewer than 30 working days, it would mean the department would have virtually no time to confirm the accuracy of the material provided. There is a real concern, then, that the Liberal’s so-called streamlined process is nothing more than a rubber stamp. When our Conservative government was in power, one of the bills the government of the day brought forward was the Safe Streets and Communities Act. This legislation required that meaningful consultation with community members be carried out before a supervised injection site could be established. Because this legislation was quite detailed, having 26 different requirements, it ensured that a fully informed decision was made. The Liberals have gutted these requirements, removing the requirement for evidence and reducing the criteria from 26 to five. The Liberals justified their decision to gut the Safe Streets and Communities Act by saying it was too onerous, but the same week the Lib- 205 The Federal response to the Opioid Crisis erals forced a stop to debate, silenced the health committee, and rammed this bill through, the Health announced the approval of three new supervised injection sites for Montreal. Clearly, the former criteria were not too cumbersome. A thorough application process helps organizations avoid mistakes and sets them up for long-term success. This has been affirmed by one centre after another in European countries. The fact that the Liberals rushed Bill C-37 through the House, by cutting off debate and imposing unprecedented restrictions at committee, shows they are unwilling to listen and unwilling to consult, as they promised they would during the election. Furthermore, refusing to hear from a single witness, either in favour or opposed to the bill, means parliamentarians have no context to understand whether or not the bill actually lives up to the intention of the drafters. Ironically, at committee, the Liberal members voted to amend their own legislation. This is odd. They deleted the requirement that applicants must provide evidence to support their application. This is something the Supreme Court actually outlined. This is from the government that claims to value science and evidence-based decision-making. It is one of the tag lines they like to use quite commonly. It is really quite concerning, because, as my Liberal colleagues have pointed out, lives do in fact hang in the balance. On December 16 of last year, nine people passed away from drug overdoses in Vancouver. Eight of these deaths took place in the Downtown Eastside. Interestingly enough, it was in the Downtown Eastside that the Vancouver fire and rescue department responded to 745 calls due to overdoses in November. This is significant, because the Downtown Eastside is the home of Insite, the first legal supervised injection site in Canada. Interestingly, the Liberals and the NDP have rushed Bill C-37 through Parliament with the rationale that legalizing supervised injection sites is the only way to stop rising numbers of opioid overdose fatalities. However, the evidence from Vancouver’s Downtown Eastside appears to contradict this narrative. Despite the presence of a supervised injection site, offering clean needles and the ability to test street drugs for fentanyl, there continue to be dozens of overdose fatalities only steps away from the Insite building. It is clear that the Liberals have not fully considered the impact of this legislation. Our Conservative caucus supports all but one section of the bill. The Conservative critic for health attempted to work with the Lib- erals to separate out that one section, while passing the remaining sections, in order to allow the health committee to conduct a proper study. The Liberals refused this offer. Instead, they have used every procedural trick in the book to ram the bill through the House with absolutely no scrutiny or thorough process. Again and again, the Liberals have shown that they uphold democracy the same way a screen holds water. This reckless approach undermines the authority of local communities to have a voice over their own affairs. It threatens the effectiveness of this legislation by preventing drafting errors from coming to light. It also increases suspicion around the approvals process, thus undercutting local support for harm-reduction facilities. For these reasons, I stand in opposition to Bill C-37.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, I always find it a little rich to be lectured on democracy by the Conservatives, who developed an expertise in all sorts of measures that were, frankly, far from democratic, and they developed quite the expertise on time allocation. The reason we are moving forward with the bill as fast as possible, and we have the support of the NDP, is precisely because the bill would save lives. The member does not have to take my word for it. She can take the word of the medical experts, the mayors, the provincial officers who have asked for these safe injection sites. Had the previous Conservative government responded to the Supreme Court judgment in a way that reflected what is asked instead of making it so onerous for communities where these sites are needed, where these sites would save lives and prevent transmission of diseases, we would not be here today with Bill C-37. Does the member at least agree that the section, which their amendment requests to remove, is one major section that would make the laws in Canada closer to what the Supreme Court has said, that would prevent the loss of life that we have seen occurring far too often in this country, with regard to opioids?

Conservative MP Rachael Harder (Lethbridge, Alta.):

Mr. Speaker, the hon. member across the way said that, if we had heard from the medical community or if they had a voice on this issue, then we would be able to acknowledge that there is a call for this and that it does in fact save lives. The truth is that I would have loved to hear from those individuals who could have confirmed that. They are called witnesses, and there was a motion put forward by the Liberals that prevented us from being able to hear from witnesses during committee stage. Had the Liberals not moved that motion, we would have heard from those witnesses, but we did not.

NDP MP Linda Duncan (Edmonton Strathcona, Alta.):

Some years ago, the Conservatives brought forward a bill in response to a court direction that they actually take action to establish safe injection sites, because in the opinion of the court, having heard experts, they actually save lives.

206 The Federal response to the Opioid Crisis

The Canadian Medical Association’s Dr. Haggie, then the president, in responding to that court decision said:

“While for some this is an ideological issue, for physicians it’s about the autonomy to make medical decisions based on evidence, and the evidence shows that supervised injection reduces the spread of infectious diseases and the incidence of overdose and death.”

Dr. Stan Houston, who is a renowned doctor in Edmonton, strongly supports this. He says there are lots of reasons to support safe injection sites, including reducing hepatitis C and HIV. More than 87 organizations in my city have called for the federal government to support them on establishing these safe injection sites, so I am wondering what evidence the member has to show, if she thinks it should be evidence-based, against the establishment of safe injection sites.

Conservative MP Rachael Harder (Lethbridge, Alta.):

Mr. Speaker, once again I would like to acknowledge that under the previous criteria, three safe injection sites were approved for the city of Montreal, clearly showing that those 26 criteria were not in fact too cumbersome, but actually very much needed in order to make sure that these centres were set up to be effective for the long term. Many experts whom I have talked to have affirmed that it is good to go through a thorough application process to make sure that these injection sites are set up to effectively serve the communities in which they are placed. On a second note, with regard to evidence again, I would love to see evidence, and that is why I was so impressed that our former government’s criteria beforehand actually called for evidence, because we should be making evidence-based approaches. Unfortunately, the Liberals gutted the word “evidence” from the piece of legislation, Bill C-37 that is before us today, so it is no longer required. We are not making decisions based on evidence anymore, because the Liberal government took it out.

Parliamentary Secretary to the Minister of National Revenue Kamal Khera (Brampton West, Ont.):

As members are aware, Canada is facing an opioids overdose crisis across this country. We have seen very troubling figures and have heard many tragic stories. As stated earlier in the House, British Columbia alone saw 916 illicit drug overdose deaths in 2016, an almost 80% increase from the year before. The majority of these overdoses are due to opioids. Other parts of the country have been impacted as well, with Alberta reporting 343 apparent overdoses related to fentanyl in 2016, which is an over 30% increase from the year before. While some areas have been more acutely affected that others, drug use is not unique to one part of the country, and the potential for this crisis to spread is very real. Our government is committed to addressing this complex public health issue through a comprehensive, collaborative, compassionate, and evidence-based approach to drug policy in Canada. To that end, the Minister of Health with support from the Minister of Public Safety and the Minister of Justice announced the new Canadian drugs and substances strategy on December 12 of last year. This new strategy replaces the previous national anti-drug strategy with a more balanced approach for restoring harm reduction as a core pillar alongside prevention, treatment, and enforcement, and supporting these pillars with a strong evidence base. The Canadian drugs and substances strategy formalizes our government’s commitment to taking an evidence-based and more appropriate health-focused approach to addressing problematic substance abuse in our country. The bill before us would ensure a sound and modernized legislative base to support this new strategy. This comprehensive bill aims to balance protecting public health and maintaining public safety. It is designed to better equip health professionals and law enforcement with the tools they need to address this issue. Specifically, this bill would improve the government’s ability to support the establishment of supervised consumption sites as a key harm reduction measure in communities. It would address the illegal supply, production, and distribution of drugs, and reduce the risk of controlled substances used for legitimate purposes being diverted to the illegal market by improving compliance and enforcement tools. In addition to introducing this new strategy, proposing this bill, and building on our five-point action plan, our government has taken and continues to take concrete steps to address problematic substance use. Since coming into office, our government has used all the tools available to address this issue. One of the first steps our government took, as expressed by experts, was calling for an increase in availability of naloxone, a drug that temporarily reverses an opioid overdose. We acted quickly in this regard to remove the requirement to have a prescription to facilitate access to naloxone in March 2016. Further, our government completed an expedited review of an easier to use nasal spray version of naloxone, which, as of October 2016, is now approved for sale in Canada. In the meantime, our Minister of Health used the extraordinary legal authorities available to her under the Food and Drugs Act to issue an interim order to allow the emergency import of naloxone nasal spray from the United States. This significant step has increased access for emergency responders and helps to address the growing number of opioid overdoses.

207 The Federal response to the Opioid Crisis

We have also demonstrated our support for the establishment of supervised consumption sites, a key harm reduction measure. Through a thorough and rigorous review in January 2016, Health Canada granted an exemption from the Controlled Drugs and Sub- stances Act for the Dr. Peter Centre to operate as a supervised consumption site. Not long after that, in March 2016, Health Canada granted Insite an unprecedented four-year exemption to continue its extremely important work in the Downtown Eastside neighbourhood of Vancouver. Insite has demonstrated time and again through a countless number of peer-reviewed research studies that it saves lives without increasing drug use and crime in the surrounding area. This four- year exemption is a positive shift from the previous annual exemptions. Just last week, Health Canada issued three new exemptions for supervised consumption sites in the city of Montreal, the first such exemptions outside of the province of British Columbia. I do want to briefly touch upon a concern that was raised in this House by the opposition, that the views of communities would no longer be important in the assessment of an application to establish a supervised consumption site. Let me be very clear; this was actually determined by the Supreme Court of Canada. The Supreme Court of Canada determined that the Health must consider expressions of community support or opposition when reviewing such applications. Our government is respecting the Supreme Court of Canada’s decision by proposing to include these factors in this legislation. We support the need for community consultation in the application process for considering the establishment of supervised consumption sites. We understand and respect that communities may have valid concerns about a proposed site, and that these concerns deserve to be heard and should be adequately addressed by applicants in their applications. The proposed amendments would demonstrate that respect for communities is a multi-faceted issue. It means that the concerns of communities must be considered and addressed by the applicants. However, it also means that the federal government should not place any unnecessary barriers in the way of communities that need and want to establish supervised consumption sites as part of their local drug harm reduction strategy. In order to combat this crisis head on, our government is also supporting private member’s bill, Bill C-224, the good Samaritan drug overdose act, a bill that would help encourage individuals who witness an overdose to call for emergency help. It would provide immunity from minor drug possession charges for individuals who experience or witness an overdose and call for emergency assistance. The opioid crisis is something we know we cannot fix alone. We need collaboration with all levels of government, experts, and professionals. This is why we are committed to working with our colleagues across Canada to address the opioid crisis, from medical professionals to law enforcement partners. In November last year, the Minister of Health co-hosted an opioid summit and conference along with the Ontario minister of health. The summit and conference brought together governments, experts, and key stakeholders to address the opioid crisis and to determine a path forward. Participants heard a number of perspectives on this crisis from people who use drugs, families devastated by opioid misuse, health care providers, first responders, educators, and researchers. Provincial ministers and heads of organizations with the ability to bring about change committed to a joint statement of action to address the opioid crisis. This joint statement of action reflects a combined commitment for each participant to work within respective areas of responsibility to improve prevention, treatment, and harm reduction associated with problematic opioid use by delivering on concrete actions. We will publicly report on the progress of these actions, starting in March 2017. In conclusion, Bill C-37 is a key example of our government’s commitment to establishing a comprehensive, collaborative, compassionate, and evidence-based approach to drug policy in order to reduce the harms caused by drugs that are currently being experienced by individuals. One life lost to an opioid overdose is one too many. We need to take action now. As this bill would help save lives, I strongly encourage all the members in this House to support this very important piece of legislation.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, as my colleague just said, one life lost is too many. I go back to the Delta mother who lost both her children within 20 minutes of each other, both of them in their 20s. I have a list here of over a dozen kids aged 21, 23, 24, and mid-20s. That is just a snapshot. These kids were not injecting. They were not using consumption sites. I would like to ask the member what the government is doing in this regard, because one life lost is one too many.

Parliamentary Secretary to the Minister of National Revenue Kamal Khera (Brampton West, Ont.):

We need to have a comprehensive approach in order to face this crisis. Harm reduction alone will not solve the opioid crisis. It requires a range of approaches, which also include treatment. There is a tragic shortage of treatment facilities in this country. In my previous role as Parliamentary Secretary to the Minister of Health, I heard loud and clear that there is a significant gap in getting access to treatment, especially when it comes to mental health and addictions. That is why our government is able to offer the provinces and territories $5 billion of new money for mental health and addictions in the health accord. We certainly hope that provinces, especially those facing the greatest challenges, will use some of these resources to expand access to treatment facilities so that people will get the treatment that they need. 208 The Federal response to the Opioid Crisis

NDP MP Jenny Kwan (Vancouver East, B.C.):

Mr. Speaker, I have been listening to this debate with interest of course and often the Downtown Eastside, the community I represent, has been referenced. The member for Lethbridge talked about the Insite situation, where people in or around a community continue to overdose, as though somehow that is evidence to show that Insite is not working, as though somehow that is evidence to show that harm reduction is not working. If the member looked into this situation she would realize that Insite is not a 24-hour, seven days a week service. It has also reached its capacity. This goes to say why this legislation needs to be passed. We need to get on with ensuring supervised injection facilities are happening in communities where there is a demonstrated need, as the Supreme Court decision clearly outlined. I would extend this invitation to the member opposite, in fact, to all members of the House. When anybody wants to speak to a witness, I would welcome them. I would personally ensure that they could sit down and talk about this issue with Dr. Patricia Daly, who is the chief medical health officer for the City of Vancouver, as well as Dr. Perry Kendall, who is the health officer for the Province of British Columbia. I would like to extend this offer to the member for Lethbridge and to the member who just spoke on the issue of supports. People are burning out in our community—

Parliamentary Secretary to the Minister of National Revenue Kamal Khera (Brampton West, Ont.):

As I have said many times in the House, our government’s policies are driven by science and evidence. Evidence clearly shows that when properly established and maintained, supervised consumption sites can save lives and improve health without negatively impacting surrounding communities. They provide hygienic facilities and sterile equipment. They are supervised by qualified staff members who can provide advice on harm reduction and treatment options, as well prevent overdoses. These sites may be the first time an individual comes in contact with a health care professional.

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

Mr. Speaker, it is an honour to speak on behalf of the people of Nanaimo—Ladysmith, but this is certainly a hard story. I support the government’s approach moving forward, but I want to talk about the impact in my immediate community, to describe the imperative of why action is so important. Since 2008, Nanaimo has had more deaths per capita from drug overdoses than anywhere else in British Columbia. Our region had a 135% increase in opioid deaths last year, and fentanyl was present in 50% of overdoses. This is a national emergency. Our region has not had the action that we need on it and the federal government response has been unacceptably slow. In October, at the health committee, I urged action of a study, which was initiated by an NDP motion by my colleague, the member for Vancouver Kingsway, that federal leadership was needed immediately to tackle the opioid overdose epidemic. I urged better access to Drug treatment programs and safe consumption sites, and support for health professionals, including addiction training. I urged that the government also create a national action plan on post-traumatic stress disorder for front-line emergency personnel and public safety officers in this vital line of work. When I talk with firefighters in Nanaimo, they tell me they used to see three overdose calls a year. Now they see three a shift. These fine young men and women signed up to fight fires mostly. I want to read some of the words from Mike Rispin, one of the chiefs at the downtown Nanaimo fire department. He says:

“In my 25 years as a fire fighter we have had periods when there was a sharp increase in opioid overdoses, due to a stronger drug on the streets. These periods lasted usually only a few weeks. Sadly, the recent introduction of fentanyl has made our response to overdoses a regular occurrence and I can only foresee this as a regular ongoing issue...I...can only imagine what we will see with the use of carfentanil (which has been discovered in town now). We will be having even more O/D’s and more difficulty bringing those patients back to consciousness. Nanaimo is a small community of 90,000 but the overdoses we are seeing now is increasing dramatically. Thankfully the Island health authority has opened a safe injection site which should assist in reducing deaths from the use of opioids.”

How did we get here? Opioid prescription rates are sky-high in Canada versus other countries. Our doctors over-prescribe, and that is because the pharmaceutical companies oversell. Chronic pain is not managed well in our country. Some people are just left completely on their own and they do become drug-dependent because they are not getting the pain management support they need.

209 The Federal response to the Opioid Crisis

We also have, and we have seen this particularly in the riding of my colleague, the member for Vancouver East, childhood sexual abuse unrecognized, unreported, untreated. Gabor Maté, a doctor who has worked particularly in the Downtown Eastside, said every drug-addicted woman patient of his, every one of them, was a victim of childhood sexual abuse. This is the “hungry ghost” syndrome that he describes a psychic wound that cannot be healed, people turn to drugs. Some communities were used as a test market for new drug ingredients. That certainly is our speculation about Nanaimo. Many people using illegal drugs are not aware that fentanyl is included in them and they get into terrible trouble. In my community, I want to salute the many heroes who have stepped up in the absence of provincial and federal leadership. They have saved a lot of lives, but it has been at a great personal cost to them. I am hugely grateful for their work. By supporting this bill, I hope we will get the support they need to do this very difficult job they have been given. Another group that is such a hero in my community is AIDS Vancouver Island and the AVI Health Centre. Claire Dineen, the health promotion educator in Nanaimo, has led training for 800 people who are now trained in how to administer naloxone, which is the antidote to fentanyl. That woman has saved a lot of lives. I also want to salute Dr. Paul Hasselback, who is the chief medical officer for the Vancouver Island Health Authority. People are very lucky to have a man like him in our riding. When I meet with him, he has both the United Nations Declaration on the Rights of Indig- enous Peoples and the recommendations of the Truth and Reconciliation Commission on his desk. That is a sign of a man who is fully integrated in his work and making change in our country. He wrote:

“For the past four years, the riding that “you” represent has had rates of narcotic overdose fatalities that are some of the highest in the country.... During this time close to one hundred of our neighbours, friends, and families have passed away from this preventable tragedy. In four years, overdoses have become a leading cause of preventable deaths in our community.... an integrated approach to a community response has resulted in a much smaller increase in 2016 when compared to other BC communities. Action can save lives.”

He went on in his letter to state:

“When finally presented through actions of the province of BC with ways to implement overdose prevention sites where emergency response is available, the community has overwhelmingly embraced the service.... Supervised consumption is to be recognized as a health service that can and should be provided in a variety of settings.... We also need to look to the future and how to prevent drug addiction. Youth employment, affordable housing, meaningful community contributions are our best approach to engaging those that illicit drug predators would target as future consumers. Action is needed now to mitigate this crisis, and needs to consider what could be done to reverse the recruitment of persons to experiment with potentially addictive drugs.... While legislation is welcomed, it focused again predominantly on the enforcement side of the equation, permitting for harm reduction services. What actions will the federal government take in prevention and in facilitating treatment or at least research into effective treatment? What actions will the government take on engaging youth on drugs similar to past efforts to work on tobacco?”

He finished by saying:

“Family Day is a great day to remember that many of our friends and colleagues have personally been affected through a member of their family. I have many stories that I have heard that are gut wrenching efforts to help loved ones. There are also stories of success to be shared.”

I have another success story from my riding. This is sent by a third-year biology student attending Vancouver Island University. He was one of the organizers of Vancouver’s first unsanctioned supervised injection sites. When people were dying on the streets and we could not get provincial or federal support, Jeremy Kalicum and others took action, and he writes this description:

“In short order, we established an unsanctioned supervised injection site equipped with harm reduction supplies, volunteer nurses, and naloxone. Our goal was to provide a judgment-free space that would allow people who use drugs to feel that their situation and struggles were not being ignored. Although people who use drugs were initially sceptical of our service they soon learned that we were not there to entrap them...[we] wanted them to be safe.” 210 The Federal response to the Opioid Crisis

That facility is not operating now because the health authority opened a supervised injection site in the last few weeks. I am proud that the New Democrats led the fight against the Conservatives’ Bill C-2, which was absolutely damaging at the exact time we needed progressive action. I am glad the Liberals are bringing forward Bill C-37. It is overdue. We wanted it a year ago. We want the Liberals to call this a national emergency. The war on drugs approach has clearly been a failure. Instead of stigmatizing and punishing Canadians who are suffering from substance abuse disorders, it is time for bold and compassionate leadership from the federal government. We need to rapidly expand proven harm reduction approaches, while making significant long-term investments in prevention and public addiction treatments of all kinds. I urge Parliament to vote in favour of Bill C-37. I urge the government to accelerate its action in some of the other areas that New Democrats have identified, to view drug addiction as a health issue, and, most important right now, to send our thanks and support to the front-line responders who fill a tremendous gap in a time of true national emergency.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Mr. Speaker, it is important to recognize that the New Democrats have acknowledged the importance of the legislation and supported us in trying to push it forward. It is truly appreciated, but it is one aspect of a comprehensive approach that the government has taken to deal with a national crisis. I wonder if the member would comment on the importance of working with the many different stakeholders, whether it is provincial entities, the municipal governments, first responders, or the communities. There is a much larger role for all of us to play and the important role the national government needs to play is one of leadership. It is a holistic approach in trying to prevent many of these accidental overdoses from taking place. Would the member agree?

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

Mr. Speaker, we were hoping a year ago that the federal government would step up and declare the opioid overdose crisis a national emergency. We had testimony at the health committee. Dr. Emberley from the Canadian Pharmacists Association said that it was definitely a national problem, that no community was unaffected and for that reason, he believed it had to be treated as a national crisis. As well, Dr. Blackmer from the Canadian Medical Association said that the chief public officer should be coordinating a national response to the opioid overdose crisis. There is a lot the federal government can learn from what is being done at the provincial level. This is a national emergency. We wish the Liberals had stepped up earlier. We certainly thought they were going to based on their election rhetoric. People have died in the interim. We want them to accelerate their actions and support front-line workers, addicts and their families.

NDP MP Linda Duncan (Edmonton Strathcona, Alta.):

Mr. Speaker, I would like to thank my colleague for her very heartfelt and well-founded speech on the bill. As she says, we need the federal government to respond to this national health emergency crisis. We also need, as a way to prevent this and as she mentioned, investments in affordable housing and harm reduction safe injection sites. That is what my mayor, Mayor Don Iveson, is calling for in the city. Right now, the cities have to pay for the protection measures that are in place to have police respond. Therefore, they are to be given naloxone kits but also the analysers which cost a lot of money. What additional measures, in addition to passing the bill, could the federal government take to ensure people are no longer living at risk and people who are resorting to drugs feel there is some kind of mental health support available for them?

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

Mr. Speaker, there is so much work the federal government can do if it truly wants to step up to the plate on this. I was elected to local government for 12 years before being elected to the House and we heard this again and again. If we had partnership with the federal government on a national strategy to abate poverty, we would lift so many people out of being in health crisis. If we better supported home care, then we would have seniors supported where they want to be, which is at home. We would not have people brought into the emergency department, clogging up acute care beds. One after the next, if we take our federal leadership role to help people in the most desperate places, we save money ultimately for the government. We are easier on front-line workers and families, and we allow people to have the dignified life that every Canadian surely deserves.

211 The Federal response to the Opioid Crisis

Parliamentary Secretary to the Prime Minister (Youth) Peter Schiefke (Vaudreuil-Soulanges, Que.):

Problematic substance use and addiction pose significant risks for individuals, families, and communities. Our government is committed to addressing this complex public health issue using an approach that protects public health and maintains public safety through drug policy that is comprehensive, collaborative, compassionate, and evidence-based. Problematic substance use and addiction pose significant risks for individuals, families, and indeed, communities. Our government is committed to addressing this complex public health issue using an approach that protects public health and maintains public safety through drug policy that is comprehensive, collaborative, compassionate, and most importantly, evidence based. A comprehensive public health approach to this crisis must include harm reduction alongside prevention, treatment, and enforcement. Harm reduction recognizes that not all individuals are ready, willing, or able to seek treatment for drug addiction. Those who for whatever reason are outside the treatment system deserve to be treated with dignity and respect. Just like every other Canadian, their lives are valuable and they are worth saving. Supervised consumption sites and other evidence-based harm reduction measures provide services to active drug users to help improve their health and prevent harms, including death. I know some members in the House talk about supervised consumption sites as controversial and say that they have well-grounded concerns about this portion of Bill C-37. Today, I want to address these concerns by discussing the evidence on supervised consumption sites. This evidence is available in peer-reviewed journals, including some of the most esteemed medical journals around the world. We are living in a time when opinions can somehow become facts simply by stating them in a public forum. This concerns me and it should concern everyone in the House. As Canadians, we are lucky to have the most well-researched supervised consumption site in our own backyard, Insite. While supervised consumption sites have existed in Europe since the 1980s, the studies done on Insite produced specific, measurable evidence of the impact of this supervised consumption site on drug users and on the surrounding community. Insite began as a pilot project and was the focus of a significant scientific evaluation. Over 30 peer-reviewed journal articles came out of this evaluation, all of which demonstrated that Insite was achieving its objectives without having a negative impact on the surrounding community. I will not stand here and list off each of these studies, but I will mention a few. For example, a 2004 study published in the Canadian Medical Association Journal found that in the 12 weeks after Insite opened, the number of drug users injecting in public and the number of publicly discarded syringes and injection-related litter were reduced as a direct result of Insite being there. Further, a 2006 study published in The New England Journal of Medicine found that at least weekly use of Insite and any contact with the facility’s addictions counsellors were both independently associated with people entering a detoxification program more quickly. Finally, given the opioid crisis that we are currently facing, I want to highlight a 2011 study published in The Lancet. It found that fatal overdose rates in the area around Insite decreased by 35% after the opening of the site. This is compared to a decrease of only 9.3% in the rest of the city during the same time period. Furthermore, the European Monitoring Centre for Drugs and Drug Addiction indicates that the common concerns regarding supervised consumption sites, such as increases in crime and drug use, are simply not grounded in evidence. It is clear from the research that supervised consumption sites can play an important role in a community’s response to problematic drug use. However, this does not mean that supervised consumption sites should be opened without taking into account the needs of a community and public health and safety considerations through a thorough review of an application. Rather, it means that the application process should start from a place that acknowledges the evidence. Sites need to be properly established, considering the need for a site, community concerns, and local conditions that may influence the effectiveness of the site. They must be properly maintained to ensure clients continue to receive proper care and communities continue to have confidence in the service that is being provided. It is understandable that Canadians may have questions and concerns regarding the establishment of such a site in their community. These sites are still relatively novel in North America. That is why consultation with communities plays an integral role in the success of a site. The Supreme Court clearly recognized the importance of consulting with community members when establishing such facilities and included community support or opposition as one of the five key factors the Minister of Health must consider when assessing any application. I do want to make one thing clear. Consultations are just one part of the application process. The government is committed to evidence-based decision-making. That means casting aside current ideological debate during discussions about drug use, taking all of the relevant information into account, and making informed, evidence-based decisions. That is why Bill C-37 would replace the 26 criteria currently in the legislation with five factors described by the Supreme Court of Canada in Attorney General of Canada, et al. v. PHS Community Services Society, et al. in 2011. Reducing the number of criteria applicants would have to address would relieve the administrative burden on communities seeking to establish a supervised consumption site, but it would also do so without compromising the health and safety of those operating the site, its clients, or the surrounding community. Removing the application criteria from legislation allows the government to maintain a thorough evidence-based application process that can be adapted and updated over time to reflect emerging science. At the same time, it would keep communities at the heart of applications and allow applicants to respond more quickly to emerging health issues. 212 The Federal response to the Opioid Crisis

For example, there would no longer be a requirement for applicants to submit evidence that supervised consumption sites are effective and have public health benefits. As I noted earlier, the evidence in this regard is clear. Instead, applicants would need to demonstrate the need for the site and the public health benefits of the proposed site for the local community. This change would help ensure that applicants considered their local context, including the needs of their community, when designing their proposed site. This government is committed to making objective, transparent, and evidence-based decisions. With respect to supervised consumption sites, the evidence is clear: properly established and maintained sites can save lives without having a negative impact on the surrounding community. I urge all members to support Bill C-37 so that we can move forward on addressing the opioid crisis through a comprehensive response that includes evidence-based harm reduction measures that help save lives.

Conservative MP Dianne L. Watts (South Surrey—White Rock, B.C.):

Mr. Speaker, I was delighted to hear that the consultation was an integral part of the strategy and that the community was at the heart. However, all of the language around community consultation was removed from the bill. Several amendments were also voted down. I will touch on some of them. One was regarding obtaining letters of support or opposition within a two-kilometre radius of a site. That was voted down. One was regarding identifying schools and day cares within a two-kilometre radius. That was voted down. One was regarding obtaining a letter of support or opposition from the mayor and council, or the police chief. That was voted against. There is no criteria laid out within the bill, and I wonder where the integral part of community consultation within Bill C-37 is as it relates to the comments that my colleague has just made.

Parliamentary Secretary to the Prime Minister (Youth) Peter Schiefke (Vaudreuil-Soulanges, Que.):

Mr. Speaker, it is actually outlined quite clearly under the heading “Application”, proposed paragraph 56.1(2)(e), “expressions of community support or opposition.” The reason it is included in there is it is one of the five key criteria that was outlined by the Supreme Court in its decision. It is a key component of what we are proposing here. We are very proud that we are including it, because we understand the importance of ensuring that communities provide their support and have a chance to voice their opposition or support of any one of these sites.

NDP MP Gord Johns (Courtenay—Alberni, B.C.):

The health committee heard about the chronic underfunding of community-based detox and addictions treatment. Under the Conservative government, we saw addiction treatment get cut by 15%. I would ask the member if he also agrees that there is a lack of investment in treatment facilities for people with addictions. I know the Liberals said that they do not support calling this a national emergency, and do not believe that would give the public health officer any new tools. I am wondering what new tools the government can offer in immediate resources in the upcoming budget, because this is a crisis. Will the member agree with me that this is a national emergency?

Parliamentary Secretary to the Prime Minister (Youth) Peter Schiefke (Vaudreuil-Soulanges, Que.):

Mr. Speaker, one thing I can say is that this government takes this crisis very seriously. There are many aspects of Bill C-37 that are going to do some good across the country. We are ensuring that we are doing all that we can as a government to respond to this crisis. There are two key components. One is to ensure that we provide the CBSA with the tools necessary to allow it to look at packages that are less than 30 grams that are coming in from the United States and elsewhere. This would make sure that the primary source of this product coming into our country is being addressed by the CBSA. The other component is to ensure that we register the pill pressers and other devices that are required to make some of these opioids. We are taking a comprehensive approach, a wide-eyed view. I am very proud of the different initiatives that are included in Bill C-37. I will add that we are always looking at different ways that we can ensure we are doing right by Canadians, particularly youth who are affected by the opioid crisis. We are going to continue to look at different ways that we can help them.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, one thing that is of particular concern to me is we have known that fentanyl and carfentanil have been coming in from China for probably close to a year now. I would like to ask the hon. member why it has taken so long to get this particular piece of legislation to the table. The Liberals talk about this meaning lives. It has taken a year to deal with something as simple as giving border security agents the tools they need to stop some of the fentanyl and carfentanil from coming into this country. 213 The Federal response to the Opioid Crisis

Parliamentary Secretary to the Prime Minister (Youth) Peter Schiefke (Vaudreuil-Soulanges, Que.):

Mr. Speaker, as I said, this is something we have been working on for quite some time, ensuring that we are consulting with stakeholders all across the country, giving the justice committee and different committees the time necessary to look at this, and making sure the recommendations we are putting in place will actually have an impact on solving this crisis. One of the things I will state again is we are very proud of the fact that this bill would empower the CBSA to look at the different packages that are coming in. Is would allow CBSA to do something that it has not been able to do before, which is to look at packages that are less than 30 grams to see whether they contain fentanyl, so we can put a stop to the direct source of this problem, which is this product making its way into our country to begin with. As I said, we are always going to look at different ways of doing it. We are going to ensure that we take the time to do it right by consulting the different stakeholders.

Conservative MP Len Webber (Calgary Confederation, Alta.):

Mr. Speaker, it is my pleasure to rise today to speak to Bill C-37. The bill would amend the minister’s powers and discretion when it comes to approving drug injection sites in communities across Canada. It would remove community safeguards and put these important decisions entirely in the hands of a single minister and not in the hands of the local community. In an ideal world, we would not have to deal with the issue of drug addicts and where they choose to consume their deadly drugs, but we do. In an ideal world, drug abuse and the crime it causes in our communities would not be something we would have to face, but it is. In an ideal world, every addict would be on the road to recovery and the success rate would be 100%. That is just not the case. In reality, drug abuse has been around as long as anyone can remember, and it is getting worse. Literally, people are dying every day from their addiction and drug abuse. Many years ago, before I entered politics, I served on the Alberta Alcohol and Drug Abuse Commission, or AADAC. I served on it for a number of years. I learned a lot about drug addiction and the incredible pain that it causes. The experience there affirmed to me why we should never deal with drugs in a cavalier manner. Canada already has good legislation in place to permit drug consumption sites or safe injection sites, whatever we want to call it, but let me stress before I continue that there is no such thing as a safe injection site as there is nothing safe about drug injection and the abuse of drugs. The Liberals and the NDP claim that this current legislation is so onerous that no organization can succeed in getting the drug consumption site approved, yet we see that the government approved three of them in Montreal earlier this month. This proves the current legislation does strike a good balance. Referring to the current legislation and its purpose, the Supreme Court of Canada has set out clear criteria that must be met before a drug consumption site can be approved. One pillar of the current Conservative legislation was strong community consultation, which the Supreme Court agreed was essential. These consultations were not meant as a way to prevent sites from opening, but rather to adhere to the advice of experts in the field and to respect the community that would eventually have to support such a facility. Experts in drug addiction have testified before Parliament that for a drug consumption site to be effective and have any benefit, there must be a buy-in from the local community, a buy-in from the local law enforcement, and a buy-in from the local health officials. Let us stop for a moment and explain what these sites are. These sites are a designated place where we allow people to cause harm to themselves while immune from the law of the land. They can shoot up with a deadly illegal drug as long as they do it at one of these sites. If they do the same thing a block away, they are breaking the law. We must ask ourselves, how do we allow certain people to break the law multiple times a day, and how do we square that with society’s expectations as laid out in our criminal laws? How do we con- done the use of illegal drugs as a society and then tell our kids that they are not good for them? Very few people who are offered help at these injection sites ever accept an offer for treatment. They do not want to give up their highs and face the reality that awaits them. Of those who do enter treatment, even fewer see the program through. Of those who see the program through, even fewer actually stay clean. I have had numerous conversations with addictions counsellors in the past, and many have told me that the reality is, finding someone they can take from a drug abuser status to a somebody clean status is like finding a needle in a haystack. They say that in reality, most of these people currently addicted to drugs will die from their addiction. They may die earlier in life. They may develop health-related issues. They may die while engaged in crime to feed their addiction or they may simply overdose. These addiction counsellors say that these sites do save lives but then they question if they really do. If an addict’s life is saved today or tomorrow or next week, but that individual dies the week after from an overdose, was that life really saved? The counsellors suggested that these consumption sites are therefore not really a conduit to treatment but rather facilities for self-destruction and abuse until the addiction wins the war on its victims. That is a sobering assessment of what we face. Therefore, we really need to target the source of this problem as it appears rarely fixable after the fact. We need to prevent access to addictive substances before an addict develops. We need to stop the Liberal and NDP attitude of acceptance when it comes to drugs. Instead of campaigning to make drugs legal, those members should be campaigning to make it harder for folks to get introduced to the world of drugs. I along with my Conservative colleagues have been pushing for the Liberal government to tackle the root cause and that is the continuous flow of illegal drugs into our country and onto our streets. 214 The Federal response to the Opioid Crisis

I was appalled when all Liberal members voted down a motion I introduced a few months back in health committee to get the Chi- nese ambassador to come and tell us what his government is doing to prevent deadly drugs from being shipped into Canada, because 98% of illicit drugs come from China. Voting down that motion was disheartening and disgraceful. The Liberal government is more concerned about being friends with the Chinese government than it is with stopping the flow of deadly drugs on Canadian streets. The Liberals and the NDP want to make it really easy to open up a drug consumption site by removing the safeguards, removing community consultations, and turning a blind eye to the effect it will have on the community. The NDP wants to remove all of the burden of proof from the applicants when it comes to opening up drug injection sites. It is funny. Those members want a less onerous application process for safe injection sites, yet they want to increase the burden on job-creating applicants when it comes to building pipelines. They argue that safe injection sites will save lives. I say that getting pipelines built will save lives as building them would reduce our escalating suicide rate in Alberta. High unemployment and the despair in our oil patch is also costing lives. As I stated before, the experts are telling us that we need community buy-in for these facilities to be successful. Why do the Liberals and the NDP want to sneak these facilities into our communities without proper consultation? Drug consumption sites do have some benefits. They allow us to hide our problems away from the streets and they do save addicts so that they can fuel their addiction for another day. In very few cases they also facilitate a path for recovery. Let us not kid ourselves and believe that there is a lot of light at the end of this tunnel. These sites do help keep things like dirty needles out of our parks. They do make it cheaper for the health care system to monitor and save some addicts. They do not reduce the drug problem in Canada. They do not stop people from becoming addicts. They very seldom get addicts off drugs. These sites do not curtail the profits for organized crime. They are not a silver bullet. They are one very weak tool in our fight against addiction and its deadly toll. If we want these sites to have some positive benefit and improve outcomes then we need community buy-in and this is done through open, transparent, and exclusive consultations. Sadly, this is not what this bill would do. It would weaken the existing legislation. Therefore I must vote against it.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, the member mentioned that community support as stated by the Supreme Court was not meant as a way to prevent safe consumption sites from opening. It was not meant to prevent the opening of safe consumption sites. We have taken the exact language that is in the Supreme Court judgment, which states that one of the factors to be taken into account is the expression of community support or opposition. What was meant to prevent these sites from opening were the 26 criteria in Bill C-2 that the previous government put forward. The member mentioned that three sites have opened in Montreal. Does he know how long it took for those sites to open even though we are facing a health crisis in Canada when it comes to opioids? I will answer my own question. It took nearly two years for those sites to open even though the community, the mayor, the provincial actors, as well as health professionals in Montreal wanted them. Is the member at least aware of the time it took for these sites to be approved under the previous legislation? While I have the floor, I must say that I am a bit challenged by the comparison that the member made between pipelines and these safe consumption sites. Addicts are people. The government has a responsibility to protect people sometimes from themselves and that is what these safe consumption sites are all about.

Conservative MP Len Webber (Calgary Confederation, Alta.):

The point that I was trying to make in committee was simple, although maybe difficult to express. I firmly believe that when applying for a pipeline or a drug injection site, the burden of proof should rest with the applicant and not the taxpayer. I know that New Democrats believe that those applying for a pipeline must prove that it is in the public interest, that it is safe, and that strict operating conditions would be applied. I expect the same of those who want to open drug injection sites in communities. That was my point with regard to pipelines. With regard to community consultation and how long it took to get these facilities in Montreal, it may take time, but we also know that there is a lot of Nimbyism in our communities, and I do not blame them. These facilities are magnets for the types of people and activities that we work hard to shield our children from. That said, these facilities will have to go somewhere else, on somebody else’s street. The key thing, hon. member, is that communities be properly consulted and this legislation would not allow that. This is what the -ex perts are telling us, hon. member, and why the Liberal government is so determined to move ahead without hearing from key stakeholders.

NDP MP Gord Johns (Courtenay—Alberni, B.C.):

The war on drugs has not worked. That approach has not worked. People are using hard drugs in our communities, people we know. I saw a man in downtown Vancouver, who came from a good family, who is struggling with addiction. He went to Insite, a safe place to do drugs. He ended up getting treatment and went home. It is really important to know that we can save lives. I hope it is not the Conservative position that those who are not ready or able to seek treatment today are not worth saving. The Conservative government cut addiction facilities by 15%. Maybe the member can explain this to the House, We know that we have to take a multi-faceted approach. We have to do what we can to stop drugs coming into our communities, to provide safe places for people 215 The Federal response to the Opioid Crisis to do drugs, and for people to get the therapy and addiction services they need. Does the member agree with me that we need to take a multi-faceted approach? No one has died at Insite. It is important that we take a holistic approach to tackling this problem. We have tried with education. Children are now doing drugs in Vancouver. I hope the member will come to the Downtown Eastside. He will meet people from my rural community who have ended up there and see the benefits of this facility.

Conservative MP Len Webber (Calgary Confederation, Alta.):

Mr. Speaker, I will tell the hon. member that I have been to Insite. I toured it over the summer. It was a disturbing and sad sight. Of course, I agree with the work that is being done at Insite, but my main point tonight was that we need community consultation when we implement other facilities like Insite into other communities across Canada. The tour that I was allowed to partake in with a number of colleagues was disturbing. The police accompanied us and we went into the back alleys on East Hastings. I can say that the work it is doing is good work. Needles are being put away safely, people are provided with safe needles, people are monitored, and naloxone is available if it is required, which is a good thing. However, my point tonight was that we need community consultation before opening safe injection sites across Canada.

Liberal MP Francis Scarpaleggia (Lac-Saint-Louis, Que.):

Protecting the health and safety of Canadians is a key priority of this government, and that is why on December 12, 2016, the Minister of Health, with support from the Minister of Public Safety and Emergency Preparedness, introduced Bill C-37 in the House of Commons. This bill would make several amendments to the Controlled Drugs and Substances Act and the Customs Act in connection with the government’s efforts to address the current opioid crisis as well as problematic substance use more generally. This a comprehensive bill that seeks to balance the important objectives of protecting public health and maintaining public safety. It is designed to better equip both health professionals and law enforcement with the tools they need to address this issue. Over the last decade, the harms associated with problematic substance abuse in Canada have become more complex and have been changing at a rapid pace. The line between licit and illicit substances has blurred with the opioid crisis, prescription drug misuse, and the rise of new designer drugs. The government is committed to helping Canadians affected by problematic substance abuse. Legislative and regulatory controls are certainly an important part of this approach. However, as we know, drug use and dependency pose significant risks for individuals, families, and communities. Our approach to addressing problematic substance abuse must include preventing and treating addiction, supporting recovery, and reducing the negative and social impacts of drug use on individuals and their communities through evidence-based harm-reduction measures. These obviously must also be part of our approach to addressing the problem. Harm reduction is viewed by experts as a cost-effective element of a well-balanced approach to public health and safety. It has been a very good debate. I have listened intently, and it has been very informative.

FEBRUARY 15, 2017 Health Minister Jane Philpott moved that Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts, be read the third time and passed.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, it gives me great pleasure to rise on the third reading of Bill C-37. I am particularly gratified at the speed with which the bill has moved through the House of Commons. I want to thank all members, including all parties, who have been very helpful in agreeing to time allocation, agreeing to expediting the committee process, and the fantastic work at the committee level to move the bill along. This demonstrates the serious nature of the bill, and recognizes the ongoing opioid crisis and the need for urgent action. Bill C-37 is one of a range of comprehensive responses to this very challenging issue. We are eager to advance the bill through Parliament to help protect the health and safety of Canadians and their communities. It has been said before in the House that problematic substance use is an issue that affects Canadians of all ages. It affects people from all socio-economic groups. We should also point out that there are, however, particular groups that are excessively vulnerable to the risks associated with problematic substance use, people living in poverty, people who have experienced trauma in their lives, and indigenous peoples of Canada.

216 The Federal response to the Opioid Crisis

We are facing nothing short of the greatest drug crisis our country has faced. It is a national public health crisis related to opioids. For example, one may draw attention to the fact that in British Columbia last year more than 900 people died from overdoses. That was an 80% increase over 2015. The majority of those deaths were related to the rapid spread of the drug fentanyl. Elsewhere in Canada, we are hearing from law enforce officials that there are increasing numbers of seizures of fentanyl and carfentanil. Last week, we heard about the distressing number of deaths linked to opioids in Alberta. For example, in 2016, 343 people died in Alberta from fentanyl overdoses. That was an increase over 257 the previous year. It is necessary that the Government of Canada use every single tool at our disposal to help turn the tide on this crisis. We need a policy approach that is comprehensive, collaborative, compassionate, and evidence-based. Bill C-37 would further strengthen our government’s response to the opioid crisis. Lest there be any doubt that we are pulling out all the stops to respond to this crisis, let me review what we have done over the past year. It includes things like ensuring naloxone, which is the antidote to overdose, is available on a non-prescription basis across the country. That involved me ensuring that we had naloxone nasal spray available on an emergency order so it would be available to Cana- dians, and expediting the approval of naloxone nasal spray. We also launched Health Canada’s opioid action plan. This is a plan to improve access to education for both the public, as well as prescribers, to ensure that we support better treatment options, that we reduce access to unnecessary opioids, and that we expand the evidence base. In the matter of expanding the evidence base and getting better data, we supported McMaster University to produce guidelines for prescribing opioids in situations of chronic pain. Those new guidelines are now available for consultation. We overturned a ban on prescription heroin so doctors might use it through Health Canada’s special access programs to treat the most severe cases of addiction. We have supported the good Samaritan drug overdose act, which offers immunity against charges for simple possession for individuals so they will call 911 if they witness an overdose and they will stay at the scene to help. We have also put in place a number of regulations to schedule fentanyl precursors for controlled substances, making it harder for illicit substances to be manufactured in Canada. I co-hosted, along with the minister of health for Ontario, the opioid conference and summit. At that summit, we had nine provincial and territorial health ministers. We also had 30 other organizations. We produced a joint statement of action that had 128 commitments. In addition, in collaboration with the provinces and territories, we have put together a special advisory committee that includes the Council of Chief Medical Officers of Health. This committee is very active at ensuring we have better access to data that is up to date about the state of the circumstances. We also have a task force within the federal health portfolio to work with all federal departments in a comprehensive response to the crisis. We funded the Canadian research initiative on substance misuse. It is providing now evidence-based guidelines for medication-assisted treatment. In December, I joined the Minister of Public Safety and Emergency Preparedness in introducing Canada’s new drugs and substances strategy. We reintroduced at that time harm reduction as a key pillar in drug policy. I would like to talk now a bit about what we have done to support the establishment of supervised consumption sites. Early on, we granted an exemption to the Dr. Peter Centre in Vancouver to operate a facility, and we provided an unprecedented four year exemption to Insite to continue the good work it was doing. For communities that have demonstrated a need and desire to have such a site in their community, we want to create an environment that will encourage applicants to come forward. That is why, pending passage of the bill, we have adjusted operational procedures in the interests of removing unnecessary barriers to the review and approval of supervised consumption sites. Just last week, I was very pleased that we were able to issue exemptions for three new supervised consumption sites at fixed locations in Montreal. The time frame to approve these sites was unacceptable. It took a year and a half, and that was due to the onerous 26 criteria that existed under the previous legislation. However, finally we were able to get an exemption for them. These new sites, located in Hochelaga, Maisonneuve and Ville-Marie districts and operated by the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Ile-de-Montréal, will be able to provide care for people in those areas. Health Canada has expedited a review of 10 pending requests for approval in other communities. There is an additional site in Mon- treal, three sites in Toronto, two in Vancouver, two in Surrey, one in Ottawa and one in Victoria. Even while doing this, we have maintained the key essential criteria to ensure we protect the health and safety of staff, people who use drugs, and the neighbours who are in the areas of the proposed sites. We are working with all applicants to ensure that those applications are complete and that the department has received the necessary information. Passing Bill C-37 will be so helpful to streamline the application process and it will be a big step forward for these communities. Some have wondered why we have not declared a public health emergency. What I have said for months is that clearly we are in the midst of a national public health crisis of unprecedented proportions related to a growing number of opioid overdose deaths. However, the Federal Emergencies Act, which was formerly called the War Measures Act, is a tool of last resort. It is there to ensure public safety

217 The Federal response to the Opioid Crisis and security when a national emergency cannot be addressed by any other law. This act was not used in the case of SARS, H1N1 or Ebola. It is not the right instrument, but as I have already noted, we will make use of every tool at our disposal. We have already taken extraordinary steps at the federal level, and Bill C-37 is another essential step. Bill C-37 needs to be passed without delay. This is not a political matter or an ideological matter; it is a matter of saving lives. With the current growing rates of opioid overdoses and deaths, we have recognized there are gaps and weaknesses in the current federal legislative framework as it relates to controlled substances. To address those under Bill C-37, we will provide the government with the ability to more easily support the establishment of supervised consumption sites, a key measure in harm reduction. We will also address the illegal supply, production and distribution of drugs. We will reduce the risk of diversion of controlled substances that are used for legitimate purposes to the illegal market by providing improved compliance and enforcement tools. Bill C-37 would simplify and streamline the application process for communities that want and need supervised consumption sites. It would replace the 26 application criteria with the five factors that were identified by the Supreme Court in its 2011 decision regarding Insite. It is important for all members to understand that Bill C-37 retains the need for community consultation, and it also adds increased transparency, making it a requirement for the Minister of Health to make public decisions on applications, including any reasons for denial. To support these proposed changes, Health Canada will post information online about what is required in applications, how the process works, and the status of applications. Supervised consumption sites are an essential part of a harm reduction measure. There is a vast abundance of international and Canadian evidence that shows that when they are properly established and maintained, they save lives and improve health without increasing drug use or crime in surrounding areas, they prevent infection, and, best of all, they provide a safe, non-stigmatizing, non-judgmental way for people to be introduced to the health care system. Harm reduction measures in Bill C-37 complement a number of other actions that the government is taking to protect community safety. For example, the RCMP is working with the Chinese ministry of public safety to combat the flow of illicit fentanyl and other opioids into Canada. Bill C-37 is proposing to prohibit the unregistered importation of pill presses and encapsulators, which would make it more difficult to produce illicit drugs and, in turn, keep these illicitly produced opioids and other substances off our streets. Bill C-37 would also give border services officers greater flexibility to inspect suspicious incoming international mail. As has been said before, just a standard-sized envelope can contain enough fentanyl to cause thousands of overdoses. Before I conclude, I want to say a few words about treatment. It is absolutely essential to understand that we will not turn this crisis around by harm reduction alone. People need to have access to the broadest range of treatment options. Delivery of health services, including the treatment of addictions, falls largely under provincial and territorial jurisdiction. That is why I am very pleased to say that this fiscal year the federal government is transferring $36 billion to the provinces and territories to support the delivery of care. With the support of the Prime Minister, we identified new funding for the provinces and territories, in the order of $5 billion for mental health over the next decade, which will help people facing mental illness, including addiction. We need to address the social drivers of the opioid overdose crisis. That includes things like poverty, social isolation, unresolved trauma, sexual abuse, and mental illness. It is widely understood that untreated mental illness is a common cause of addiction and early intervention is absolutely essential if we are going to counter such addiction. I want to emphasize in the House that we need to include all four pillars in our Canadian drugs policy: prevention, treatment, harm reduction, and law enforcement. Prevention is so essential, as we understand that issues like social equity are absolutely important, cultural continuity, people having the opportunity to have healthy and safe childhoods, and making sure people heal from any unresolved trauma and grief in their lives, which might drive them to problematic substance use. There is no single action that, on its own, is going to end this opioid crisis immediately, but Bill C-37 is an absolutely essential step in the process of moving to that end. We need a balanced approach. We need to work collaboratively with all other levels of government and civil society organizations. All Canadians need to work together. We need to have partnerships across the country, including, as I said, with provinces, territories, and municipalities that are very much engaged on this matter and, of course, indigenous leaders. We need to protect Canadians, to save lives, to address the root causes of this crisis, to give people hope, and to make sure that all matters are addressed in order to turn the tide of the opioid overdose crisis. I encourage all hon. members to recognize the importance of this bill and to support its speedy passage through the House. I look forward to working with all members to that end.

Conservative MP Harold Albrecht (Kitchener—Conestoga, Ont.):

Madam Speaker, I want to thank my colleague, the Minister of Health, for her work on the health file. There is no question in my mind that she has the best interests of Canadians at heart. However, we may agree to disagree on a couple of facts. First, we agree on this side of the House that the opioid crisis needs attention quickly and forcefully. There is no question about that. The other part of Bill C-37 refers to supervised injection sites. I think we would find on this side of the House, and, indeed, probably within each party, that there are differing opinions on that. In fact, some of the opinions are supported, clearly, by front-line police officers in terms of their safety and efficacy and public safety. 218 The Federal response to the Opioid Crisis

My question for the minister is this. Why did her party not allow the bill to be split into two component parts, which would have clearly allowed fulsome debate on both issues, and then, more importantly, why are Liberals shutting down debate and minimizing the amount of time that members of Parliament, who were elected to represent their communities here in the House, can debate this issue?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Madam Speaker, I wonder if the hon. member can understand the kind of pressure we receive when members of the communities are telling us every day that they are going out and literally seeing people dying in the streets. I recognize that the hon. member may struggle with the challenges associated with this, and there is always some anxiety related to how we best respond, but the evidence is clear. The hon. member should meet with the chief of police in Vancouver, and meet with the chief of police in Calgary, and talk to them. Although some leaders at first doubted whether supervised consumption sites would be helpful, they have become absolutely convinced that it is essential to save lives. It is reprehensible for us to not move forward on this. The lives of people are at stake.

NDP MP Tracey Ramsey (Essex, Ont.):

Madam Speaker, the NDP will be supporting Bill C-37. It is so incredibly important to my riding of Essex. I am holding an opioid round table this Friday with stakeholders, and very concerned families who are desperate for help for their family members, and for those in their community who are suffering under this crisis. As a member of a committee of this House, it is incredibly important that we honour the work that is done at committee. Therefore, my question to the minister revolves around the health committee and the emergency study that it conducted into the opioid crisis. The very first recommendation that was made with all-party support was to declare opioid overdoses a national public health emergency. This would give the public health officer of Canada extraordinary powers to act immediately while Bill C-37 works its way through Parliament. My question to the minister is this. In the face of this mounting death toll across our country, will the minister stand today and declare a national public health emergency so we can start saving lives in Canada?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

With respect to the recommendations of the health committee, it has made an excellent series of recommendations, and has done fantastic work. I would encourage the member to read the Emergencies Act to make sure that it is well understood, and to realize that this particular circumstance does not require the invoking of the Emergencies Act. If the member can tell me a single thing that we could do by invoking that act that we cannot already do, I would be happy to hear it. I have told this House repeatedly that I will pull out every stop and will take every action that is necessary. However, there is nothing that act would allow that we cannot already do. We have the authority to do what needs to be done. I want to encourage provinces, territories, municipal leaders, and health care providers to also do their part. We cannot solve this alone. We will do everything within our power to make sure that it is turned around.

Liberal MP Bill Casey (Cumberland—Colchester, N.S.):

Madam Speaker, I am pleased to rise on this bill because I was a member of the health committee that studied it. We heard from doctors, nurses, scientists, and police, but the most compelling testimony was from paramedics. I want to mention the paramedics from Vancouver especially, because they deal with this issue day in, day out, all day long. I do not know how they can do it repeatedly. They told stories about finding young people unconscious in alleys with needles still in them, how they would bring them back to life, and then two days later they would get another call and come back to the same situation with the same person. It was an incredible story. What we are dealing with is an incredible emergency, and Bill C-37 is designed to deal with that emergency. I want to ask the minister this. How can passing Bill C-37 help those paramedics especially, because I do not know how they can do it, day in, day out? It must have a tremendous effect on them and their families.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Madam Speaker, I want to thank the member for his excellent leadership role on the committee, which has done such outstanding work on this crisis. He draws attention to something that is very important, which is that we need to recognize the incredible work of first responders, in particular, paramedics. The pressure on these paramedics is remarkable, and I have heard similar stories. Bill C-37 would allow the increasing availability of supervised consumption sites so that these paramedics would have somewhere to take people where they would be welcomed, where people would know that they can be introduced safely into the health care system,

219 The Federal response to the Opioid Crisis and where we can prevent death from overdose. They might have an opportunity as well to be introduced to treatment when they are ready for that. Therefore, we encourage the availability of these sites, and encourage all players to make sure that we increase access to treatment so that lives will be saved, so that people will find that there is a way to find hope for their future, and so that we can also make sure that first responders are respected and do not have to go through this terrible ongoing crisis.

Conservative MP Garnett Genuis (Sherwood Park–Fort Saskatchewan, Alta.):

Madam Speaker, I wonder if the health minister can very clearly explain to us why the government did not accept our request for unanimous consent to split the bill. Had the government accepted that, four-fifths of the provision of this bill would already be in the Senate and perhaps would already be law. Why did the government not accept our offer to expedite those sections of the bill so that we could have gotten on with the parts we agree on faster without forestalling the debate on the one section on which we disagree? Why was the government not willing to work in that non-partisan way to actually get those key sections done?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Madam Speaker, I am very pleased that the Conservatives were able to vote in favour of the expedited process in the committee that agreed to move on this. It speaks to the fact that some of their members recognized that this is an urgent matter. When we look at the data from British Columbia, we see there are four, five, six people dying every single day. This is absolutely unacceptable, that we would stand by and continue to debate a matter when we have a bill that could help communities like not only Vancouver but Edmonton, Calgary, and Toronto to be able to have the facilities available. I would be happy to speak with members about any additional ideas they have, but we have to get this bill through.

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

Madam Speaker, as members know, New Democrats support the bill. I spoke at length yesterday about the impact that it would have to support front-line RCMP, ambulance attendants, firefighters, and community volunteers who are doing their best to fight this huge epidemic. My community of Nanaimo has been hit very hard. I would love, though, to hear more about the minister’s reasons for not calling a national health emergency. I note that Dr. David Juurlink, the keynote speaker at the minister’s own opioid summit; B.C. health minister Terry Lake; and stakeholders across Canada are all still calling for a declaration of a national emergency by the federal government. It is my understanding that this would facilitate more federal funding, community-based detox, addictions treatment, and emergency pop-up safe injection sites and safe consumption sites on an emergency basis.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Madam Speaker, I would encourage the member to speak to Dr. Juurlink, who now understands the reasons why it is not appropriate to declare a national health emergency, but there are many features that the member asked for that we are already doing. If she wants more funding, I encourage provinces across this country to accept the $5 billion that we have offered through the health accord, and to put that money to work to provide better access to mental health care and treatment. We have offered mobile units. The Public Health Agency of Canada has said to many communities, including those in British Co- lumbia, “Let us know when you need our emergency mobile units. We will get in there and set them up.” Let those communities know we are prepared to do everything that it takes.

Conservative MP Garnett Genuis (Sherwood Park–Fort Saskatchewan, Alta.):

We have seen a funny pattern from government members, where they draw our attention to a significant problem yet actually refuse to collaborate in a non-partisan way to move these things forward. That is very clearly on the record. Members can laugh, but this is not a funny topic, and it is not funny that we tried to move this forward quickly and the Liberals got in the way. Let us review the record of what happened. The bill contains certain provisions that are vital for addressing the challenges we face. It also, though, contains a provision that would remove effective community engagement on supervised injection sites. We have a big problem with that, and I will talk about why that is later on in my speech. It is important for people to understand what the government has done here. Recognizing the need to move quickly on certain provisions but also the need to have thorough debate on this one particular provision on community consultation, our very hard-working member for Oshawa, our health critic, brought forward a request for unanimous consent to split the bill.

220 The Federal response to the Opioid Crisis

What he proposed was very reasonable, and it would have effectively addressed this issue. What he proposed was to split the bill into two sections. The sections on which we all agreed there be urgent action, and I will talk about what those are, he and all of us would agree to immediately deem adopted at third reading, fully adopted by the House, and sent to the Senate. Very likely the Senate would have moved quickly on that as well. Those provisions could already be law today and already addressing this problem right now as we speak. That was our proposal brought forward by the member for Oshawa. However, the government said no. Why? It insisted that removing an effective voice for communities in the process had to be tied to these other important life-saving measures. It was the Liberals’ decision to slow this down by refusing to split the bill. In fact, the offer we proposed in our unanimous consent motion was not just to expedite the provisions on which we agreed. It was also to immediately deem referred to the Standing Committee on Health the provisions on which we disagreed. We were even willing to move that immediately to committee for study while immediately adopting those things on which we agreed. This is how we proposed to work in a non-partisan fashion to move quickly on the things we could move quickly on to get this done. The government, while pleading about the need and the urgency of this crisis, actually refused to give unanimous consent to our proposal to expedite those sections. Given the strong words coming from the health minister and other members of the government, it is utterly shameful that they refused to work to move this forward. I would like to highlight the sections of the bill we agree on and the sections of the bill that could today already be law had the government been willing to work in a non-partisan manner. They will still become law eventually, but it is unfortunate that we were not able to move on the timeline we wanted. The bill proposes to regulate the import of pill presses. Currently, pill presses, which are used for putting together illegal drugs, can be imported freely. The bill contains important provisions that would have any pill press imported registered with Health Canada and that would give our border services officials the authority to detain unregistered pill presses at the border. This is a very important measure that we have strongly supported. It could be law today if the government had been willing to work to expedite this in a non-partisan manner. Another great provision in the bill would increase prohibitions against certain actions related to controlled substances. This would enhance the ability of the government to stop, in this instance, the transportation of illicit substances. It would enhance the power to do that under the relevant legislation. Again, it is a very positive provision. It would be making a difference if it were law today. It is something we could have moved forward on more quickly. The bill would grant increased powers to the Canada Border Services Agency to open and inspect packages entering Canada, packages that it suspects may contain contraband such as drugs. Again, it is an important provision that CBSA be given the power to move forward and open packages that it believes contain illicit substances. Again, there is no reason anyone should oppose that. That is why it should have been done by now. It should have been passed quickly. It would have been passed quickly had the government agreed to work with the opposition and split the bill, as we proposed. In terms of the category of things we agree on, the bill proposes temporarily accelerated scheduling, essentially allowing the Minister of Health to quickly, but temporarily, schedule and control new drugs and substances under the relevant legislation. This is important, because we have seen new drugs coming to the fore on a regular basis. These powers are important. Four out of the five changes that we would say yes to on this side of the House could already have been law today had the government been willing to work with us. Why was it so important for us to raise concerns and to insist on further debate on the one provision on which we disagree? The government is proposing to change the community consultation process on supervised injection sites. I have talked before about broader concerns about supervised injection sites. I know that there are many Canadians who do not believe we should have legal islands that allow people to use drugs legally. If we want to send the strongest possible message about the dangers of drug use, we may want to be optimistic in our compassion instead of pessimistic in our compassion. Many Canadians reflecting on that have broader concerns about these supervised injection sites. Let us be very clear. That is not the question in this legislation. The question in this legislation is the degree to which, and the nature of how, communities should be engaged in the conversation about that. The original provisions that were put in place under the previous government established some key requirements with respect to how communities had to be engaged. There had to be strong engagement with the community to maximize the chances that these types of facilities would be successful. The previous legislation put in place a reasonable process to get that done. The government is proposing in this legislation to significantly pare down any kind of engagement. Previously, there was a requirement that the period of consultation be at least 90 days. The new provisions would allow a period of consultation of up to 90 days. There would actually be no minimum. They could spend two days undertaking the consultation. The requirements in the legislation they put forward are pared down. It says:

“An application for an exemption under subsection (1) shall include information, submitted in the form and manner determined by the Minister, regarding the intended public health benefits of the site and info rmation, if any, related to (a) the impact of the site on crime rates; (b) the local conditions indicating a need for the site; (c) the administrative structure in place to support the site; (d) the resources available to support the maintenance of the site; and (e) expressions of community support or opposition.” 221 The Federal response to the Opioid Crisis

They have to provide some of that basic information. They would satisfy the provisions of the new bill if applicants simply said that they talked to a few people in the community about opening a supervised injection site and no one liked it, but at least they talked to some people. That would be sufficient under the -pro posed legislation. Let us talk about what the Liberals took out. We hear a lot from the government about the importance of scientific evidence. Actu- ally, the existing application requirements we put in place require “scientific evidence demonstrating that there is a medical benefit to individual or public health associated with access to activities undertaken at supervised consumption sites”. Among other things, the previous legislation actually requires that scientific evidence be presented on what the impacts would be in the context of the application. That would be removed by these new requirements. We put requirements in place for consultation with local law enforcement and local governments, which are going to be called upon to respond to the challenges and situations that are in place. Those were things that were in place before and would now be pulled back. One of the defences we hear often from the government and the NDP about supervised injections sites is that there are actually some drug treatment services available at the sites. I know that still does not allay many people’s concerns, but the consultation process that currently exists, that we put in place, requires that a description of drug treatment services available at the site be provided with the application. If people are going to apply to open a supervised injection site, they actually have to provide information to the government about the kind of drug treatment services that would be available. If that is one of the key arguments for allowing supervised injection sites, because it seems that it is, listening to the comments that have been made, then it should be particularly emphasized and required that the person who is applying to open a supervised injection site actually provide some information to the government about what is going to exist in that space vis-à-vis drug treatment. That should be there. The existing legislation requires, for example, that we have criminal record checks for those who are going to be involved with these facilities. There are a lot of important requirements the existing legislation has in place, and these are basic things, like consultation and engagement with the community and providing information about what is going to be in place in terms of support for people who are trying to get off drugs. All these things should be there, but we have this vastly pared down proposal in terms of what would actually be required for the application. It is going to be so much easier for people to apply to open these supervised injection sites, and there are no requirements to ensure that we will have the due diligence in place. Again, members can debate the merits of supervised injection sites, but the existing legislation at least ensures that they are doing the kinds of things they are supposed to be doing. The new proposed legislation by the government completely turns the page on that by not engaging communities and not requiring the kind of due diligence we included in that application at all. I will conclude by saying again that we had an opportunity to move forward with those provisions on which we all agree. Those could be law today, but instead, we are still debating the entire bill, because the government refused to split it. The Liberals brought in closure on these important community consultation measures. I say that we move forward with the things that will save lives now, but let us continue an important conversation about whether communities should be engaged when these types of injection sites are opened. I think it is important that communities be engaged in conversations. I believe that communities are compassionate and that they care about these issues. It is not only the federal government that cares. If we engage communities, if we engage local law enforcement, we will get better solutions that will be more responsive to the needs of the community and will be more likely to solve this problem. The government needs to know that it cannot fix this problem on its own. It needs to work with the opposition. It needs to work with other levels of government. It needs to work with communities. If we are going to address this problem, we need more voices at the table and more collaboration. That is what we are standing for in the opposition, and that is why, in its current form, I have to oppose the bill.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Madam Speaker, the section the member’s party is suggesting be separated from the bill is the section that would change the 26 criteria the previous government put in place to five criteria, which would streamline the application for safe consumption sites in communities where they are needed and where they are appropriate. Under the current criteria of the previous government, three sites were approved in Montreal. Does the member know how long it took for these three sites to be approved? It took 22 months, nearly two years. Does the member think it is reasonable, when we know that there are people dying in various cities across Canada, in record numbers, to wait such a long period of time before we approve these sites? These are sites that are asked for by local health professionals, by communities, and by provincial governments. Does he think it is reasonable, when we have people dying in record numbers, to wait such a long period of time? Does he not think instead that we are better off moving to what the Supreme Court of Canada has stated should be the five guiding principles when we approve these safe consumption sites?

222 The Federal response to the Opioid Crisis

Conservative MP Garnett Genuis (Sherwood Park–Fort Saskatchewan, Alta.):

Madam Speaker, Winston Churchill said that it is not enough to do your best. One has to know what to do and then do one’s best. This is why having a proper review process in place is important. It is not enough to say that we just have to do something, without actually having the proper due diligence in each case to make sure that we are doing the right thing and that it is going to have the greatest impact and save the greatest number of lives. If we are concerned about scientific evidence, the government should have left the criterion in that required the presentation of scientific evidence as part of the application. If the Liberals are concerned about people getting off drugs, they should have left the criterion in that requires the government to receive information about what is going to exist at a facility in terms of drug treatment. Of course we have to respond to this crisis, but we have to do it in the right way. If we remove the due diligence that is involved in setting up these facilities, there is no guarantee at all that we will save more lives. In fact, we may well put more lives at risk. This is why we have to get it right. This is why we should expedite the sections on which we can agree, but we need to have full debate. I think we need to reinsert some of these criteria back in to ensure that these things are being done in an appropriate and effective way that maxi- mizes the chances that we can give people the best hope we can.

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

Madam Speaker, it is a little hard to listen to the member in this debate. I am part of a community that has been very hard hit by the opioid overdose crisis. I have observed the operation of the supervised injection site, Insite, in Vancouver, and the Conservatives thwarted every effort to open additional health-based life-saving supervised injection sites for the 10 years that they were in power. It is a little hard to listen to the words of my colleague. Only an hour after the Conservatives introduced Bill C-2, the Conservatives were fundraising, stating that Liberals and New Dem- ocrats wanted addicts to inject heroin in people’s backyards. It is no wonder we ended up with communities being concerned about the impact of actually delivering a health care service to people who are addicted and whose lives are now in peril because of the fentanyl crisis that no one has been able to get ahead of. I would like to hear the member’s thoughts on that. Even though he was not in Parliament last time around, I would also like his thoughts about his own party having cut addictions treatment funding by 15% while the Harper Conservatives were in power.

Conservative MP Garnett Genuis (Sherwood Park–Fort Saskatchewan, Alta.):

Madam Speaker, obviously we have wider philosophical disagreements about whether somebody using dangerous hard drugs really should be considered in the same category as other health care services. We can have a longer discussion about supervised injection sites specifically. Again, my view is, and I do not have a problem saying it, that we should be focusing our efforts and resources on things to get people off of drugs, such as rehab, more investments in chemical detox, and these kinds of things. I am very supportive of those kinds of investments. Of course, generally speaking, more of that activity happens at the provincial level, but there is a role for the federal government as well. I see the importance of that and I am happy to advocate for it. I do think, though, it does not follow that if we believe action is needed, we need to take power away from local communities in terms of determining the process of that action. Communities, families, local governments, and provincial governments are compassionate and seized with this problem, so taking authority away from them to be engaged with their communities is not an effective way to address this crisis. We should, in fact, be doing more to mobilize the knowledge and experience of communities and families in terms of building the kinds of strategies that are going to address specific issues in specific areas. The response that makes sense in one community may not be the same as the response that makes sense in another community. When an external group makes an application, and all it has to do is provide some general information to the government about whether the community was supportive or opposed with no timeline prescribed, I do not think that is an effective way to engage the community to actually respond to the problem.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Madam Speaker, I would ask my colleague first and foremost to recognize this issue as the national crisis it is. The Minister of Health and the government have taken a very aggressive and proactive approach to try to deal with this in a number of ways. A big part of it is working with others. Whether it is provincial or municipal jurisdictions, first responders, just name it, all of the stakeholders need to come together to try to resolve a very serious problem, a crisis, as the Minister of Health herself indicated. There has been an immense amount of co-operation from the New Democratic Party on this issue. The issue that the Conservatives seem to be stuck on is the supervised safe injection sites. That was part of the legislation, which many of the stakeholders are very anxious to see.

223 The Federal response to the Opioid Crisis

Does the member not recognize that this is, in good part, a holistic approach? It is not just the legislation, even though the legislation is absolutely critical, and that is the reason we are trying to advance this issue. The member desires further debate, but the issue was well debated in Parliament under Prime Minister Harper. The former questioner pointed out that the Harper regime had a fundraising scheme based on a theory that the Conservative Party is still advocating today. We disagree with that theory.

Conservative MP Garnett Genuis (Sherwood Park–Fort Saskatchewan, Alta.):

Madam Speaker, there are some specific questions that the parliamentary secretary and the government need to answer about why the government refused to split the bill to actually allow it to move forward if the Liberals are so concerned about this crisis, because we all should be concerned about this crisis. At the end of the day, it does seem to be the case, with the NDP co-operating with the government, that we are the only party in this House that is standing up firmly for the role of local communities to be involved in these decisions. If we are the only party that has to stand up for that principle, so be it, because I am so convinced that we are right and that Canadians are on our side on that point. Communities are compassionate. Local governments are compassionate. Local families are compassionate. We need to engage them in a conversation, in a meaningful consultation that gives them time to present ideas, looking at local evidence, and looking at the scientific evidence about the impact. What is wrong with engaging communities and looking at that local evidence? If we are the only party that stands up for it, so be it. If people donate to the Conservative Party, as is being criticized by others, because of our commitment to engaging communities in the process, well people donate to political parties for all kinds of different reasons and we are certainly going to stand up for our principles, whatever the consequences of that are.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, I have to point out something that is just demonstrably false from the Conservative Party. It is right in the legislation before us, if my hon. colleague cared to read it. The bill would specifically require an applicant to furnish evidence of the local conditions giving rise to the site, the potential health benefits, and more important, expressions of public support or opposition. When the member tells this House and Canadians that the community’s wishes are not part of this legislation, he is simply wrong. I wonder if he could comment on that. Has he read the legislation?

Conservative MP Garnett Genuis (Sherwood Park–Fort Saskatchewan, Alta.):

Madam Speaker, if the member had listened to my speech, he would know that not only have I read the legislation, but I actually have read into the record the specific section that he refers to. Here is the point, and the member would know it if he had been listening to my remarks. It is that the previous section requires scientific evidence demonstrating what the impacts would be in the community. It requires engagement with law enforcement. It requires specific engagement and support of local governments. Just asking the applicant to make some statement of expression of community support or opposition is not sufficient. It would not actually mean that the community would have had more time or ability to rule on the decision.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, for any Canadians who are watching, I am glad that they can see that the Liberal Party, the New Democratic Party, the Green Party, and I am not sure about the Bloc, are willing and ready to move quickly on this legislation and not sit here and debate and slow down legislation when Canadians are dying every day. It has been well established that Canada is currently in the grips of an unprecedented national public health emergency. I am glad to hear both my Liberal and Conservative colleagues increasingly using that term to describe the opioid crisis. The New Democratic Party started using the term back in November, and that is because this is a national public health emergency and our fellow Canadians are suffering and dying every single day. Fifty Canadians are dying every week from opioid overdoses in this country. That is a national crisis. It also bears repeating that this crisis has become dramatically worse in recent months. In 2016, in my home province of British Columbia alone, there were 914 drug overdose deaths. That is an 80% increase from the year before. In December, just a couple of months ago, we recorded the highest number of overdose deaths in B.C.’s history with 142 lives lost. That is more than double the monthly average of overdose deaths since 2015 and a sharp increase over September, October, and Novem- ber. There were 57 overdose deaths in B.C. in September, 67 in October, 128 in November, and 142 in December. I can only guess that the number will be even higher for January. While the Conservatives want us to debate and consult, New Democrats want to act and save lives. In December, the B.C. Coroners Service announced that morgues in the city of Vancouver were frequently full as a result of the unprecedented number of overdose deaths, forcing health authorities to store bodies at funeral homes. 224 The Federal response to the Opioid Crisis

This crisis is in large part the legacy of Canada’s now defunct anti-drug strategy. Decades of a misguided criminal approach to drug policy has proven to be counterproductive, fuelling Canada’s unregulated illegal drug market and leaving a scarcity of evidence-based health services, including harm reduction and treatment programs for people suffering from substance use disorder. The Conservatives cut 15% from the addiction service budget in their last year in office. International research demonstrates that the criminalization of drugs increases rates of drug production, consumption, availability, and adverse drug-related health effects, but that is the evidence, and for the last 10 years our drug policy in this country was not based on evidence. It was based on ideology. Because this crisis has been years in the making, it will not be solved by any one action or piece of legislation. I think we all know that. The passage of Bill C-37 must be the beginning of a much deeper examination of how we understand and respond to drug use and addiction in Canada. For many years, New Democrats have been advocating for an evidence-based and health-focussed approach to drug use and addiction. Our party understands that substance use is not a moral failure. We also understand that criminal approaches that aim to punish or isolate those with addiction issues only serve to compound the suffering of those already experiencing tremendous pain. As Dr. Gabor Maté, a Canadian physician who specializes in addictions has said:

“Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experience. A hurt is at the center of all addictive behaviours. It is present in the gambler, the Internet addict, the compulsive shopper and the workaholic. The wound may not be as deep and the ache not as excruciating, and it may even be entirely hidden — but it’s there.”

That is why New Democrats have pushed the federal government to reinstate harm reduction as one of the four pillars of Cana- dian drug policy ever since it was removed by Stephen Harper. That is why New Democrats led the fight against the Conservatives’ Bill C-2 from the day it was introduced. That is why we have pressed the Liberal government to repeal or amend Bill C-2 since February 2016, one year ago, when the opioid overdose crisis was in its earliest stage. Last fall, the NDP successfully moved a motion at the Standing Committee on Health to conduct a study on the opioid overdose crisis. This led to a report with 38 recommendations to the federal government, most of which have not yet been implemented, I would point out. We were the first to call for a declaration of a national public health emergency. Such a declaration would empower Canada’s Chief Public Health Officer to take extraordinary measures to coordinate a national response to the crisis, a measure the Liberal government, still to this day, refuses to take. Last December, we attempted to fast-track Bill C-37 because of the dire need to deal with this crisis as quickly as possible, but that, again, was blocked by the Conservatives. Indeed, Bill C-37 continues to be delayed because the Conservatives refuse to acknowledge the crucial importance of harm reduction, and the evidence that supervised consumption sites save lives now. Today, I am saddened to see that the Conservatives still have not learned from their mistakes, and I am deeply troubled that they continue to liken supervised consumption sites and the approval of same to pipeline approval processes. After their bizarre offer to trade supervised consumption site approvals for pipelines, at the health committee, the Conservative member for Lethbridge argued that these health facilities should require the same social licence as energy projects before they are permitted to save lives. The member argued that we must maintain Bill C-2’s unnecessary barriers because the placement of a site will impact the communities in which they are located. For once, I agree with the member for Lethbridge. It is absolutely correct that these sites do indeed impact communities: by saving lives, by reducing crime, and by providing opportunities for recovery to people suffering from a disease. The Conservative Party likes to imagine that supervised consumption sites might be imposed on communities by the federal government. The opposite is true. Supervised consumption sites only exist in Canada due to the tireless efforts of advocates and community members who contribute their time and talent to provide evidence-based, life-saving health services. Sometimes, they have even done so at the risk of their own liberty. Vancouver’s Dr. Peter Centre provided supervised consumption services, in violation of federal law, for over a decade, since 2002, before the federal government finally granted it a legal exemption. Vancouver’s Insite had to fight the federal government all the way to the Supreme Court of Canada to keep its doors open. Even then, instead of complying with the spirit of the ruling, the Conservative government of Stephen Harper passed Bill C-2 as a thinly veiled attempt to prevent any new site from opening in Canada. Today, as we speak, at least three overdose prevention sites are operating in the open in Vancouver without a legal exemption, against the law, exposing the staff who work there to criminal sanction because they are answering a higher call. They are answering the call of saving lives. That is why they are doing it. The truth is supervised consumption sites do not harm communities; they help them. The evidence from Insite has been overwhelming and crystal clear. 225 The Federal response to the Opioid Crisis

By the way, the Conservatives talk about the negative impact of supervised consumption sites on communities. They never quote a single piece of evidence, not a shred, from any operating supervised consumption site because there are only two in Canada. Those two in Canada have been studied and written up in periodicals as respected as The Lancet and the evidence is crystal clear. They save lives. They reduce crime around the area. They stop open drug use. They reduce the spread of disease, and they stop the detritus of used needles in consumption sites from being out in the community where they can harm our community members and our children. That is the evidence. When the Conservatives say that these sites impact communities, darn right they do, and they do so by helping the community. There is not an iota of evidence to the contrary. Perhaps the Conservatives should listen to Edmonton’s Mayor Don Iveson who recently said, “This is not a homeless, addicted issue. This is in pretty much every neighbourhood.” The opioid crisis is here. It is already affecting our communities. Every day, it is claiming the lives of our friends, our family members, our neighbours. The Conservative Party’s argument that supervised consumption sites will somehow introduce opioid addiction to unaffected communities is baseless fearmongering, and it is deeply stigmatizing to Canadians with substance use disorders. The truth is communities across Canada have been asking to open supervised consumption sites for years. It was by refusing to grant section 56 exemptions that the federal government was overruling both my home city of Vancouver and my home province’s repeated requests. Indeed as Vancouver’s Mayor Gregor Robertson has said: “Factors such as the impact of the site on crime rates and expressions of community support or opposition should not be relevant to the federal government’s approval process. Those issues are local matters, and as such, are best dealt with by local officials, such as municipalities, health authorities, and local police agencies, who understand the issue.” I will leave it to the Conservative Party to explain why it does not trust local authorities to make those determinations. It has been community heroes, not the federal government, who have been on the front lines showing leadership throughout the current crisis. The efforts of these selfless people have undoubtedly saved lives and although there are too many to name individually here, I would like to specifically acknowledge the Herculean efforts of a few people. The are: Ann Livingston and Sarah Blyth, founders of B.C.’s Overdose Prevention Society; Hugh Lampkin, long-time member of the Vancouver area network of drug users; Daniel Benson of the Portland Hotel Society; Gregor Robertson, mayor of Vancouver; Kerry Jang, city councillor of Vancouver; Maxine Davis, executive director of Vancouver’s Dr. Peter AIDS Foundation; Katrina Pacey, executive director of Vancouver’s Pivot Legal Society; Dr. Perry Kendall, B.C.’s Chief Medical Officer, the first and only medical officer in the country who has declared a public health emergency in British Columbia because he recognizes the extent of the crisis facing our community; and Dr. Gabor Maté, who is an internationally-renowned expert in addictions. Having repeated requests for a declaration of a national public health emergency ignored by the current federal Liberal government, these front line organizations and the Government of British Columbia were forced to take the extraordinary measure of disregarding federal law by opening non-exempt pop-up supervised consumption sites which are operating right now as I speak. These sites have operated for months despite the daily risk of prosecution faced by those working at them as staff and volunteers. Here is what the College of Registered Nurses of B.C. said to its membership last month.

“This crisis may be prolonged and continue to worsen; as these overdose prevention services are being established across our province, in any place there is a need, we are being asked by nurses, “Is my licence at risk if I provide nursing care in these sites and conditions that can be less than ideal?”

Our courageous front line health workers should never be forced to ask that question. That is why the NDP introduced an amendment at the health committee that would have allowed provincial health ministers to request in writing from the federal health minister emergency approval for supervised consumption sites in response to a local crisis. Such an exemption would bypass the normal application process, and go into effect immediately for up to a year with the possibility of renewal. The federal minister would be required to post a provincial request online and post the response within five days. This change was aimed at removing the potential for distant political considerations in Ottawa, many of which we hear expressed by members of the House today, to undermine or impede timely evidence-based decision responses to provincial public emergencies. In the unusual situation where a province has declared a provincial health emergency, instead of forcing it to go through the application process which takes time, and time in a crisis like this costs lives, it gives the federal health minister the ability to grant a temporary approval quickly. The Liberal government has repeatedly claimed that, with this legislation, it is now doing everything in its power to address this crisis, but that is demonstrably false. The government has failed to take many actions. There are literally dozens of them that are open to the government to take to respond to this crisis which it seems reluctant to do. 226 The Federal response to the Opioid Crisis

Recently, the City of Vancouver sent a list of nine recommendations to the federal government to help address this crisis, including calling for a central command structure, daily meetings with Health Canada, and improved treatment services. A coroner’s jury in British Columbia recently issued a list of 21 recommendations for action and the Standing Committee on Health in December issued a report detailing 38 recommendations for the government alone, again most of which remain unimplemented. The Lib- eral government is not doing everything it can to address the opioid crisis. It is taking some measures, but not all the measures it needs to. When the health committee conducted the emergency study last fall into the crisis, the first recommendation made with all-party support was to declare opioid overdoses a national public health emergency. This call was echoed by Dr. David Juurlink, the keynote speaker at the health minister’s own opioid summit last fall and now by B.C. Health Minister Terry Lake, a Liberal, and stakeholders across the country. In the face of a mounting death toll, a declaration of a national public health emergency would allow us to start saving more lives today. Furthermore, during our study, the health committee heard that access to treatment for opioid addiction is almost nonexistent in indigenous communities, and where there is access, it is short-term access. That is because nurses employed by Health Canada do not have the scope of practice to support indigenous people in addressing opioid addiction in their own communities beyond 30 days. Yet, the Liberal government has made absolutely no commitment to ensuring full access to long-term, culturally appropriate addictions treatment in indigenous communities. Finally, the health committee’s recent report on the crisis made three separate and specific recommendations, calling for significant new federal funding for public community-based detox and addictions treatment. But the federal government will not commit to making any new funding available for detox and treatment in budget 2017, so far. The health minister continues to recycle money dedicated to mental health, and claims that money can be used for addictions treatment. We are looking for new, specific, targeted funds for addictions treatment in this country. Mental health is a huge area, and there are many needs in this country. We all know that. We wanted targeted money from the government, and the government has refused to make that commitment so far. I believe it behooves this House to be honest with itself. Would the federal government be so noncommittal and cautious in its approach if these deaths were caused by any other disease? As we look to the future, we must let go of our prejudices in order to hold on to our loved ones. Donna May, the founding member and facilitator of mumsDU, moms united and mandated to saving drug users, lost her daughter Jac to addiction at the age of 35. She said:

“Most people would think that the hardest thing I’ve ever had to face was her death; the death of a child; the death of my only girl. However, that’s not it at all. The hardest thing I’ve had to face in my life is realizing how my ignorance towards my daughter’s addiction cost me years with her that I will never get back. There are no ‘do-overs’ when your child is dead! Now I can only share my experience and what I’ve learned since, so that other parents can take something from it.”

In many respects, substance abuse is one of the last remaining acceptable targets for health care discrimination. With all the evidence available to us, we should know better. If we are to succeed in treating addiction as a disease, which it is, we need to acknowledge that fear, stigma, and ignorance about those who suffer from addiction are widespread and in many respects have framed our approach to this crisis. That is why, although these legislative changes are long overdue, they do not go far enough, fast enough. We need federal coordination and funding to address the crisis right now and over the long term. Canada’s failure to treat addiction and substance use disorders by successive federal governments as a medical condition was explained to the health committee by Dr. Evan Wood from UBC.

He said:

“I’ll just ask you to imagine a scenario of somebody having an acute medical condition like a heart attack. They would be taken into an acute care environment. They would be seen by a medical team with ex1pertise in cardiology. The cardiovascular team would then look to guidelines and standards to diagnose the condition and to effectively treat it. Unfortunately, in Canada, because we haven’t traditionally trained health care providers in addiction medicine, we have health care providers who don’t know what to do, and routinely do things that actually put patients at risk. In addition to the lack of training for health care providers, the overall lack of investments in this area has meant that there aren’t standards, guidelines [or beds] for the treatment of addiction.”

227 The Federal response to the Opioid Crisis

Dr. Mark Ujjainwalla, medical director of Recovery Ottawa, said:

“The problem we face here is that the real issue with addiction is not opiates. The real issue is the inability of the present health care system to treat the disease of addiction. An addiction is a biopsychosocial illness that affects 10% of society, probably more if you include families, and it is the most underfunded medical illness in our society. The problem is that it’s also a highly preventable and very highly treatable illness. It’s very unfortunate that people don’t see that. When it affects your family or you, you can feel the pain and suffering, and you watch the tragedy unfold in front of you.”

I would like to conclude my remarks by imploring this House to take a lesson from Estonia, a country that recently overcame an opioid crisis very similar to Canada’s. The head of Estonia’s drug abuse prevention department said, “I think the most important thing is you don’t waste time. If you really want to learn from us, that’s the mistake we made. Don’t look for some new solutions, because you have them.” We could say that history does not look kindly on those who dither in times of crisis. To put it bluntly, it is not the history books that should keep us up at night; it is the lives that we continue to lose every single day to entirely preventable causes. Canadians are looking to us to provide leadership in a crisis. It is time for us to deliver.

Parliamentary Secretary to the Minister of Families, Children and Social Development (Housing and Urban Affairs) Adam Vaughan (Spadina-Fort York, Ont.):

I have sat with the big city mayors, and in particular Mayor Gregor Robertson of Vancouver, and listened to their calls for action. I immediately approached the Minister of Health. We are moving on those urban issues very quickly in concert with our cities, because cities and towns are on the front lines of this issue. We have the call for a national disaster and immediate action, which is being taken by the government. What actions in the national disaster designation are not being taken as a result of us not designating it that could not be taken as a result of good advice from the member opposite? In other words, we believe we are doing everything we can. What would the additional designation do that we are not doing now?

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Under the Emergencies Act, the declaration of what is called a public welfare emergency is open to the government, and it is clearly written in the spirit of some sort of natural disaster or outbreak of disease, if we read the legislation. There is a number of powers it gives the national chief public health officer in a case like that, and two of them in particular I would encourage my hon. colleague to consider. One is that it would authorize the government to flow emergency funding in an expedited fashion, as opposed to having funding go through the normal processes of this place. Second, and more important, it sanctions the opening of hospitals and clinics on an emergency basis. If there were a virus spreading around the country and we were losing 50 people a week, we would be opening pop-up clinics, almost like MASH, all over the place where people could go to get vaccinated, to get treatment. Those are the kinds of clinics I believe these supervised overdose prevention facilities could be designated as. Then they would not be operating illegally as they are now. Cities and towns could be opening these supervised consumption sites on an emergency basis and do so legally under the Emergencies Act.

NDP MP Robert Aubin (Trois-Rivières, Que.):

Anyone who was lucky enough to hear his speech will understand the emotional intensity triggered by this problem. This is something my colleague has to deal with every day, which was reflected in his comments. I think he was right to slam the Conservative Party, because we have been debating this problem, namely, the injection site issue, not the opioid crisis, over the past several Parliaments, with still no resolution. I appreciate the collegiality among most parties of the House, since most of us want to expedite the passage of this bill. However, the Liberal government is expected to present its upcoming budget perhaps next week, or in two weeks’ time at the latest, and my concern is this: what if there are no new investments to address this crisis? Would that not be truly Machiavellian, the perfect example of doublespeak?

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, I think all members of the House would probably agree that one of the fundamental solutions to the crisis facing us is its prevention and treatment as a health issue. That means our words are not particularly helpful unless they are backed up by actions. The action I would like to see by the government is significant and substantial new funding for addictions treatment facilities of every 228 The Federal response to the Opioid Crisis kind across the country. There is no one size fits all. We need facilities for young people, women, and indigenous communities. There are differences with respect to alcohol and drug addictions. We need the full panoply of resources for the country to really start making a dent in this. In generosity to the Conservative colleagues, I will say this. They express in the House the perspective that drugs are a dangerous product, and they are right. I think everyone in the House views drugs as unhealthy, and we wish Canadians would not use or abuse them. Ultimately, we need to get to that next level where we take an evidence-based, health-based approach to drugs. That will start with the Liberal government providing significant funding. I asked a question today about the fact that 90% of Canadians right now were operating without a new health accord. While the government is negotiating with the provinces, I would ask it to recognize the emergency before us and find money in its budget that can be diverted from other places and put into addictions services. It would be money well spent and it would help save the lives.

Green Party leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Madam Speaker, I want to thank my hon. colleague from Vancouver Kingsway for his work on this, and on the health committee. I had a chance to be part of the clause-by-clause on Bill C-37, and I appreciate all his efforts there. I want to thank him for raising the comparison to pipelines, which has been made all too often here, that somehow there is a con- tradiction in trying to save lives and reducing the obstacles to saving lives that can be compared to the reasonable regulatory hurdles for building thousands of kilometres of pipeline across first nations lands, which would threaten every stream it crosses, and the oceans and coastlines that will be traversed by tankers carrying bitumen and diluent, which cannot be cleaned up. I found the comparison distasteful, and I appreciate him dealing with it in the House this afternoon.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, in the spirit of generosity, I understand where the Conservatives are coming from. What they are talking about is the need to have appropriate regulatory processes for the approval of varying projects in our country. However, we would all do well in the House if we viewed the issue before us as one of public health. Although it is tempting to draw on analogies from other areas, I do not think we can really do justice to this issue unless we focus on the fact that the decisions we make today and the steps we take as parliamentarians will have not only an economic impact but one of life or death. Everybody in the House probably has a family member, a relative, a friend, a colleague or a workmate who has suffered from an addiction. None of us are immune to that. Therefore, let us work together in a spirit of collegiality, look at the evidence, move swiftly, and deal with this very serious social issue, which has been ignored for far too long by every level of government in our country.

NDP MP Sheila Malcolmson (Nanaimo-Ladysmith, B.C.):

My own community of Nanaimo—Ladysmith has seen a tremendous effort by first responders and community organizations that have worked very hard to fill the gap in the failure of federal and provincial leadership. I hope the member can describe the human cost on the first responder side, and what this government action might do to alleviate pressure on firefighters, nurses, and community organizations.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Madam Speaker, the front-line workers, the firefighters, police, paramedics, nurses, and volunteers across the country, are nothing short of heroes and heroines for what they have been doing for us. They have been responding to people in the most extreme circumstance, literally when they are dying or dead, and they have been bringing them back to life. They are doing this day after day. These are the people we need to be supporting. Let us do that by moving the bill forward as soon as we can.

Liberal MP Darrell Samson (Sackville—Preston—Chezzetcook, N.S.):

The bill before is an extremely important one. We have a health crisis, and we need to respond quickly. Our government, with the support of many members in the House, is doing just that. I would like to begin by extending my sympathy to all those who have lost a friend, neighbour, family member, or co-worker through this crisis. In the past eight years in Nova Scotia alone there have been over 800 overdoses, and half of those have been due to the use of opioids. This is the situation in Nova Scotia, but the situation is much greater in other provinces. For example, in British Columbia, 900

229 The Federal response to the Opioid Crisis people lost their lives through overdose in the last year, which is 80% more than in 2015. At a national level, overdoses now outnumber the deaths due to motor vehicle accidents. This gives us an interesting comparison, and shows how sad this crisis is. This crisis has no boundaries. There is no age, gender, or income factor. This is an addiction; it is an illness. All governments need to respond to this crisis. We have to find the root causes and then find solutions through the most current evidenced-based policies to support that. Addictions can take hold of someone trying to cope with physical or emotional pain. The tragic thing about fentanyl is that the drug is so powerful, a minuscule amount can have dramatic effects and even cause death. As little as 30 grams, enough to fill a regular envelope, can cause as many as 15,000 people to die of an overdose. That is why our government and all members of the House must pass a bill quickly, because every moment counts. This legislation would roll back changes made by the previous government, the so-called Respect for Communities Act. That legislation added an unnecessary burden on provinces, local governments, and communities in applying for an exception under the Controlled Drugs and Substances Act to establish a safe consumption site. Bill C-37 would accomplish this by simplifying and streamlining the previous process and its 26 application criteria. That is why only three sites in the last two years have been established under those criteria. Our government is applying the wisdom of the Supreme Court of Canada, which indicated five important factors: one, evidence on the impact of such facilities on crime rates; two, local communities indicating that there is a need for those types of sites; three, establishing regulatory structures and making sure they are in place to support the sites; four, having the necessary resources; and, five, having communities express support or opposition. That is what is important and what the bill would provide. In addition, whichever applications are denied or approved, the decisions would be made public. It is important that they be public. The fact is that supervised consumption sites save lives. That is the important thing here: they save lives. The Vancouver sites help integrate people with addiction problems into the health system in an environment where they are not judged or stigmatized. Harm reduction is not our government’s only strategy. Our government has made it clear that we will invest $5 billion in mental health as part of the health agreement. Prior to 2006, the Government of Canada had a federal drug strategy that had a balanced approach between public health and public safety that included the four key pillars: prevention, treatment, enforcement, and harm reduction. The previous government removed harm reduction as a pillar in our national drug strategy. This was unfortunate, because evidence has shown time and time again that harm reduction strategies are needed to ensure good public health outcomes. As part of this government’s commitment to evidence-based policy-making, the Minister of Health has reinstated harm reduction as a pillar of our strategy. Along with harm reduction, our government has also eased access to the life-saving overdose treatment naloxone. Canadians can now access this drug antidote without a prescription and we have ensured emergency supplies are available for all Canadians. In terms of enforcement, the RCMP has been diligently working to try to stop the flow of fentanyl. An agreement was recently reached with China on this issue. Furthermore, under this legislation, the Canada Border Services Agency would have more flexibility to inspect suspicious mail which it believes may contain prohibited goods. This measure would only apply to incoming international mail from areas of the world where prevalence of illicit drugs is greater. In closing, I would like to commend the Minister of Health for her hard work in combatting this crisis and working toward a solution, and her leadership in bringing this legislation forward. I also want to thank members in all parties in the House for their contribution to this debate, as well as the NDP, the Bloc, and the Green Party that have directly supported this bill.

NDP MP Tracey Ramsey (Essex, Ont.):

Madam Speaker, in my community what I am hearing is that there are a lot of people who are working on the opioid crisis and who are helping people with addictions but there is no coordinated effort. They are looking for federal leadership. They want this crisis to be declared a public emergency so that all of their efforts can come together in a coordinated way so they can use their resources to help more people. There is a desperate cry in my riding of Essex and also in southwestern Ontario for the federal government to show leadership. Medical experts have also been clear that there is an alarming lack of access to publicly funded detox and addiction treatment centres. This is very true in my area. I have heard the minister talk about funding for mental health, but could the member tell me if budget 2017 will contain significant new funding for addiction treatment specifically?

Liberal MP Darrell Samson (Sackville—Preston—Chezzetcook, N.S.):

I cannot speak for our government with respect to what is going to be in the budget, but I can say that our government has already promised to advance $5 billion over the next 10 years for health issues. This bill would clear the way for the government to take immediate steps moving forward. Members must remember that our government has been working with provincial governments and local communities as well to move this forward. 230 The Federal response to the Opioid Crisis

Conservative MP Michael Cooper (St. Albert—Edmonton, Alta.):

Madam Speaker, I agree with the hon. member for Sackville—Preston—Chezzetcook that there are many positive aspects in Bill C-37 but the real problem with the bill is that it would gut the Respect for Communities Act. Some say that the criteria in the Respect for Communities Act is too onerous and I disagree with them. Nonetheless, we on this side of the House try to work with the government. We put forward some simple amendments that, for example, would require a letter of support from the local municipality and local police force, an amendment that would require that persons within a two-kilometre radius of a supervised injection site be consulted, and an amendment that would require a 45-day consultation period, given that Bill C-37 would gut the minimum 90-day consultation period. What could possibly justify the government rejecting all three of these common-sense amendments? Is it really just because the government wants to gut—

Liberal MP Darrell Samson (Sackville—Preston—Chezzetcook, N.S.):

Madam Speaker, we have to keep in mind that the Conservative government in the last 10 years did all it could to close these centres and made it so difficult that it was unachievable. This bill would allow us to move forward quickly and get it done. The debate has been going on for years and it is now time to move forward. This is a first step but there are many steps to take. This is an extremely important first step that will help people on the ground today.

Liberal MP Sukh Dhaliwal (Surrey—Newton, B.C.):

Madam Speaker, last July, the city of Surrey had more than 60 fentanyl overdoses in a 48-hour stretch. Our office held an emergency summit and we asked all first responders, health care professionals, and members of all parties to come together to come up with a strategy. I am glad that the minister has taken the lead on this. The hon. member mentioned safe consumption sites. How would safe consumption sites help my riding of Surrey—Newton and the city of Surrey in general? My constituents are asking the government to expedite safe consumption sites.

Liberal MP Darrell Samson (Sackville—Preston—Chezzetcook, N.S.):

Madam Speaker, research clearly shows that these sites save lives. We plan to do this as quickly as possible.

Liberal MP Sonia Sidhu (Brampton South, Ont.):

While I am supporting this positive move, I must say I am still deeply troubled by this crisis that continues to hit communities. On a personal note, I was deeply touched after hearing from those affected. As a member of the Standing Committee on Health, I, with my colleagues from all parties, studied this crisis. In fact, we chose to pass a motion to undertake an emergency study of the crisis. We were all in lockstep with the minister, trying to make a positive difference and to make choices that would save lives. That motivation drove us to work hard, and work together. We worked collectively and openly on this. That is something I am quite proud of and something I have valued in my time as the MP for Brampton South, and as a fellow parliamentarian of all who serve together in this place. In committee, we heard from wide-ranging front-line perspectives, experts, and from the Minister of Health directly on this. I would like to make particular note of the testimony the committee heard from indigenous peoples on October 25, which I feel was compelling, honest, and a real wake-up call about what we need to do to ensure we address the needs of indigenous communities. For starters, improving access to naloxone treatment, the life-saving medication used in the case of an opioid overdose, was needed for rural and remote first nations in particular. That was a key part of the minister’s action plan coming out of the summit, and goes to show what we can do when we consult all communities. In looking at the bill, I see that Bill C-37 addresses what we heard from the Canada Border Services Agency about practical changes that would help prevent drug-making materials from entering the country. I applaud the minister’s work also to check suspicious international mail packages that are 30 grams or less, which could be used to smuggle in any amounts of substances that may cause harm. This is a good precaution to benefit Canadians. I want to remind colleagues that the bill is the product of hundreds of voices coming together. Our committee members were gra- ciously invited to join in the health minister’s summit on this as well. Coming out of the summit, we saw action. In fact, the joint statement of action by 42 organizations to address the opioid crisis was a broad but concrete approach that includes all those involved, from health care providers, to first responders, to educators, to researchers, and to families as well. I want to applaud our Minister of Health, and Ontario’s minister of health as well, for leading that conference, which focused on concrete steps and delivering clear results. 231 The Federal response to the Opioid Crisis

Our government has taken action from day one, building on our five-point action plan to address opioid misuse. We have taken concrete steps, such as granting section 56 exemptions for the Dr. Peter Centre and extending the exemption for lnsite for an additional four years. We made the overdose antidote naloxone more widely available in Canada. Our government recently approved three safe consumption sites in Montreal that the community asked for. Further, at the local level, we have seen action already undertaken. In the city of Toronto, the mayor met with the mayor of Vancou- ver and other officials in order to plan a proactive not reactive response for Ontario as the crisis drifts eastward. The mayor of Hamilton held a discussion about this as well, and other municipalities have been doing the same. I hope more municipalities will reach out, learn from one another, and take proactive measures in their communities. The numbers and the experts support this as the right way to public health, and it also delivers cost savings. I see how various aspects of the bill address a lot of the concerns we heard at committee and at the opioids summit. While many members have made note of the urgency of passing the bill, I think the majority of members showed time and time again in recent weeks that they were willing to collaborate to move quickly on this. I want to reassure members that I believe the bill is an extremely collaborative and well-thought-out bill that responds to experts in the field as well as front-line needs. It gives me comfort to know that this bill would make a difference. As others have said before, and I agree, we are in a national public health crisis in Canada. In 2016, thousands of Canadians tragically died of accidental opioid overdoses, and more will die this year. Our government and its partners must work together aggressively to save lives. If people have friends or neighbours who are hearing the Conservatives’ argument that facilities like Insite are the wrong approach, I would encourage them to contact me or other members on the health committee who would be happy to provide non-partisan, evidence-based information on why that does not reflect the safe consumption site model we see working already in Canada. All members of this House can agree that our hearts go out to the families and friends affected personally when a loved one has lost his or her life instead of having another chance. Last year in British Columbia alone, more than 900 people died from a drug overdose, an 80% increase from 2015. This legislation simply proposes to ease the burden on communities that wish to open a supervised consumption site, while putting stronger measures in place to stop the flow of illicit drugs and strengthening the system in place for licensed controlled substances facilities. Experts and stakeholders told the previous government and then told our government that Bill C-2 as it stood was not helping this crisis. That is why we took action to reverse the barriers that were holding back communities that have long been asking for the ability to save their citizens’ lives. We know there is more to be done as we move forward. We know that sadly the situation is getting worse. The deaths from overdoses will now be greater than deaths caused by car accidents. This tragic crisis continues to move eastward in Canada, with increasing drug seizures of fentanyl and carfentanil across the country. We will continue to work with our partners across the country to continue bringing forward evidence-based solutions to save lives and ensure that 2017 is the year that will mark a turn in this national public health crisis. Many people in Brampton South have asked me about my work on the health committee, and I have mentioned over and over that we all agreed we should turn our focus to this study due to the emergency at hand. They ask me why and they are always engaged when hearing about how we can work together at committee to address real problems and issues that our fellow Cana- dians face. Again, the way our committee worked together is one of the cherished moments I have of being an MP, and I hope we get more chances to work collaboratively again. This crisis called on us as leaders in our communities and as parliamentarians to take action. In October 2016, I put forward a motion that the health committee call upon the Minister of Health to move as quickly as possible to conduct a review of the laws and regulations in place with regard to safe injection sites. I suggested that the review have an end goal to improve the health and safety of Canadians, using a strong evidence-based approach. With Bill C-37, I feel the minister and government have responded fully to the motion that the health committee passed in October of last year. I am proud to be supporting this legislation that would save the lives of Canadians who need our help.

Conservative MP Harold Albrecht (Kitchener—Conestoga, Ont.):

Madam Speaker, certainly on this side of the House we have unanimous agreement that we need to work on this challenging problem. A number of weeks ago in committee, our health critic offered to actually split this bill into two parts to deal with the crisis part and then to work on the issues that we might have some disagreement on. In fact, the parts of the bill that should be implemented could actually be law right now had the Liberal government agreed to do that. My question has two parts. One, why did the Liberal government not agree to allow us to split the bill into two parts and facilitate the quick movement of this bill? Two, now that the bill is here, why did the Liberals limit debate on this bill for those of us in Parlia- ment who have been elected by our constituents to represent them to be able to give their voice here in Parliament? Why did the Liber- als limit debate by closing down debate? 232 The Federal response to the Opioid Crisis

Liberal MP Sonia Sidhu (Brampton South, Ont.):

Madam Speaker, I appreciate my colleague’s passion on this issue, but as he heard, 900 lives were lost in Vancouver. This is an urgent matter. We have to take steps. Evidence shows that when properly established and maintained, supervised consumption sites save lives and improve health without negatively impacting the surrounding communities. Our minister brought forward Bill C-37. I want all members to support this valuable bill so we can save Canadian lives.

Liberal MP Angelo Iacono (Alfred-Pellan, Que.):

The government is taking the necessary steps to respond to the fentanyl overdose crisis across the country. I think my colleague would agree that our government bases its decisions on facts, science, and sound evidence. That is why we want to support the establishment of supervised consumption sites in cities that want them, because this reduces harm. I wonder if my colleague could tell the House about other beneficial effects the bill will have on the health and safety of all Canadians.

Liberal MP Sonia Sidhu (Brampton South, Ont.):

Madam Speaker, our government made the overdose antidote naloxone more widely available in Canada. It saves Canadians’ lives. I appreciate that our Minister of Health took this step. Last November, the Minister of Health co-hosted a conference on opioid overdose crisis which resulted in 42 organizations bringing forward concrete proposals on their own. Our government is also continuing to respond to the tragic crisis in the way that is comprehensive, collaborative, and compassionate. We will continue to work with our partners across the country to continue bringing forward evidence-based solutions to save lives. That is why all members, as well as those across the way, are debating Bill C-37. We are all working together to save Canadians’ lives.

Conservative MP Larry Maguire (Brandon—Souris, Man.):

Madam Speaker, I would like to ask my colleague about the situation she has looked at. She indicated there were some 900 deaths in Vancouver. They have injection sites, as has been pointed out by colleagues and others and I just want to also follow up. We still have not received an answer to the question that we have placed multiple times today about why the government did not split the bill. There is about 80% of it that we have agreed with. It could very well have been enacted by now and perhaps saved even more lives, yet the government seems to be against community consultation. I am wondering if she can provide an answer to both of those.

Liberal MP Sonia Sidhu (Brampton South, Ont.):

Madam Speaker, we need to have a comprehensive approach in order to face this crisis. This is not the time to play politics. This is a time to act. We need to act urgently.

APRIL 3, 2017 This debate was part of Private Members’ Business. The House resumed from November 17, 2016, consideration of the motion that Bill C-307, An Act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence), be read the second time and referred to a committee.

NDP MP Don Davies (Vancouver-Kingsway, B.C.):

Mr. Speaker, I rise today to speak to Bill C-307, an act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence). This legislation proposes to allow the Minister of Health to implement regulations to restrict access to non-tamper-resistant controlled substances or classes of controlled substances. The bill also imposes an annual reporting requirement on the Minister of Health if no regulations are made “specifying controlled substances or classes of controlled substances that must have tamper-resistant properties or abuse-deterrent formulations”. As we consider the bill, which is principally aimed at curbing prescription opioid abuse, it is important to remember how we arrived at the current overdose crisis, which has claimed an estimated 20,000 Canadian lives over the last 20 years. For over two decades, opioids have been overused and over-prescribed by doctors for pain management and other causes, leading to many patients becoming dependent and addicted. 233 The Federal response to the Opioid Crisis

Canada has among the highest per capita volume of dispensed opioids in the world, totalling some 19.1 million in Canada in 2015 alone. That is up from 18.7 million the year before. This is about one opioid prescription written for every two Canadians last year. Even though there are no credible peer-reviewed studies that demonstrate that opioids afford more benefit than harm for chronic pain, opioid use has been marketed beyond palliative care and cancer patients for regular use to people experiencing back pain and other common ailments. Manufacturers, incorrectly, led prescribers to believe that addiction was a rare consequence of using prescription opioids long-term and that fewer than 1% of patients would become addicted. However, in reality, the addiction rate is estimated to be 10%, with 30% suffering from opioid use disorder. In 2012, Purdue Pharma Canada, the manufacturer of the potent prescription opioid OxyContin, pulled OxyContin from the market and replaced it with OxyNEO, a tamper-resistant alternative that is difficult to powderize, snort, or inject. Purdue strongly supports changing legislative and regulatory regimes to mandate that over time the entire prescription opioid market be tamper-resistant. Under the previous, Conservative government, Health Canada drafted regulations that would have compelled opioid manufacturers to make their oxycodone products, and eventually all opioids, tamper-resistant. However, the current Liberal government abandoned that plan in April 2016, on the basis that there is insufficient proof to back up claims that tamper-resistant formulations have positive policy benefits. Health Canada concluded that requiring tamper resistance would not have the intended health and safety impact of reducing overall drug abuse. At the time, the Minister of Health told the Standing Committee on Health, “It would be wise if it worked, but the result is that the introduction of tamper-resistant products only serves to increase the use of other products on the market. You can’t take a single approach to a drug.” To be sure, independent expert opinion on tamper resistance ranges from the view that its application has very limited efficacy for addressing opioid abuse, to the view that tamper resistance is a counterproductive move aimed in part at extending the drug manufacturers’ patent protections. Testifying at the health committee’s fall 2016 study of the opioid crisis, proposed by the New Democrats, Dr. Philip Emberley, director of professional affairs for the Canadian Pharmacists Association, said:

“...we still see tamper-resistance as one solution, [but] not the only solution.... [T]here are some numbers out of the U.S. that say it has had some effect. However, we have to be very cautious of the unintended consequences, which may end up being even worse than what we were trying to prevent in the first place.”

To understand these potential consequences, a U.S. study published in the academic journal JAMA Psychiatry looked at what happened in drug use patterns before and after tamper-resistant OxyContin came on the market. It found that abuse of OxyContin dropped significantly, from 45% to 26% of all users, but heroin use rose from 25% to 50% and effectively cancelled out any drop in OxyContin abuse. Many simply kept using OxyContin, and about one third of them found a way around the tamper-resistant formulation. Another 43% were simply unable to crush the new, tamper-resistant pill, so they just swallowed it and got high anyway. Only 3% of those surveyed gave up the drug altogether when the new, tamper-resistant formulation came out. Dr. Emberley’s caution was reiterated at the health committee by one of Canada’s leading drug safety experts, Dr. David Juurlink, who said this:

“I think abuse-deterrent formulations are a good thing generally. You can crush them, and you can chew them, and you can get a much higher level in your blood than you would by taking them intact, but you can’t powderize them, inject them, or snort them, but it is a mistake to think this is the way out of this problem. These products tend to materialize on the market as the patent on the original product expires, so a cynic might wonder if this is primarily a business decision. The fact is that the primary route by which opioids are abused is oral. I know for a fact that physicians, when they hear about these abuse-deterrent formulations, think that these are somehow impervious to abuse. They are totally abusable. If you could snap your fingers and have them all be abuse deterred, great. It is not a major part of the solution to this problem, in my view.”

At best, I could say that the impacts of tamper-resistant opioids are presently unclear. However, because New Democrats are unwilling to dismiss any potential tool to address the opioid crisis, we believe that this bill should be rigorously studied at the health committee, with extreme caution paid to the potential for unintended harm. Let me be clear. We will not hesitate to oppose this legislation if, based on the preponderance of evidence, we determine that tamper resistance is likely to be counterproductive. 234 The Federal response to the Opioid Crisis

Ultimately, New Democrats want a much more comprehensive response to the opioid crisis. Since last fall, our party has been calling on the federal government to declare opioid overdose a national public health emergency, because such a declaration would empower Canada’s chief public health officer with the authority to open temporary clinics and supervised consumption sites on an emergency basis, and allocate emergency funding on the scale needed to comprehensively address the opioid crisis. The Minister of Health has repeatedly dismissed our calls, on the basis that the federal government already has the ability to take these measures without an emergency declaration. However, here we are today, in April 2017, with no end in sight to the opioid crisis. The legislation to streamline supervised consumption site approvals remains stalled in the upper chamber, and budget 2017 fails to devote a single dollar in emergency funding to combat the crisis. Somewhat shockingly, Budget 2017 also makes deep cuts to addictions treatment funding, when access to publicly funded programs is already appallingly insufficient across this country. As the opioid crisis escalated in 2012, the Conservatives cut funding for addictions treatment by approximately 20%, allocating $150 million over five years. That is still $40 million more than the Liberals’ entire allocation for the Canadian drugs and substances strategy just announced in the last budget. The Canadian drugs and substances strategy expands on the now defunct national anti-drug strategy’s pillars of prevention, treatment, and enforcement to include harm reduction. In our view, that is a positive change, but it means a broader mandate with only 20% of the anti-drug strategy’s funding. With a federal reaction like this, one could be forgiven for believing that the opioid crisis is over. However, in my home city of Vancouver the crisis is getting worse by the day. Vancouver Fire and Rescue Services reported 162 overdose response calls for the week of March 20, a 56% increase from the previous week, when 104 calls were responded to. To date, in 2017, there have been 100 overdose deaths in Vancouver alone. There were 215 in all of 2016. If rates of overdose deaths continue at this pace, Vancouver could see nearly 400 deaths in 2017, double the number recorded in 2016. In order to reverse this trend, the City of Vancouver is advocating for increased access to treatment-on-demand options. Apparently, this request has fallen on deaf ears at the federal level. Indeed, the Prime Minister seemed to acknowledge it last month when he visited Vancouver and pledged this: “It’s really important for all Canadians to consider that this is something we cannot continue to ignore, we cannot continue to stigmatize. We need to start addressing this as the real societal health problem it actually is.” However, as former U.S. Vice-President Joe Biden used to say, “Don’t tell me what you value. Show me your budget, and I’ll tell you what you value.” Canadians do not need more empty words or broken promises from their federal government; they need real support to end the opioid crisis. I call on the Prime Minister to honour his word by taking emergency action to finally and fully address this immense human tragedy.

Conservative MP Rachael Harder (Lethbridge, Alta.):

Canada is in the midst of a massive public health crisis related to opioids. Codeine, fentanyl, oxycodone, hydrocodone, and morphine have become household names, it seems, in the Canadian public, and of course this has a lot to do with the crisis at hand. Whether it is diverted pharmaceuticals, fentanyl purchased over the Internet from China, or stolen horse tranquillizers, dangerous and lethal opioids are making their way onto the streets of Canada and the consequences are fatal. The most alarming thing is how quickly opioids are growing, both in use and in the number of overdoses. To put things in perspective, the chief coroner of British Columbia told us at the health committee that illicit drug deaths involving fentanyl increased from 5% in 2012 to 60% in 2016. This is not just a crisis that affects those who find themselves without a home. There are 55,000 Canadian high-school students who reported in September 2016 that they had abused some sort of opioid pain reliever in the past year. In Ontario, in 2010, one in eight deaths of individuals aged 25 to 34 was found to be opioid-related. Families are being destroyed; lives are being lost; and all Canadians are experiencing reduced access to health and social services because of the resources required to look after this crisis. For me, this public emergency hits close to home. Lethbridge is near the epicentre of this epidemic in Canada. Last fall, five men in my riding were arrested for possessing just over 1,000 fentanyl pills destined for the streets of Lethbridge. Several subsequent arrests resulted in police recovering hundreds more fentanyl-laced pills. What has this meant for Lethbridge? Without being alarmist, we have seen organized crime in our city increase drastically, and the users of these drugs have made parts of Lethbridge no-go zones. There is a playground in my community where children used to enjoy playing regularly, and now it is known as “needle park”. This is a place where children no longer play and parents no longer feel safe, because of the needles that are left on the ground. Even for those not in direct proximity to drug dealers or opioid users, the effects of this epidemic are still felt. In Lethbridge, our first responders have all had to divert significant resources to address this crisis. This means that other crimes committed within our community are under-investigated or not investigated at all. It also means that EMS responders are increasingly overworked as they respond to the spike in drug overdoses. It means that firefighters have to deal with increased risks when they respond to residential fires for fear that they could be dealing with a contaminated illicit drug lab or equipment thereof.

235 The Federal response to the Opioid Crisis

This is to say nothing of the increased burden on our social service agencies. Lethbridge has punched far above its weight when it comes to the Syrian refugees who have come into our community. This influx of refugees has stretched our resources to the max because of the lack of support from the Liberal government. Many of these organizations have had to punch above their weight and are now starting to reach their breaking point. This is on top of the opioid crisis and the mental health crisis that results from the jobs crisis in Alberta. My heart goes out to the mental health workers in my community for the remarkable work they are doing around the clock and the way they are trying to divert this issue. This crisis has a human face, as sons, daughters, husbands, wives, cousins, brothers, and sisters are all lost to lethal street drugs laced with these opioids. I recognize that the opioid crisis is multi-faceted, but Bill C-307 is one key step to cutting it off at the source. Criminal enterprises have far too easy a time diverting legitimate pharmaceuticals to illicit street drugs. This is because the most common forms of opioid-based drugs are easily manipulated. Prescription pills can be ground down to snort, or the active opioid compounds can be extracted and used as a building block for different street drugs. Tamper-resistant forms of these pharmaceuticals can take several forms to reduce the ability to manipulate and extract the drug. The physical properties of the pill can be used to make manipulation much more difficult, such as providing a drug that cannot be altered without neutralizing the opioid compounds, or a chemical can be included that counteracts the euphoric effect of the opioid if the drug is manipulated, either by grinding or by heating it, making the drug useless to street providers. In June 2014, our previous Conservative government provided a notice of intent to industry. We announced that new regulations were coming that would require tamper-resistant formulations of specific controlled substances such as oxycodone. The intent of the former Conservative government was to reduce the diversion of opioids for illicit purposes to keep them off the streets. Sadly, the current government chose to overturn this decision, which has now had failed consequences on Canadians from coast to coast. One youth who I had the chance to talk to in my riding took the opportunity to brag to me that he was taking his prescription drugs and selling them for $25 a pill. His chronic pain allows him lifetime access to these pills and it now serves as his main source of income. Diverting these drugs to the illegal markets can be stopped. If we can stop this illicit secondary market for illegal pharmaceuticals, it will decrease one of the sources that make these street drugs so accessible. I will be the first to admit that this is a complex issue and that this one change will not solve the entire problem. There are a whole host of changes required in order to stop opioids from ending up on our streets. Canada’s physicians need to overhaul prescribing practices for opioids. Reducing the number of people with legal access to these drugs will also decrease the number of Canadians using illegal alternatives after their prescriptions end. Furthermore, I am pleased to note that the government has taken a recommendation from Conservative members to now allow the Canada Border Services Agency to check packages smaller than 30 grams. This decision came out of a report that was written by health committee. The fact that this could not be done before allowed an unlimited supply of fentanyl to be mailed in small packages and enter our country so it could be sold on the street market. I am also pleased the Liberals listened to health committee on the need to regulate pill press machines. These machines allow the toxic and deadly mishmash of chemicals in these street drugs to be pressed into professional-looking products that can easily be pack- aged and shipped. The new import controls on pill press machines is a good start, although more could be done. Finally, we need to tackle the source of this problem at the root, which is the lack of treatment options for those who suffer from mental health problems. This makes them susceptible to using street drugs in the first place. If the ongoing mental health crisis is allowed to continue in our city cores, on our reserves, and in our schools and universities, the drug crisis in our country will only continue to grow. The money in budget 2017 with regard to this issue is a good start, but a national strategy and further initiative is a must when it comes to mental health care in Canada. Whether it is fentanyl, crystal meth, or the next street drug that is easily produced and cheap to buy, at the heart of all of these drug uses, this epidemic that we face, are people who are emotionally hurting. This is why the human face of this epidemic is so heartbreaking to acknowledge. These are vulnerable people who have chosen drugs because they do not have the support and necessary tools to take on life. This is why I ask all members of the House to understand the further pain that opioids cause to Canadian families and to individuals. I ask members opposite to support this important legislation, Bill C-307.

Liberal MP John Oliver (Oakville, Ont.):

The intent of Bill C-307 is to enable the federal Minister of Health to require prescription medicine, specifically opioids, to have abuse-deterrent formulations or tamper-proof, tamper-resistant properties. By doing so, it will make these drugs more difficult to crush, snort, or inject, reduce their potential for misuse, abuse, and diversion to our streets. I strongly agree with the sponsor of the bill when he said that this issue was about public health, about saving lives and doing the right thing. Canadians are the second-highest consumers of prescription opioids in the world. Fifteen per cent of Canadians aged 15 years and older report using prescription opioids in 2013. It is estimated that about 10% of patients prescribed opioids for chronic pain become addicted. Furthermore, the increased availability of prescription opioids in households has meant that Canadian youth have begun using them for recreational purposes. Six per cent of youth aged 15 to 19 years indicated they abused opioid pain relievers in the past year.

236 The Federal response to the Opioid Crisis

These trends result in significant harms. In Ontario, one in eight deaths of individuals aged 25 to 34 years was found to be opiate-related in 2010. Similarly, there has been a substantial increase in the number of opioid-related deaths in Quebec, reaching almost three deaths per 100,000 persons in 2012. The response to the crisis by the government has been rapid, and I am pleased to see an evidence-based, health centric focus on harm reduction return to our health policy and legislation. The Minister of Health has already responded to the crisis through a five-point action plan that includes better informing Canadians about the risks of opioids; supporting better prescribing practices; reducing easy access to unnecessary opioids; supporting better treatment options for patients; and improving the evidence base and data collection. The minister also convened a two-day pan-Canadian conference on opioid abuse in November 2016, which generated many of the changes that were introduced to the House in Bill C-37. Further, the Standing Committee on Health, which I am proud to be a member of, issued a comprehensive report and recommendations on the opioid crisis on December 12, 2016. In the committee study, the issue of tamper-resistant technologies did not emerge as a preventive strategy. During the course of its study, the committee held five meetings, in which it heard from a range of stakeholders, including federal and provincial government representatives, health care professionals, addiction experts, emergency front-line responders, representatives of first nations communities, and individuals with lived experience in substance abuse and addiction. These witnesses outlined specific ways to address the opioid crisis and implored the committee to make recommendations that would lead to concrete action. The 38 recommendations focused on harm reduction; prevention, including training for physicians in prescribing practices and public education; treatment, including addiction treatment and improved access to mental health services; and law enforcement and border security changes. Tamper-resistance formulations were never documented in witness testimonies as an effective strategy. Let me expand on this point. One of the debate points over the proposed change to the law in Bill C-307 is about whether an explicit legislative authority is needed to require certain drugs to have tamper-resistant formulations. The government’s position is that the current regulation- making authorities under the Controlled Drugs and Substances Act are sufficient already to develop regulations should the evidence demonstrate a need for them in the future. From this point of view, Bill C-307 is unnecessary. Further, nothing in Bill C-307 would speed up that regulation-making process. The sponsor of Bill C-307 outlined many tamper- resistance technologies currently under development. The government strongly supports opioid manufacturers who wish to take proactive measures to make their medications harder to abuse. That is why it recently published guidance to drug manufacturers on what evidence was required to demonstrate tamper-resistant properties for prescription drugs. It is also clearly the sponsor’s view that the technology has been sufficiently developed in the area of tamper resistance and there is enough real-life evidence of positive outcomes to move forward with regulations. I would disagree. First, tamper resistance has not been shown to reduce the rate of addiction, overdose, and death related to opioid misuse. Remem- ber, a tamper-resistant opioid is still an opioid. Based on current evidence it is no less dangerous and no less addictive. Data from the United States and Ontario shows that opioid-related deaths continued to increase even after the introduction of reformulated OxyCon- tin to the market. Further, as I stated earlier, this strategy was not recommended by the many experts from whom the health committee heard testimony. Second, only a small number of people who misuse OxyContin pills crush them or dissolve them; most simply swallow them. Roughly a quarter of those who were misusing OxyContin before the tamper-resistant version was marketed continued to do so after its introduction. They did so by moving from inhaling or injecting the drug to, again, simply swallowing them. A sizeable population defeated the tamper-resistant properties, with information on how to do this available on the internet. Of course, those who misused by swallowing OxyContin continued to swallow reformulated OxyContin. Tamper resistance does not mean tamper-proof. Third, tamper-resistant technology is not sufficiently developed to cover the entire class of opioids, some of which come in the forms of patches, sprays, or injectable liquids. Fourth, and perhaps most important to me, the introduction of tamper-resistant technology seems to only reduce the abuse of one type of drug in exchange for another. The most common response to the introduction of reformulated OxyContin in the United States was migration to other drugs, including heroin and fentanyl. In the case of tamper resistance, it can result in a substitution or balloon effect. Studies already have found that prescriptions for hydromorphone and fentanyl increased in Ontario after the province restricted access to OxyContin, suggesting a substitution effect could been happening in Canada already. Members are, of course, all aware of the deadly impacts of the current surge in fentanyl-related overdose deaths in Canadians. Be- cause of the high demand for this drug, organized crime groups began importing illegal fentanyl as analogs from China. These are then transformed into tablet forms in clandestine labs in Canada, using pill presses and disguised as other opioids, such as OxyContin. The unknown potency of illegal fentanyl and other synthetic opioids, coupled with the fact the users are often unaware that they are taking illegally manufactured pills, has resulted in a dramatic increase in illicit drug deaths in Canada. British Columbia has become the epicentre of the crisis. The percentage of drug deaths involving fentanyl increased from 5% in 2012 to 60%. In 2016, with the involvement of fentanyl doubling the rates of drugs in the province, British Columbia experienced approximately 60 deaths a month by August 2016 from illicit drug use. 237 The Federal response to the Opioid Crisis

We do not want to make uninformed policy decisions that could increase the substitution of OxyContin to illegal fentanyl. The substitution effect can also lead to higher risks of administration, such as injection, which is associated with the spread of hepatitis and increased risk of overdose. I want the residents of my riding of Oakville to be protected from the opioid crisis and illicit fentanyl distribution. I want all Canadians to be protected from misuse of opioids. I have been meeting to discuss addiction and prevention with key agencies in Oakville, including the medical officer of health, service providers at the Halton Alcohol Drug And Gambling Assessment Prevention and Treatment Services, ADAPT, and, most recently, with the Halton chief of police, Steve Tanner. Tamper-proof has not come up. I applaud the sponsor of Bill C-307 for the attempt to help address this crisis, but for the reasons stated above, I do not believe the bill would change the government’s ability to respond to the crisis. Nor do I believe evidence-based research supports the underlying position taken by the bill. Finally, I do not think the bill would help the vulnerable and at-risk people in Oakville. For these reasons, I will not be supporting Bill C-307.

Conservative MP Dave MacKenzie (Oxford, Ont.):

The intent of this bill is to enable the federal minister of health to require specific controlled substances or class of controlled substances to have “abuse-deterrent formulations” and/or “tamper-resistant properties”. This will make these pharmaceutical substances more difficult to abuse. Bill C-307 will make it possible for Canada’s health minister to take immediate action whenever Canadians are being hurt or killed by a specific drug. We can do something, one thing, to help keep Canadians safe. We can do something when it becomes apparent that there is a deadly narcotic substance available that we no longer want available in its current form because it is dangerous and can be too easily abused. We can do something, by supporting Bill C-307. While this bill can apply to any substance under the two categories of drugs in the health legislation, this bill may in fact only be implemented on rare occasions, and yet it will help Canada’s minister of health take swift action to save lives and prevent terrible suffering. The government does have opposition to Bill C-307. In the previous hour of debate on November 17, 2016, Canadians learned of the Liberal government’s initial response to Bill C-307, and we were disappointed. However, we hope that following today’s second hour of debate, the Liberal government will agree to support sending this bill to committee for further study and consideration. I want to address the reasons for opposing Bill C-307 from the parliamentary secretary to the Minister of Health. I want to remind everyone that abuse-deterrent and tamper-resistant technologies across the class of opioid medications are only one tool among many others to combat prescription opioid abuse. Crushing and snorting of these powerful narcotics is often the gateway to other forms of abuse, including pill-popping and the movement to more dangerous illicit substances, such as fentanyl, carfentanil, W-18 and U-47700, especially for young Canadians. I am hopeful that we would do everything in our power to stem this tide. Would all drugs be required to be tamper resistant? No, this bill will not result in only tamper-resistant drugs being available in the Canadian market. This is precisely the point. The United States is leading the way and moving forward to provide Americans with many drugs in a tamper-resistant form. This movement is supported by the Federal Food and Drug Administration, the DEA, and the Trump administration. Seven medications with tamper-resistant or abuse-deterrent formulations, with more to come, are now approved in America. The parliamentary secretary did not report much of the growing body of evidence to this House in her speech during the first hour of debate. The speech she delivered did include references to a selective literature review on the benefits and risks of abuse-deterrent formulation, tamper-resistant medications. The recently concluded health committee hearings and the opioids conference did not hear from all stakeholders, including actual pain patients taking these abuse-deterrent formulation, tamper-resistant medications; representatives from the industrial producers of abuse-deterrent formulation, tamper-resistant medications; nor any international and independent experts in the field of abuse deterrence. There is more consultation needed by the government. In fact, the health minister’s public statements often acknowledge the value of wide consultation, and it is one of the orders in her mandate letter from the Prime Minister. The government’s opposition to Bill C-307 expressed by the parliamentary secretary did not follow another instruction to the Minister of Health in her mandate letter from the Prime Minister. That directive asks the minister to provide Canadians with science and evidence- based approaches to inform public policy. There is strong scientific confirmation of tamper-resistance technology and abuse-deterrent formulations. There are no maybes or guesswork about these technologies. They work. Tamper-resistance and abuse-deterrent formulation technology is here to stay. It is sound science. It is the future. Increasingly, powerful medications will be available in the protected forms contained in Bill C-307. Someday, all powerful medications will be released to the public in these forms. These technologies are a product of the scientific advances of the western pharmaceutical technology. Doctors want to prescribe to their patients medications that will not harm them. Doctors want to prescribe to their patients medications that patients cannot hurt themselves with, even if they try. 238 The Federal response to the Opioid Crisis

Patients want their doctors to prescribe them medications that will not hurt them, even if they make a mistake while trying to follow the instructions on the prescription. Everyone wants prescriptive medications that cannot be cut up, crushed, and sold as drugs to be abused. We can do this now. The technology does exist. We can protect ourselves and others right now. Someday our society will be able to protect our population from the risks and the harmful effects of strong medications that are being abused. This technology will be widespread and used on virtually all potentially harmful medications. Bill C-307 proposes to provide our Minister of Health with the power to name a single substance and declare it unavailable to Canadians unless and until it is in a tamper-resistant or abuse-deterrent formulation. This would save lives every time that we find a particular substance is being abused with deadly results. The health minister could invoke this tool immediately and stop the loss of lives and terrible suffering at any time. We have seen numerous drugs, one at a time it seems, being the latest drug of choice to abuse. Some of them are producing deadly results in large numbers. With the passage of Bill C-307, we could stop any of the newest drugs from being available for abuse. We could demand that they are are only made available in a tamper-resistant or abuse-deterrent formulation. There is a question of costs, and the concerns about the possible increase in costs for public and private payers of medications with abuse-deterrent and tamper-resistant formulations have been addressed. The introduction of these products in the United States and Canada has been shown to drive down prescription volumes for these medicines. The result is that the costs remain the same, not higher. Again, the parliamentary secretary did not provide us with the evidence of this fact; she reported that her government continues to be concerned about costs. However, the cost issue has been addressed, with evidence. There needs to be more up-to-date research on the facts and figures concerning the deployment of medications with both abuse-deterrent and/or tamper-resistant properties. The federal government and the provinces have every cost-containment tool at their disposal today to rein in drug costs. The highly successful pan-Canadian Pharmaceutical Alliance is a very effective alliance that operates to set the best prices for public pharmaceutical plans. In turn, the work of the alliance also affects, and sometimes dictates, the prices in private plans. This system ensures that patients are getting medicines at affordable levels. The provinces and territories have the power of bulk buying. There are numerous examples of medications available at reasonable costs and even lower costs following negotiations between governments and producers. The pharmaceutical firms can employ scale pricing if they know they will realize specific large numbers of sales over specific time frames. This common marketplace practice- ac commodates the costs to the consumer and makes abuse-deterrent and tamper-resistant medications available and affordable. I remind all members of the House that every single opioid molecule known to medical science is already off patent. Regulations designed in the previous Parliament make it clear that any company can bring in a competing technology to any abuse-deterrent medication. I am reminded frequently of the use of the term that we do not need 99 reasons for why we cannot do something, we only need one reason for why we can. This is one reason for why we can work to save lives across this country, by adopting Bill C-307.

Conservative MP Earl Dreeshen (Red Deer—Mountain View, Alta.):

As someone who has spent a great deal of time with young people as an educator for 34 years, I have seen the effects and the terrible things that happen because of drugs. I do not think there is anybody in this House who is unaffected by that same type of damage. When we know there is something out there that could possibly help, this is critical. With the opportunities that young people have when they get hold of drugs, and the partying and other stuff that ties into it, we realize that the damage hurts many families. The intent of Bill C-307 is to enable the federal minister of health to require specific controlled substances or classes of controlled substances to have either abuse-deterrent formulations, ADFs, and/or tamper-resistant, TR, properties. This bill would make these pharmaceutical substances more difficult to abuse and would make it possible for Canada’s health minister to take immediate action whenever Canadians are being hurt or killed by a specific drug. Bill C-307 would help keep Canadians safe when it is determined that a particularly deadly narcotic substance that is available in its current form is too dangerous and can too easily be abused. While Bill C-307 could apply to any substances under the two categories of drugs in the health legislation, the provisions of this bill may in fact be implemented on rare occasions. We are led to believe that the Liberals will someday announce a package of measures that they think will help combat the scourge of drug abuse in Canada. We also know that the Liberals are supporting legalized marijuana. I will have a lot to say about that in the future, again as someone who has seen the serious damage to families and young people that has taken place, especially to developing brains. We can only hope that when adopting this measure in Bill C-307, at a time in the future when the Liberals announce their further policies on drug abuse, maybe they will have something they can tie in to that. I heard one speaker earlier talking about discussions where there were a number of recommendations. We have to look at some of the other damages that exist as well, to find out exactly what is taking place. Again, abuse-deterrent and tamper-resistant technologies across the class of opioid medication is only one tool among many others that are there to combat prescription drug abuse. Bill C-307 would do something to prevent the ability to crush, snort, or ingest powerful narcotics that have been taken from pills, patches, or sprays prescribed by doctors. We hear disturbing things about some prescrip- 239 The Federal response to the Opioid Crisis tions and how they get into the hands of young people, and into the hands of older people as well. Sometimes the drugs are being sold because people would sooner be in pain and get money for their drugs. They know that there will be problems down the line. These are the kinds of abuses that we constantly see. This kind of drug abuse becomes a gateway to other forms of abuse, including pill-popping and taking too many pills in order to get high at parties. It becomes like a Russian roulette as to what people will take. Abusing drugs that are available from doctors or pharmacies also leads to abuse of more dangerous illicit substances, as has been mentioned before, such as fentanyl, carfentanil, W-18, and U-47700, especially by young Canadians. Passing Bill C-307 into law would result in tamper-resistant drugs being available in the Canadian market. However, these are only drugs that we discover are being easily and widely abused. They could be identified by the minister of health and taken off the shelves until they are manufactured with tamper-resistant or abuse-deterrent properties. I believe that people who are in the business of making sure that drugs are safely presented to Canadians would be able to deal with this and be more than pleased to help in protecting young people, and all people who seem to have gone off the rails in this particular area. We have heard a great deal of rhetoric and slogans and we have heard the review of newspaper clippings by Liberal MPs who have spoken against Bill C-307, but we have not heard any better ideas than what is proposed in Bill C-307. We have not heard support for research into tamper resistance. We have not heard the Liberals pursue Bill C-307 as part of their innovation strategy. I imagine the current Liberal government is searching for ways to spend billions of taxpayers’ dollars or borrowed money on innovation, so here would certainly be an opportunity. At the same time, in a very few laboratories in Canada and the United States, teams of scientists are working to make these pills and patches and sprays tamper-proof, and they are succeeding. They are all going to tell us that they may need more money and more funding so the research can be accelerated and expanded. They want to go faster and someday have many of the more powerful medications that a doctor would prescribe either difficult to abuse or impossible to abuse. Canada could be leading the way on the conversion of some of these drugs to a completely safe state. The government needs to get to work. Canadians want to hear from acute pain patients taking these ADF and TR medications, from representatives from the industrial producers of ADF and TR medications, and from international and independent experts in the field of abuse deterrence. This is one of the critical and important things that we have to be aware of. More consultation needs to be done by the government. Instead, it seems bent on simply voting down Bill C-307 and abandoning the wealth of opportunities that this field of medicine can provide. Canadians are being hurt and killed by drugs that are available, drugs that can be broken into and abused in such a way as to cause overdoses. We could prevent that. The Liberals do not want this. All of this anti-recreational drug talk is boring to the Liberals. They have better things to do with billions of borrowed dollars than to help prevent death and serious injury from the abuse of drugs. They are more concerned about legalizing marijuana. We hear terrible stories of house parties where someone hands out crystals crushed from pills to young people, who try it. Some might get really sick or go into trauma, and hopefully someone calls 911. Most often, though, we hear about these deaths the next morning. Having seen and recognized how serious this can be, people realize that something has to be done. In the health minister’s mandate letter from the Prime Minister, she is told to consult with Canadians. That directive asks the minister to provide Canadians with science- and evidence-based approaches to form public policy. There is strong scientific confirmation of tamper-resistant technology and abuse-deterrent formulations. The minister should get to work and put Canadians to work developing this field of science in order to protect our children from the powerful medications prescribed by our doctors and found in our medicine cabinets. Whether the government agrees to help or not, powerful medication will be available increasingly in the protected forms contained in Bill C-307. Someday all powerful medications will be released to the public in these forms. I hope enough Liberal backbenchers will show backbone and vote in support of Bill C-307 so that it can be sent to committee for further study. I hope enough Liberal MPs do not listen to the dictates from the PM and the health minister and will vote in support of Bill C-307. These brave MPs will be able to tell their constituents that they at least tried to save the lives of young folks who are getting hurt or killed by abusing drugs that are already at home and in the family medicine cabinet. The supporters of Bill C-307 will be able to hold their heads high when they go home, because they will have tried to convince their government to do the right thing. Everyone should get behind this effort. It is just one thing, but these things add up. They save lives and they prevent suffering.

Conservative MP Kevin Sorenson (Battle River—Crowfoot, Alta.):

Mr. Speaker, it is a pleasure to stand in the House and have the final say in debate on my private member’s bill, Bill C-307. The creation of my private member’s bill came about from having a wife and a daughter who are registered nurses. Especially, my daughter came to me and said, “Dad, something has to be done.” I live in a small rural riding where we typically do not believe we have the same problems, difficulties, and issues that are faced in cities such as Vancouver, which we heard the member of Parliament talk about this morning, but the issue of prescription and illicit drug abuse has touched every riding in our country.

240 The Federal response to the Opioid Crisis

This is an issue that we all face in the communities we represent as hon. members of Parliament. It is an issue that has ravaged some communities, destroyed families, and has taken far too many lives. Most tragically, it has taken a disproportionate number of lives from young and indigenous Canadians. I listened as the New Democratic member of Parliament from Vancouver stated that 20,000 people in Canada have died from opioid abuse over the years. There were 156 call-outs in that one community in Vancouver to the fire department or to 911 dealing predominantly with fentanyl and opioid abuse. Canadians expect that we would respond to numbers and issues like that. Can any member of the House forget the headline on September 17, 2016, in the National Post, which read: “Eight overdoses in 13 minutes and one devastated suburb”? That article stated that they did not have enough responders to get out to the various eight overdoses in that span of 13 or 15 minutes. It was one small-time drug dealer who contaminated a batch of cocaine he made with fentanyl that caused the tragedy. The alleged dealer said that he had no idea what he had done. Right now—and I do not even have it printed out yet—the CBC is carrying a story. In New Brunswick, an individual’s former physician—and they name the individual—is being charged with drug trafficking. It is alleged the 35-year-old doctor wrote prescriptions for 50,000 OxyContin and OxyNEO pills, picked them up herself, and did not give them to the patients. We have a crisis in the country. Emergency responders know that when there is a fentanyl overdose, they use naloxone to save the lives of victims, but in this case we do not know where those 50,000 pills were going. Tragically, as we have already heard this morning, far too often when we open the papers in the morning—especially in British Columbia and the west, but more and more across into the east—the papers are reporting the deaths of those who have used a drug without knowing that it had been laced with something like fentanyl. Bill C-307 would help prevent so-called dealers from breaking into medication that is available to Canadians from pharmacies. It would prevent these clandestine drug manufacturers from adding the active ingredients from prescription drugs to another drug and causing them to be deadly. The bill would give the health minister the power to quickly act and remove some of these from their availability to people who would abuse them. No one should be using drugs, yet we live in a society where peer pressure, life stresses, and many other factors cause people to abuse drugs. These people do not factor in the possibility of dying when they try those drugs. It is time that Parliament responded. Let me end by saying this. The Liberal government said in the last budget that it was going to have an innovation budget. These are exactly the things that happen when research and development goes out with innovation money, looking at a problem, and asking whether it can be made abuse-deterrent, whether it can be made in a formulation that cannot be misused by those who get their hands on it. Therefore, I would encourage the governing party to allow the bill to go to committee—not to make it law today, but at least to allow the bill to go to committee, where it can be studied and the benefits of this measure can be seen. I thank every member of Parliament for their consideration of this bill. I encourage everyone to support it Wednesday evening, allow the committee to do some work on it, and report back.

MAY 8, 2017 Conservative MP Bob Saroya (Markham—Unionville, Ont.) moved that Bill C-338, An Act to amend the Controlled Drugs and Sub- stances Act (punishment), be read the second time and referred to a committee.

Conservative MP Bob Saroya (Markham—Unionville, Ont.):

Mr. Speaker, I rise today to address a serious issue that is destroying lives and causing thousands of deaths in Canada each year. The importing and exporting of dangerous drugs and substances is a serious threat to Canadians. While the Liberal government has taken some constructive steps to combat the threat posed by the trafficking of lethal drugs and substances, little has been done to deter or to punish criminals. I therefore have introduced Bill C-338, which would amend the Controlled Drugs and Substances Act in order to increase sentences for offences related to the importing and exporting of controlled drugs and substances. Bill C-338 indicates that if the subject matter of the offence is a substance included in schedule I and in an amount that is not more than one kilogram, or is in schedule II, the offender is guilty of an indictable offence and liable for imprisonment for life and to a minimum punishment of imprisonment for a term of two years. The proposed bill also specifies that if the subject matter of the offence is a substance included in schedule I and is in an amount that is more than one kilogram, the offender is guilty of an indictable offence and is liable for imprisonment for life and a minimum punishment of imprisonment for a term of three years. At present, minimum sentences stand at one year for less than one kilogram and two years for more than one kilogram. This is unacceptable. Such light punishment does not deter drug traffickers from continuing to import and export and profit at the expense of society’s most vulnerable. The reality is that criminals who import and export deadly drugs and substances are responsible for thousands of lost lives.

241 The Federal response to the Opioid Crisis

Canadian families expect safe and healthy communities in which to raise their children. Canadians are especially concerned about crime, which is why our previous Conservative government introduced and passed more than 30 measures aiming at the strengthening of our justice system and standing up for victims and keeping our streets safe. We also specifically targeted gangs and other criminal organizations by introducing tougher sentences for drug traffickers who exploit the addictions of others for personal profit. Canadians lose faith in the criminal justice system when they feel that the punishment does not fit the crime. Elected representatives can and should provide guidance on sentences to reflect the view of all Canadians. The Conservatives make no apologies for strengthening penalties for drug traffickers or other crimes. All parliamentarians must ensure that sentencing reflects Canadians’ desire to get tough on drug dealers and on other criminals. Over the past five years, we have seen a deeply disturbing spike in overdoses involving the synthetic opioid painkiller fentanyl. It is so strong that exposure to a microgram is often fatal. Just to put that into perspective, a microgram is what one would get who took a standard 400-milligram pill of ibuprofen and cut it into 4,000 pieces. That tiny grain of drug may kill someone who comes in contact with it. Prescription-grade fentanyl is up to 100 times more toxic than morphine. It is often used as a last-resort painkiller to treat ter- minally ill cancer patients. It is especially dangerous if one has never been exposed to opiates before. In Canada, drug dealers can order the illegal substances for drug production online from overseas suppliers, many of whom will guarantee reshipment in the event that the package is intercepted. The drug is then produced in basement labs and kitchens, but in such conditions that it is impossible to predict the strength of each dose. Earlier this year, in my riding of Markham—Unionville, a drug lab was discovered in the heart of an upper-middle-class residential neighbourhood, forcing residents to evacuate their homes. For people who are looking to abuse the drug, fentanyl creates a blissful feeling similar to the effects of heroin, but an overdose shuts down the area of the brain that controls breathing. This generally results in brain damage or death. Many people end up taking fentanyl accidentally. Drug producers are lacing other drugs with fentanyl, and the users have no idea that what they are buying will kill them. Unsuspecting drug addicts might buy what they think is OxyContin, but it is actually fentanyl, or a young student who may be experimenting at a party may end up overdosing on fentanyl. The user is not expecting difficulty in breathing and a slowed heartbeat. It is not only hard-core drug addicts and junkies who are victims of this epidemic. It is regular people, such as Jack Bodie, a 17-year- old Vancouverite, who died in a park after taking fake OxyContin pills with his younger friend. It is 33-year-old Szymon Kalich from Edmonton, who was found dead in the hallway of a residential building and whose mother received the news when the police showed up on her doorstep two days later. It is a nine-month-old baby in Winnipeg, who was rushed to the hospital by paramedics after being exposed to residue of the opiate in his parents’ home. From coast to coast to coast, no community in any member’s riding is immune to this epidemic. According to the Ontario Drug Pol- icy Research Network, 734 people died of opiate-related causes in Ontario in 2015, averaging two people every day. This number totals far more than the 481 people who died in motor vehicle accidents in 2014. Over 80% of all opiate-related deaths in 2015 were accidental. Almost 60% of accidental deaths occurred among youth and younger adults between the ages of 15 to 44 years. Fentanyl use increased by 548% between 2006 and 2015, and fentanyl is now the opiate most commonly involved in opiate-related deaths. British Columbia and Alberta have been hit the hardest. According to the Coroners Service of British Columbia, overdoses of illicit drugs claimed the lives of 922 people in B.C. in 2016, making it the deadliest overdose year on record and representing an increase of 80% from the previous year. In B.C., from January through February of 2017 there were 139 illicit drug overdose deaths in which fentanyl was detected. This is a 90% increase over the number of deaths, 73, occurring during the same period in 2016. From January to February of 2017, fentanyl was detected in 61% of illicit drug overdose deaths, 139 of 227. Vancouver Coastal Health had the highest number, 48, of illicit drug overdose deaths in which fentanyl was detected in January and February 2017, followed by Fraser Health with 39 and Vancouver Island Health Authority with 29. The health service delivery areas with the highest number of fentanyl-detected illicit drug overdose deaths in January and February of 2017 were Vancouver with 43, Fraser South with 24, and the Okanagan with 15. When looking at individual townships over the same time period, the highest numbers of deaths were seen in Vancouver, Surrey, and Victoria. In 2016, a review of toxicological findings of 325 fentanyl-detected illicit drug overdoses deaths was conducted. In 96% of these deaths, at least one substance other than fentanyl was detected. The other most frequently detected drugs leading to death were cocaine, methamphetamines, amphetamines, and heroin. Parliamentary data in January 2017 suggested that the proportion of illicit drug overdose deaths with fentanyl detected, alone or in combination with other drugs, is approximately 61%. According to Alberta Health, 343 people died from fentanyl overdoses in 2016 in Alberta. The province showed a 33% increase in the rate of overdose deaths linked to the drug from 2015, and a dizzying 110% rise from just two years ago. Calgary saw the lion’s share of the death toll, with 149 deaths in 2016. Of those 343 deaths, 22 were linked to carfentanil, an opioid that is 100 times more powerful than fentanyl. Alberta’s fatality numbers have not reached the level of B.C.’s, but the toll has been devastating, claiming 717 lives since 2014, 261 of those in Calgary. According to the report from Alberta Health, 80% of those who died last year were male, nearly half between the ages of 25 and 39. In most fentanyl overdoses, multiple substances were also involved, primarily cocaine, methamphetamine, and alcohol.

242 The Federal response to the Opioid Crisis

I would like to give more standardized statistics for each province and each year, but this epidemic has exploded so quickly that many provinces do not yet have a system for organizing information. It has been called a Canada-wide disaster. In Ottawa, the director of the city’s drug treatment program has stated that the fentanyl being sold in the streets is too strong to even be treated by overdose antidote kits. In late April, The Ottawa Hospital reported 15 fentanyl overdoses over a period of 72 hours. However, there are other new synthetic opioid painkillers similar to fentanyl on our streets. W-18 is similar to fentanyl, but 100 times as toxic. It is 10,000 times stronger than morphine. In 2015, it was detected in three drug seizures. By October 2016, it was detected in 30 drug seizures. I truly understand the need for robust prevention and treatment options for addicts, but you cannot rehabilitate dead people. The criminals who import and export deadly drugs and substances do not care about the effects they are having on people’s lives. They do not care if they will be responsible for the deaths of many Canadians. They are not deterred by the current punishment for the crimes they are committing. What they know is that they can take $10 worth of fentanyl and make $5,000 selling it on the streets. As it stands, the Controlled Drugs and Substances Act provides inadequate and unintimidating punishment for criminals who import and export lethal drugs and substances. Those who import and export these drugs and substances must be brought to justice and must face increased mandatory minimum sentences. Our constituents expect us to do more to keep their children and communities safe.

NDP MP Alistair MacGregor (Cowichan—Malahat—Langford, B.C.):

Mr. Speaker, as a resident of British Columbia, specifically on Vancouver Island, I need only look across the water to see how bad the fentanyl crisis is in Vancouver. Indeed, and I direct my comments to the government side, if we had an infectious disease killing at the rate that overdoses are in British Columbia, the government would have mobilized far more resources and in a much quicker time frame than has been done. I am glad to see that the Conservatives recently joined us to declare the opioid crisis a national health emergency, but when we attempted to move Bill C-37 through the House quickly to deal with the problem, Conservatives attempted to block it. I am just wondering what the member’s reasoning was for that blocking.

Conservative MP Bob Saroya (Markham-Unionville, Ont.):

Mr. Speaker, one death is far too many. The numbers in this epidemic have gone up over the past five years. Look at the numbers in B.C. of 992. We need to make sure that we put an end to this crisis. Most of the drugs are coming from overseas. We need to put an end to this, especially the drug dealers who are making a profit on the lives of Canadians.

Conservative MP Blaine Calkins (Red Deer—Lacombe, Alta.):

Mr. Speaker, I want to thank my hon. colleague for bringing this very important piece of legislation forward for discussion. A recent study of the Insite facility in Vancouver found that over 86% of the drugs that are used at that facility are laced with fentanyl, and over 90% of the heroin. Right now the people of Edmonton, and the Albertans he mentioned, are being faced with the Edmonton city council, in its infinite wisdom, which is complete sarcasm, deciding to bring these sites into the downtown core of the city, knowing that these drugs are laced with other drugs. We see the usage rates between Alberta and B.C. being virtually the same. I am wondering if my colleague could comment on whether he thinks it is wise for the city of Edmonton to pursue this policy when we see the absolute and total damage that making drugs more accessible and readily available is causing to communities.

Conservative MP Bob Saroya (Markham-Unionville, Ont.):

Mr. Speaker, the cities of Edmonton, Calgary, and any city in any province, should be doing what the hon. member suggests. As I said earlier, a life saved is a life saved. From the Conservative side, we will always be on the side of the victims. We will always stand up for victims rather than for the criminals. On the Liberals’ side, it is the other way around. They always stand for the criminals rather than the victims.

Parliamentary Secretary to the Minister of Justice and Attorney General of Canada Bill Blair (Scarborough-Southwest, Ont.):

Mr. Speaker, as I read the member’s private member’s bill, there is a great focus on punishment. I am wondering if he has given any consideration to the issues of prevention, treatment, and harm reduction. Canada has proudly followed a four-pillar strategy in dealing with this health crisis, yet there seems to be very little in the bill that speaks to the other three pillars. I wonder if he would like to expand on that. 243 The Federal response to the Opioid Crisis

Conservative MP Bob Saroya (Markham-Unionville, Ont.):

Mr. Speaker, there are many things that we can balance. It is all about the balancing act. We are saying, let us get the drug dealers. The Liberal Party has brought some things to this issue that would help, but this is about taking the drug dealers off the streets. For 40 years, the former police chief put those criminals behind bars. I hope we can keep up the same by asking for two years of imprisonment for less than one kilogram of the drugs, and three years for over one kilogram. It is not much to ask. In my view, some of these guys should be charged with murder rather than sending them to two years in jail. It is not much to ask.

Parliamentary Secretary to the Minister of Justice and Attorney General of Canada Bill Blair (Scarborough-Southwest, Ont.):

Mr. Speaker, I am pleased to have the opportunity to discuss this morning, Bill C-338, an act to amend the Controlled Drugs and Substances Act, which proposes to increase mandatory minimum penalties and imprisonment for the importation and exportation of certain drugs. The objective of Bill C-338 is to target the importation and exportation of powerful opiates such as fentanyl in Canadian communities, an objective that everyone in the House would agree is laudable. The bill proposes to denounce the importation and exportation of these lethal drugs by increasing the mandatory minimum penalty from one to two years where the quantity of these drugs is less than one kilogram and certain aggravating factors are present. In other cases, the mandatory minimum penalty would be increased from two to three years. The bill also proposes to increase the mandatory minimum penalty from one to two years for the importation or exportation of any amount of a schedule II drug, namely cannabis. As has been already articulated in the House this morning, we find ourselves in the midst of a national health crisis, and this has put the spotlight on the importance of comprehensive and evidence-based Canadian drug policies. Canadian communities are feeling the devastating impact from the growing number of opioid-related deaths and overdoses. Cana- dians deserve nothing less than concerted government action that would have an immediate impact on addressing the influx of opioids in our communities. The policies put in place to respond to this crisis must be informed by performance measurement standards and evidence. These policies must have an immediate impact on reducing the number of these tragic deaths. This is why I am happy to see that the Government of Canada has instituted a modernized Canadian drugs and substances strategy. The Canadian drugs and substances strategy is focused on prevention, treatment, and enforcement, but it also reinstates harm reduction as a core pillar of Canada’s drug policy. The CDSS champions a comprehensive, collaborative, compassionate, and evidence-based approach to drug policy. In furtherance of this strategy, the Minister of Health introduced Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts, to address the serious and pressing public health issues related to opioids. This legislative response is one important part of the government’s comprehensive approach to drug policy in Canada. Bill C-37 proposes, first, to simplify and streamline the application process for supervised consumption sites; second, to clamp down on illegal pill presses; and, third, to extend the authority of border officers to inspect suspicious small packages coming into Canada. In relation to the last point, extending the Canada Border Services Agency’s inspection powers is important, because one standard-size envelope can contain 30 grams of fentanyl, potent enough to cause 15,000 overdoses. These numbers increase exponentially where the substance in question is carfentanil. In addition, the government has invested over $65 million over five years to support the new CDSS and implement its five-point opioid action plan. This amount is in addition to the $10 million in emergency support that the federal government has provided to the Province of British Columbia to assist in its response to overwhelming numbers of overdose and opioid-related deaths in that province. The five-point opioid action plan is focused on increasing public awareness, supporting better prescribing practices, reducing access to opioids in appropriate cases, supporting better treatment options for patients, and improving Canada’s data collection and evidence base to inform more effective drug policies in the future. That is not all that the government of Canada is doing. Canada is also working closely in collaboration with our international partners, such as the United States and China, to address this crisis. Senior law enforcement and border officials are already working -to gether on a regular basis to curb the flow of illegal opioids across international borders, and I will cite an example. The Royal Canadian Mounted Police has reached an agreement with China’s Ministry of Public Security to enhance operational collaboration, identify key areas of concern, and work towards a more coordinated approach to combat fentanyl trafficking originating from China. Such partnerships are a testament to the reality that this epidemic is a very serious international problem which will require international co-operation to fix. Addressing the roots of the opioid crisis demands a whole-of-society response. This brings us to Bill C-338. Although its stated objective is both timely and I am certain well intentioned, the proposed increase to mandatory minimum penalties is neither likely to contribute to deterring offenders from importing and exporting powerful opiates, nor to have any impact on addressing opioid-related deaths across Canada. I am not aware of any evidence suggesting that increased mandatory minimum penalties would be effective in reducing the importation or exportation of these lethal drugs, including opiates, into Canada. 244 The Federal response to the Opioid Crisis

Although deterrence is a frequently cited argument of supporters of mandatory minimum penalties, my understanding is that the vast majority of the research in this area shows that these mandatory minimum penalties are ineffective in deterring crime. In fact, the likelihood of being caught represents the far greater deterrent. In addition to the fact that increasing mandatory minimum penalties would not likely have a meaningful impact on lowering the number of opioid-related deaths in Canada, Bill C-338’s proposal to increase mandatory minimum penalties would have a number of adverse effects on the proper administration of the criminal justice system, all of which have been well documented here in Canada and abroad. I am aware of several studies that suggest that mandatory minimum penalties actually lead to far fewer guilty pleas, increased litigation, and an increase in the time required to complete cases. Given the Supreme Court of Canada’s recent decision in Regina v. Jordan, we must be mindful of policies that contribute to excessive delays, which plague our criminal justice system. In fact, last month, when federal, provincial, and territorial ministers responsible for justice met to discuss priority responses to further reduce delays in the criminal justice system, they unanimously identified mandatory minimum penalties as one area of legislative reform that could help in improving court delays. International research also reveals that the use of mandatory minimum penalties to combat the war on drugs in the United States has resulted in far higher costs associated with the dramatic increase in litigation and the use of imprisonment. I am also concerned about the charter risks associated with increasing mandatory minimum penalties. I am aware of two recent Supreme Court of Canada decisions that clearly state that mandatory minimum penalties that apply to offences that can be committed in various ways under a broad array of circumstances and by a wide range of people are constitutionally vulnerable. Based on these rul- ings, I am concerned that the mandatory minimum penalties proposed in this bill are vulnerable, because they could apply to offenders who have committed a crime for which the proposed mandatory minimum penalty would be unjust. Bill C-338’s increased mandatory minimum penalties are not necessary to signal to Canadian judges that these offences should be treated seriously. Canadian judges, in appropriate cases, already exercise their discretion to impose significantly higher sentences in excess of the proposed mandatory minimum penalties. For example, in Regina v. Cunningham, the Court of Appeal for Ontario confirmed that the appropriate sentencing range for first-offender drug couriers who smuggle large quantities of cocaine should be in the range of six to eight years’ imprisonment. In that decision, the court, mindful that many drug couriers are easy prey for commercial drug traffickers, noted that such concerns must give way to the need to protect society from the untold grief and misery occasioned by the illicit use of hard drugs. In fact, it increased a three-year sentence imposed to five years’ imprisonment and stated clearly that it is the responsibility of the courts to warn would-be couriers, in no uncertain terms, that they will pay a heavy price for choosing to import large quantities of hard drugs for quick, personal gain. More recently, the British Columbia Court of Appeal, in Regina v. Smith, noted that given the development of a public health crisis surrounding opioids, a higher sentencing range was appropriate for certain trafficking offences under the Controlled Drugs and Substances Act. I am confident that the courts will impose just sentences based on the facts before them. On the whole, I believe that the approach advanced by the government is the right one. Changes to increase mandatory minimum penalties may seem on their face attractive, but they simply will not work to address the public health emergency. For all the reasons I have noted, the government will not support Bill C-338.

NDP MP Alistair MacGregor (Cowichan—Malahat—Langford, B.C.):

Unfortunately, the bill before us does nothing to address the phenomenon of drug use and sees fit only to increase the punishment, through mandatory minimums, for those who are engaged in the import and export of certain substances listed under the Controlled Drugs and Substances Act. Bill C-338 would amend subsection 6(3) of the Controlled Drugs and Substances Act to punish those who import schedule I or schedule II substances. Schedule I substances include opium, codeine, morphine, cocaine, fentanyl, and of course, the deadly carfentanil, while schedule II is known mainly for cannabis and its derivatives. Specifically, under paragraph 6(3)(a), the bill would make an amendment so that there would be an increase from a minimum punishment of one year to two years’ imprisonment for not more than a kilogram of a schedule I substance or for any amount of a schedule II substance. Under paragraph 6(3)(a.1), the bill would make an amendment so that the minimum punishment was increased from two years’ to three years’ imprisonment for importing and exporting a schedule I substance that is more than a kilogram. Increasing mandatory punishments is a favourite legislative pastime of the Conservative party, and this was especially true under the previous Harper government. The opioid crisis Canada is experiencing is a national emergency that had its origins in my home province of British Columbia. It is a complex phenomenon, a problem the Conservative legacy of supposed tough-on-crime legislation has been ineffective in stemming. The Supreme Court of Canada has been particularly critical of some of the mandatory minimums, from the previous government, it has struck down. In April 2015, the Supreme Court dealt the Harper government’s tough-on-crime agenda a serious blow by striking 245 The Federal response to the Opioid Crisis down a law requiring mandatory minimum sentences for crimes involving prohibited guns. The six-three ruling, penned by the chief justice, took aim at the government’s keeping-Canadians-safe justification for tough sentencing laws. In her ruling, she said,

“The government has not established that mandatory minimum terms of imprisonment act as a deterrent against gun-related crimes.... Empirical evidence suggests that mandatory minimum sentences do not, in fact, deter crimes....”

In April 2016, the court ruled six-three that a mandatory minimum sentence of one year in prison for a drug offence violates the Charter of Rights and Freedoms. The court ruled that the sentence cast too wide a net over a wide range of potential conduct and stated in its ruling:

“If Parliament hopes to maintain mandatory minimum sentences for offences that cast a wide net, it should consider narrowing their reach so that they only catch offenders that merit that mandatory minimum sentences. In the alternative, Parliament could provide for judicial discretion to allow for a lesser sentence where the mandatory minimum would be grossly disproportionate and would constitute cruel and unusual punishment.”

Bill C-338 stems from a belief that we can arrest and incarcerate our way out of the problem of drugs in our society. However, if we look at the facts, they show otherwise. Police-reported drug offences in 2014, after the Conservative tough-on-crime legislation from the year before, showed that meth possession went up 38%, heroin possession went up 34%, MDMA possession increased by 28%, meth trafficking went up by 17%, and heroin trafficking went up by 12%. It is clear that the Conservative agenda on mandatory minimums for drug crimes has not decreased drug use across the country, and it is evident that we need effective solutions now. The Conservatives recently copied the NDP’s call to declare the opioid overdose crisis a national health emergency, yet the Conser- vatives blocked our attempt to move Bill C-37 swiftly through the House in December, which would have saved lives faster. If we look at some of the main points in Bill C-37, it would simplify the process of applying for an exemption that would allow for supervised consumption, which has been shown to help people take care of their issues. It would prohibit the importation of designated devices, which are used in manufacturing drugs. It would have expanded “the offence of possession, production, sale, or importation of anything knowing that it would be used to produce or traffic in methamphetamine”. These were clear-cut solutions to a problem our province has been long suffering through and that is now making its way across Canada. I would like to read some quotes from validators of our position. Dr. Virani, who is a medical director at Metro City Medical Clinic, in Edmonton, said:

“I have yet to meet a police officer who has said they can arrest their way out of this problem, and I have yet to meet a judge who’s said that he can incarcerate his way out of the problem, and I certainly hope that health isn’t thinking [they can] ignore-and-wait their way out of this problem, because it is clear it is getting worse and worse.”

British Columbia’s provincial health officer, Dr. Perry Kendall, said:

“ Simply prohibiting and increasing penalties without resources to support and educate haven’t been terribly effective. [But] you need to do a number of things to limit the supply of drugs on the street.”

I am disappointed and frustrated that the Liberals’ promise of a review of mandatory minimums is not complete. It was last year that the Supreme Court handed down its decision on the Jordan case, which was in response to decades of inadequate resources for our justice system from successive federal and provincial governments. We now have a situation where serious criminal charges are either being stayed or withdrawn. While I appreciate that the Minister of Justice has recently met with her provincial counterparts, I sincerely hope that the review of mandatory minimums is completed soon and in a comprehensive way so that we do not have a continued piecemeal approach to justice legislation created by private members’ bills, like the one before us today. Canada is currently experiencing an unprecedented opioid overdose crisis. Illicit drug overdoses claimed the lives of 914 people in B.C. alone in 2016, making it the deadliest overdose year on record and representing an increase of nearly 80% from the year before. A significant spike in drug-related overdoses in 2016 prompted B.C.’s provincial health officer, Dr. Perry Kendall, to declare a public health emergency for the first time in the province’s history.

246 The Federal response to the Opioid Crisis

Under the Harper government’s anti-drug strategy, $190 million was budgeted for treatment alone in the first five years of the strategy, from 2007 to 2012, but only $77.9 million was actually spent. The total treatment budget for the next five years of the strategy was cut to $150 million. However, this represents $40 million more than the Liberal budget has allocated for its entire Canadian drugs and substances strategy. How much longer do we have to wait for the current government? I will now move on to my conclusion. We need real measures that deal with the problem of drugs, rather than tying judges’ hands in sentencing laws in order to appear tough. A sentencing judge should retain the discretion to sentence within the limits set by Parlia- ment. Judges must be able to weigh all the evidence and decide on a fair sentence that fits the crime. Mandatory minimums take away judges’ ability to do just that. I sincerely fail to see how increasing jail time by a year for those who import or export schedule I or schedule II substances is in any way going to contribute to a meaningful reduction in drug use in our country. It is for that reason I will be voting against Bill C-338. We need the federal government to take leadership on the opioid crisis now. Mayors and premiers have been asking for help dealing with drug overdoses. It is time that we all work together to bring forth effective policies to tackle this national crisis.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, I am very pleased stand to congratulate my colleague from Markham—Unionville on this very important private member’s bill, Bill C-338. As we know, the opioid crisis is impacting communities and families across Canada. My home of British Columbia has been on the coalface, where the addictive use of drugs is now playing Russian roulette. Users never know when they have something in a drug that will kill them. It does take a multi-pronged approach to tackle this issue. It is a public health emergency, and we continue to ask the Liberal government to recognize it as such. However, it is also important to realize it is a criminal justice issue. This has not been spoken to very well in all the conversations I have heard about this issue. I will talk a little about how the bill would provide a very important tool, but it is important to first talk about the scope of not just the problem, but the tragedy. We need to also talk about what has been done to date and, more important, what still needs to be done to deal with this issue. As many are aware, the recent epidemic is characterized by an increasing number of deaths with elicit fentanyl, an opioid substance. Fentanyl was detected back in 2012, when it was in 5% of elicit drugs. By 2016, it was as high as 60%. Fentanyl, carfentanil, and other drugs are cheap. They are easy to synthesize, and readily available, with a significant volume coming into the country from China. It is being cut into street drugs, with lethal effects. Carfentanil, which is a tranquillizer used for elephants, was confirmed on the streets last fall. It is 100 times more potent than fentanyl, 4,000 times more potent than heroin, and 10,000 times more potent than morphine. If anyone has ever had an accident or injury where he or she has received a dose of morphine in the hospital, carfentanil is 10,000 times more potent. It is coming in by mail order from China. A Calgary man was arrested in September with one kilogram, which could have killed 50 million people. In B.C. alone, four people have died every day in 2017. It is not any better from 2016. We are on track to go from 900 and some to 1,300 deaths. In one week alone in Vancouver recently, there were 15 deaths. Again, we are averaging four deaths per day. This is just British Columbia, but it is happening across the country. The people who are dying have many profiles. They might have struggled with addiction for many years or it might just be a young teenager at a party who, for the first time, makes a very bad decision. A recent Facebook post traumatically affected many. A brave mother from Calgary, Sherri Kent, posted a picture of her in a hospital bed with her son Michael just before he died. He was in the intensive care unit, connected to many tubes. There was absolute anguish on her face as she was saying goodbye to him. He had made such a terrible mistake. She did that to raise awareness throughout Canada. There has been some action to date. Certainly, British Columbia is taking a good lead. Our colleague from Coquitlam—Port Co- quitlam introduced the Good Samaritan Act, which was recently proclaimed. That was a good step. There is better availability of naloxone, which is used to treat an overdose, although we now hear these drugs have become so potent that people do not respond to it the way they used to. Bill C-37, which the government put into place, had some good measures in it. However, I continue to have concerns that it moved away from community consultation on safe injection sites. That is an important gap and it is still missing, especially as we now know many of the people who are dying would never use a safe injection site. Although this measure has value in some communities, to take away the ability for community input or to require community input was a bad step. The banning of the pill presses or importation of designated devices was a good step, as well as some additions to the schedules of substances when there was a reasonable grounds to represent risk. Most important was the additional power for Canada Border Services to inspect and search packages. We heard that with 30 grams, service agents did not have to inspect. That is absolutely critical because this is coming into the country in an envelope. That is a good measure. What has been missing in our struggle against this crisis? The federal government. Although the provincial government in British Columbia has asked, the federal government continues to decline in declaring this a state of emergency. The Public Health Agency of Canada should be playing a role in this. There is no good education and awareness campaign. We need the federal government to take on a comprehensive education and awareness campaign. 247 The Federal response to the Opioid Crisis

The next area that has had inadequate services and support is detox and recovery. That is primarily provincial. I know many examples of people who are desperate to get off drugs and turn their lives around. They have found that they do not have any opportunities in the support they need to detox. We have not talked about the criminals, and my colleague is doing that. These people are knowingly importing and selling drugs on the street, which do kill people. This bill would specifically target gangs and other criminal organizations by introducing tougher sentences for drug traffickers who would exploit the addictions of others for personal profit. Those who import and export these drugs should be brought to justice and should encounter increased mandatory minimums. I listened to my Liberal colleague. All of a sudden the Liberals have this huge obsession that mandatory minimums are not good. However, mandatory minimums have been around almost as long as the Criminal Code. Probably half of the mandatory minimums were put in place by Liberal governments. For the Liberals to argue that mandatory minimums are always bad and that there are all these issues with mandatory minimums is absolutely ridiculous. They have put many of them in place. The argument is that mandatory minimums are bad and they do not help. Getting criminals off the street, even if it is for two years, is two years when they are not out there putting fentanyl in drugs that are killing children. The other thing the Liberals need to be held accountable for is that this is a mandatory minimum of somewhere between two years and life. This is not fettering the discretion of judges. It is saying that parliamentarians believe judges cannot go below two years, that there are no circumstances, ever, where less than two years is an appropriate sentence for someone who is potentially killing our children. It should be attempted murder. It could go as high as the maximum, jail for life, but, as parliamentarians, we are saying that for those who put fentanyl into drugs and sell them on the streets or bring them in with that purpose should go to jail for two years, at the absolute minimum. For the Liberals and the NDP to say that is not okay is absolutely appalling to me. They need to say that to the mothers and fathers, the families that have lost their children, that they do not think it will help and that they do not want to have a baseline of two years for these people to go to jail. This is a reasonable bill. Canadians and Parliament have been saying forever that there is baseline for what is acceptable. For people importing drugs, lacing drugs, and selling those drugs on the streets, doing it knowing people can be killed, two years in jail as a mandatory minimum is simply not even enough. The fact that the Liberals and the NDP will not support the bill is absolutely shameful.

Conservative MP Dave MacKenzie (Oxford, Ont.):

The bill really touches the tip of the iceberg with respect to these drugs. I heard my colleague talk about how other parties were opposed to mandatory minimum sentences. From past experience, I know we have had mandatory minimums on a lot of crimes. Impaired driving is the most frequently charged Criminal Code offence, and has had mandatory minimums for a long time. This offence is equal to impaired driving. This bill would address those people who bring drugs into the country for no purpose other than to provide them to younger people, typically, who perhaps do not realize what they are ingesting. Many times the drugs are a real danger to the first responders who attend: the police, the firefighters, and the ambulance and hospital staff. Increasing the offences for people importing and exporting these controlled drugs and substances should just be the beginning. Everybody in here should be supportive of that. We face a rising tide of crime in relation to the public health crisis we are facing with opioids. Codeine, fentanyl, OxyContin, hydrocodone, and morphine have become household names as Canadians learn of the extent of this crisis and families suffer losses of their loved ones. I truly wish that those people who are opposed to having mandatory minimum sentences for individuals who break this law, bring the drugs into the country and distribute them across the country could see how families are torn apart by these drugs. Diverted pharmaceuticals, fentanyl purchased from China, and stolen horse tranquillizers are finding their way onto Canadian streets with fatal consequences. Most worrying of all is the speed with which illegal opioid sales have grown and the number of overdoses. To put things into perspective, the chief coroner for British Columbia told us at the health committee that the percentage of illicit drug deaths involving fentanyl increased from 5% in 2012 to 60% in 2016. If that is not enough to wake up everybody in the House to the fact that we need to do something to get mandatory minimums in place, I do not know what will wake them up. It is not just a crisis that affects those who find themselves living without a home, but one that affects Canadians of all ages. Fifty-five- thou sand Canadian high school students indicated that they had abused opioid pain relievers in the past year. That is a tremendous number. In Ontario, one in eight deaths of individuals aged 25 to 34 years was found to be opioid-related in 2010. That number will not go down; it will simply go up. Families are being destroyed, communities are being invaded, and all Canadians are experiencing reduced access to health and social services because of the resources required to fight this epidemic. This is a public emergency that hits close to home. Organized crime has now found a foothold in places and at levels never seen before. When the other side wants to legalize marijuana and when we see what this has done, we can only project what the future will be for organized crime. Even for those people who live in areas free of dealers and opioid users, the effects of this drug in drug crime are still felt in people’s access to services. 248 The Federal response to the Opioid Crisis

First responders have had to divert significant resources to address this crisis. Ambulance services, firefighters, police, and hospital emergency rooms are all having resources diverted to address this crisis. This means other crimes committed against local residents are not being investigated. It means ambulances resources are increasingly overworked as they respond to a spike in drug overdoses. It means firefighters now have to additionally consider the chance that what appears to be a simple residential fire may in fact be an illicit and contaminated drug lab, a danger to both their immediate safety and their long-term health. This says nothing about the increased burden on social services that are already stretched due to the Liberal government’s lack of support to local communities. Mental health workers are already facing an uphill battle against criminal gangs continually pushing all kinds of harmful drugs into the community. If we are to help those most in need, then we also need to fight this crisis at its source and punish those who would wish to continue it. This would bring justice not only to those caught in addiction, but to the sons, daughters, husbands, wives, brothers, and sisters already lost to these lethal street drugs. I recognize that the opioid crisis is multi-faceted, but Bill C-338 is one key step in cutting off the source. I support the bill because criminal enterprises are not facing harsh enough sentences for diverting legitimate pharmaceuticals to illicit street drugs. Those pushing opioids into our streets and communities need to know that their actions will incur serious penalties. The House is currently debating Bill C-307, which, through tamper-proof safeguards, would deny illegal manufacturers the easy ability to use legal prescriptions to create illicit substances. Cracking down on this prescription loophole would deter many Canadians from selling their prescriptions for easy profits. If we can increase the possibility of serious jail time for dealing illegal opioids, we can send a message to all criminal enterprises that Canada is a place they should not risk operating in. I would be the first to admit that this one change would not solve the entire problem. A whole host of changes are required to stop opioids from ending up on our streets. Canada’s physicians need to overhaul prescribing practices for opioids. Too many prescriptions are being exploited for criminal profit and manufacturing. We must ensure the quick implementation of measures to allow Canada Bor- der Services Agency employees to check packages smaller than 30 grams, and we must ensure they are properly enforced, as called for by Conservative members. Enforcing this measure would ensure an end to the previously unlimited supply of fentanyl mailed in small packages from China. The government must also ensure that once we have removed these opioids from the streets and placed the criminals behind bars, these same drugs do not end up infecting our prison populations as well. Canadian prisons are currently facing great problems in keeping these dangerous narcotics out. Correctional Service Canada has reported that now even fentanyl has found its way behind bars, as well as the overdoses connected with it. The government needs to ensure that Correctional Service officers have the proper equipment to deal with this rise in overdoses and do more to keep these drugs out of our prisons. In conclusion, I would say that we need to tackle the source of this problem, which is the lack of treatment options for those with mental health issues, who, as a result, are left most susceptible to dealers and other criminals. If the ongoing mental health crisis is allowed to continue in our streets, on our reserves, and in our schools and universities, the drug crisis and the criminal enterprises that go with it will only continue to grow. A national strategy for dealing with this is an absolute priority. Whether it is fentanyl, crystal meth, or the next street drug that is easy to produce and cheap to buy at the heart of this drug epidemic, it is the people who are emotionally hurting. This is why the human face of this epidemic is so heartbreaking to acknowledge. These are vulnerable people who have chosen drugs because they do not have the support and the necessary tools to take on life. Those who would wish to exploit them for illicit gain must know that they will face the full force of the law and serious jail time. This is why I am asking all members of this House to understand the further pain that opioids are causing to Canadian families and to support this very important piece of legislation, Bill C-338.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Mr. Speaker, the opioid crisis in Canada is something that the government has recognized. The Minister of Health has done a phenomenal job working with the many stakeholders, particularly the Province of British Columbia, not only recognizing the problem but taking actions that will ultimately assist in resolving the problem the best way we can. The member and others are aware of Bill C-37, a bill introduced by the Minister of Health, which addresses the opioid crisis. However, that is not all this government has done. The government has also provided an additional $65 million over five years for national measures to respond to the opioid crisis and implemented an opioid action plan. In addition, the government has provided $10 million in urgent support for British Columbia, to assist with its response to the overwhelming effects of the emergency in that province. We recognize that this issue goes well beyond the province of British Columbia. The government is seized with the issue and will continue to move forward. With respect to the issues the member has brought forward in this legislation, the parliamentary secretary said it best, that measures are already in place in Canada. Quite often, the courts will exceed the three years.

249 The Federal response to the Opioid Crisis

MAY 12, 2017 Democratic Institutions Minister Karina Gould (Burlington, Ont.) moved that a message be sent to the Senate stating that the House agrees with amendment 1 (a) made to Bill C-37, and proposes to amend amendment 1(b).

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

It is clear from the discussions and debates that have taken place that, while we may not always agree on a way forward, we all understand the urgency of the situation and share the same goal of saving lives and reducing the growing number of opioid overdoses. The Senate has adopted three amendments to Bill C-37, all of which deal with the proposed application process and requirements to obtain an exemption under the Controlled Drugs and Substances Act for a supervised consumption site. The first amendment adopted by the Senate modifies the ministerial authority to post a public notice and solicit input concerning a specific application. The version of Bill C-37 adopted by the House of Commons proposed allowing the minister to determine an appropriate length of time for public comment, up to a maximum of 90 days. The amendment adopted in the Senate requires that any consultation must be a minimum of 45 days, and retains the previous maximum of 90 days. Our government supports this amendment. I understand that there have been some questions from public health stakeholders on whether setting a minimum consultation period could delay applications. I want to reiterate that this consultation period is not required, but rather that a public notice can be posted, if there is a need. Such an authority would likely be used if there were concerns that community consultations were not sufficient. Further input would be helpful in making a decision in such instances, ensuring a reasonable amount of time is provided to the public to comment on a specific application. We think it makes sense. Therefore, we support this amendment. The second amendment adopted by the Senate specifies that the Minister of Health may establish citizen advisory committees for approved supervised consumption sites where it is deemed appropriate. While such committees could be seen as a way to maintain an open and ongoing dialogue with the surrounding community, it also represents a level of citizen oversight and influence that is not in place for any other health care service. We know that people who use drugs already face discrimination and stigmatization that can prevent them from accessing the services they need to stay alive. By including a process that could further add to the stigmatization faced by people who use drugs, this amendment runs against the intent and the spirit of Bill C-37. For this reason, our government respectfully disagrees with the second amendment. Finally, the last amendment adopted by the Senate would require staff who supervise the consumption of substances at a site to offer clients access to an alternative pharmaceutical therapy before they consume illegal drugs at a supervised consumption site. I would like to explain some of the concerns that our government has with this amendment as it is currently written. I want to make it very clear that our government is entirely supportive of providing immediate access to evidence-based treatment options for people living with addictions who are ready and willing to enter treatment. This would be the ideal situation. However, the situation in practice at a supervised consumption site is far more complex than simply writing the words into legislation. There are a number of factors that must be considered. First, as I have already mentioned, people who use drugs already face significant barriers in accessing the health and social services they need, often due to stigmatization and discrimination. Supervised consumption sites are meant to be low-threshold, easily-accessible services. The more requirements or rules that are added to the process for accessing supervised consumption sites, the less accessible this service becomes to the vulnerable population it is meant to serve. Further, if this amendment is included in the legislation, I want to make it clear that none of the supervised consumption sites operating in Canada, nor most of the 18 applications that are currently before Health Canada for consideration, would meet the legislated criteria for operation. If the single word “shall” is kept in the amendment, additional requirements and burdens are automatically imposed upon supervised consumption sites and those who operate them. This would make it more difficult to establish new supervised consumption sites in communities where they are wanted and needed. As such, requiring staff to offer immediate access to treatment could cause significant delays in the opening of any new supervised consumption sites. The purpose of Bill C-37 is to reduce burden and streamline the application process so that communities can open supervised consumption sites as part of a comprehensive plan to reduce harms associated with illegal drug use, including deaths. Given the current opioid crisis, these considerations raise major concerns for our government. Finally, except in certain specific circumstances, regulating health care services is generally the responsibility of the provinces and territories. Our government has taken concrete action to pave a path forward towards improving treatment, for example, by removing barriers at the federal level and undertaking knowledge-exchange activities to improve awareness of the options available in Canada. However, at the end of the day, the provinces must make health care decisions based on the needs of their citizens. There are also costs associated with offering access to immediate treatment. This is something that would have to be considered by the provinces and weighted against their other health priorities. The fact is that Canadians are dying every single day, and communities are urging us to set up supervised consumption sites to stop the overdoses and the deaths. I do not want the federal government to be what stands in the way of communities saving lives here and now. Improving access to treatment is a goal that our government will continue to support. I can assure the House that our government will continue to support future supervised consumption sites in developing a strong link with treatment services. We will encourage all

250 The Federal response to the Opioid Crisis potential sites to work closely with their respective provincial governments to make this happen. However, for the reasons I have just outlined, our government submits that the word “shall” in this provision must be changed to the word “may”. By now, everyone in this room is well aware of the critical and urgent nature of the opioid crisis that has been devastating communities across the country. The rising mortality rates and drug overdoses are deeply concerning. These are real communities where real people are dying, communities where front-line workers are exhausted, and friends and families are losing loved ones. We are facing a public health crisis, and we need to work together to stop it from claiming more lives. In order to do so, our actions must be collective, comprehensive, and aimed directly at protecting the health and safety of our communities. This is a complex issue that requires a comprehensive approach. The Minister of Health has been clear that Canada’s drug policy must be comprehensive, compassionate, collaborative, and evidence- based, and use a public health approach when considering and addressing drug issues. To that end, on December 12, 2016, the Minister of Health announced an updated drug strategy for Canada. The Canadian drugs and substances strategy would replace the current national anti-drug strategy. This strategy formally restores harm reduction as a core pillar of Canada’s drug policy, alongside prevention, treatment, and enforcement. All pillars are supported by a strong evidence base. The minister further supported this approach when she introduced Bill C-37, a bill that proposes many important legislative changes to address the opioid crisis. Problematic opioid use involves an intricate web of intersecting issues that must be addressed simultaneously, using different tactics. Today I would like to underline the importance of continuing to move quickly through the legislative process. First, the proposed changes contained in the bill would provide the law enforcement community with the tools needed to better address the supply of illicit opioids and other drugs in Canada and to reduce the risk of the diversion of controlled substances. The sharp rise in opioid-related overdoses and deaths has been intensified by an increase in illicit fentanyl coming into Canada. Bill C-37 would ensure that law enforcement is better equipped to keep deadly drugs like illicit fentanyl out of our communities, in a number of ways, such as making it a crime to possess or transport anything intended to be used to produce or traffic a controlled substance, allowing temporary scheduling of new psychoactive substances, and supporting faster and safer disposal of seized chemicals and other dangerous substances. It is critical that we support members of the law enforcement community who work on the front lines of the opioid crisis. It is critical that this bill be passed quickly so we can prevent illicit opioids and other drugs from reaching our communities. Our government is also committed to working with its partners to help reduce the harm to citizens and communities associated with problematic substance use. Evidence has shown that supervised consumption sites, when properly established and maintained, have the potential to save lives and improve health without increasing drug use and crime in the surrounding area. Bill C-37 proposes to support communities seeking to operate supervised consumption sites by streamlining the application process, as well as the renewal process for existing sites, to align with the five factors set out by the Supreme Court of Canada, without compromising the health and safety of the surrounding community. A key component of this legislation involves ensuring that the voices of communities are heard by being more flexible and supporting the ability to tailor consultations to each community as appropriate. This improved approach preserves the requirements for community engagement. Each application would be subject to a comprehensive review, without delaying the implementation of these life-saving sites in the communities that need them the most. We all have an important role to play in overcoming this crisis. We must support the efforts of all community members, from the volunteers, civil society organizations, health professionals, legal professionals, and of course law enforcement groups, if we are going to tackle this crisis. The legislative changes proposed in Bill C-37 demonstrate our government’s concrete support for communities grappling with this crisis by increasing law enforcement’s ability to respond to the evolution of the illicit drug market and to take early action against suspected drug production operations. Furthermore, the changes proposed in the bill to remove unnecessary barriers to establishing supervised consumption sites and to emphasize community engagement would support communities by ensuring that these sites ultimately met the objectives of saving lives and reducing harm. Our government will continue to work collaboratively with communities, provinces, territories, and key stakeholders through a comprehensive approach to drug policy. I want to thank every one of you for your work on Bill C-37 and for your commitment to this urgent matter. We cannot turn our backs on the communities being affected by this crisis across the country. I urge all members of the House to move forward with the proposed legislative changes, which would support communities, and ultimately, save lives.

Conservative MP Colin Carrie (Oshawa, Ont.):

I think members will remember that when this bill was put forward to the House, the Conservatives offered to split the bill and pass the majority of it unanimously, because we actually agree with the majority of the bill. However, the section regarding injection sites is a little bit controversial, so we wanted to debate that. Unfortunately, the Liberals used their majority and basically pushed it through committee without having a reasonable debate. I want to thank the Senate and its members for actually having a full debate and welcoming witnesses who had something to say about it. How did we get here? Out of the three amendments, one that was almost unanimously supported was the amendment to allow for pharmaceutical substitution. 251 The Federal response to the Opioid Crisis

When addicts present at clinics asking for help, they come in with vials of poison, basically, made up in a drug dealer’s basement. They are not safe. They are dangerous. This amendment would allow addicts to be offered a pharmaceutical-grade option instead of forcing them to use these dangerous drugs. Why would the minister not allow addicts, who have a treatable condition, to get quality care and have pharmaceutical grade alternatives offered each and every time they come to those clinics?

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

One of the reasons we got to Bill C-37 is that initially, the Conservatives’ Bill C-2 established 26 criteria, which were very burdensome for communities that need and want safe consumption sites, which science demonstrates save lives. Our idea was to come back to the five criteria established by the Supreme Court and to get closer to those criteria so we could move more swiftly, because we know that every single day Canadians are dying from opioid use in this country. We need to take swift action and act decisively, with respect for the communities where they would be established. We need to make sure that where they are needed and wanted, these safe consumption sites are established.

NDP MP Murray Rankin (Victoria, B.C.):

Mr. Speaker, I agree with the parliamentary secretary on a couple of things. I agree that this is a national health crisis. British Co- lumbia, Vancouver and my community of Victoria, is ground zero, so I could not agree more with that. I also agree with the need to move this through as quickly as we can. The NDP has pledged to do all we can in that regard. What I do not agree with the member on is his characterization of the Senate being swift but thorough in its assessment. Three months is an unacceptably long time in a public health crisis like the one we are facing. Specifically, the government has said it will accept one single amendment proposed by the Senate, a minimum 45-day public consultation period for supervised consumption site applications. This will slow down the approval process and will hinder quick action in the case of an emergency. I can do no better than to cite not one, not two, but three Liberal members of the health committee: the member for Brampton South, the member for Oakville, and the member for Calgary Skyview. The member for Brampton South said:

“This amendment would remove the minister’s discretion and prevent sites from being approved in an urgent situation. We don’t need a delay of extra days, particularly if there’s urgent need of a site.”

She goes on. Why would the government, in the face of resistance by virtually all of our allies in this matter, accept such a regressive amendment?

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

As far as the member’s question on the amendment is concerned, it should be noted that this amendment requires a 45-day minimum consultation, if necessary. Not every request is subject to a 45-day minimum consultation. In cases where this is necessary, where there might be a need for community consultation, there would be a consultation period of no less than 45 days and no more than 90 days. In these cases, we think it is only right to give the public time to be heard. As I said in my speech, this will only happen if there is a need for such consultation. It will be determined on a case-by-case basis.

Liberal MP Rémi Massé (Avignon—La Mitis—Matane—Matapédia, Que.):

Can the hon. member explain to the House what are the key pillars to our government’s approach that will help him address the important issues associated with the opioid crisis?

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, there are different pillars, but I think it is clear that the police have an important role to play. The important thing is to stabilize the crisis that is currently affecting Canada and ensure that fentanyl does not find its way into our communities. We need to ensure that drug dealers, those who shamelessly put this drug in the hands of the young people of our community, are severely punished. We need to give police all the tools they need. 252 The Federal response to the Opioid Crisis

It is vital that we take a public health approach in responding to this crisis, since we know we have a duty to protect Canadians, even if it is sometimes from themselves. I believe that safe consumption sites allow people to use drugs while preventing overdose deaths, by reducing the stigma associated with the use of illegal drugs and the discrimination these users face. There has never been an overdose death at a safe consumption site. That is a fact, and it is clear that we need to adopt a public health approach to deal with this crisis, which has had an often devastating effect in too many communities across Canada.

Conservative MP Colin Carrie (Oshawa, Ont.):

We know that pharmaceutical substitution is successful. The evidence from Switzerland is very clear that it works. Under the amendment put forward by the Senate, the addict would not have to commit a crime. The addict would not have to worry about the potential of an overdose. The public would not have to worry about being the victim of a crime. When this was done in Switzerland, we saw a dramatic reduction in illegal drugs. We saw less criminal activity and more people actually moving into treatment. Again, if we have diabetics who need pharmaceutical-grade insulin and obtain it illegally, and they go into a medical facility, what are the ethics and the moral responsibility of that facility? We are talking about offering an addict who has a treatable condition the exact same quality care we would offer any Canadian who required treatment for a treatable condition. My question, again, is to the parliamentary secretary. Why would he not give addicts, who are at the lowest point in their lives, the same quality of medical care we would give any Canadian who had a treatable condition?

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, I outlined the reason pretty clearly in my speech, if the member had been paying attention. We have nothing against allowing those pharmaceutical options to be offered. The word “shall” in the amendment is what causes us a problem. If it were to be changed to the word “may”, that would make it acceptable. The member is well aware that there are jurisdictional issues. We are not delivering the services. We have to work with the provinces and territories, and we are willing to do that to encourage them to get that support. We have to look at the reality. The word “shall” would jeopardize the operation of safe consumption sites in Canada and the approval of safe consumption sites in Canada, which is definitely not our goal.

NDP MP Erin Weir (Regina—Lewvan, Sask.):

Mr. Speaker, the member across the way defended the government’s acceptance of the first Senate amendment on the grounds that it would not really do anything, that it would not actually require a 45-day waiting period in all cases. It would only happen, if necessary, some of the time. I would like to clarify whether the government is supporting this amendment because it believes it would actually improve the legislation or whether this a matter of giving the Senate a pat on the head and validating the changes the government has made to the Senate, which have really emboldened that outdated and undemocratic institution to push back against urgently needed legislation passed by the great majority of elected representatives in the House of Commons.

Parliamentary Secretary to the Minister of Health Joël Lightbound (Louis-Hébert, Que.):

Mr. Speaker, I thank the Senate for its work. We support the first amendment because we think that when there is a need for such consultation, and it is not required that there be consultation, the consultation period would be a minimum of 45 days to allow the public to make its voice heard in such circumstances. I thank the Senate and all members in both Houses for the work they have done on this important issue.

Conservative MP Colin Carrie (Oshawa, Ont.):

Mr. Speaker, today we are debating a motion put forward by the Minister of Health. The motion addresses the amendments proposed by the Senate in regard to Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts. First, I want to stress that the opioid crisis continues to be an absolute tragedy. People across the country are still dying at an alarming rate, and there is no one solution to this. In fact, I think most Canadians would agree that there are many factors that have contributed to and continue to contribute to this serious issue.

253 The Federal response to the Opioid Crisis

When Bill C-37 was first introduced in the House, I made a point to let the minister know that my colleagues and I were very much in favour of the majority of the bill. I had the chance to take part in a health committee study that had taken place prior to the tabling of the bill which looked specifically at the opioid crisis in our country and what we were facing. Taking part in the study allowed me to truly learn and empathize with struggling addicts, communities, first nations, health professionals, and families that have had to endure an opioid-related death. We learned that there were many factors that contributed to this crisis. While one cause of the crisis results from illegal substances and organized crime, many people are battling addiction because of the practice of over-prescribing of painkillers. Some of these causes have yet to be addressed, but I definitely think the right steps are being taken, at least for the most part. I stated earlier that I was in favour of most of the bill, and that is because the minister recognized that tackling the production, distribution, importation, and consumption of deadly drugs needs to be made a priority. She listened to the advice of Conservatives on the health committee and in the Senate, and I commend her for that. I will not get into details about Bill C-37 as I have already had the opportunity to do so twice now, but I do think it is important to acknowledge and point to the bill’s attempt to weaken public consultation in the approval of injection sites. That is why, when I had the chance to review the Senate’s amendments to Bill C-37, I was glad to put my support behind them. I will summarize the Senate’s amendments. The first amendment ensures that there is a minimum consultation period of 45 days prior to the approval of an injection site. The second amendment looks to establish a citizen advisory committee responsible for advising the approved injection site of any public concerns, including public health and safety. The amendment also looked to have the committee provide the minister with a yearly update on these matters. The third amendment directs those working at the site to offer the person using the site legal pharmaceutical therapy before that person consumes illegal drugs obtained illegally. Unlike here in the House where the Liberals rammed the bill through with minimal debate, the Standing Senate Committee on Legal and Constitutional Affairs was able to hold five meetings and hear from 22 witnesses. That is in contrast to the health -com mittee, which only scheduled one meeting on the bill, with only four witnesses appearing, and none of whom was the Minister of Health. The Senate’s amendments are well thought out and take into consideration communities and those battling addiction. I must admit that I was surprised to see the minister agree to the first amendment, as her colleagues voted against the same amendment brought forward by the Conservatives. I am happy that she made the right choice in ensuring that communities at least will have some chance to be involved, if only in a small way. I do, however, want to acknowledge my disappointment with her rejection of a voluntary community committee. The minister’s refusal to include community involvement in regard to injection sites goes against the majority of testimony we heard. Over and over again, witnesses at committee stated that injection sites would not be successful without community support. Community support goes beyond harm reduction advocates. It includes mothers, fathers, law enforcement, and of course the local government. The minister knows that by passing the Senate’s amendment to establish a citizen advisory committee, it would demonstrate and respect the fact that not everyone wants an injection site in his or her backyard. I want to talk about the reasons I support a community committee. By establishing a community committee, it would ensure that the injection site remains clean, and that it operates in a way that prioritizes the health and safety of Canadians. It would ensure that the minister of health, the individual who is responsible and who ultimately approves the site, remains in the loop about the community’s concerns with regard to the site. It would ensure that he or she, along with the actual operators of the site, would be held accountable and to a high standard. That should be the goal. The health and safety of those battling addiction and the health and safety of all citizens should be a priority. That is why I was shocked that the minister’s motion looks to change the wording of the Senate amendment that would improve the bill. The third amendment seeks to offer pharmaceutical therapy as a substitution to an illegally obtained and possibly deadly poison. I realize that the minister’s concerns lay in the fact that these sites may range in different services such as an injection site within a hospital to mobile injection sites, but what strikes me as odd is that we would discourage the use of a legal substitution for heroin such as methadone. For those who may not know, methadone is a maintenance treatment which, according to the Centre for Addiction and Mental Health, CAMH, prevents opioid withdrawal and reduces or eliminates drug cravings. It is by offering substitutions that are legal and of pharmaceutical grade such as methadone that could lead a serious drug dependent individual to seek treatment and get the help he or she needs to get clean. Again, should that not be the goal? The CAMH also states that an individual who is physically dependent on opioids such as heroin or fentanyl is kept free of withdrawal symptoms for 24 hours after a single dose of methadone. In contrast, a person who uses heroin or other short-acting opioids must use three or four times a day to avoid withdrawal. There is no argument here. By ensuring that users are offered legal substitution, crime rates will decrease and the likelihood of seeking detoxification treatment will go up.

254 The Federal response to the Opioid Crisis

I would like to read testimony from the Senate’s hearing in which the minister was actually a witness. I will quote Senator White:

“I spent last Sunday night and Monday night in East Hastings with police officers and health officials walking up and down those streets and visiting some of the facilities. The biggest concern raised by community members who aren’t addicts and by police officers and health officials is the use of illegal drugs. I notice that we did see a regulatory change that will allow for the use of medical-grade heroin, but we did not see any regulatory changes that will allow for the medical use of other than medical-grade heroin. My perspective and that of most people around supervised injection sites is that they move to the relationship between a doctor and an addict, not organized crime, a drug dealer and an addict who is committing crimes but an addict and the doctor which is where it is now. Will we see regulatory change that will allow for greater use of prescriptive pharmaceuticals rather than illegal and illicit poison? I don’t want to call them drugs because they’re not that.”

At that time, the Minister of Health responded. She said:

“Thank you for the question. It is a very good one. I encourage honourable senators to work with us in ensuring that access to all range of treatments and responses to this health problem are there. Some of this requires the decisions of provinces and territories as well as medical practitioners who obviously make decisions about what appropriate treatments are. There is nothing in the bill and nothing in the law that would prevent provinces from expanding a treatment centre associated with a supervised consumption site to be able to allow these kind of treatments to which you are referring to work closely. I think it is an outstanding model and it’s a model that we have to perhaps talk about a little more in public. I know, senator, you are well aware of the work done in other countries. Switzerland is perhaps the best example of that. When people are determined to have opioids use disorder and/or have legal problems associated with their substance use disorder they are introduced to the possibility of being able to be prescribed medications. It certainly has been effective in decreasing crime rates in those areas, very dramatically decreasing overdose rates and treating this as a health issue.”

That is what the minister said when she was a witness. Why the change? In Switzerland, they do in fact offer drug substitution as proposed in the Senate amendment, and as stated, it has led to a dramatic reduction of illegal drugs, has reduced crime rates, and has lowered overdose rates. This model has seen high levels of acceptance because rather than an addict illegally obtaining illegal drugs, the individual is able to get pharmacological help from a doctor with the goal of leading to seeking proper treatment. That is why this is so important. This amendment would allow an individual to enter a site and be offered a legal drug by a medical practitioner as opposed to a dangerous and potentially deadly drug, a poison bought from a drug dealer. This, as I have stated, removes the potential of overdosing and eliminates criminal activity. If the Liberals really wanted to treat addiction as a health problem, they should be encouraging doctors and nurses to be at these sites administering alternatives that many addicts do not even know about. We should not be encouraging irresponsible administering of illegal drugs that are manufactured and mixed in a drug dealer’s basement lab. We know that they are being laced with fentanyl, carfentanil, and much more. We have an overdose crisis in this country. I will not object to the assertion that injection sites can temporarily save lives, as it is always better when an individual is revived, but we need to be looking at ways to prevent the overdose from happening in the first place. I believe this amendment that would guarantee that the drug user is offered an alternative pharmaceutical therapy prior to putting something poisonous and potentially deadly into his or her body would do just that. That is why it is crucial that the Liberal government take initiative and ensure that injection sites do not become a place for people simply to get high. If injection sites are wanted in communities, they should be used to ensure that addicts are offered legal, safer alternatives to dangerous and illegal street drugs that have been obtained illegally from drug dealers, alternatives that would decrease overdose rates and decrease crime rates, which I believe should be the overall goal. 255 The Federal response to the Opioid Crisis

I realize that the minister has not flat-out rejected the amendment, but by changing the words “shall offer” to “may offer”, we would guarantee that the majority of users would not be offered a legal, safer alternative. We would not force diabetic Canadians who rely on insulin to commit a crime or numerous crimes to find an illegal insulin supply and to buy their treatment from drug dealers, would we? Canadians expect their government, if it truly feels that addiction should be treated as a health problem, to provide safe treatment options and detoxification programs for those suffering from addiction. The Liberal plan, unfortunately, provides none of that. The response to this crisis has been horribly slow. We are still debating a bill that was tabled in December and communities are still seeing an increase in overdose deaths. Our country has seen no progress in increasing access to detox treatment, which is another issue that must be addressed but has failed to be addressed by the current Liberal government. We know that not all addicts are willing to go into treatment, which is why I believe that, with the certainty of many new injection sites opening up in the near future, we should at a bare minimum be ensuring that users have a choice between a poisonous street drug or a legal alternative. In conclusion, this is how I view the situation. The motion put forth by the minister leaves out communities and eliminates the likelihood of reducing crime and overdose rates by offering legal substitution. The approval of an injection site will have a profound impact on any community. Perhaps some will be successful and some will not, but the individual approving the site, the minister of health, should be putting the health of Canadians first. He or she should be encouraging the use of pharmaceutical alternatives over illegally obtained street poison. He or she should be held accountable for the success or failure of approved sites, and not just be the individual responsible for rubber-stamping them. The minister has not even stated how she will measure that success. Will she keep statistics on how many addicts get referred to treatment and on how many are referred to detox programs? This is why I would encourage all parties and members of this House to review very carefully the Senate amendments. They would not make the application process any more difficult and they would not slow down the approval process. All they would do is give citizens within a community that has an approved site a voice, and give those who are addicted to deadly drugs a safer alternative. In a caring country such as ours, should that not be what it is all about? The Senate amendments were well thought out and put the health and safety of Canadians first. I challenge the Liberals to do the same. Therefore, I move:

“That the motion be amended by deleting all the words after the word “That” and substituting the following: “the amendments made by the Senate to Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, be now read a second time and concurred in.”

Conservative MP Marilyn Gladu (Sarnia—Lambton, Ont.):

Mr. Speaker, one of the things that most concerns me about the bill and the amendments is that the Liberal government continues to be hypocritical, always saying that we have to respect the provincial jurisdiction and other jurisdictions. However, it has not respected the jurisdiction of municipalities to determine whether municipalities want safe injections sites. My riding of Sarnia—Lambton wants a detox centre, but it does not want a safe injection site. The bill would do nothing to protect the rights of municipalities to decide what they want. Could the member comment on that?

Conservative MP Colin Carrie (Oshawa, Ont.):

Remember, when during the election, the Liberals said that they would return postal delivery to all Canadians. How did that go? They did put into effect a consultation process for communities about the community mailboxes. In other words, if Canada Post -de cides it wants to put a mailbox in somebody’s community, it now has to consult with municipal leaders and the community. It also has to listen. It has an ombudsman. If the community mailbox is not working out for a community, the community has a way of getting back information. In other words, the Liberals want to consult with everybody it seems, except for communities, with respect to what some people call “safe injection sites”. We know there is nothing about these sites that are safe. Addicts, unfortunately, are taking illegal drugs, obtained illegally from crime sources, deal dealers, and injecting them into their arms. If these sites are to be put into a community, we need to ensure we respect the communities and their right to have a say in where the sites go.

NDP MP Erin Weir (Regina—Lewvan, Sask.):

Mr. Speaker, my colleague, the member for Oshawa, noted that the amendment the Liberal government accepted from the Senate was one the Liberals previously voted against when put forward by the Conservatives. 256 The Federal response to the Opioid Crisis

I wonder if my colleague believes the Liberals have changed their minds on this point or whether they are just trying to validate the million dollars per year they are spending on this new process to appoint, supposedly, independent senators who now feel emboldened to push back on and delay legislation passed in the House?

Conservative MP Colin Carrie (Oshawa, Ont.):

Mr. Speaker, my NDP colleague will have to excuse me if I cannot explain why the Liberals are flip-flopping on these things. We really cannot explain it. The reality is, quite correctly, that the Liberals did vote against this before. Now, instead of allowing the bill to be split and most of the bill to be passed immediately and allowing the health committee the opportunity of debating this and getting proper amendments put forward, they had to put it to the Senate. The Senate has brought these back. These amendments are based on the testimony of witnesses who came forward. When we look at this, I think everyone would agree that these are simply reasonable amendments. It helps to protect communities and protect addicts themselves, to ensure the proper treatment is offered to them. At the end of the day, as a compassionate society, this is a crisis. If we are using that link that an injection site is being put into a community to get people into treatment, we should be ensuring the proper treatment is there. We should ensure that pharmaceutical substitutions are there and that these addicts can be properly referred to detox programs and addiction programs. Unfortunately, none of that is ensured in the legislation.

NDP MP Murray Rankin (Victoria, B.C.):

Mr. Speaker, 40 or 50 people are dying every week in our country from drug overdoses. All parts of Canada have been affected by this crisis, none more than British Columbia and, in particular, Vancouver and Victoria, the epicentre of this opioid crisis. This bill deserves the attention of the House on an immediate basis, and I am pleased it seems to be proceeding quickly through this place. It took the government much too long to recognize the magnitude of this crisis affecting so many Canadians, but it did so, finally, on December 12, the minister tabled a bill that would allow us to take action, certainly not to eliminate the opioid crisis but to at least address its symptoms. We supported the bill then and we will support the bill going forward in an expedited basis through this place. It is perhaps unusual for an opposition party to agree to time allocate anything but, as the Conservatives have acknowledged, we have a national health emergency and Canadians expect us to act accordingly, and we will do so. My hon. colleague from Vancouver Kingsway moved, on December 13, to fast-track this legislation to the Senate. Sadly that was blocked in the House and more time was wasted and more lives were lost. The Senate has now made amendments to the bill, taking months to get it back here for us to get on with the job. We are here today to talk about those amendments the Senate brought forward after those three months. I have spoken with people in my community of Victoria and Vancouver, those who are on the front lines of this crisis. They have asked us to speak against these amendments, and we do so today. They undermine the intent of the bill and essentially disregard what we, as an elected body, have worked so hard to implement over the last few months. In a question for my colleague across the way, I pointed out that the Liberals at health committee essentially agreed that these kinds of amendments ought not to be proceeded, yet we have them back here again. The Senate seems to think it can do a better job, taking a long time to arrive at the same place. It is really quite disappointing that in light of that history the government has seen fit to accept one of those amendments, which I will turn to momentarily and address in content. The one of the three amendments that was accepted by the government this morning was amendment one. It would create a minimum 45-day public consultation for supervised site applications. Why would we reject that? Why would all the allies encourage us to do so? They claim that it will slow down the approval process and hinder quick action in the event of an emergency. I can do no better than to remind the government what three Liberal members said at committee when the same issue was up for discussion there. I quote, for example, the Liberal member for Brampton South, who said:

“..it is important to note that one of the five criteria in this bill already includes community consultation. It is important, but it’s sufficiently covered off in the proposed legislation. It includes all the broad information in there.”

She is right. It is already in there. Everybody knows public consultation is a critical aspect. Of course it is one of the criteria for the approval of any site. It seems entirely redundant and potentially disturbing when people have an emergency and do not need to have any minimum times addressed.

257 The Federal response to the Opioid Crisis

I would refer to what my Liberal colleague from Calgary Skyview said:

“Time is of the essence when we are setting up these clinics. This amendment will con- strain or tie the minister’s hands for 45 days in terms of taking any action. Look at all the lives that may be lost in that delay. Those are my comments.”

I do not know why we are here to talk about what the Senate has done. Why the government would accept those amendments is frankly beyond us. The second amendment we have heard about from our Conservative colleagues is on alternative pharmaceutical therapy and serious constitutional doubts about it. The parliamentary secretary referred to whether a federal government could mandate a particular kind of therapy. At first blush, it would to be squarely within provincial jurisdiction. This has to be considered as something that could be problematic. Any amendment to that effect that would perhaps discourage people from using supervised consumption sites would undermine the purpose of this bill. The New Democrats called for legislation to address the opioid crisis over a year ago, and we will not allow this to be delayed any longer. We cannot allow more people to die. At a minimum, 2,000 people will die this year in our country. Last year, 914 people died in my home province of British Columbia alone. With fentanyl and now carfentanil, the crisis is only escalating geometrically. The bill needs the urgent attention of this place. We must get on with it and we will do whatever we can to support moving on with this as we go forward. We cannot accept the Senate amendments and will vote against them, but we will vote strongly in favour of this public health bill to deal with a national health emergency.

Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Mr. Speaker, there are occasions when I truly agree with the NDP on positions, and this is one of them. With the national crisis we face today, we have seen strong action from the Minister of Health, working with the different stakeholders of all political parties in different regions of our country. We want the legislation to pass. Would the member not agree that the universal acceptance and need for this legislation, which goes beyond Ottawa, is quite impressive and the sooner the bill goes through both Houses, the better it will be for all Canadians?

NDP MP Murray Rankin (Victoria, B.C.):

Mr. Speaker, I can return the compliment to my friend across the way. It is somewhat unusual for us to be agreeing on very much, but on this one, I could not agree more. I knew people in my community who died. I know what the bill would do and how important it is. Therefore, I accept the challenge from my colleague to get on with the job and not let small problems get in the way. That is why we put water in our wine when the bill was before us initially. It is not perfect. It went to committee. I was pleased not that the Senate took as much time to come back with the same things, but that members of the health committee rolled up their sleeves and looked at it really quickly. I will not be hung up on these Senate amendments. I do not understand why the government feels it has to accept one, which is clearly regressive in the minds of their own Liberal colleagues. However, that is not the point. The point is to get this done as quickly as possible. The New Democrats will support the government moving it forward, given the national health crisis this entails.

Conservative MP Karen Vecchio (Elgin—Middlesex—London, Ont.):

Mr. Speaker, I admire the work that has been done by the member for Victoria and I know his heart is definitely in the right place. There are great concerns within my own community. I have reached out to police officers and many different individuals, including the chief health officer in my area. The issue is that communities have to be involved because it is about safe communities. I am very concerned with the Respect for Communities Act being repealed in this situation. As the member said, when we talk about Surrey, B.C., or places like Coquitlam, I recognize the urgency. That is why Conser- vatives tried to ensure that parts of the bill moved forward and other parts were delayed so we could have further discussion. My communities want to be part of that conversation. I would like the member to talk about how communities could still have a say on this.

258 The Federal response to the Opioid Crisis

NDP MP Murray Rankin (Victoria, B.C.):

Mr. Speaker, I do not challenge for a moment the member’s good faith and desire to move forward in this crisis. The ability to involve the community is at the core of the bill. It is one of the key criteria. I can only speak to the experience in my community. Victoria is anxiously waiting and desperate to get a safe consumption site up and running. The first thing they did was work with the communities, carefully and fully, with the full support, I am happy to say, of the police, which recognizes this as not only a public health issue but a public safety issue. I do not think the bill does anything but support community involvement. The amendment that would require a citizen advisory committee is not well-thought out. It has the effect of (a) being redundant to a core criterion in the bill and (b) possibly delaying the creation of safe consumption sites and the saving of lives.

MAY 15, 2017 The House resumed from May 12 consideration of the motion in relation to the amendments made by the Senate to Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, and of the amendment.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I am thankful for the wonderful opportunity to speak to the amendments adopted in the Senate relating to Bill C-37. This is an act, as we know, to amend the Controlled Drugs and Substances Act, and to make related amendments to other acts. Before I begin, I thank my colleagues in the House and the Senate for their work on the bill to date, for reviewing this important legislation, and for recognizing the urgency of the issue. I particularly want to thank all my colleagues who supported getting the bill through the House as quickly as possible. This bill, as proposed, will help our federal government and its partners to combat the existing opioid crisis and deal with the more general drug problem in Canada. For that reason, I urge my colleagues to support the bill so it can be adopted without delay and to help protect the health and safety of Canadians and their communities. It is clear that we are in the midst of a national public health crisis. Last year in British Columbia, more than 900 people died from illicit drug overdoses. If trends continue in 2017, we can expect 1,400 people in British Columbia to die this year as a result of overdoses. However, British Columbia is not alone. In Alberta, close to 500 people died from overdoses in 2016. We are also seeing signs that the opioid crisis is spreading to other parts of Canada. For example, seizures of fentanyl have increased in almost every province over the last year. Our government is responding. We are taking actions that are compassionate, collaborative, comprehensive, and evidence-based in our approach to drug policy. Our aim is to take a public health approach to addressing the opioid crisis and problematic substance use in general, while also ensuring law enforcement officials have the tools they require to keep communities safe. That is why, last fall, the Minister of Public Safety and Emergency Preparedness and I announced the new Canadian drugs and substances strategy. This new strategy replaces the previous approach by addressing problematic substance use as primarily a public health issue, restoring harm reduction as a key pillar of Canada’s drug policy, alongside prevention, treatments, and enforcement, and supporting all those pillars from a strong evidence base. Bill C-37 and the revised amendments our government proposed support this strategy by updating the law to focus on harm reduction measures. Streamlining the application process for supervised consumption sites is central to this legislation. Solid evidence shows that, when properly set up and maintained, supervised consumption sites save lives, and they do it without increasing drug use or crime in the neighbourhood. To this end, Bill C-37 proposes to amend the current legislation in two ways. It will establish a streamlined application process that aligns with the five factors set out in the Supreme Court of Canada decision in 2011, in Canada vs. PHS Community Services Society. It will also improve the transparency by requiring decisions on supervised consumption site applications to be made public, including reasons for denying such an application. We need to create an environment that encourages communities that want and need these sites to apply for them. I can assure the House that Bill C-37 and the revised amendments our government is proposing will ensure that communities that want and need these sites do not experience unreasonable delays in their efforts to save lives.

259 The Federal response to the Opioid Crisis

The first amendment specifies that should the Minister of Health choose to post a notice to seek further public input regarding an application, the public should have a minimum of 45 days to provide feedback. Some members, and indeed members of the public as well, have questioned why we are accepting this Senate amendment. To be clear, the ministerial authority to post a public notice regarding an application for up to 90 days exists under the current legislation. Bill C-37, as introduced by our government, made that time period more flexible but retained the optional nature of the posting and the optional nature of an extra consultation. The only thing that would change with the Senate’s amendment is that should a public notice for further consultation be posted, it must be posted for a minimum of 45 days. Our government supports this amendment, as it would ensure that in the special cases where further community consultation was warranted, communities would receive a reasonable amount of time to provide comment on specific applications. I will repeat that this consultation would not be required by legislation, and indeed, it would be the exception rather than the rule. The second Senate amendment would give the Minister of Health the authority to establish citizen advisory committees for approved sites where deemed necessary. Our government understands the intent of this amendment. It could be to bring together supervised consumption sites and community members. However, adding this oversight of supervised consumption sites, which is not used for any other health service as a legislated requirement, would further stigmatize their clients and potentially reduce the use of these critical facilities. As such, we respectfully disagree with this amendment. The final amendment adopted by the Senate would require that clients of supervised consumption sites be offered an alternative pharmaceutical therapy before they consumed substances at the site. While the intention of this amendment may be to encourage the provision of evidence-based treatment options to people who use drugs, it is critical that the application process for supervised consumption sites not be hindered by additional federal requirements for immediate access to treatment services. This could impose an additional burden and make it more difficult to establish and operate supervised consumption sites. As written, this amendment could result in charter challenges on the grounds that an individual’s safety and security could be jeopardized if that person could no longer access the services offered at a supervised consumption site. It also represents significant jurisdictional issues, since it could be construed as regulating a health service or clinical practice. In addition, repeated offers of pharmaceutical treatment could actually discourage people who are not yet ready to begin treatment from using supervised consumption sites. This would be counter to the aim of supporting communities that need these sites to save the lives of their community members. For these reasons, our government proposes that we amend the wording to say “may” instead of “shall” and remove subsection 2 of this amendment. For all the reasons I just outlined, our government does not support the amendment to the motion moved by the member for Oshawa. I also want to remind the House that this bill includes other important initiatives, because the opioid crisis is a complex problem that requires a comprehensive response. The pathways to addiction are numerous, but they are connected through their origin in personal pain, whether that be mental or physical pain. These issues are all too often exacerbated by multiple social determinants of health, including poverty, homelessness, and lack of access to economic resources, making the reality of addiction and the path to recovery all the more difficult to navigate. To add to this complexity, the drug environment in Canada has changed drastically in recent years. Strong drugs like fentanyl, carfentanil, and other analogs have made their way into Canada, and they are often being disguised as prescription drugs like Percocet or oxycodone, or they are mixed with other less potent street drugs, such as heroin or cocaine. With that in mind, l would like to take this opportunity to specifically discuss the Senate amendments with respect to establishing supervised consumption sites. This crisis is impacting high-risk, long-term drug users as well as recreational drug users who do not expect that the drug they are using could contain fentanyl. As we all know from the devastating local news reports across this country, the crisis is also affecting young people who are experimenting with drugs. That is why, in addition to important provisions regarding supervised consumption sites, Bill C-37 also includes proposals that would modernize the current legislative framework and create new law enforcement tools to confront the ongoing crisis. For example, Bill C-37 proposes legislative measures to prohibit the unregistered import of pill presses to Canada. If passed, it would allow border officials to open international mail of any weight should they have reasonable grounds to suspect that the item may contain prohibited, controlled, or regulated goods. As well, it would grant the Minister of Health the necessary powers to quickly temporarily schedule and control a new and dangerous substance. It is important to point out that Bill C-37 and the revised amendments our government is proposing are part of a suite of vital measures that our government has taken to combat the opioid crisis. For the benefit of the members, I think it is worth mentioning some of our government’s other initiatives. We have made naloxone available without prescription, and we have expedited the review of naloxone nasal spray to ensure that multiple formats are available to Canadians. We have granted exemptions to Insite and the Dr. Peter Centre to operate supervised con-

260 The Federal response to the Opioid Crisis sumption sites in Vancouver, and we have now issued exemptions for a total of three supervised consumption sites at fixed locations in Montreal and are expediting reviews for the approval of 18 additional sites in 10 cities: Montreal, Toronto, Vancouver, Surrey, Ottawa, Victoria, Edmonton, Calgary, Kelowna, and Kamloops. Our government has also rescinded the prohibition on access to an important treatment option, prescription heroin, to treat more serious addictions. We have finalized new regulations to control chemicals used to make fentanyl, making it harder to manufacture illegal substances in Canada, and we have supported the passage of the important Bill C-224, the Good Samaritan Drug Overdose Act, which I am pleased to say achieved royal assent on May 4. Finally, we are providing $100 million in federal funding to support the Canadian drugs and substances strategy, as well as an additional $10 million in emergency funding to British Columbia and $6 million in emergency funding to Alberta. It is important that members understand that there is no single action that will end this opioid crisis immediately. There is no single law or policy that will do so. It requires comprehensive, urgent action. The adoption of the amendment our government is now proposing and making Bill C-37 law would be, however, a very important step forward in supporting a new approach to drug policy in Canada. As proposed, this legislation would give our government and law enforcement agencies more effective tools to fight problematic substance use and provide more support to communities that are battling this crisis locally. The amended legislation would also help our government work with partners to implement an evidence-based approach that is comprehensive and collaborative. Therefore, I encourage all members to support Bill C-37 and our approach to the Senate’s amendment in order to protect Canadians and save lives. I thank my colleagues for their important work in this regard, and I thank you, Mr. Speaker, for the opportunity to discuss it.

Conservative MP Cathy McLeod (Kamloops—Thompson—Cariboo, B.C.):

Mr. Speaker, I agree that Bill C-37 has some very important initiatives to tackle this particular crisis, but I continue to be very concerned. As a former mayor and a former member of a local council, I know that anything we have tried to make sure was included that gave communities the ability to have a thoughtful process has been taken away, such as the initial removal of the need for council approval. In Kamloops, 100% of council agreed with it, but council members also had the right and the ability to say they wanted to move forward. That was stripped away. We had a very thoughtful suggestion from the Senate that there be some advisory support. I think advisory support could do many things in terms of how cities deal with this issue, above and beyond the particular crisis. Again, that has been stripped away. Why does the minister not trust local governments and local communities to have a part in the decision-making? It would appear that she does not trust them to be part of the solution.

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I want to reiterate this, because I am not sure everyone has fully comprehended the severity of this crisis in British Columbia. Based on the number of deaths that have occurred in the first three months of this year, if trends continue there will be 1,400 deaths from overdose in British Columbia. This is a serious matter. We see no end in sight, and we have to make sure we use all measures within our jurisdiction to respond to it. As the member says, of course it is important to respond to the community to make sure there is a demand for these sites, that there is a need for these sites, and that there is appropriate community consultation. I trust that the member is aware that those were among the five factors the Supreme Court gave us. It required, even within Bill C-37, that the Minister of Health take them into consideration in recognizing the need for a site. Clearly, that need has to be demonstrated, and the community must have the opportunity for input. It is at the discretion of the Minister of Health to determine whether further consultation is required. We know there is a huge demand for this. I speak on a very regular basis with people in these communities who are desperate to have supervised consumption sites. Community consultation includes consultation with the members of the community who are seeing their friends, family members, and young people dying. They need the opportunity for input too. These are the members of society I hope members of this House will take into consideration when they are considering this bill. As it relates to the matter of having a citizen oversight body, no other health facility has a legislative requirement for that. We know that some health facilities like to have community oversight bodies, but having a legislative requirement, as I said in my remarks, would further stigmatize a population whose members are dying because of the stigmatization of their community. It is important that we not introduce any further barriers to making sure we save people’s lives.

261 The Federal response to the Opioid Crisis

Green Party Leader Elizabeth May (Saanich—Gulf Islands, B.C.):

Mr. Speaker, this will be the second time only in six years as a parliamentarian that I have voted for time allocation. I voted for it also on Bill C-37. The question here is urgent. I agree with the minister, although I would say that this may be the classic case of the perfect being the enemy of the good. When lives are at stake, I do not think we can take the time to argue over improvements that, frankly, I would want to see made too. We know that on the street, fentanyl is being found in 80% of the street drugs that are otherwise not identifiable as fentanyl. Can the minister give us any update on what is being done on the ground while we get this bill through the House as fast as possible?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I thank the member for supporting time allocation in this case. I agree with her that this is an exceptional piece of legislation because there is a tremendous amount of urgency. I appreciate her upstanding perspective on how to address it, as she said, knowing that there may be ways this could be further improved but that time is of the utmost necessity, because people are dying. The member has also reiterated, perhaps after reading it in the newspaper in the last couple of days, that there is evidence now in British Columbia that when we look at some of the drugs being sold on the street, over 80% of some drugs are now contaminated with fentanyl and some of its analogues. We have always had challenges with problematic substance use in society. As I said earlier, it goes with things like poverty, homelessness, unresolved trauma, and the abuse people have experienced. This was made worse, as the member knows, by the unfortunate reality of the over-prescription of opioids based on deceptive pharmaceutical practices. This is an area we are working on as well with a number of medical educators and regulatory bodies. What has made this crisis unprecedented are these new highly potent products. It affecting not just Canada but North America, and now we are seeing it even further around the world. I am happy to tell the member about a number of initiatives. As I said, we are working with 42 organizations across the country, regulators and educators of health professionals, to make sure we understand the work that needs to be done to address over-prescription. We are, of course, also working with organizations across the country to expand access to treatment. I alluded in my notes to the fact that we have taken steps to allow products to come into the country. For example, there is the possibility of using pharmaceutical-grade diacetylmorphine as a treatment option, and we are encouraging multiple approaches to treatment. There is so much being done, and I am happy to update any members who are interested.

Liberal MP Sukh Dhaliwal (Surrey—Newton, B.C.):

Mr. Speaker, last summer, in light of the tragedies that have happened in Surrey, all members of Parliament were asked to an emergency summit, in fact the member for South Surrey—White Rock was also invited, as well as all the MLAs and local professionals. I brought that issue to our hon. minister. The hon. minister has taken steps since then on the harm reduction measures, balanced with an enforcement strategy. However, critics in Surrey are asking me to tell the minister that we are not doing enough and we are not doing it fast enough. Would the minister be kind enough to tell the people in Surrey what the minister has done, and the plan to deal with this in a fast and efficient manner going forward?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, the member’s question gives me an opportunity to speak to what is taking place in Surrey. Indeed, I was in Surrey not very long ago addressing this very issue. Surrey is one of the municipalities where I saw a tremendous amount of collaboration from members of the community. I met with the mayor and with a number of health providers in that community to hear what they are doing. One of the things I was very impressed with is that they have done exceptional work in terms of gathering data. For instance, they were able to share with me the number of overdoses that were determined to have taken place in Surrey last year. The emergency medical services in Surrey have evidence of over 2,000 overdoses that took place. Some very interesting information came out of the work that was done in Surrey. We found that these overdoses are not just taking place in the downtown core, but are taking place all throughout the city. I could give the member all kinds of examples of other things that are being done which would reassure the people of Surrey, but while we are on the topic of data, perhaps I could share that one of my concerns is about the lack of good data across the country, and the tremendous need to co-operate with multiple orders of government and other agencies. One of the things I have asked the Public Health Agency of Canada to do, for example, is to launch an epidemiologic study, and to do so immediately. That will give us better information in understanding who is taking drugs, what drugs are being taken, the causes of the overdoses in these communities, and where they are taking place. They will begin that work immediately. There are a number of other initiatives that we are taking to make sure we are working with coroners, medical examiners, Canadian Institute for Health Infor- mation, Statistics Canada, and multiple organizations, to get the data we need that will drive the change to save lives. 262 The Federal response to the Opioid Crisis

Conservative MP Kevin Sorenson (Battle River—Crowfoot, Alta.):

Mr. Speaker, I am pleased to participate in the debate on Bill C-37, legislation proposed by the Liberal government to help deal with the opioid crisis that is affecting too many communities across Canada. I am not encouraged after hearing the minister’s comments. She talked about 900 fatalities in British Columbia in the last year, 500 in Alberta, that 1,400 have died of overdoses. She said after quoting this that she sees no end in sight. That tells us the severity of what we are facing across Canada. However, it seems a little disappointing that the minister does not give a lot of answers to the problems that she sees. Bill C-37 does not contain enough answers. In fact, we believe there are some problems with Bill C-37. Today, we are considering some amendments by my colleague, the official opposition health critic. It is my first entry into the debate on Bill C-37, although it is not the first time I have dealt with this. As a member of Parliament back in 2001-02, we had an opioid problem in the country. There was a committee struck, the Special Committee on the Non-Medical Use of Drugs. We travelled across Canada and to Germany, and I believe to France, Switzerland, and a number of other countries. We saw safe injections sites. At that time, they believed it was the answer to the opioid problem. They called them safe injection sites then, not supervised consumption sites. I guess the government feels that supervised consumption sites sells a little better. I travelled with Randy White, a member of Parliament from Abbotsford. I think he would find it very disappointing that 16 years later we are still debating the same types of issues and have seen even greater problems since some of these safe injection sites have been incorporated into the landscape across our country. I will take this opportunity to thank my colleague, the member for Oshawa, for all his hard work on the health file on behalf of his constituents and Canadians. As a doctor, he understands all aspects of the health file. For many years, we have benefited from his input, his comments, and knowledge. He has been on the committee for years as well. Today, he is asking the House, again, to consider the amendments to Bill C-37 that have been brought forward by the Senate of Canada. His amendment states:

“That the motion be amended by deleting all the words after the word “That” and substituting the following:

‘the amendments made by the Senate to Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, be now read a second time and concurred in.’”

The first amendment that the Senate brought forward ensures that there is a minimum consultation period of 45 days prior to the approval of an injection site. The second amendment looks to establish a citizens advisory committee that is responsible for advising the approved injection site of any public concerns, including public health and safety issues. The amendment also looks to have the committee provide the minister with a yearly update on these matters. The third amendment directs those working at the site to offer the person using the site some legal pharmaceutical therapy before that person consumes or injects illegal drugs. It is disappointing that the minister is flatly refusing to accept the amendments from the Senate. I believe that many Canadians would feel that those amendments are fair, substantive, and reasonable. The Senate does not amend legislation from this House very often. The Senate takes very seriously any amendments that it would recommend to the House. Therefore, when senators do take the time to study and bring forward amendments, we should be paying attention to what they do. We should not discount it as quickly as the minister did. The Senate tries to help the government and this House pass good legislation. It wants to help us ensure that the laws we pass accomplish what we want done. The Senate wants to help ensure that our legislation would not cause other harm, or place an unnecessary burden on Canadians. There are many reasons for the Senate to return a bill to the House with amendments, and it is important that we accept suggestions and recommendations from the other place and agree to consider them seriously. The first amendment asks for a minimum consultation period of 45 days prior to the approval of an injection site anywhere in Can- ada. The Senate knows that not all Canadians want injection sites in their local communities, or, as the minister calls them, supervised consumption sites. Anyone looking at community injection sites would understand why. Those who have been involved understand why. To discount the amendment out of hand is disappointing. The Senate is trying to inject a measure of democracy into Bill C-37 by providing communities with a chance to further consider proposals for injection sites. We hope that the Liberals will respect that. The Liberals talk about inclusion, but we see the opposite. They talk about partnerships with other levels of government, but we see the opposite. Why will they not listen to Canadians? They promised to do politics differently. They said that under their rule, we would all live to our full potential as Canadians, whatever that means. They also promised to consult with Canadians. Now, when the Senate is suggesting that they consult with communities as to where a safe injection site is going to be put, they do not want to hear it. The Liberals do not want to hear from those communities or from those groups that would advocate for one site being a better place than another site.

263 The Federal response to the Opioid Crisis

The Liberals should learn to listen to the grassroots of communities and allow them to have their say. Under Bill C-37, communities should be encouraged to make comments, to offer suggestions, to consider proposals on where an injection site should be built, or if it should be built at all. That is what being community minded is all about. The government should not be afraid of local governments, citizens, community organizations, or anyone who has a differing opinion. The first amendment wants to allow a local community, large or small, to have at least 45 days to study and prepare before the government opens an injection site. That is fair. The Senate believes it is reasonable, diplomatic, and democratic, but the Liberals say no. Far from delaying the approval of a new injection site, a courtesy to the community is about to be changed. The second amendment wants to establish a citizens advisory group. Much like the first amendment in some respects, the Senate is trying to help the government with Bill C-37, and after great study on the subject, it felt that this amendment would do that. The Senate is recommending that a group be formed that will help communities deal with the challenges of establishing an injection site. That would be generous and very helpful. Many Canadians do not know much about what happens at a safe injection site or a supervised consumption site. We want them to be aware of the opioid crisis that is facing Canada and what the Liberals see as solutions. Canadians only know the images that they see on the media, which depict the horrors, for example, of Vancouver’s Downtown Eastside, what we used to call heroin districts and other things in the United States and Europe. The constituents that I represent in Battle River do not want to become like the Eastside of Vancouver. In fact, I do not know of too many constituencies, rural or urban, that do. Being almost like a Bible belt in parts of Alberta, more time is probably spent praying for drug victims on those streets. They care very much. They feel badly when they see lives being ruined by the opioid crisis. I believe the communities are there and want to help. We want to do the right thing. We want to address the crisis, even if it is in our own communities. As we can see from the statistics that the minister quoted of 900 deaths in B.C. last year and 500 in Alberta, it is in every community. However, the Liberals are saying that we must do only what the Liberal politicians in Ottawa say we have to do, whether that is in Alberta or anywhere else, and by opposing amendment number two, the Liberals are denying Canadians the opportunity to be involved. The government does not want experts bringing their knowledge into communities and making recommendations and suggestions or amending anything. The Liberals are trying to dictate what every community in Canada must do when it comes to their supervised consumption sites. That is too bad, because wherever the opioid crisis raises its ugly head, in most communities, rural or urban, those communities would like to have some credible and knowledgeable assistance. Why do the Liberals not want that? The government is saying that it knows what is best: one size will fit all. Imagine, as injections sites are brought into communities across Canada, that none of the lessons learned would be shared with those communities, none of the problems that have been dealt with successfully in certain communities would be available to other communities so that they would be able to benefit. The Senate is simply trying to help the government with its bill. The Senate is trying to look out for communities, large and small, by having experts who know about the problems help communities grapple with them. That would be a good thing. We hope the government does not dig in its heels on these amendments. We hope that the minister is not just saying that we should do what she says because she knows best, but it seems that is what she is doing. Canada has many different diverse communities. The operators of injection sites would appreciate being advised of community concerns and local health and safety issues. Not all injection sites would be able to operate the same way in every community. There are many concerned citizens in every community in Canada. I have seen this in my own large geographical constituency. In every small town and village, there are folks who know very well how the local community operates, and we want to allow them to help. We do not want the Liberals to consider their efforts to be interference. We need everyone with knowledge and experience to work on the opioid crisis. We do not want to exclude the very people who can help us the most, the residents who know how things work in their communities. If the government proceeds with this program, every community could certainly benefit by having five to 10 volunteers within the immediate vicinity of the site at least consulted. The third amendment that the Senate brought forward directs those working at the site to offer the person who is using this illegal drug some legal pharmaceutical therapy. Much of the drugs that are being used are obtained illegally. In Senator White’s speech in the other place, as a long-time police officer and city police chief, he talked about the day that an addict uses his drug as a day of crime, when he or she would go out and usually commit various crimes in order to raise enough funds to obtain the drug. If this plan is adopted, should we not give those people in those sites who would be using at least some counsel or therapy? Why would the government not listen to what the senators are calling for here? Is it not the most basic and simple thing to try to help those who are abusing opioids at the time they are actually going to use them? Is it not in the best interests of the addicts, and of our society, to help those individuals who are addicts to get off opioids? It sounds as though the Liberals are saying no. The more people abuse themselves with harmful opioids, the more they will want to stop as their health declines. I have never met one who wants to keep going. They wish they could get out of the rut they are in. As their relationships with others disappear and their finances disappear, they are going to want help and they are crying for help. They will need to be rescued in order to save their lives.

264 The Federal response to the Opioid Crisis

They probably had a very difficult time getting drugs from some of these drug dealers. The drug abuse world is a violent, lawless world. Every time a drug abuse victim visits an injection site, we should be offering them an alternative. We should make saving that person’s life a priority. Why would the Liberals not want that? It is unbelievable. It is almost as if the Liberals are trying to enable the continuing abuse of drugs by drug addicts. It is unfair. This is not the sunny ways the Prime Minister talked about. It is not helping everyone live to their full potential as Canadians, as the government said it wanted to do. What we see is mismanagement of the opioid crisis. We should make it a criminal offence not to offer an alternative to someone who is so addicted to a drug that they need supervision when they inject that drug. Anyone in that position needs help. They may not accept the help being offered, but at least it should be -of fered to them. If everyone knows that the injection site is offering a way out, an alternative, then we have a better chance of saving lives. I have heard some say that offering pharmaceutic therapy could erode the relationship between the drug abuser and the facilitator at the injection site. Really? Could offering a little counsel could lose the relationship between the two? I think the Liberals are off base on this. The facilitator, as they call it, would be from the community. To the extent that the facilitator may not approve of the drug abuse, that facilitator would want to be ready to help if he or she is asked. I would say that is true in many parts, if not all parts, of Canadian communities, and I hope it would be true in our communities. That is the Canadian way. We are there to help. Is that not what the Prime Minister tells the world—that Canada is there to help? What part does he not get? I see that my time is running short, so let me just say this: are there good things in Bill C-37? Not much, but we hope the Liberals will support the first amendment and include communities. We hope the Liberals realize communities need time to figure out how they will provide an injection site, and we hope the Liberals are willing to come up with something that could satisfy the third amendment. There are other measures in Bill C-37. The bill gives the Canada Border Services Agency the authority to open international mail of any weight, should there be reasonable grounds. Perhaps this may sound like a good measure, but I think we had better be careful what we ask for here. In their hurry to find some solution, they may have eroded some of the rights of Canadians, and a lot will depend on the term “reasonable grounds”. Allowing searches of packages and shipping and so on will slow down commerce. Do we mean “reasonable grounds” that there are drugs in there? I think there are already reasonable grounds for every package, if they want to use that, but again, it may not be exactly what they want to accomplish. If passed, Bill C-37 could add prohibitions and penalties that would apply to possession, production, sale, importation, or transport of anything intended to be used in the production of any controlled substance, including fentanyl. That is a good measure. I brought forward a private member’s bill that offered to allow the minister to allow Canadians access only to specific narcotics that have tamper-resistance or abuse-deterrent formulations. The technology is there now. This measure would only be used when a particular drug is being abused with deadly results of the kind we saw with fentanyl. Oxycontin is available now as OxyNEO, a tamper-proof pharmaceutical, but the government voted against it. Today the minister said that this is just one measure that will fight the opioid crisis. It is funny, though, that when pharmaceutical companies and United States governments under Obama and other states started going down that road, this minister said it was not in our best interests. We should improve Bill C-37 so that it helps Canadians deal with the opioid crisis. We should support the amendments that are being debated, and we should support the amendment of the member for Oshawa.

Liberal MP Ken Hardie (Fleetwood—Port Kells, B.C.):

Mr. Speaker, the response that needs to be asked is about the urgency of the situation. We want a 45-day consultation period, but in British Columbia’s case, at the rate people are dying, 113 people would die just in the consultation period. There was an opportunity in the House a few months ago to fast-track the bill and get things going so that safe injection and safe consumption sites could get up and running. That was blocked by the same party that wanted to do away with the one and only safe injection site in the Downtown Eastside of Vancouver, and that would be the Conservatives. Since then, 92 people in B.C. have died. The implication is that these safe consumption sites would pop up in every nice community and small town across the country. I would ask the member whether it is not the case that these are needed where there are currently dirty needles on the ground and people shooting up in doorways, not in the member’s community and, thankfully, not in mine?

Conservative MP Kevin Sorenson (Battle River—Crowfoot, Alta.):

Mr. Speaker, I take great offence to what the member said about our wanting to have a debate in this place. He almost alleged that people were dying only because we did not get those safe injection sites into their communities or have them coming to communities near them. It is not that way. Extra debate on an issue like this is not the reason people are dying. Another point is that in 2001, members travelled to countries such as Germany on this very issue. The member said in his question that safe injection sites would clean up the situation of people shooting up in doorways and in parks. No one involved with safe injection sites believes that. If people go to safe injection sites, they will be supervised there, but if the member were to go around the safe injection site, as we did, he would still see people shooting up on sidewalks and needles in the park. He would still be warned about walking in sandals or barefoot through parks. He could not do it, because the truth is that people do not only go to the safe injection site.

265 The Federal response to the Opioid Crisis

If they know they will get a clean needle, they will typically go there, get a needle or two, and those needles will be disposed of the next time they shoot up. Typically, as members found out in Germany, Switzerland, and some other countries, the next time is not at the safe injection site. We do have an opioid crisis. The government voted against a private member’s bill, Bill C-307, that would have established tamper-resistant fentanyl. No, the government would not accept that. It was not designed to be the answer to all of the problems, but one little tool in the tool kit, exactly as the minister said, but she said that was not the government’s plan. We need to proceed. The Senate did a study. It brought in people from all across Canada, worked hard, and took its study very seriously. Now the Liberal government wants to reject the amendments from the Senate because it believes it knows that one size fits all. It is shameful.

NDP MP Sheila Malcolmson (Nanaimo—Ladysmith, B.C.):

Mr. Speaker, shameful would characterize 10 years of Conservative inaction, followed by a year and a half of Liberal foot-dragging, followed by three months of Senate stalling, studying the exact same questions that were debated and rejected at committee, while people continue to die at rates way beyond other countries. In my community of Nanaimo, 13 people died just in the first three months of this year alone, and 28 people died last year. We are losing people at the same rate as Vancouver. The west coast has been hit very hard by the opioid crisis for all kinds of reasons, such as over-prescription, access to west coast shipping, untreated pain, improper way of supporting people with PTSD. The causes are myriad, but the solutions have fallen completely to the front line: ambulance, paramedics, firefighters, social workers, NGOs that train people in naloxone. If the House cannot get it together and actually remove the barriers to the solutions that have been identified, that is shameful. Specifically, the member is talking about the community consent amendment that the Senate has brought, an idea that was rejected at committee. Specifically the legislation already requires the Minister of Health to consider expressions of community support when they consider licensing a new site. Why on earth would the member continue to propose and support the Senate amendment, which just gets in the way of the approval of treatment facilities for addicted people?

Conservative MP Kevin Sorenson (Battle River—Crowfoot, Alta.):

Mr. Speaker, I do not question the member’s concern on this. Obviously, all of us are concerned about the crisis. There were 900 fatalities in her province last year. She says that it has to be community consent. It is community consult. The amendment states that there be a 45-day consultation period with the community. It is not asking for a consensual agreement. The senate has asked that communities be given the opportunity of 45 days before safe injections sites are brought to their communities. Again, it is almost like the heavy hand of Ottawa coming down saying it knows best in every community across this land. I disagree with that. However, I do agree that we need to look for ways we can adequately move forward and recognize the significance of what we see. This issue did not begin 10 years ago under our government. In 2001-02, I was on that non-medical drug committee when we travelled the country and the issue was there. We have new opioids being brought forward almost monthly. It might be a bit of an exaggeration, but if it is not OxyContin, it is fentanyl. If it is not that, it will be something else, many of which are concocted in the basements of homes and garages. Like Senator White, I hate to use the word “drugs”. They are poison in some cases. The fact is that the safe injection site is not the answer to the problem. It may be an answer, but it is not the answer, especially a safe injection site that cannot give counsel to the individual, the third amendment. The shameful part is not bring forward measures that would simply keep the issue going as it is now, the status quo, but that seeing some effective changes. I am disappointed the member is so anxious, it seems, to open these safe injection sites, but says we do not need counselling within them.

Conservative MP John Barlow (Foothills, Alta.):

Mr. Speaker, my colleague and I come from very similar constituencies in rural Alberta, and I have been inundated with letters from my communities. It is not whether they want a safe injection site. They want to have input and community consultation on not only whether they want one, but where it goes as well. I would like my colleague to talk about some of the feedback he is getting from his rural communities on this issue.

Conservative MP Kevin Sorenson (Battle River—Crowfoot, Alta.):

Mr. Speaker, the communities are engaged. I have been here for 17 years and I have brought forward a private member’s bill, a rural riding, and typically we think of Downtown Eastside Vancouver and others, to deal with tamper-proof opioids. That shows how much community involvement there is. My wife and daughter are registered nurses. My daughter has told me that we have to do something, that people are coming in, asking for the kit. They know the drugs they are taking, which are made in garages, will be laced with poisons. The member is right, as much as I hate to admit it. It is not just happening in the big cities anymore. In rural ridings, especially with the economy in Alberta, which I think is a contributing factor, we see it more and more all the time. We need answers that will actually help. 266 The Federal response to the Opioid Crisis

Parliamentary Secretary to the Minister of Innovation, Science and Economic Development David Lametti (LaSalle-Émard-Verdun, Que.):

Mr. Speaker, I would like to thank each of the members of the House, the House Standing Committee on Health, the Senate, and the Senate Standing Committee on Legal and Constitutional Affairs for their work on Bill C-37. I would also like to thank the minister as well as her current and previous parliamentary secretary for all the work they have done on this and the leadership they have shown. The hon. members of the Senate have adopted some amendments to Bill C-37 around supervised consumption sites, particularly for supporting public consultation in the application process. I welcome the opportunity to rise in the House today to speak to the amendments to Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts. As all my colleagues know, there is currently a troubling number of overdoses and fatalities associated with opioids and other substances in Canada. Far too often, we hear about new and powerful drugs that end up in our communities and heartbreaking stories of families and communities that lose loved ones to an overdose. To help address the challenges associated with problematic substance use in Canada, Bill C-37 proposes important legislative changes to support a new Canadian drugs and substances strategy, a comprehensive, collaborative, and compassionate strategy composed of four pillars, which are prevention, treatment, harm reduction, and enforcement, each one built on a strong foundation of evidence. These proposed legislative changes will help provide public health officials and law enforcement organizations in Canada with the tools they need to help communities in addressing problematic substance use, including live-saving harm reduction initiatives to help those struggling with opioid use disorder. Bill C-37 was drafted to offer a real solution to the communities dealing with this crisis by eliminating, among other things, unnecessary obstacles to opening supervised consumption sites. Should it receive royal assent, Bill C-37 will streamline the application process for supervised consumption sites by replacing the current 26 criteria set out in the Controlled Drugs and Substances Act with the five factors set out by the Supreme Court of Canada in its 2011 decision regarding Insite. These factors are: one, impact on crime rates; two, local conditions indicating need; three, regulatory structure in place to support the facility; four, resources available to support its maintenance; and, five, expressions of community support or opposition. Reducing the number of criteria will alleviate the administrative burden on communities wanting to open a supervised consumption site without compromising the health and safety of those using the site, their clients, and the neighbouring community. I want to underscore our government’s position on the importance of community consultation in the establishment of supervised consumption sites, while also reducing the barriers for communities to establish life-saving services for their citizens. Our government recognizes and respects that there is a balance between a community’s need for adequate time and appropriate channels to provide valuable feedback and the need to minimize unnecessary delays in the administrative process for critical harm reduction services. In Bill C-37, our government is proposing an authorization process that respects the Supreme Court of Canada’s decision and criteria, including the requirement that the minister of health must consider expressions of community support or opposition when reviewing applications for supervised consumption sites. The proposed approach will give the communities the assurance that their voice will be heard and that every application is subject to a thorough review. While supervised consumption sites have been shown to be effective in reducing the harms of problematic substance use, the Min- ister of Health needs to make informed decisions on future applications, which could include collecting additional information and hearing directly from community members when necessary. Our government is committed to the protection of public health and the maintenance of public safety. Health Canada will do the necessary verification so that any potential site operates in a responsible manner and ultimately meets its stated objectives of saving lives and reducing harms. In the amended bill, the minister would continue to have the authority to post a notice of the application and invite public comments. Such a provision could be used in cases involving extenuating circumstances where the minister feels that further community consultation is warranted. Our government supports the Senate amendment to establish a minimum public comment period of at least 45 days, which will offer the public time to provide its feedback on site applications when the minister chooses to post the public comment period. Bill C-37 retains the previous maximum consultation period of up to 90 days. The communities have an important role to play in the successful launch of a supervised consumption site. They have to work together on meeting the challenges and determining whether such a program is appropriate for their neighbourhood. The support of the community within which the sites are located is a key element in a supervised consumption site’s ability to have a positive and meaningful impact. This requires constructive dialogue among community members to find common ground and address potential concerns. 267 The Federal response to the Opioid Crisis

At the same time, our government also recognizes that stigmatizing problematic substance abuse can negatively impact the rates of which harm reduction services, such as supervised consumption sites, are accessed by those who need them. Adding measures for supervised consumption sites that are not applied to other health services add to the stigmatization of the sites and those in need and unnecessarily impact access to these critical services. In addition, the advisory committee could be composed of individuals who do not have adequate qualifications to warrant their oversight of a health care service. As such, our government does not support the second amendment adopted by the Senate. Now more than ever, it is important to help communities open supervised consumption sites in order to help address the underlying issues of problematic substance use. The proposed changes will help us ensure that community members have the opportunity to make comments on applications for proposed centres, that federal legislation does not contribute to further stigmatizing these centres relative to other health services, and that there are no obstacles or unjustified delays to opening these centres where they are wanted and needed. Because the need for supervised consumption sites is urgent in helping to save lives, it is imperative that the process not be overly burdensome so as to unnecessarily delay the establishment of potential sites. While our government recognizes the benefits and supports the use of alternative pharmaceutical therapy, the decision to offer additional services to clients should be made by each site based on the needs of its community. It is for this reason that our government does not support the amendment as currently written. We respectfully propose that the word “may” be substituted for “shall”. Health Canada would also support communities through the publication of a revised application form, available online, and simplified guidance to help site applicants through the process and clearly state what documentation is required to support the minister’s consideration of the Supreme Court of Canada’s factors. The application form would provide details on how to address these Supreme Court criteria. The criteria would be streamlined and modified to provide applicants with greater flexibility to consider their local context. We cannot turn our backs on the preventable deaths occurring across the country. We must do our part, and that includes passing Bill C-37. I urge all members of the House to support our government’s proposed legislative changes that would support communities rather than place unnecessary barriers in their path.

Conservative MP Garnett Genuis (Sherwood Park—Fort Saskatchewan, Alta.):

Mr. Speaker, I want to ask specifically about this issue of people who go into supervised injection sites being offered an alternative in the context of going in. I understand this is one of the Senate amendments that the government is rejecting. It is also a part of previous legislation. Those who defend supervised injection sites generally do so on the basis that there is still hope and still an effort to put people on a path to recovery, and yet the government seems allergic to having specific language in the legislation that would ensure that people were at least offered a step on that path to recovery. I wonder if the parliamentary secretary can explain this allergy. Why, when we have these supervised injection sites, should we not at a minimum insist that people be offered some kind of an alternative when they are going in?

Parliamentary Secretary to the Minister of Innovation, Science and Economic Development David Lametti (LaSalle-Émard-Verdun, Que.):

Mr. Speaker, the problem is with making the requirement mandatory. Certainly in a local context, where there is local expertise and local need and those needs are being assessed, there is the possibility, as we are proposing in terms of an amendment to the amendment, to allow that kind of suggestion to happen without making it mandatory. It is in making it mandatory that potentially more delays are added to the system, that we add an extra layer of advising that may not be necessary and which in fact may be an impediment to quick and expeditious treatment. As I mentioned in my remarks, there is also the question of expertise and adding another layer of assessment as to who is an expert in those alternative therapies. Parliamentary Secretary to the Leader of the Government in the House of Commons Kevin Lamoureux (Winnipeg North, Man.):

Mr. Speaker, it is important to recognize that the Minister of Health is looking at this as just one tool that is being used to combat that national public health crisis. We have invested literally $10 million in emergency funding in B.C. and millions of additional dollars in Alberta. There has been a great deal of consultation with the different stakeholders to make sure that the government is working with others in trying to minimize the crisis. Could my colleague talk about the necessity of strong national leadership and how important it is that we work with the local levels of government and other stakeholders, in particular our first responders? 268 The Federal response to the Opioid Crisis

Parliamentary Secretary to the Minister of Innovation, Science and Economic Development David Lametti (LaSalle-Émard-Verdun, Que.):

Mr. Speaker, we are in the middle of a crisis, and therefore, we need national leadership to coordinate the response across the country and to allow the appropriate level of resources to be targeted at the specific regions of the country that need it the most. That being said, we are trying to strike a balance with this legislation with local communities to help identify and work with us toward finding solutions and that includes first responders. Much of what we are doing in this legislation is listening to the suggestions that those people have made on the ground to us in terms of dealing with this crisis.

NDP MP Tracey Ramsey (Essex, Ont.):

Mr. Speaker, earlier this year in question period, I asked the government for immediate action on the opioid crisis. I said that we cannot afford to wait for Bill C-37 to wind its way through the parliamentary process. Ironically, months later, while this legislation has made progress, it has not yet received royal assent. At the time, I asked the government to provide immediate and direct support to communities like those I represent in Essex, which continue to grapple with this public health emergency. Unfortunately, this crisis continues to spiral. Front-line workers do not have the resources that they need. People in my community are frustrated and angry by the lack of response from the government. Earlier today, the Minister of Health spoke about emergency funding to B.C. and Alberta. I would like to remind her that communities across Canada need emergency funding. Small communities especially are struggling to deal with this issue when there is not a holistic plan. We need care in this country that sees people from detox through transition and into rehab. That is very difficult to find in small communities. We need the government to step up with the resources necessary to bring this crisis under control. In my riding of Essex, youth addiction is a significant issue. In fact, our county has the seventh highest rate of youth addiction in the province. People in law enforcement feel that their hands are tied and they are stuck in the cycle as well. They pick up the same person, bring him or her to the hospital, and then the person is back on the street again. They want to be part of the solution, but there is currently no way for them to participate in that. Families are feeling desperate. When a loved one experiences an addiction, the parents and the family struggle so much. It is life or death. They try to support their loved one in getting help, but there are so many gaps in the system that it often feels like the system is working against them. Families are doing all they can to help each other. This morning I spoke with a woman from my riding who was trying to help another family save their child. Fortunately, she was able to get her daughter into treatment and her daughter is healthy today, but this is not the case for everyone. If it were not for Narconon and family support systems that are popping up, we would have no formal way for people to be able to find out what treatment is available to them. When someone with an addiction is ready to detox and then go to rehab, it is often the beginning of a frustrating experience of running up against the common problems of lack of beds, long wait lists, and a complete lack of resources. People with addictions simply cannot get the help they need and sadly, this can have tragic consequences. People not being able to get into help is heartbreaking. I have met with some of these families. They have visited me in my office. It is a very emotional conversation with people who are struggling to get their loved ones the help that they need. I have heard their pain and sorrow, and more often, their frustration and anger. When families tell me that their only hope is that their loved one will somehow end up in jail so that their loved one can get the treatment that he or she needs, this tells us how incredibly broken our system is. Since I held a round table several months ago, seven more people have died in our region due to opioid addictions. I implore the government to revisit its five-point plan and reconsider the level of resources that this public health crisis deserves. I would like to ask what the government can offer to rural communities like those in Essex to assist with strengthening the response to the opioid crisis.

Parliamentary Secretary to the Minister of Public Safety and Emergency Preparedness Mark Holland (Ajax, Ont.):

Mr. Speaker, our government is indeed deeply concerned about the growing number of unintentional opioid overdoses and deaths being reported in Canada, including those involving fentanyl and carfentanil. We know that this is a complex issue and that no one organization or level of government is going to be able to find a solution on its own. Months ago, we recognized that there was an opioid crisis in Canada, and since then this government has taken swift and concrete action. We have been working closely with the provinces and territories, community organizations, academia, and international partners in all areas of response, from prevention and treatment to law enforcement and harm reduction. We listened when nurses, doctors, pharmacists, patients, and parent organizations told us that removing the requirement for a prescription to access naloxone would allow for a more rapid response in a potential overdose situation, increasing the chance of survival. We applauded the decision of those provinces and territories that followed this recommendation and delisted naloxone in their jurisdictions.

269 The Federal response to the Opioid Crisis

Health Canada has also worked to provide access for Canadians to a single-use nasal spray delivery system for naloxone, which has already been approved for use in other countries. This provides our first responders and communities with an alternative to injectable naloxone that is easier to carry and administer in the event of an overdose outside a hospital setting. In November last year, the Minister of Health co-hosted an opioid conference and summit, along with the Ontario Minister of Health and Long-Term Care, where participants from across the country, in a joint statement of action, committed to concrete actions to address this crisis. The Public Health Agency of Canada is using tools at its disposal to deal with a national public health event of concern. A special advisory committee on the epidemic of opioid overdoses was struck to focus on urgent issues related to the opioid crisis. This committee is co-chaired by Canada’s interim chief public health officer and the chief medical officer of health for Nova Scotia. Supported by the Public Health Agency of Canada, it includes representation of the chief medical officers of health from every province and territory. This federal, provincial, and territorial committee provides a mechanism for collaboration and information-sharing among jurisdictions focused on improving data gathering and surveillance, supporting harm reduction efforts, and addressing prevention and treatment options. To inform response efforts and to monitor the extent of the crisis, the committee is sharing, coordinating, and analyzing existing data on the public health impact of opioids in Canada. This includes examining indicators, standardizing definitions, and lending support to collaboration between chief coroners and medical examiners, led by the Canadian Institute for Health Information. Special advisory committees have previously been established as a cross-jurisdictional mechanism to allow for timely decisions on public health operations and to facilitate policy advice to deputy ministers of health, including during significant public health events such as the H1N1, Ebola outbreaks, Zika, and the welcoming of over 25,000 Syrian refugees. I could go on at great length. This is a very serious crisis, one the government is meeting with all available tools at our disposal.

NDP MP Tracey Ramsey (Essex, Ont.):

Mr. Speaker, I thank the parliamentary secretary for expressing his concern, but without action, it is hollow and meaningless to people in our communities who are watching their loved ones suffer and die. The government cannot focus only on big cities, because action is desperately needed in small towns like LaSalle, Amherstburg, Essex, Kingsville, and Lakeshore in southwestern Ontario, which have no ability to get into those beds, who call up the hospital and cannot get into rehab, because there are no beds available. Where does that leave them with their loved ones who are looking for a rehab facility that does not exist in our region, who have to travel out of town, who have to be on wait-lists? Rural communities cannot be left behind in the government’s plan to address the opioid crisis. How is the government helping rural communities that are being devastated? The government needs to show leadership and declare a national public health emergency.

Parliamentary Secretary to the Minister of Public Safety and Emergency Preparedness Mark Holland (Ajax, Ont.):

Mr. Speaker, in December, our government announced the new Canadian drugs and substances strategy. I certainly appreciate the member’s concern for rural communities. It is one I share. This strategy will restore harm reduction as a core pillar of Canada’s drug strategy. The member also referenced some of the emergency funding put in place. We had recent funding announcements in February 2017 and in budget 2017, including $100 million over five years, starting in 2017-18, with $22.7 million per year ongoing to support national measures associated with the new drug strategy and the implementation of the opioid action plan. That, of course, would also affect rural communities.

270 The Federal response to the Opioid Crisis Mentions in Question Period

NOVEMBER 28, 2017 NDP MP Brigitte Sansoucy (Saint-Hyacinthe—Bagot, Que.):

Mr. Speaker, in the past few months, there have been more than 60 cases of opioid overdoses in Montreal. The crisis has even reached Laval, where at least 10 more overdoses have occurred. The crisis is only getting worse across Canada. For a year now, the NDP has been calling on the Liberal government to treat the opioid crisis as a national emergency, so that communities in need can access more resources. With seven people dying every day, what is this government waiting for to declare that the opioid crisis has become a national emergency?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, our government is deeply concerned about the opioid crisis in Canada. We have taken several emergency measures on this issue, including significant federal investments, a new law, and expedited regulatory action. Going forward, we will be working with the provinces and territories to expand access to treatment, support innovative approaches, and respond to this crisis. We will fight against the stigma of opioid use.

NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, devastating news out of Alberta reveals a 40 per cent increase in opioid deaths this year and Canada will lose 3,000 lives in 2017. Families affected by this crisis are growing dismayed by the Prime Minister’s glacial response. In fact, Moms Stop the Harm has started the “Do Something Prime Minister Photo Campaign” by sending photos of lost loved ones to the PMO. The Prime Minister has ignored our call to declare the opioid crisis a national public health emergency. How many more Canadians need to die before he finally listens?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, our government recognizes the tragic impact of the opioid crisis that has faced our country. We remain committed to taking action through this compassionate, collaborative, and evidence-based approach. I also had the opportunity to meet that group when I was in Edmonton last week. Formal declarations of an emergency will not provide us with any additional tools or extra measures to provide to the opioid crisis. Our government will continue to work with all partners to address this crisis and the underlying cause of problematic substance use.

NOVEMBER 7, 2017 Conservative MP Alice Wong (Richmond Centre, B.C.):

Mr. Speaker, during the first quarter of this year, opioids killed over 900 Canadians. The government needs to help. The Liberals gave only $10 million to fight the opioid crisis but has no problem giving $500 million to the Asian infrastructure bank. Why is the government sending $500 million to foreign billionaires, when we have Canadians dying in our streets by the hundreds? Canada is our home.

Parliamentary Secretary to the Minister of Health Bill Blair (Scarborough-Southwest, Ont.):

Mr. Speaker, I am very pleased that the member opposite has given us an opportunity to talk about some of the things our government is doing to address the opioid crisis. For example, our government has provided $10 million in urgent support to our provincial partners in British Columbia and $6 million to the Province of Alberta to assist with its response. That is in addition to $22.7 million ongoing of the $100-million commitment in budget 2017 to support national measures associated with the Canadian drugs and substances strategy to respond to this terrible health crisis. 271 The Federal response to the Opioid Crisis

NOVEMBER 3, 2017 Conservative MP Kellie Leitch (Simcoe—Grey, Ont.):

Mr. Speaker, I am also shocked by another revelation. We have a Liberal government that wants to legalize marijuana, and yesterday we learned that the Liberals may be planning to decriminalize all drugs. In my clinic, kids are asking, “Is it okay to do drugs now?” Young Canadians know drugs are bad for them. The Liberal drug policy is damaging to Canadians, especially to Canadian kids. Could the minister confirm if decriminalizing hard drugs is Liberal policy, and what dangerous drugs are on that list?

Parliamentary Secretary to the Minister of Health Bill Blair (Scarborough-Southwest, Ont.):

Mr. Speaker, quite frankly, those members are making this up. We are in a national public health crisis. Unlike the members opposite, we are bringing forward solutions to deal with this crisis and responding in a way that is comprehensive, compassionate, and evidence based. While we have made it very clear that we plan to legalize, strictly regulate, and restrict access to cannabis in a careful way to keep it out of the hands of children and youth and to stop criminals from profiting, we have been equally clear that we are not considering legalizing any other substances. We will continue to work with our partners to bring forward innovative solutions to battle the opioid crisis and to save lives.

NOVEMBER 2, 2017 Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.):

Mr. Speaker, I was saddened to read today that the leader of the official opposition has adopted Stephen Harper’s approach to the opioid crisis. He is proposing that people with addiction issues should be arrested and incarcerated instead of being provided the help they need to stay alive and work toward a healthy future. The fact that the Conservatives want to reinstate Stephen Harper’s failed strategy is irresponsible. People with addiction issues need help, not incarceration. Will the Minister of Health please update this House on her efforts to address the opioid crisis and provide needed support—

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, I would like to thank my honourable colleague for his work and his tireless efforts in this matter. Like him, I was extremely disappointed yesterday when I heard the opposition leader’s outdated belief. Unlike the Conservatives, our government is actually supporting law enforcement where it matters. Rather than prosecuting those with mental health and addiction issues, we are disrupting illegal drugs at the border and diverting people out of the criminal justice system. With Bill C-37 and C-224, our government is taking a compassionate, evidence-based approach to reduce barriers to treatment and encourage innovative measures to prevent overdoses and save lives.

OCTOBER 31, 2017 Conservative MP Ed Fast (Abbotsford, B.C.):

This past Friday in Abbotsford, within a 10-hour period, five different residents died of opioid overdoses. This kind of tragedy is playing out in hundreds of communities across our country, yet the federal government’s silence on this health crisis has been deafen- ing: no response, no strategy, no plan. When will the minister wake up and realize Canadians are dying on her watch? When will she act?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, our government recognizes that we are in a public health crisis and we are responding in a way that is comprehensive, collaborative, compassionate, and also evidence-based. We recently announced $7.5 million that will enhance the development of evidence-based practices that could be used by those dealing with the crisis on the ground. This builds on our investment in budget 2017 and many actions to date. We will continue to bring forward evidence-based solutions to help save lives and turn the tide of this national public health crisis.

272 The Federal response to the Opioid Crisis

OCTOBER 26, 2017 NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, last week the Minister of Health was at ground zero of the opioid crisis. She visited the Downtown Eastside in Van- couver and heard from front-line workers about the brutal realities of this growing epidemic. For 12 months we have been urging the Liberal government to declare this a national public health emergency, and for 12 months it has refused. Today [U.S. President] Donald Trump declared this a public health emergency. How is it possible that the government has fallen behind the Trump administration in taking action to save lives?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, we are in a national public health crisis in Canada, and we are responding in a way that is comprehensive, collaborative, compassionate, and evidence-based. We recently announced $7.5 million to enhance the development of evidence-based practices that could be used when dealing with this crisis on the ground. To build on this investment in budget 2017, and many actions to date, we will continue to bring forward evidence-based solutions to help save lives and turn the tide on this national public health crisis.

OCTOBER 17, 2017 NDP MP Brigitte Sansoucy (Saint-Hyacinthe—Bagot, Que.):

Mr. Speaker, we have just learned that more than 60 people died from opioid overdoses in Montreal this fall, and the situation is only getting worse across Canada. A number of stakeholders are calling on the government to declare a state of emergency. Even President Trump recognizes that the situation in the United States calls for a protracted battle and significant funding. What is the government waiting for? When will it declare the opioid crisis a Canada-wide emergency?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, we are in a national public health crisis in Canada and we are responding in a way that is comprehensive, collaborative, compassionate, and also evidence based. We recently announced an investment of $7.5 million that will enhance the development of evidence-based practices that could be used by those dealing with this crisis on the ground. These build on our investment in budget 2017 and many actions to date.

OCTOBER 16, 2017 Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.):

Mr. Speaker, the B.C. Coroners Service announced last week that the province’s death toll from suspected overdose now stood at 1,013, more than the entire number recorded during 2016. We know this is an urgent public health crisis. Could the Minister of Health tell us what she is doing to address this deadly epidemic?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, I would like to thank my honourable colleague for his advocacy on this issue. Our government has been very clear that this is a national public health crisis in Canada, and we are responding in a way that is collaborative, compassionate, and comprehensive. In addition to passing Bill C-37, which streamlines the application process for supervised consumption sites, we are also providing over $10 million in urgent support to British Columbia to assist with its response to the opioid crisis. Our government will continue to bring forward evidence-based solutions to help save lives in Canada.

273 The Federal response to the Opioid Crisis

SEPTEMBER 21, 2017 NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, 2016 saw more Canadians die from opioid overdoses than any year in history. More than 2,800 Canadians lost their lives in every corner of our nation. Despite this devastating death toll, the government refused to declare a national public health emergency and claimed it was making “progress”. Health Canada just reported that 2017 is on track to see more than 3,000 deaths, breaking records in Vancouver, British Columbia, and nationwide. Does the new minister call this progress, and if so, can she explain how, when the death toll continues to mount?

Health Minister Ginette Petitpas Taylor (Moncton—Riverview—Dieppe, N.B.):

Mr. Speaker, we do recognize that we are in a national health crisis in Canada, and we are responding in a way that is comprehensive, collaborative, compassionate, and also evidence-based. Last week, I announced $7.5 million that will enhance the development of evidence-based practices that could be used by those dealing with this crisis on the ground. This builds on our investment in budget 2017 and many actions to date. We will continue to bring forward evidence-based solutions to help turn the tide on this national public health crisis.

MAY 18, 2017 NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, the government convened a panel to revise Canada’s guidelines on opioid prescription. This is an important step to address the overdose crisis. However, now we learn that one of the members of that panel was a paid adviser for pharmaceutical companies, including Purdue, a major opioid producer. Given the record of misrepresentation by the drug industry that fed this crisis, how did the government allow an individual with a clear conflict of interest to help draft new prescription guidelines?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I indeed was concerned when I heard these allegations of potential conflict of interest. As a result, I want to make sure that the guidelines will have the confidence of physicians and other prescribers who expect to use them. I have asked the associated university to do a thorough investigation of what took place and to report back to me. I have also asked the Canadian Institute for Health Information to convene a meeting to have experts advise as to the acceptability of the guidelines and whether they indeed will have the confidence of those for whom they have been written. I will report back further to the public, as necessary.

MAY 16, 2017 NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, yesterday the Minister of Health confused Vancouver and British Columbia when it comes to the opioid crisis. Clearly, the member for Vancouver Centre was correct when she said her government is ignoring the west. However, one thing the minister did get right is the horrifying increase in overdose deaths under her watch. Three thousand Canadians will die in 2017, a 50 per cent increase over last year. Does the minister still think she is making progress?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I thank the hon. member for raising this issue again in the House. Again, we will talk about the fact that this is an unprecedented national public health crisis. We are working determinedly on all aspects of the crisis. Our response is comprehensive. We have invested money in prevention. We are investing money in treatment. We are scaling up access to all ranges of treatment, including pharmaceutical grade diacetylmorphine. We are making sure we are expanding harm reduction sites, including the passage of Bill C-37 in the House yesterday, to make sure people will have harms reduced. We will continue to work at all levels to save the lives of Canadians.

274 The Federal response to the Opioid Crisis

FEBRUARY 3, 2017 NDP MP Tracey Ramsey (Essex, Ont.):

Mr. Speaker, not only is the opioid crisis taking lives and destroying families in Canadian cities, but this public health emergency is also impacting smaller communities, like the ones in my riding in Essex County, at an unprecedented rate. Canadians need immediate action from the federal government, now. We cannot afford to wait for Bill C-37 to wind its way through the parliamentary process. Will the government immediately declare a national public health emergency and provide immediate and direct support to our Canadian communities?

Environment and Climate Change Minister Catherine McKenna (Ottawa-Centre, Ont.):

Mr. Speaker, we are in a national public health crisis here in Canada, and the response to this crisis needs to be comprehensive, collaborative, compassionate, and evidence based. Building on our five-point action plan to address opioid misuse, the Minister of Health co-hosted a conference and summit on opioids that resulted in 42 organizations making concrete commitments to address this crisis. I was also very pleased that yesterday at committee, all parties came together to rise above partisan politics and bring us closer to the passing of Bill C-37.

FEBRUARY 2, 2017 Conservative MP Candice Bergen (Portage—Lisgar, Man.):

Mr. Speaker, the Liberal member for Beaches—East York is on record calling for the legalization of all illegal drugs. Yesterday the Prime Minister refused to denounce that position. Will the Minister of Health have the courage to stand today, denounce that position of that Liberal member of Parliament, and state for the record that the only drug the Liberals will be legalizing is marijuana, and please be clear for all Canadians?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, as I have just said, our approach to drug policy is evidence-based. We have made it very clear that we have plans to legalize access to cannabis and to strictly regulate it. We have plans to legalize no other substances. We will work together to address the opioid crisis in a manner that is comprehensive, evidence-based, and responds to the needs of Canadians.

FEBRUARY 1, 2017 Interim Conservative Leader Rona Ambrose (Sturgeon River-Parkland, Alta.):

Mr. Speaker, I have another question for the Prime Minister. One of his Liberal members, the member for Beaches—East York, thinks that the Prime Minister is not going far enough when it comes to legalizing marijuana. He wants the Prime Minister to “decriminalize all drugs”. There is a good reason that all drugs are not legal, and that is because they ruin the lives of our loved ones. Will the Prime Minister unequivocally denounce the comments that his Liberal colleague made and immediately commit to Canadian families that he will not put our youth at risk in legalizing tough, hard drugs like heroin and cocaine?

Prime Minister Justin Trudeau (Papineau, Que.):

Mr. Speaker, the government is committed to evidence-based policy, unlike the previous government. That is why we support safe consumption sites and want to do everything we can to protect Canadians from the ongoing opioid crisis. We have committed to legalizing marijuana, but we are not planning on legalizing anything else at this time.

DECEMBER 13, 2016 Liberal MP Hedy Fry (Vancouver Centre, B.C.):

Mr. Speaker, Canada is facing a public health crisis of tragic proportion. In B.C. alone there were 700 deaths this year from fentanyl-laced opioids, and 1,100 across the country. In B.C. and Alberta, thousands are treated, near death, in emergency rooms. Most affected are IV-drug users, youth, those who use recreational drugs, and first responders who are at risk from this high-potency fentanyl. Can the Minister of Health tell us what she is doing now to save lives, and what tools and resources will she employ to prevent more deaths? 275 The Federal response to the Opioid Crisis

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I thank the member for Vancouver Centre for her outstanding advocacy on this very issue. We have introduced an approach to drug policy in this country that is comprehensive, collaborative, compassionate, and evidence-based. We recently held an opioid summit and conference, at which 42 organizations made commitments as to what they were going to do to address this very crisis. Yester- day, I was very pleased to introduce the Canadian drugs and substances strategy, which will put control of that strategy into the hands of the minister of health, where it belongs. We will add harm reduction as a pillar into our response, and we will make sure that Canadians—

DECEMBER 8, 2016 NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, carfentanil is a devastating drug, a hundred times more powerful than fentanyl. It has hit Canadian streets, and people are dying in British Columbia and Alberta. It is so deadly that first responders are overdosing when they merely enter a room in which it is airborne. Yet the government refuses to declare a national public health emergency or repeal Bill C-2, as experts have called for to save lives now. Can the minister tell us, what is she waiting for? Must more Canadians die?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, like the member opposite, I am extremely concerned about the extraordinary circumstances surrounding the opioid crisis, which is the cause of hundreds of deaths across the country. I can assure the member opposite that my department and I and our government are working on this matter every day. I am working with my colleagues, including the Minister of Public Safety and Emergency Preparedness, on this file. We are making sure that first responders have the resources they need. This very day I was in communication with the Minister of Health for British Columbia to discuss making sure that all resources are being made available to respond to this crisis.

NOVEMBER 28, 2016 NDP MP Murray Rankin (Victoria, B.C.):

Mr. Speaker, in Victoria, people are dying from drug overdoses in record numbers. Last week, we lost five people in 72 hours. Since January, we have lost 56 in Victoria and 622 across B.C. The government has done nothing to change a Conservative law that makes it extremely difficult to open safe injection sites. Vancouver Mayor [Gregor] Robertson has called on the government to speed up the application process. Will the minister move immediately to expedite these applications and declare the opioid crisis a national health emergency?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I share the concern of the member for Victoria for this very serious problem. Members need to know that six or seven people die every day in our country as a result of opioid overdose. That is simply unacceptable. I share the member’s grief and his passion. I work on this file every day. I have already enumerated many of the actions that we have taken. We will take steps to make sure that safe, supervised consumption sites are available in the country. Every step that we can take will be done in collaboration with our partners.

NOVEMBER 23, 2016 Liberal MP Randeep Sarai (Surrey Centre, B.C.):

Mr. Speaker, as all members in the House are painfully aware, there is an opioid overdose crisis going on in B.C. and across Canada. Could the minister update the House on what she is doing to work with our partners in health from across Canada?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, as the member for Surrey Centre well knows, we are facing a growing and serious public health crisis in our country as it relates to opioids. We are determined to make sure that we proceed actively on a drug policy that is collaborative, comprehensive, compassionate, and evidence-based. It is for this reason that last week I co-hosted a conference and summit in Ottawa, where we brought together people with lived experiences, their families, health care professionals, and every level of government. We had educators and regulators there, and we all worked together on a plan to address this crisis. We will work in partnership to find immediate solutions to address the problem— 276 The Federal response to the Opioid Crisis

NOVEMBER 17, 2016 Liberal MP John Oliver (Oakville, Ont.):

Mr. Speaker, there is a health crisis in Canada. The number of opioid-related deaths is skyrocketing across the country. This is not just a mental health and addictions issue. From our children experimenting at parties, to addiction to prescription opioids for pain control, all Canadians are at risk. In my home province of Ontario, 663 people died in 2014 from opioid overdoses, and over 800 are projected to die in British Columbia this year. It is a national issue. We need to act now. What will the government do to address this crisis?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, in this country we are facing a public health crisis. It is a crisis of opioid overdoses and deaths. People die every day as a result. That is one of the reasons I am co-hosting a conference tomorrow and the following day, bringing together stakeholders from across the country, people with lived experience, health experts, governments, regulators, and educators. We are going to make progress on this when we work collectively, when we develop a comprehensive plan, and I look forward to taking further steps on that.

OCTOBER 18, 2016 Conservative MP Len Webber (Calgary Confederation, B.C.):

Mr. Speaker, the fentanyl crisis is getting worse, and the Liberals are ignoring the obvious. China is the primary source of illicit fentanyl in Canada. The Liberals would rather deal with deadly street drugs after they are in the hands of Canadians, instead of targeting the source. This morning, we attempted to have the Chinese ambassador appear before committee to explain what his government is doing to help Canada tackle this deadly drug epidemic. Why is pleasing the Chinese government more important to the Liberals than saving the lives of Canadians?

Parliamentary Secretary to the Minister of Health Kamal Khera (Brampton West, Ont.):

Mr. Speaker, our government is deeply concerned about the growing number of overdoses and deaths caused by opioids. We launched a five-point action plan to address opioid misuse, and in November the Minister of Health will be hosting a summit on opioids, bringing together experts, patient groups, governments, and regulators to discuss the current crisis and identify actions moving forward. We will continue to work with our partners to implement the action plan and to combat this problematic substance abuse all across Canada.

SEPTEMBER 30, 2016 Liberal MP Ken Hardie (Fleetwood—Port Kells, B.C.):

Madam Speaker, Canadians only need to turn on the news to see the devastating effect that the misuse of fentanyl is having in our communities. My home province of British Columbia has already declared a public health emergency after a dramatic increase in the number of overdose deaths from illicit drugs such as fentanyl, and 800 people are projected to die due to overdoses in B.C. by the end of the year. This is an issue affecting all provinces and territories, and we need to act. Will the Minister of Health inform the House what our government is doing to combat the opioid crisis?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Madam Speaker, the member for Fleetwood—Port Kells has raised a very serious matter. We are deeply concerned about the growing number of overdoses and deaths caused by fentanyl and other opioids. That is why we have delivered a five-point action plan to address the opioid crisis in this country. It includes work done in collaboration with our partners, including Senator Vern White. We were able to take a step in August to restrict the chemicals used in the illicit production of fentanyl. We have much more work to do in collaboration with health professionals, addiction experts, provinces and territories, and all members of all parties to implement—

277 The Federal response to the Opioid Crisis

SEPTEMBER 22, 2016 NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, there is an overdose epidemic gripping our nation. This year alone, 2,000 Canadians are expected to die. Stakeholders are unanimous that opening supervised injection sites is one way we can start saving lives immediately, yet the government has refused to amend Conservative legislation that the former Liberal health critic said was designed to block new sites. Will the Liberals listen to the evidence and amend Bill C-2 so that we can take action and start saving Canadians’ lives?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, I have been working with all of my partners across the country on a comprehensive plan to address the opioid crisis in this country. That includes making sure all of the pillars of drug policy are addressed, including harm reduction. One of the most effective mechanisms of harm reduction is supervised consumption sites. I have instructed my department to make sure there are no unnecessary barriers in place. We are addressing the legislation and look forward to dealing with it appropriately to make sure those sites will be available for Canadians.

MAY 11, 2016 NDP MP Don Davies (Vancouver Kingsway, B.C.):

Mr. Speaker, opioid overdoses are a growing epidemic across the country. Hundreds of people are dying. British Columbia has declared a public health emergency, yet the Minister of Health abandoned regulations requiring tamper-resistant forms of these powerful prescription drugs. She claims that they will not solve the problem because they only apply to a single narcotic. However, the solution is obvious: make the entire class of opioids, including fentanyl, tamper-proof, as the U.S. is doing. Why will the minister not do so and save lives?

Health Minister Jane Philpott (Markham-Stouffville, Ont.):

Mr. Speaker, my colleague opposite has raised a very important matter, and that is the matter of prescription drug abuse in this country. It is something with which I have the deepest concern. I am pleased to work with my colleagues, including those in British Columbia, who have particularly led the way on this file. It will require a comprehensive approach, one that includes prescriber guidelines, one that includes patient information, one that includes treatment, and one that includes prevention. We will address all matters of evidence to make sure that we have the best way forward, and a comprehensive plan.

278 The Federal response to the Opioid Crisis Opioid-related articles in Hill Times publications

HILL TIMES STORIES

December 7, 2017 “TAXING MEDICAL CANNABIS HURTS VULNERABLE PATIENTS”

BY GORDON FOX

With so much attention focused on the Trudeau government’s plans to legalize recreational cannabis, it is important to not forget the thousands of Canadians currently benefiting from treatment with medical cannabis. Unfortunately, some of the decisions the government is making today are disadvantaging those patients. In order to legally purchase medical cannabis, patients require the written authorization of a physician, similar to the prescription required to receive the vast majority of medications. However, unlike all other prescription medications, which are tax free, medical cannabis is subject to HST. The government recently announced that not only will this sales tax continue, but that medical cannabis will also be subject to the same excise tax as recreational cannabis. Cannabis is a very promising medical treatment, already recognized as having substantial evidence of efficacy for a variety of conditions and is already helping improve the lives of many Canadians. However, the government’s plan is to have medical cannabis taxed not just once, but twice. This tax treatment already creates a significant hardship for patients and the addition of the excise tax will only make it harder for them to afford the treatment they need. Medical cannabis is not covered by any of the provincial drug benefit plans and only very sparsely by private plans, so most patients have to pay out-of- pocket for their medical cannabis, even though they are covered for most other medications. Even worse, the government’s taxation plans may hurt efforts to fight the opioid crisis. Medical cannabis has been shown to be an effective treatment for chronic pain, and has the potential to substitute for a significant percentage of opioid prescriptions – reducing side effects and the potential for abuse. Opioids, however, are fully covered by most drug insurance plans and are not subject to taxation, meaning that patients will have to pay significantly more to use medical cannabis than they will for continuing with (or starting) opioids. The government should be encouraging patients to substitute medical cannabis for opioids where appropriate, not discouraging them through higher taxes. Medical cannabis has also been shown to help reduce use of other medications, such as benzodiazepines, which in certain circumstances present challenges for both physicians and patients. The proposed tax regime will have the same discouraging effect on pursuing cannabinoids as an alternative to benzodiazepines. The government has argued that they plan to tax medical cannabis because otherwise Canadians will get medical cannabis authorizations without true medical need in order to avoid paying the tax on cannabis they really want for recreational purposes. This is, quite frankly, an insult to both Canadian doctors and the patients for whom they prescribe cannabis. If those who want to use cannabis recreationally are so able to easily secure a doctor’s authorization, then why is there such a push for legalization? Doctors take their responsibilities seriously, and the 200,000 Canadians benefitting from medical cannabis today are suffering from serious health conditions, not simply finding a way to use recreational cannabis. Further, many of the conditions (e.g. chronic neuropathic pain, spasticity in patients with MS, and anxiety) for which cannabis has substantial evidence of efficacy need to be managed by physicians. If patients with legitimate medical need pay just as much tax for their cannabis as do those Canadians looking to use cannabis recreationally, fewer of these patients will bother going to their doctor when they can simply buy cannabis at a retail store. This will hurt their overall quality of medical care.

279 The Federal response to the Opioid Crisis

If the government sees a genuine need to discourage recreational users from attempting to secure medical cannabis, then a better and fairer solution is to authorize the availability of more advanced dosage forms of cannabis for medical users. Licensed producers have long asked the government to allow them to supply cannabis in forms such as tablets, metered dose inhalers, and topical including transdermal patches. These forms would more clearly be recognized as medical products and would be more acceptable to doctors and patients while also being of far less interest to recreational users. Canadians pride themselves on a public healthcare system designed to ensure that all Canadians, no matter their income, can get the treatment they need. Taxing medical cannabis directly contradicts this principle, putting effective treatment out of reach of many lower and middle income Canadians. As they work to get the rules in place for recreational cannabis, the government should not forget those thousands of Canadians benefiting today from medical cannabis and the many thousands more who could benefit. Gordon Fox is the CEO of Emblem Corp, a licensed producer of Medical Cannabis in Canada. The Hill Times

November 27, 2017 EXCERPT FROM “PITFIELD EXITS PETITPAS TAYLOR’S OFFICE, MOUS- SOUNI ENTERS AS NEW POLICY ADVISER”

BY LAURA RYCKEWAERT

Caroline Pitfield has exited Health Minister Ginette Petitpas Taylor’s office, where she’d been serving as director of policy since the beginning of 2016. Ms. Pitfield is listed as having officially switched to post-employment status as of Nov. 13, according to the federal conflict of interest and ethics commissioner’s online registry. She was originally hired to oversee the policy team in then health minister Jane Philpott’s office back in January 2016, and before that was working as executive director of strategic policy and ministerial services at the Public Health Agency of Canada. Ms. Pitfield has about a decade of experience in federal public service under her belt, including her roughly year-and-a-half with PHAC, a government agency under the Health minister’s portfolio. She’s also a former legal counsel with Health Canada, a former executive adviser to the deputy minister for health, and a former director of strategic policy, research, and cabinet affairs with Public Safety Canada. Ms. Pitfield is the daughter of the late Liberal Senator and former Privy Council clerk Michael Pitfield, who passed away in October at the age of 80. She’s also sister to Tom Pitfield, head of Canada 2020 and husband to Liberal Party president Anna Gainey. On the flip side, Kate Moussouni recently joined Ms. Petitpas Taylor’s staff team at Health as a new policy adviser to the minister. Until recently, she was working as a national priority adviser for the Canadian Centre on Substance Use and Addition in Ottawa. A non-governmental organization, the centre was created through federal legislation in 1988 to provide leadership on tackling the issue of substance use in Canada. Alcohol, marijuana, and prescription drugs (which would include opioids) are listed among the centre’s areas of focus on its website, along with tackling treatment and supports; children and youth; First Nations, Inuit and Métis; impaired driving; mental health and substance abuse; and workforce development for addictions professionals. Responding to the national opioid crisis is a major priority for Ms. Petitpas Taylor as health minister, as indicated in her Oct. 4 mandate letter, along with working with other ministers to ensure the passage of the government’s cannabis legalization legislation, Bill C-45 and C-46. Ms. Moussouni is also a former project officer with the Canadian Institutes of Health Research, as indicated by her LinkedIn profile, and during the summer of 2011 interned with the United Nations Office on Drugs and Crime’s drug health branch, amongst other past experience. Other policy advisers currently working for Ms. Petitpas Taylor include: Travis Gordon, Kathryn Nowers, and policy and regional adviser for Western and Northern Canada Ashleigh White. Meanwhile, Thierry Bélair has been hired on a press secretary to the minister. Mr. Bélair comes to Ottawa from Quebec, where until recently he’d been working as press attaché to the province’s minister for higher education and status of women, Hélène David. Mr. Bélair is now working closely alongside the minister’s communications director, Yves Comeau, who’s been in the office since the beginning of June. Previously, Andrew MacKendrick was press secretary in the Health minister’s office, but departed on the heels of the Aug. 28 cabinet shuffle to follow his boss, Jane Philpott, to her new role as Indigenous Services Minister. Geneviève Hinse is chief of staff to the minister. The Hill Times

280 The Federal response to the Opioid Crisis

November 15, 2017 “DECLARING OPIOID CRISIS A PUBLIC EMERGENCY LEGALLY QUESTIONABLE UNDER CURRENT LAW, EXPERTS SAY”

BY JOLSON LIM

If the federal government declares the opioid crisis a public health emergency through the Emergencies Act, it would be on shaky legal footing and outside the scope of what the law is intended for, legal and public health experts say. The federal NDP and British Columbia government have called on Ottawa to declare the rise in opioid-related deaths and hospitalizations a public health emergency to no avail from the Liberal government, which claims doing so wouldn’t grant it new authority or unlock resources that it currently doesn’t have. University of Ottawa law professor Craig Forcese told The Hill Times he’s “puzzled” by discussions around the Emergencies Act, which allows Ottawa to take special temporary measures to protect the safety and security of Canadians during a national emergency. Prof. Forcese said out of the four types of emergencies the act covers (public welfare, public order, international, and war), an opioid crisis could hypothetically constitute a “public welfare emergency.” Out of what’s classified in that category under the act, only a “disease” would ever come close to justification, he said. “It is not clear to me that the opioid crisis would fit within this concept, and instantly raises legal doubt about whether the government acts lawfully,” he said. The Emergencies Act is seen as an instrument of last resort, allowing Ottawa to enter into areas typically under provincial jurisdiction, such as administering health care through emergency clinics. For a crisis to be deemed a national emergency, the act states, it must exceed the capacity or authority of a province to deal with it, and cannot be effectively dealt with by other Canadian laws. A declaration is active for 90 days with the option to renew and has never been invoked in its 29-year existence. The Liberals haven’t ruled out declaring a public health emergency, but stated in a response to a December 2016 report from the House Health Committee endorsing such an action, that the crisis requires a “longer term, sustained, and co-ordinated effort, which the Emergencies Act is not designed to provide.” Dr. Kumanan Wilson, a senior scientist at the Ottawa Hospital Research Institute, told The Hill Times that the Emergencies Act is intended for “acute situations,” such as short-term pandemics, making the opioid crisis as a national emergency a tough sell. Amy Swiffen, law professor at Concordia University, told The Hill Times she doesn’t believe the opioid crisis can be interpreted as a public health emergency because it’s not exclusively a short-term event. She said a “whole can of worms that gets opened up” by declaring it as such because of the legal questions that would arise. “You create a context where you have a permanent emergency and the federal government would have special powers in a way that’s almost unending,” she said. Prof. Swiffen added that if the Emergencies Act was activated, unsupportive provinces could challenge the declaration. She said if the federal government acts in areas of traditional provincial jurisdiction, “it would no doubt become an issue of federalism.” Dr. Wilson said because of the jurisdictional friction it can cause, the federal government may never use the act, even when action is more merited. He said jurisdictional issues in health crises have occurred before, and cited an incident where federal epidemiologists were turned back by Ontario during the 2003 SARS outbreak, that ultimately killed 44 people in Canada. NDP MP Don Davies (Vancouver Kingsway, B.C.), the party’s health critic, described the Liberals’ interpretation to The Hill Times as an “unjustifiably narrow reading of the act” and said there is no wording that confines its scope to “viral outbreaks” as opposed to “chemical outbreaks.” He added that no provinces have expressed opposition to such a declaration so far. Mr. Davies cited two orders in the act that could immediately help. One would allow expedited funding that bypasses Parliament, while the other would permit establishing emergency clinics. He said Ottawa can then declare overdose prevention sites popping up in major Canadian cities as medical clinics, giving them legal status and federal funding support. Donald MacPherson, executive director of the Canadian Drug Policy Coalition, called the opioid crisis a “mass poisoning,” and supports a national declaration but said “actions on the ground are most important.” Conservative Senator Vern White (Ontario), told The Hill Times he believes a national emergency declaration is “more for show,” but at least shows Ottawa is “trying to focus energy,” and must be accompanied by new funding announcements. Dr. Wilson said the constraints of Emergencies Act, especially in relation to the opioid crisis, speak to the need to have a more nuanced, collaborative, or at least clearer, health-specific public emergency law. He said changes especially need to be made regarding information-sharing between the different levels of government.

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The Canadian Medical Association proposed a health-specific emergency law following the SARS crisis, and included five tiers that could be invoked depending on the severity of the emergency. CMA stated in 2003 that because of the “political and economic implications” of invoking the Emergencies Act, Ottawa loathes the use of its powers. Therefore, a new law clarifying the division of powers could produce better public responses to health crises. “Even if you have legislation, if the provinces aren’t on board, then it doesn’t really matter,” Dr. Wilson said.

Advocates want Ottawa to increase commitments In May, the Liberal government passed Bill C-37, streamlining the process for approving supervised injection sites. However, the Liber- als didn’t accept a Senate amendment requiring injection sites to provide drug replacement therapy, which Sen. White has championed. Sen. White said the fact House Liberals removed the amendment “makes absolutely no sense,” and that the therapy, which provides non-street level, toxicity-checked, and less-addictive drugs to users, has had success in Switzerland. Ottawa also legislated giving customs agents more power to check heavier mail for illicit drugs. Certain tools commonly used in drug production have also been blacklisted. The federal government is providing $10-million to hard-hit British Columbia to assist in their response. More than 1,100 people in the province died from suspected illicit drug overdoses in the first nine months of 2017, its coroner’s office reported on Nov. 9. The Public Health Agency of Canada said there were 2,816 “apparent opioid related deaths” in 2016, with an illicit fentanyl problem in the West and a prescription opioid crisis in Eastern Canada. Ottawa should prioritize pain-treatment alternatives, such as physiotherapy, and support reducing the number of opioid prescriptions, the Coalition for Safe and Effective Pain Management said in an interim report. The coalition’s chairman, Michael Heitshu, told The Hill Times that 19 million prescriptions were written last year, and said the “problem right now is that many important alternatives are not properly available because they’re outside the public system.” The federal government has also dispatched workers to study data-tracking nationwide, increased drug and addiction-related research, and expanded access to naloxone overdose prevention kits. Mr. MacPherson said Ottawa could increase funding for drug recovery treatment programs and through re-examining drug decriminalization and legalization, which he suggests is the “core” issue in addiction response. The Hill Times

November 15, 2017 “HEALTH MINISTER DETERMINED TO TACKLE OPIOID CRISIS”

BY HEALTH MINISTER GINETTE PETITPAS TAYLOR

The opioid crisis will, sadly, claim the lives of thousands of Canadians this year. This public health crisis will touch every part of the country. I want to address the steps our government is taking to address this issue. In my mandate letter, the prime minister was very clear. As minister of health, I am to “[w]ork closely with other orders of government, as well as substance use experts, service providers, first responders, law enforcement, and people with lived and living experience in order to ensure Canada’s response to the current opioid crisis is robust, well-coordinated, and effective.” I recently saw first-hand the toll the opioid crisis is having in Vancouver as well as the tremendous lifesaving work that is being done there. I spoke with people who face this crisis every day, and it strengthened my resolve to do everything possible to help. The opioid crisis is a national tragedy, and we must act. Through our work with the provinces and territories to collect and share national data on deaths related to opioid overdoses, we know that more than 2,800 Canadians died last year as a result of an opioid overdose and that 3,000 Canadians could die this year. Such a death toll is unacceptable, and my priority is as minister of health is addressing it. We have taken many important steps to address this crisis already, but we know more needs to be done. In the last year, we have made significant new federal investments, including $100-million over five years to support the Canadian Drugs and Substances Strategy and $20-million in urgent funding to British Columbia, Alberta, and Manitoba. We have implemented new legislation and fast-tracked regulatory action, including passing Bill C-37, which allows for streamlined assessment and approval of safe consumption sites across the country—which we know are doing incredible work in reducing the potentially deadly grip of substance abuse. We are also reducing regulatory barriers to treatment and supporting the Good Samaritan Drug Overdose Act, which will enable those suffering from a drug overdose to get the emergency help, quickly and without judgment, that they need to survive. We have taken steps to reduce harms by making it easier to access life-saving naloxone, by approving more than 20 new supervised consumption sites, and by raising overdose awareness. 282 The Federal response to the Opioid Crisis

In talking to those with lived and living experience, I believe that there are three key areas where we need to improve our response as a nation: 1. improving access to treatment; 2. supporting innovative approaches to addressing this crisis; and 3. taking steps to address stigma related to opioid use. Above all, we need to be compassionate and collaborative. The prime minister has asked his cabinet to make decisions on the best available evidence; that is my commitment to Canadians, to health professionals, and to those on front lines dealing with this epidemic. As health minister, I am determined to take the necessary actions to protect the health and safety of Canadians. I will continue to work with my colleagues in the provinces and territories to combat this crisis. While much has been done, our work remains unfin- ished: we will continue our efforts to stop this epidemic and, above all, save lives. Ginette Petitpas Taylor is the health minister and Liberal MP for Moncton-Riverview-Dieppe, N.B. The Hill Times

November 15, 2017 “POP BAD, POT GOOD? LIBERALS ARE CONFUSED ON HEALTH”

BY CONSERVATIVE MP MARILYN GLADU

These are confusing times on the health file, with the Liberal government sending mixed messages to Canadians. Its official objective is supposedly to help Canadians live healthier lives. So the first priority for the health minister was to legalize recreational smoking of marijuana, which the Canadian Medial Association says causes a significant increase in schizophrenia and associated psychotic disorders, depression, and addiction in persons under the age of 25 who consume it. And, of course we all know that smoking any substance is harmful to our health. The legislation allows 12- to 17-year-olds to possess up to five grams of marijuana, when we know the right message to be sending is that the only acceptable amount of marijuana consumption by youth in that age group is zero to avoid extreme harm to their development. Essentially, this legislation is being rushed, especially considering that the public education needed (and recommended by all jurisdictions that have legalized the drug already) has not even been developed yet. Despite this, the Liberals have announced half a billion of taxpayer dollars towards the legalization process. In comparison, on the opioids crisis, which has seen 16 Canadians hospitalized each day, the Liberals have announced $7.8-million in funding and are focused not on putting treatment centres in place to help people get off drugs, but on safe injection sites where addicts can safely continue to be addicts. Here in Ottawa, there are plenty of safe-injection sites, but no availability of beds in treatment centres to give addicts the help they need to leave the life of drugs behind them. Across the country, the need for treatment beds is just as urgent. Having heard from parents who have lost children from opioid overdoses and who could not find treatment for them makes me feel that the Liberals have lost track on this particular file. Many advocacy groups suggest there is a lack of leadership at the federal level on this issue. At the same time that the Liberals are making it easier for people to take drugs, the government has indicated support for a Senate bill to prohibit advertising and marketing of “unhealthy” foods targeted at children up to age 17. They are sending the message that it’s bad to have pop, but OK to have marijuana. This is the confusing part. There are many concerns about how to actually “ban” the specified advertising in question to youth, and what actually constitutes youth advertising/marketing. Will this mean 16- and 17-year-olds can no longer work in restaurants and convenience stores where these advertisements exist? We simply don’t know. The Liberals are also drafting a re-do of the Canada Food Guide. A government consultation paper suggests that less emphasis should be placed on milk and meat and more on plants, without a fact- and evidence-based argument. So: no milk, no meat, no pop—just marijuana. Now if you find this depressing, you will not be pleased to find that there were funds for mental health announced two years ago and re-announced in the fall economic update, but I have not seen a plan for this funding yet. We absolutely need to address the suicide crisis in the country, and it is well recognized that we are underfunded in the whole area of mental health. However, there may be some good news on the health file. My private member’s bill on palliative care that was unanimously supported in the House of Commons and supported at a Senate committee is in the Senate for the final vote. This bill will come with a plan to get consistent access to palliative care for all Canadians—something that is urgently needed. The House Health Committee, of which I am vice-chair, has completed its study on pharmacare, and will have the report out by the new year. For the 12 per cent of Canadians who lack prescription drug coverage today, this will be good news. Canadians value our health-care system, and we need to work towards healthier outcomes for all. That’s what I will be doing as the shadow minister for health for the official opposition. MP Marilyn Gladu (Sarnia-Lambton, Ont.) is the health critic for the official opposition Conservatives. The Hill Times 283 The Federal response to the Opioid Crisis

July 26, 2017 “B.C.’S ADDICTIONS AND MENTAL HEALTH MINISTRY TAKING ON A DAUNTING, AND WORTHY, CHALLENGE”

BY TIM POWERS

John Horgan, the new premier of British Columbia, made history last week when he took office. He fulfilled a campaign promise and created a full ministry responsible for mental health and addictions. Establishing a stand-alone department like this one was welcomed by many mental health advocates, not just in British Columbia but across the country. British Columbia is struggling with a highly-publicized opioid crisis. Mental health and wellness is a Canadian challenge. So there are some good politics to be had in establishing a new ministry to focus on these problems. It is a symbolically important move at a minimum, and symbolism properly channelled can be potent. If B.C.’s Ministry of Mental Health and Addictions proves to be an effective operational department it could start a trend in provincial public administration across Canada. Other provinces could follow suit and resource similar undertakings. That means Canadian health care funding models might be altered, fundamentally changing the policy and advocacy environment. But the task of making B.C.’s new ministry an effective one that will actually help advance mental wellness and addiction treatment outcomes will not be an easy one. Premier Horgan appointed Judy Darcy, the former head of the Canadian Union of Public Employees, as the minister for this portfolio. Darcy also spent time in health care. She was recently the business manager for the Hospital Employees’ Union in British Columbia. Darcy is no stranger to working in difficult environments, with multiple diverse stakeholders, all the while being held to account for the results. Well-respected Vancouver Sun columnist Vaughn Palmer wrote about the real challenges Darcy faces. “It means pulling together programs and clients over a half dozen ministries and agencies, never an easy task amid bureaucratic resistance and organizational silo- ing at the best of times.” He added: “she needs to address the immediate challenge of out of control abuse of opioids, in effect creating a ministry to manage a crisis in the midst of a crisis.” Darcy’s mandate letter, which was released publicly, speaks to the urgency with which she is supposed to act. The document states, “work in partnership to develop an immediate response to the opioid crisis that includes crucial investments and improvements to mental-health and addiction services.” She has also been instructed to create a strategy to “guide the transformation” of B.C.’s mental health system. Deciphering the political code here, Darcy could get the money and latitude to act. But transformation, as Palmer pointed out, is not without its trip wires. Horgan and Darcy’s other challenge will come from the health care sector itself. While publicly many have and will continue to laud the creation of this new ministry, advocates for the treatment of other illnesses could potentially be upset that their initiatives did not receive similar high-level political commitment and investment. That will create new competitive pressures on the British Columbia health care system, where expectations for everything from disease-specific spending to enhanced politicking on “why my sickness matters more” will kick up. It is hard not to argue that decades of work by mental health advocates are starting to pay off. Twenty or 30 years ago it would have been po- litically foolhardy to launch a department focused on mental health and addictions. Any premier who would have suggested it would likely have been advised by their colleagues to leave it in the shadows, or less kindly told the idea is “madness; people don’t want to talk about that stuff.” Full marks should be given to Premier John Horgan and the British Columbia New Democrats for pushing the envelope and establishing this department. While the public mood has evolved over the decades towards unseen illness, this is still a brave move—because success, however it will be measured, is far from certain, and dramatically altering health care delivery is not for the faint of heart. Tim Powers is vice-chairman of Summa Strategies and managing director of Abacus Data. He is a former adviser to Conservative political leaders. The Hill Times

May 8, 2017 “OPIOID CRISIS IN CANADA: WHAT ARE WE WAITING FOR?”

BY DON DAVIES

Last month brought with it a grim reminder for those struggling on the front lines of Canada’s opioid crisis. April 14 was the one year anniversary of provincial health officer Dr. Perry Kendall’s decision to declare the overdose epidemic a public health emergency in British Columbia. Unfortunately, despite a year of amplified efforts from municipalities, health professionals and community volunteers, the overdose epidemic is getting worse across Canada, not better.

284 The Federal response to the Opioid Crisis

In April, British Columbia’s first responders once again broke the record for suspected overdose calls in a single day. B.C. Emergency Health Services says it responded to 130 suspected overdoses in the province on Wednesday, April 26. The previous record was 121, on Nov. 20, 2016. In Vancouver alone, the number of overdose deaths has already reached 141 this year, more than half the 215 deaths recorded for all of last year. The city is on pace to reach 400 overdose deaths by the end of the year—almost double the 2016 number, which was in itself a record. Vancouver’s Mayor Gregor Robertson has said he feels “incredible frustration and anger,” at the federal and provincial governments for not doing enough to respond. Vancouver City Councillor Raymond Louie has described the situation as “a disaster.” As the death toll continues to mount, it’s difficult to understand exactly what the federal government is waiting for. It’s time for Otta- wa to stop overstating its progress and start responding to this crisis with the urgency it deserves. Despite the federal government’s rhetorical commitment to harm reduction, legislation to streamline supervised consumption site approvals has been stalled for months in the Senate. And somewhat shockingly, the 2017 budget failed to allocate a single dime in emergency funding for the opioid crisis. This is unacceptable. There is no reason to believe that this crisis is over, under control, or indeed, won’t continue to get worse with the proliferation of carfentanil in our communities. We need to fast-track the opening of supervised consumption sites and expand opioid substitution programs. We need better pain management regimens and substantial investments in addictions treatment across the board. There is an unacceptably narrow portal for access to detox services, and a chronic shortage of publicly-funded longer-term treatment beds. In Vancouver, it takes an average of eight days to access detox services, which is directly contrary to everything we know about addiction. If someone is willing to seek treatment, we’ve got to get them into treatment right away. If we wait even a day, the moment is usually lost. In truth, effective treatment is really only available to those who can pay or are desperate enough to go into debt to access it. It is not unusual to have to pay $10,000 or more a month to get timely access to quality addiction treatment facilities in Canada—a shocking gap in our so-called universal health-care system. This has to change, and we must start building the infrastructure to provide universal access to necessary health services for everyone suffering from substance use disorder. We need different treatment modalities for different populations: treatment centres for youth, for women, for men, and for indigenous Canadians. We must build them like we build any other health care facility, and cover treatment for existing facilities. It’s time to push past the stigma and finally treat addiction as a bona fide health issue. But that will only happen when we start addressing the overdose epidemic with the same determination that we would apply to any other national public health emergency. Don Davies is the NDP’s health critic and Member of Parliament for Vancouver Kingsway, B.C. The Hill Times

May 8, 2017 “LIBERALS WIN PLAUDITS FOR INITIAL STEPS TO ADDRESS OPIOID CRI- SIS BUT ADVOCATES CALL FOR MORE TOOLS”

BY MARCO VIGLIOTTI

The statistics get grimmer, seemingly by the day. The headlines darker, more heart wrenching by the click. Canada’s opioid crisis has become full-blown. In British Columbia alone, the undisputed epicentre of the prescription and illicit opioid crisis, there were 922 fatal overdoses in 2016, according to The Canadian Press. “The opioid crisis affects all Canadians. It is devastating communities, taxing first responders and health-care facilities,” said Barb Shellian, president of the Canadian Nurses Association. “It is leading [to] an overwhelming number of deaths.” The federal Liberal government maintains that it’s actively addressing the troubling crisis, namely by pledging more funding for jurisdictions struggling to deal with the epidemic of opioid abuse and increasing access to services and products that could stem the growing death toll. For one, Health Canada has expanded access to the antidote naloxone, which works to reverse the effects of an opioid overdose. It is now available without a prescription and in a nasal spray. Many emergency responders in Canada now carry the antidote to treat overdoses. The federal government has also opened its pocketbook to help jurisdictions grappling with drug addiction issues, with the governing Liberals pledging $65-million to combat the epidemic nationwide. The money will be used for better lab testing, data, and surveillance, reports the Canadian Press. And finally, the government has voiced support for opening new supervised injection sites, where people can use potentially dangerous illicit drugs under the watch of health professionals. Since assuming office, the Liberals have approved new facilities in Montreal and Vancouver.

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Ian Culbert, executive director of the Canadian Public Health Association, which advocates on public health issues, said that while more work is needed to address the spiralling crisis, his group is pleased with the initial steps taken by the Liberals. “CPHA commends the federal government for its various responses including the announced $65-million to combat the epidemic nationwide, and the rationalization of the requirements for new supervised consumption facilities,” he told The Hill Times. “While there is much more to be done, these are promising first steps from which the provinces and territories can build their unique responses.” Captured under the expansive concept of harm reduction, supervised injection sites work to protect public health by preventing potential overdose deaths, while similarly-minded needle exchanges look to counter the spread of intravenous disease by providing untainted needles to illicit drug users. Insite, located in Vancouver’s notorious Downtown Eastside, was the first-ever supervised injection site to operate in North America. Since it opened in 2003, there have been no fatal overdoses reported at the facility. Insite operates legally under an exemption to the Controlled Drugs and Substances Act granted by the federal government. The former Conservative government announced in 2008 it would no longer provide the exemption but was thwarted by a Supreme Court ruling that stated not allowing Insite to operate would violate the Charter of Rights and Freedoms. But in 2015, the Conservative-majority House passed the Respect for Communities Act, which unleashed a wave of new regulations that critics argued made it more difficult to open new harm-reduction sites. Specifically, the bill required prospective safe injection site operators to meet a number of requirements such as obtaining a letter from the head of the local police force, statistics and other information on crime, public nuisance and inappropriately discarded drug paraphernalia in the vicinity of the site; and a report on consultations with a diverse spate of community organizations. The legislation also added new caveats for supervised injection sites applying for their annual exemption from the Controlled Drugs and Substances Act. Despite the new rules, the decision to grant the exemption was still left at the discretion of the federal health minister. A change in party, however, presaged a stark reversal in policy. The federal Liberal government that emerged after the 2015 election voiced strong support for supervised injection sites, leading to new sites in Montreal and Vancouver eventually winning approval from Ottawa. In 2016, the Liberal government announced it would replace the existing National Anti-Drug Strategy with the Canadian Drugs and Substances Strategy, which would restore harm reduction as “a core pillar of Canada’s drug policy.” Then last December, the Liberals tabled in the House Bill C-37, which, among other changes, completely eliminated the 26-point criteria for opening a safe injection site introduced by the Conservatives in favour of five benchmarks: A demonstrated need for the site, appropriate regulatory systems, appropriate resources for operators, evidence showing the impact of the site on crime, and consultation with the community. The bill also amended the Customs Act to grant more powers to crack down on illegal shipments of opioids from overseas. Many of the counterfeit synthetic opioids, including deadly fentanyl pills, come from black-market manufacturers in China. Ms. Shellian called Bill C-37 “a great step forward,” and slammed the legislation passed by the former Conservative government for making it “almost impossible” to open supervised injection sites. She hailed the Liberal bill for reducing the number of barriers to opening safe injection sites from the 26 points in the Conservative legislation to just five benchmarks but said it’s still possible to improve the legislation by “further reducing barriers.” “At currently reported overdose death rates of four per day in British Columbia and two per day in Ontario, any waiting period could result in hundreds of preventable deaths,” she said in a statement. Nevertheless, Ms. Shellian called for the quick passage of Bill C-37 and approval of additional sites where needed in Canada, pointing to the “cost-effectiveness” of these facilities. For example, she noted that illegal drug use is often linked to the spread of infections such as HIV and hepatitis C, with estimated lifetime cost for treating HIV standing at $200,000 to $300,000 per person. “Those are future expenditures that can be prevented,” she said. “Each day these sites also decrease health-care costs by reducing the number of emergency department visits.” She added that the CNA would also like to see improved access to health and social services, namely treatments to wane off addicts from opioids including, but not limited to, methadone, suboxone, and prescription heroin. A newly passed piece of legislation could also help in curbing fatal drug overdoses. The Good Samaritan Drug Overdose Act, which provides immunity from charges for drug possession or breaching parole, pro- bation, or court orders to anyone requesting emergency assistance for an overdose, received Royal Assent on Thursday and officially became law. The private member’s bill, tabled by Vancouver-area Liberal MP Ron McKinnon (Coquitlam-Port Coquitlam, B.C.), was designed to reduce the hesitance on the part of bystanders to call emergency services to respond to an overdose. The Hill Times

286 The Federal response to the Opioid Crisis

March 20, 2017 EXCERPT FROM “HEALTH ACCORD, OPIOIDS, ASSISTED DYING, AND MORE KEEP LOBBYISTS FOCUSED ON PHILPOTT”

BY DEREK ABMA

With the federal government having worked out new health-funding arrangements with most provinces, passed assisted-dying legislation, started a process to legalize marijuana, and facing a national opioid crisis, it’s not surprising Health Minister Jane Philpott would see an ample amount of lobbying since coming to office. Ms. Philpott (Markham-Stouffville, Ont.) has been named in 115 communication reports filed on the federal lobbyists registry since starting the job in November 2015 up until earlier this month. Groups lobbying her range from organizations representing health-care professionals and facilities, charities dedicated to certain diseases, private companies in the food and technology industries, and many more. Asked about her dealings with lobbyists, Andrew MacKendrick, a spokesman for Ms. Philpott, said in an email: “With a very busy and wide-reaching portfolio, Minister Philpott’s office does receive many requests from interested groups from across the country. Whether to discuss a position on government files or upcoming opportunities, it is important for the minister and her office to be open and accessible to meet with relevant stakeholders.” The Canadian Medical Association (CMA), which represents physicians and physicians in training, has easily been the most prolific group in terms of lobbying Ms. Philpott, according to the registry, having filed 17 communication reports that name her. CMA spokesman Ziad Saab said in an email that the most recent meeting with Ms. Philpott, on Feb. 13, involved CMA president Granger Avery and other CMA staff. He said the discussion centred on “the Health Accord, the 2017 budget, marijuana legislation, opioids, indigenous health, and the CMA’s 150th anniversary.” Mr. Saab added: “The majority of the discussion related to the Health Accord, with the CMA reiterating the need for leadership from all levels of government to bring real advances to the health-care system.” With all provinces except Manitoba now having reached bilateral agreements with the federal government on health funding for the next 10 years, Mr. Saab said “there is an opportunity to focus on the health of Canadians, including implementing a national seniors strategy to meet the evolving needs of our growing and aging population. The March 22 budget presents the ideal opportunity for the federal government to invest in seniors care. Canadian physicians and their patients know that the time for action is now.” The next most common lobbying group of Ms. Philpott has been HealthCareCAN, a group which represents hospitals and healthcare organizations across the country. It has filed four reports for contact with the Health minister. A summary of lobbying of Ms. Philpott by HealthCareCAN, given to The Hill Times by the organization, shows that its meetings with Ms. Philpott have featured discussions about the future of home care in Canada, securing reliable funding for the Canadian Institutes for Health Research, getting innovation and infrastructure funding for research hospitals, creating an “innovation super-cluster” in the sector of health and life sciences, supporting the government’s assisted-dying law, and advocating for a pharma-care strategy in the new Health Accord. HealthCareCAN CEO Bill Tholl said one of his mottos when it comes to lobbying is “never to fight political gravity.” And that works for him right now, since he feels that this government “actually cares about health care.” Mr. Tholl has been CEO of HealthCareCAN since 2014, and has previously held senior roles with organizations such as the Canadi- an Health Leadership Network and the CMA. He said during the time Stephen Harper’s Conservatives were in power, he felt like he was “fighting political gravity” when meeting federal officials. “Mr. Harper made no bones about it; he wanted, quote-unquote, the medicare gum off his shoe,” Mr. Tholl said. “By the way, that’s not him I’m quoting; it’s one of his senior policy advisers. Every time we walked in there, they asked, ‘What are you here to talk about?’ ‘Health care.’ ‘Well, we don’t want to talk about health care; that’s a provincial responsibility.’” That’s all changed now, and he said consultations with Ms. Philpott are particularly productive, given her background as a physician. “The first thing you realize is that she actually understands the issues,” Mr. Tholl said. “You talk to her about portable electronic health records, and how important it is to be able to move them around among physicians and between hospitals and with informal caregivers; she gets it. She was a member of a local health team.” Mr. Tholl said meetings with past Health minsters required “45 minutes of an hour explaining to the minister what the problem was, and then being left with seven to 12 minutes as the minister was going out the door to try and get his or her help to try and fix the problem. … [With Ms. Philpott], you can skip past in 10 or 15 minutes describing the opioid crisis, because she knows what the opioid crisis is.” Mr. Tholl added: “Usually with [Ms. Philpott], you’re not on the clock. If we’re into a serious conversation about opioids, as we have been, or Health Accord discussions, or we did have a conversation on this business about expanding access to electronic health records, if she’s into it, she’ll delay the meeting. At her request, the meeting will go on.” [email protected]

287 The Federal response to the Opioid Crisis

March 6, 2017 “RISING RATES OF LONG-TERM PRESCRIPTION-OPIOID USE HIGHLIGHT URGENT NEED FOR TREATMENT OPTIONS FOR CHRONIC PAIN AND ADDICTION”

BY KATE SMOLINA AND KIM RUTHERFORD

Across Canada, the tragic spike in opioid-related deaths has brought to national attention the large and complex issue of drug use and misuse. As fentanyl-related overdoses are gripping the country, there is a connected, but separate crisis of doctor-prescribed opioids being increasingly used on a regular, long-term basis. While prescription opioids are effective for short-term pain relief, there is little data supporting the effectiveness of long-term use— but there is evidence of potential harm. Longer opioid therapy can also lead to individuals requiring higher doses to obtain the same degree of pain relief. Higher doses may further increase associated harms such as overdose, falls and motor-vehicle accidents. We recently published a study that shows the population of individuals in British Columbia prescribed opioids long-term for non- cancer pain grew by 19 percent between 2005 and 2012. How big is the problem? We found that by 2012, over 110,000 British Columbia residents used opioids on a regular basis—a size similar to the entire population of Kelowna. The number is likely higher today. The rising rate of long-term prescription opioid use is occurring because each year, more people begin taking opioids than those who discontinue. This cumulative effect is producing an ever-growing population dependent on opioids. At the heart of the issue is the ongoing demand for these drugs. This demand is fuelled by many factors, including physical pain, psychological pain, psychiatric conditions and/or socioeconomic factors, such as housing, food and job insecurity, and lack of social belonging. Many of these factors are interconnected. For example, mental illnesses such as depression are a risk factor for developing opioid abuse, while depression can worsen chronic pain and chronic pain can contribute to depression. So, how should we tackle this problem? The key lies in coordinated interventions across the healthcare system. First, we need to provide better support and therapy options for those who are already using opioids on a regular basis. The current approach largely revolves around limiting supply by restricting opioid prescribing, including a push for lower doses and shorter courses of treatment. Such an approach is warranted, given that the overall prescription opioid consumption in B.C. has increased due to both the use of stronger opioids and longer durations of opioid therapy. However, restricting access is insufficient and could be harmful if implemented in isolation. Why? Asking doctors to reduce their prescribing may decrease a patient’s prescription opioid intake on paper, but it does not address the patient’s real need for pain relief nor any addiction issues that may have developed. For many patients, there are few alternatives for pain management available, due in part to a lack of publicly funded programs and inadequate public and private health insurance coverage. For instance, access to physiotherapy is often limited for those without extended health benefits, while many alternative medications for pain are costly. Other interventions, such as steroid injections, may be unavailable in some places or have long wait times. Wait lists in our health-care system are also problematic. Patients may be left taking opioids for pain management while awaiting surgery or a consult with a pain specialist. For individuals who have developed addictive behaviours, there is inadequate access to timely counselling, detox and addiction treatment programs. We have come to a point where too many patients have developed long-term dependency on prescription opioids. However, reducing opioid availability without providing alternatives may result in some patients turning to the illicit market to support their need for the drugs. There is an urgent need for coordinated, accessible, timely and affordable therapy options for the treatment of chronic pain, addiction and mental illnesses. We must also work to prevent the emergence of new chronic opioid users by ensuring there are a variety of funded options to treat acute pain to decrease the likelihood of it progressing to chronic pain. These options could include topical agents, neuropathic medications, steroid injections, nerve blocks, physiotherapy and active rehabilitation services. Finally, a public education campaign about the effectiveness and risks of using opioids is necessary. Further upstream, investment into public health programs and services that aim to encourage healthy diets, weight control, regular exercise, good sleep habits and stress management could help prevent many pain conditions. We must broaden our response to the current crisis to address the aspects of our health-care system that contribute to the increasing demand for, and continued reliance on, opioids. We can’t afford to wait. Kate Smolina is an expert adviser with EvidenceNetwork.ca. She was a postdoctoral fellow at the School of Population and Public Health, University of British Columbia, at the time the studies were conducted. She currently works as the director of the B.C. Observatory for Population & Public Health at the B.C. Centre for Disease Control. Kim Rutherford is a family physician at Spectrum Health, Vancou- ver, B.C., and a clinical instructor at the Department of Family Practice, University of British Columbia. She also works with Vancouver Coastal Health as an outreach physician in Vancouver’s Downtown East Side. The Hill Times 288 The Federal response to the Opioid Crisis

Feb 20, 2017 EXCERPT FROM “FEDS’ CONTROVERSIAL BORDER PRE-CLEARANCE BILL TOPS HOUSE AGENDA THIS WEEK”

BY RACHEL AIELLO

Last week in the House, the government passed the three bills into the Senate that were priorities at the start of the winter sitting: Bill C-30, the Canada-European Union Comprehensive Economic and Trade Agreement Implementation Act; Bill C-31, Cana- da-Ukraine Free Trade Agreement Implementation Act; and Bill C-37, An Act to amend the Controlled Drugs and Substances Act. “Since Parliament resumed, I am pleased that we have been able to advance multiple pieces of legislation” said Ms. Chagger in a statement to The Hill Times. Bill C-30 was amended at the House International Trade Committee earlier this year, while Bill C-31 passed without amendments. Both reached the Senate on Feb. 14. And Bill C-37 passed the House the day after, after an expedited journey—to the Conservatives’ chagrin and with the compliance of the NDP on time allocation—through the House of Commons and House Health Committee, with minor wording amendments made. The rush on Bill C-37, which is part of Health Canada’s overall Opioid Action Plan, was to try to address the ongoing opioid crisis across the country by seeking to remove regulations around safe-injection sites across the country, and to prohibit the import of unregistered pill presses, remove the exception currently placed on border officers to only open mail weighing more than 30 grams, and make it a crime to possess or transport anything used in the production of controlled substances. “I think that many Senators have been very active on this matter as well. Several of them are obviously very concerned. … So this is not something that anybody wants to be political about. This is extremely important that we work rapidly. I’m absolutely thrilled that our colleagues in the House have joined us in this effort, and I expect the Senators will see the same urgency, and it will allow us to have one more very important tool to respond to the crisis,” Health Minister Jane Philpott (Markham-Stouffville, Ont.) told reporters in the House foyer last week. The Hill Times

Feb 15, 2017 “B.C. MPS HEARTBROKEN OVER OPIOID CRISIS”

BY CHELSEA NASH

MPs representing ridings most heavily affected by the opioid crisis in Western Canada say seeing their communities and constituents struggle with hardship, addiction, and, increasingly, death, is heartbreaking. The Hill Times spoke to a number of MPs dealing firsthand with the crisis as it grips their communities. The conversations were emotional, at times exasperated and frustrated, or just sad.

VANCOUVER’S DOWNTOWN EASTSIDE: GROUND ZERO “It breaks my heart to see people in my community dying preventable deaths. That’s what I think they are, they’re preventable deaths,” says NDP MP Jenny Kwan, who represents the riding of Vancouver East. In 2016, there were 914 overdose deaths in the province, with 142 occurring in December alone. Her riding is known as the epicentre or ground zero of the crisis. It is also home to North America’s first supervised injection site, known as Insite. Ms. Kwan said she did not have an exact figure for the number of overdose deaths in her riding, only that it was somewhere in the hundreds. Local Members of Parliament might not be the doctors, paramedics, or other first responders dealing with the crisis firsthand, but the federal government’s control over supervised injection sites places some direct responsibility into the hands of the federal lawmakers. “I’ve raised the issue with the minister, I’ve spoken to the issue in the House of Commons, I’ve gone to the health committee as well, I’ve gone out to meet front line workers who are faced with this challenge,” Ms. Kwan said. “I’ve worked on this issue for over 20 years now.” Ms. Kwan was only elected as a federal representative for her riding in 2015, though she represented the constituency at the provincial level for almost 20 years, and was a city councillor prior to that. 289 The Federal response to the Opioid Crisis

“We have a lot of people who are struggling in our community,” she said. Vancouver East is one of the poorest ridings in Canada. Ms. Kwan attributes the high proportion of overdose deaths in her community to social determinants, including the availability of housing and social services. “It is the only place you can find some kind of housing, some kind of roof over your head.” “We don’t judge,” she said. “People live in poverty, people have experienced trauma, they have lost everything. They end up in the Downtown Eastside, so that’s our situation.” But poverty and trauma aren’t the only contributors to harbouring addiction. Sometimes, the order of events are reversed. Doctors will prescribe opioids as pain medication to those with chronic pain or other conditions. Eventually, the patient will become addicted, but the prescriptions will stop. Finding their next fix becomes all-consuming, Ms. Kwan explains. “Through that process, they end up losing their jobs, they end up losing their family, they have nowhere else to go,” she said. So, they end up in the Downtown Eastside. While first responders wait for the federal government to approve more supervised injection sites via Bill C-37, pop-up tents where naloxone, the drug used to treat an overdose, is administered, have started to, well, pop up. “In my community we have a little market in the Downtown Eastside, and the people there who are hosting the market, [hear] people say ‘overdose overdose.’ It was happening so often, that they finally just set up the tent,” Ms. Kwan explained. This way, “they can immediately kick in to try to revive the person. It’s hugely intense.” Bill C-37 is primarily an act to amend legislation that was passed by the former Conservative government in 2015. That bill, C-2, had been sponsored by then-minister of health Rona Ambrose (Sturgeon River-Parkland, Alta.), and was touted as the Respect for Commu- nities Act. The bill was largely criticized by stakeholders such as the Canadian Nurses Association for imposing too many restrictions on safe injection sites. Bill C-37 is aimed at reducing those restrictions. Through time allocation, it has been pushed through the House quickly, and was returned there by the House Health Committee Feb. 10 with an amendment. In the meantime, Health Minister Jane Philpott (Markham-Stouffville, Ont.) has approved three safe injection sites in Montreal, and is examining the applications of 10 more sites, five of which would be in B.C. (two in Vancouver, two in Surrey, and one in Victoria). In 2011, the Supreme Court of Canada ruled that impeding a drug user’s access to a safe injection site, which the court determined had been proven to save lives, was a violation of the Charter of Rights and Freedoms’ right to life and security. It ordered the government not to intervene in the operation of Insite.

VICTORIA: WHERE OVERDOSE DEATHS DON’T JUST AFFECT THE POOR “It’s grim. It’s disturbing, it’s sobering, it’s everything you’d expect,” is how NDP MP Murray Rankin (Victoria, B.C.) described the crisis in his own riding. Mr. Rankin said Victoria has seen “dozens and dozens” of overdose deaths in recent months. While “it’s been a crisis for some time,” it isn’t just affecting the poor and vulnerable anymore, he said. “What that has meant in my town is people from middle-class families…they are finding that a kid will go try cocaine on the weekend, experiment with drugs. It will be cut with literally a grain or two of this awful fentanyl, and they will die.” Mr. Rankin said that exact thing had happened to someone his son went to school with. “This was just a kid in his twenties who experimented one weekend out with friends, and he was dead the next day,” he said. Ms. Kwan and Mr. Rankin said while they support Bill C-37, and agreed to the government’s time allocation on it (opposition parties usually don’t agree to time allocation because it can limit debate on a bill), the government still hadn’t moved quickly enough. “How would you feel if you knew people, if you were standing by when tools were available to make some dent in the problem, and the Liberals took over a year to do anything?” Mr. Rankin said. Ms. Kwan said more of the same, that the longer Bill C-37 takes, more lives are lost as a result. Both MPs would like to see the government declare a public health emergency, “so we can mobilize, so we can get a handle on this situation,” Ms. Kwan said. Mr. Rankin said pop-up sites are also throughout his riding. “It’s not pretty, it’s not elegant, it’s not permanent, and it may not even be 100 per cent legal, but people are not waiting anymore,” he said. Mr. Rankin said the whole ordeal has broken his heart. “I can’t say it any more simply than that. To know people, to love people, in my community who have died. It truly is a hard thing to talk about without getting emotional.”

LONGTIME LIBERAL MP AND PHYSICIAN SAYS THERE’S MORE TO BE DONE “We need to call this a national public health crisis,” Liberal MP Hedy Fry (Vancouver Centre, B.C.), said. “I am pushing very much for our government to call it that.” Dr. Fry, who is a medical doctor, said if the overdose crisis was regarded like any other public health crisis, such as Ebola or SARS, there would be more done about it.

290 The Federal response to the Opioid Crisis

Dr. Fry said when she became an MP in 1993, the overdose deaths were just beginning. All three levels of government agreed to work together to find a solution, and started to look at what other countries were doing with overdoses and addictions. “Evidence was showing us that in places in Switzerland, harm reduction was working, and one of the keys of harm reduction was the safe injection site,” she said. Dr. Fry worked with Ms. Kwan when she was an MLA for the area to create a federal pilot project in the Downtown Eastside, creating a “bubble zone” where drugs could be used by addicts without repercussions from the law, and work could be done to help safely administer them. The result, she said, was more and more addicts sought out treatment for their addiction. Addiction is not a moral issue, Dr. Fry said, but one of public health, and it needs to be treated as such through the opening up of more safe injection sites, easier access to naloxone, the antidote for overdoses, more research, and a public declaration of a national public health crisis. Dr. Fry said she was not talking about using the Emergencies Act, though some, including the NDP, are calling for the government to formally declare a state of emergency. When it comes to allowing more safe injection sites where they are needed, Dr. Fry said she understood the political cost. “Yes it’s a political minefield, but I think Canadians need to be aware of it,” she said. The Hill Times

Feb 13, 2017 EXCERPT FROM “WILSON-RAYBOULD AIMS TO CHARTER-PROOF HUMAN TRAFFICKING LAW”

BY RACHEL AIELLO

The government’s safe-injection-site legislation, Bill C-37 passed the committee stage with one clause slightly amended late last week, as the government continues the push to get it passed as soon as possible. Government House Leader Bardish Chagger (Waterloo, Ont.) said it will be debated over a few days this week, expected to begin on Feb. 14. It is now at the report stage and the government could be looking to have it pass through report and third-reading stages in the House before week’s end. Bill C-37, An Act to amend the Controlled Drugs and Substances Act, was introduced by Health Minister Jane Philpott (Markham Stouffville, Ont.) at the end of the 2016 sitting, is part of Health Canada’s overall Opioid Action Plan. Bill C-37 seeks to remove regulations around safe-injection sites across the country. It amends the Controlled Drugs and Substances Act, the Customs Act, and the Proceeds of Crime and Terrorist Financing Act, to prohibit the import of unregistered pill presses, remove the exception currently placed on border officers to only open mail weighing more than 30 grams, and make it a crime to possess or transport anything used in the production of controlled substances. On Feb. 9, members of the House Health Committee sat for two and half hours to go through clause-by-clause consideration of the bill, with the assistance of Health Canada and Canada Border Services Agency senior officials. Earlier, the committee had agreed, on a motion from Liberal MP John Oliver (Oakville, Ont.), that it would complete the clause- by-clause by the end of that day, and any remaining amendments submitted would be deemed moved, and to submit the report on any legislative amendments back to the House by Feb. 13. The members were able to get through all amendments by 1:30 p.m. on Feb. 9. “I think all parties at the table certainly feel the urgency with regards to this piece of legislation and want to move it forward,” said Conservative MP Rachael Harder (Lethbridge, Alta.) at committee on Feb. 8. The majority of the bill was agreed to by all sides, but the better part of that committee meeting was spent going over proposed amendments—most unsuccessful—to Clause 42 of the bill. The changes that ended up being approved by the committee—yet to be passed by the House—were to the wording on what’s required for an application for a safe-injection site exemption. Now it states an application will include “information” whereas before it was “evidence,” and “administrative” instead “regulatory” with regard to the structure in place to support the site. The decision to move through the committee study of the bill so expeditiously was agreed to unanimously by committee members on Jan. 31, a day before the House passed it at second reading after being debated twice. In the House, the Conservatives unsuccessfully attempted to get support for a motion to divide the bill in two, separating the safe-injection site aspect of the bill from the more customs-based part of the legislation. The legislation was a priority bill for the governing Liberals when Parliament resumed, with the support of the NDP to have it enacted as soon as possible. The Conservatives wanted to see more community consultation kept in the bill, as Bill C-37 repeals measures around the injection-site application process that the last Harper government introduced under Bill C-2. The Hill Times

291 The Federal response to the Opioid Crisis

Jan 30, 2017 EXCERPT FROM “OPIOID BILL, CETA, BUDGET AT TOP OF HOUSE AGENDA AS MPS RETURN”

BY RACHEL AIELLO

The ongoing opioid crisis in Canada and job losses have put two bills—Bill C-37, to address safe injection sites and Bill C-30 implementing CETA—as well as the upcoming budget as top priorities when the House returns Monday after a six-week break from Ottawa. “Lots of people wonder if Parliament cares,” NDP House leader Murray Rankin (Victoria, B.C.) told The Hill Times last week, speaking about the ongoing opioid overdose crisis that has proliferated on the West Coast, with 914 people dying from fentanyl overdoses in British Columbia last year. He said he had five constituents die in one day in his Victoria, B.C., riding, and the crisis is now spreading across Canada. Bill C-37, An Act to amend the Controlled Drugs and Substances Act, is expected to come up for debate this week and spur heated debate, given the polarized views of the opposition parties. It’s a priority bill for the governing Liberals, the Conservatives say they want to see more community consultation put into the bill, while the NDP say it should be enacted as soon as possible. “It’s a moral imperative that takes precedence over the salary increases that the Liberal ministers are seeking in Bill C-24, [An Act to Amend the Salaries Act]. It takes priority over the Liberals’ efforts to undercut our pension regime in Bill C-27 [An Act to Amend the Pension Benefits Standards Act]. These are people dying on our streets,” Mr. Rankin told The Hill Times. Bill C-24 boosts the salaries for what used to be considered junior minister positions and opens the possibility to add more ministers, and Bill C-27 gives federal employers the ability to back out of defined pension benefit plans. The legislation, which was introduced by Health Minister Jane Philpott (Markham Stouffville, Ont.) at the end of the 2016 sitting, is part of Health Canada’s overall Opioid Action Plan. Bill C-37 seeks to remove regulations around safe injection sites across the country. It amends the Controlled Drugs and Substances Act, the Customs Act, and the Proceeds of Crime and Ter- rorist Financing Act, to prohibit the import of unregistered pill presses, remove the exception currently placed on border officers to only open mail weighing more than 30 grams, and make it a crime to possess or transport anything used in the production of controlled substances. Government House Leader Bardish Chagger (Waterloo, Ont.), in an email to The Hill Times, confirmed Bill C-37 is among the bills that are a priority for the government to see passed, recognizing the opioid crisis has taken a toll on several communities. She was not specific on timelines, but the bill has yet to be debated at second reading. The NDP says fentanyl is a public health crisis that needs to be addressed immediately. Mr. Rankin said in his coming meetings with his House leader colleagues he’ll make it clear the NDP wants to see it through committee quickly, into the Senate quickly, and enacted quickly. Mr. Rankin said these overdose deaths are “way worse than SARS” and other health crises Canada has seen. He said the bill isn’t perfect, but it’s a start and better than what the Conservatives did with Bill C-2, the Respect for Communities Act, in the last Parliament. “The number of people of people who have died … it speaks for itself. And people in my part of the world want to know that the federal government and the Parliament of Canada are alive to this crisis,” said Mr. Rankin. The Conservatives will have lots to say about Bill C-37, because it repeals measures around the injection-site application process that the last Harper government introduced under Bill C-2, said Conservative House leader Candice Bergen (Portage-Lisgar, Man.) The government considers the changes “reducing the burden” by allowing communities to apply for an exemption to operate a consumption site and streamlining the application process while still making sure community consultation is there. Ms. Bergen said that although her caucus has yet to determine a position on the legislation, they want to see more community consultation before these sites are approved. “Clearly, we were the government that brought in strong rigorous consultations with communities before these monitored injection sites are put into people’s neighbourhoods. I don’t see anyone in our caucus changing their mind on the importance of that,” Ms. Bergen said, adding that while she recognizes the crisis needs to be addressed. “It’s not fair to people who live in these communities, whose children are going to school, people who aren’t having a drug crisis themselves. They need to be protected as well. Communities need to be protected.” The Hill Times

292 The Federal response to the Opioid Crisis

Nov 28, 2016 SPIN DOCTORS: ‘SHOULD THE FEDERAL GOVERNMENT DECLARE A PUBLIC EMERGENCY OVER THE OPIOID ABUSE CRISIS? OR WHAT ACTION IS NEEDED?’

BY LAURA RYCKEWAERT

KATE PURCHASE, LIBERAL STRATEGIST “As Health Minister Jane Philpott has said, Canada is experiencing a public health crisis related to opioid overdoses and deaths across the country, and our government is committed to addressing the issue. “Earlier this year, we introduced the Opioid Action Plan to better inform Canadians about the risks of opioids, encourage better prescribing practices, reduce easy access to unnecessary opioids, and support better treatment options for patients. We have also allowed over-the-counter access to the overdose antidote naloxone. “Those who use drugs, their friends and family, and first responders now have better access to the life-saving drug. B.C. Premier Christy Clark says this move alone has prevented 3,000 deaths in her province this year. We have taken concrete steps to reduce access to chemicals used in the production of fentanyl, and are working with the CBSA and the RCMP to interdict illicit drugs and target organized crime groups involved in the importation, production, and trafficking of fentanyl. “Minister Philpott recently held a national conference to discuss the opioid crisis and identify a common path forward. We will continue to work with the provinces and the territories, Indigenous peoples, health care professionals, and law enforcement on a pan-Ca- nadian approach to deal with this severe and complex issue. “Our government promises to be strong partners. We have already taken many important steps, but we must—and will—do more to combat this devastating crisis.”

CORY HANN, CONSERVATIVE STRATEGIST “Drug addiction is something our party takes very seriously. We made it a priority to keep drugs off our streets and out of our communities. Drugs like heroin and other opioids aren’t just dangerous, they tear families apart, lead to criminal behaviour and destroy countless lives. Part of the issue is the mixed messaging coming from the Liberals. While on one hand they signal the will to restrict over the counter drugs like Extra Strength Tylenol, they’re using the other hand to make opioids like heroin more readily available. “In Canada, we’re already world leaders in opioid use. Making these drugs easier to get, or providing drug injection sites for addicts to shoot up doesn’t solve the issue. We need to take the drugs out of the hands of addicts, not help them inject them. Feeding addiction under the guise of treatment does not help addicts, so we closed loopholes that facilitated it. Making dangerous drugs easier to get doesn’t help our opioid abuse issue, and doesn’t help prioritize the health and safety of Canadians.”

RICCARDO FILIPPONE, NDP STRATEGIST “Too many Canadians have died and too many lives are put at risk due to opioid addiction. In 2015, an estimated 2,000 Canadians died from opioid overdoses and many provinces are seeing an even higher number of fatalities in 2016. Over the last two decades, more than 10,000 Canadians have died from opioids and an untold number now suffer from addiction. “The magnitude of the crisis has forced health care experts across Canada to call on Ottawa to declare it a national public health emergency. New Democrats have joined them in pressuring this government to do so. Declaring it a public health emergency would allow the minister to marshal the resources required to deal with such a major problem. “It’s clear that this crisis must be addressed at all levels of government, but it’s critical that the federal Liberals show leadership. The government should create a national multi-sector taskforce on opioid overdose to that end. Additionally it must also repeal or significantly amend Bill C-2 to remove unnecessary barriers to opening new harm reduction facilities. “All three measures are critical if this government intends to stem the tide of death and addiction that opioid abuse has wreaked on too many Canadian families.”

MATHIEU R. ST-AMAND, BLOC QUÉBÉCOIS STRATEGIST “There is a serious problems with the use of opioids in Canada. Canada must monitor its borders and ensure the quality and legality of the products that cross over. Minister Goodale acknowledged that Canada can and should do better in this regard. “The Minister of Health should not use this problem as an excuse to interfere with provincial jurisdiction. Already, last week, Min- ister Philpot envisioned a pan-Canadian policy to resolve the issue. However, health is the exclusive domain of the provinces. The approach with regard to this problem, like many others, differs from one province to another to better meet the needs of the population. 293 The Federal response to the Opioid Crisis

“The Trudeau government seems to find all possible opportunities to interfere with provincial jurisdiction. Instead of playing politics at the expense of Quebeckers and Canadians, the Minister should give back the money assigned for health to the provinces. Stop the coast-to-coast-to-coast politics and let the provinces resolve their own problems with the appropriate resources.”

DAN PALMER, GREEN STRATEGIST “The private healthcare choices between doctor and patient are sensitive and need to be respected, but Ottawa can no longer ignore the sharp rise in prescription opioid overdoses across the country. Top pharmacologists and toxicologists are now calling on the Health Minister to declare a public health emergency. This prescription drug abuse, combined with a critical rise in fentanyl overdoses, has compelled health experts to lobby Minister Jane Philpott for updated opioid guidelines and better education on illicit drug abuse. “Critics have pointed out that a lack of opioid data and surveillance programs makes it difficult to track how many opioids are prescribed, where they’re coming from and how many people are overdosing and dying. Seniors are particularly vulnerable as doctors face lobbying from big pharmaceutical companies to increase sales. “A rise in overdoses from fentanyl—a powerful synthetic opioid analgesic often mixed with street drugs like cocaine and heroin—has led to schools in British Columbia holding town halls and educational seminars to educate worried parents and students. This patchwork method involves police services and healthcare providers, but coordinated leadership on both illicit and prescription drug abuse needs to come from Ottawa. Minister Philpott should act as quickly as possible to reign in opioid abuse.” The Hill Times

Oct 6, 2016 “HEALTH CANADA EYEING CHANGES TO SAFE-INJECTION SITE LAW”

BY MARCO VIGLIOTTI

Health Canada is considering changes to Conservative-era legislation that critics argued made it prohibitively difficult to open new supervised injection sites, according to a senior department bureaucrat. Hilary Geller, an assistant deputy minister with Health Canada, told the House Health Committee on Tuesday that the department is looking at the legislation itself to see “if amendments may be advisable,” though she stressed that the current review process for applications for new safe-injection sites seeks to ensure they are approved based on “evidence and with sufficient support.” “These rigorous criteria protect the health and safety of both the clients and the staff, and give confidence to the community that there’s a process in place to ensure that these facilities are operating responsibly,” she said in an address to the committee, as it began hearings for its study on Canada’s opioid crisis. The committee also heard from representatives of the RCMP, the Canada Border Services Agency, and the Canadian Centre for Substance Abuse. The committee meets next on Thursday. The former Conservative government passed legislation in the spring of 2015, known as Bill C-2 or the Respect for Communities Act, that required providers wishing to open safe-injection sites, where people can use their own drugs under medical supervision, to meet strengthened new requirements, including consultation with community members, public health officials, local police forces, and provincial and territorial health ministers. The federal health minister still retains final say on whether to grant the necessary exemption to controlled substance legislation for these facilities to legally operate. Vancouver’s Insite was the first such facility to be approved in North America. Both the Liberals and NDP criticized the legislation at the time as an attempt to circumvent a historic Supreme Court ruling in 2011 that declared shutting down Insite, as the Conservatives wished to do, unconstitutional, as the facility had shown proven benefits and no discernible negative impact on public safety or the country’s health objectives. The Liberal government, however, announced last December that it’s prepared to use the existing legal framework, brought in by the Conservatives, to assess impending applications for prospective supervised injection facilities. NDP MP Jenny Kwan (Vancouver East, B.C.) is urging the government to reverse course and immediately scrap the controversial Conservative-era law. “The act brought in by the Conservatives really impedes the expansion of supervised injection facilities across the country, which has been proven to save lives,” she told The Hill Times. Conservative MP and health critic Colin Carrie (Oshawa, Ont.), however, accused the Trudeau government of fixating on safe-injection sites as a solution to opioid addiction, and said it would be better served by putting more resources into treatment. 294 The Federal response to the Opioid Crisis

“The Liberals seem to be really focusing on safe-injection sites…they’re only putting resources in to that,” he said as he posed questions at the committee meeting. “I don’t think unless you put the priority on treatment, we’re going in the right direction.” He also defended the Conservative legislation, saying it didn’t stop safe-injection sites but merely ensured the public was properly informed. Ms. Geller’s comments on supervised injection sites came as she discussed efforts being undertaken by Health Canada to address the country’s evolving opioid crisis. In addition to supervised injection sites, she said the ministry has responded to the recent surge of drug deaths by scrapping the requirement for a prescription to ascertain naloxone, an antidote that is used to counteract the effects of opioids in overdoses, and recently completed an expedited review of a “more user-friendly” iteration that would regularize its public availability. It has also responded by the increasing availability of treatment options, Ms. Geller said. Most notably, Health Canada recently amended regulations to permit doctors to prescribe heroin to individuals suffering from severe opioid addiction. Mr. Carrie, though, expressed concern about prescribing heroin to dependent patients, saying that a recent study identified an alternative to the drug that had proven just as effective in treating addiction. “Don’t you think that we should be trying to substitute a legal safer alternative than actually getting more heroin on the streets?” Mr. Carrie asked. He added that Health Canada’s Special Access Program, which was the route utilized to permit prescription heroin, wasn’t intended to be used in such a fashion, and instead was focused on aiding those with emergency and life-threatening conditions. Supriya Sharma, a senior medical advisor with Health Canada, responded that the alternative drug, a pain reliever, isn’t marketed to treat opioid addiction, and doesn’t have the same wealth of medical evidence that prescription heroin boasts. Prescription heroin has a “body of evidence” that supports its use to treat chronic addiction and has already been used in several jurisdictions, she said.

FEDS, ONTARIO TO HOLD OPIOID ABUSE CONFERENCE Health Minister Jane Philpott (Markham-Stouffville, Ont.) is fielding increasingly urgent calls to curb opioid abuse as communities across Canada struggle to deal with the consequences of what many are calling a public health crisis. While abuse of prescription painkillers has remained fixed in the public consciousnesses for years, the recent rise of fentanyl has been blamed for surging numbers of overdose deaths. Abusers often mix the notoriously powerful painkiller with other substances, such as cocaine. However, the illicit, counterfeit fentanyl available on the black market is often unpredictably potent, leading to a spike in overdoses that some observers have dubbed the “suburban crisis,” as many of those dying coming from middle and upper class backgrounds and have little to no experience with powerful narcotics. After taking root in B.C., where fentanyl claimed 433 lives in the first seven months of 2016, the powerful drug has migrated east. The Alberta government reported 272 fatal fentanyl overdoses in 2015, while the drug become the leading cause of opioid deaths in Ontario earlier this year, according to The Globe and Mail, citing preliminary figures from the province’s Office of the Chief Coroner. Amidst this backdrop, Ms. Philpott and her Ontario counterpart, Eric Hoskins, are hosting a conference on opioid abuse from Nov. 18 to 19 that will bring together experts, patient groups, governments, and regulators to address the crisis and identify actions moving forward, according to Liberal MP Kamal Khera (Brampton West, Ont.), who serves as the parliamentary secretary to the health minister. “I think we need to hear from important stakeholders, regulators, [and] policymakers,” she said. “Our government is deeply concerned about the growing number of overdoses and death caused by opioid all across the country.” She noted that the federal Health Ministry has unveiled a five-point plan on where the federal government can show leadership on opioid abuse. It calls for leadership on risk education, better prescribing practices, reducing easy access to unnecessary opioids, supporting treatment, and improving the evidence base. “We will work alongside our partners to implement the action plan,” Ms. Khera said. As the opioid crisis worsens, the health ministry is continuing to field calls from one of the country’s largest pharmaceutical producers to take immediate action to make it harder to abuse powerful prescription painkillers. Health Canada in April announced that it would not require all iterations of opioid-based painkiller oxycodone be produced in a tamper-resistant format, citing concerns about increased costs and limited evidence of efficacy in reducing abuse. Prescription drug abusers often crush or snort oxycodone pills for an immediate high, as opposed to the controlled, staggered release if consumed as intended. As such, tamper-resistant iterations, which cannot be crushed, are seen as less attractive to abusers. Purdue Pharma Canada, makers of a patent-protected tamper-proof version of oxycodone, swiftly condemned the decision by the health department, arguing it ignores important academic evidence about benefits to public health. Generic producers, however, hailed the decision as a victory for Canadian consumers, claiming it would keep costs for these drugs competitive, as more companies would be able to manufacture and distribute the products.

295 The Federal response to the Opioid Crisis

Purdue’s iteration is the only oxycodone drug approved in Canada with tamper-resistant features. The company’s patent on the tamper-resistant technology expires in 2025, though the patent doesn’t apply to the oxycodone molecule itself. This means competitors could develop their own tamper-resistant oxycodone drugs before the patent expires. Despite the initial setback, and with an important summit on the horizon, Purdue is continuing to urge Ottawa to reconsider and require tamper-resistance for all control-release opioids, not just oxycodone. “We continue to believe the adoption of products with features designed to reduce misuse, abuse and diversion across the class of controlled-release opioids can play an important upstream role in any comprehensive harm reduction strategy being undertaken by governments and other stakeholders,” Grant Perry, the company’s vice-president of corporate and government affairs, said in a statement. “We encourage Health Canada to review the evolving and compelling evidence that has led the U.S. Food and Drug Administration to have approved seven [abuse-deterrent formulations] products. To enhance the safety of patients and the public at large, we believe that all controlled-release opioids should, in time, be required to have abuse-deterrent features.” Interestingly, at the committee meeting on Tuesday, Mr. Carrie said that the former Conservative government was “moving towards” tamper resistance for the entire class of opioids. The Hill Times

Aug 29, 2016 Excerpt from “SENATORS’ BILLS ON FENTANYL PRODUCTION, GENETIC TESTING, SEAL PRODUCTS SLATED FOR HOUSE THIS FALL”

BY RACHEL AIELLO

One bill has seen one of the quickest passages through the Senate in memory, while another is fighting to make it through to the other side for the third time in as many years. Both, however, look destined for success this session, and does a third bill started by a Senator who has since retired. Two Senate-sponsored public bills —Conservative Sen. Vern White’s (Ontario) Bill S-225, An Act to amend the Controlled Drugs and Substances Act (substances used in the production of fentanyl), and Liberal Sen. James Cowan’s (Nova Scotia) Bill S-201, Genetic Non-Discrimination Act—join a bill from now retired Liberal Senator Céline Hervieux-Payette, Bill S-208, National Seal Products Day Act on the agenda in the House of Commons this fall. Public bills are the Senate’s equivalent of the House of Commons’ private member’s bills. Mr. White’s bill passed into the House on June 16, just before MPs rose for the summer. It is currently awaiting first reading, expected not long after the House resumes on Sept. 19. It has been picked up—despite some initial Conservative interest—by Liberal MP Doug Eyolfson (Charleswood-St. James-Assiniboia-Headingley, Man.) who will be the House sponsor of the bill, and his experience as an emergency room physician is something Mr. White anticipates he’ll bring to the debate. The bill seeks to add ingredients to the list of Class A precursors to the Controlled Drugs and Substances Act and in the Precursor Control Regulations in an attempt to combat the illegal manufacturing of fentanyl in Canada. Bill S-225 passed the Senate with an amendment from Senate Government Leader Peter Harder (Ottawa, Ont.) at the Senate Legal and Constitutional Affairs Committee, which added ingredients to the controlled substances list. Sen. White said Mr. Harder’s amendment was “spectacular,” and described it in an interview along these lines: “If I couldn’t use flour to make bread, could I use almond flour? So let’s add almond flour to the list.” Two Senate committee meetings held on the bill featured testimony from police forces, health professionals, experts from Health Canada, and Mr. White, who said fentanyl was a problem in Ottawa during his time as police chief, between 2007-2012. It took two months and three days from its introduction to pass unanimously in the Senate, something Mr. White said was one of the quickest turnarounds he’s seen. “I’m sure it’ll walk through the House,” Mr. White said. “It would be appalling if any Member of Parliament decides they’re going to make this political. … Let’s just pass this bill and get it done. I anticipate that’s exactly what will happen.” Mr. White acknowledged his bill’s passage will be good, but is not the “best-case scenario.” “The best-case scenario, and this isn’t about politics … is that the government would just do this themselves. They don’t need a bill to do this and the bureaucracy I think is a decade behind,” he said. Conservative Sen. Bob Runciman (Thousand Islands and Rideau Lakes, Ont.), who chairs the Senate Legal and Constitutional Affairs Committee, in observations attached to the committee report, recommended that Health Canada “streamline” the process of

296 The Federal response to the Opioid Crisis adding substances to the controlled list to speed up their response to the dangerous and continuing addition of chemical drugs likes fentanyl. On July 27, Health Minister Jane Philpott (Markham-Stouffville, Ont.) announced in a statement that the government will be supporting the amended version of the bill “in order to address the supply side of the opioid crisis,” and that it plans to bring forward legislation tackling permits and access to pill presses in as far as this is related to the drug crisis. Ms. Philpott acknowledged the growing number of deaths, calling it an opioid crisis and highlighted Health Canada’s new Action Plan on Opioid Abuse, noting the government will be hosting a summit on the issue. Mr. White said he anticipates doing similar work when he returns in the fall, pointing to other illegally manufactured drugs on the rise, like W-18, which is said to be much more powerful than fentanyl. “This will be a continuous chase for us, but I think we need to be getting ahead of it,” he said. The Hill Times

March 14, 2016 “PHILPOTT SHOULD BRING IN REGS TO ACCELERATE USE OF ABUSE- DETERRENT FORMULATIONS FOR OPIOID MEDICATIONS”

BY CRAIG LANDAU

In last week’s Health Policy briefing in The Hill Times, Health Minister Jane Philpott outlined a compelling vision that will drive her mandate. From negotiating a new Health Accord, to addressing access to life-saving pharmaceuticals, to new investments in mental health, palliative care and First Nations health, there is no shortage of issues where her leadership is needed and welcome. As a father and fellow physician, I also support her stated intent to address “the moral imperative of responding to staggering mortality rates from suicide and substance abuse.” Canada currently finds itself in the midst of two related public health crises: the under-treatment of chronic pain and the challenges of prescription drug abuse, misuse and diversion. Chronic pain affects one in five Canadians along with their families and caregivers. It is a disease that needs to be addressed, and prescription opioids remain a safe and effective treatment for appropriately selected and monitored patients. However, these medicines do have a risk and tragically, we have seen the varied costs of prescription drug abuse. A human cost that has disproportionately affected young Canadians and our First Nations communities, a societal cost given the vast health care, societal and law enforcement resources expended, and the very personal cost of stigma against doctors, pharmacists and patients who responsibly prescribe, dispense and use these medicines respectively. In 2012, after more than a decade of research and development, Purdue Pharma replaced OxyContin in Canada, with OxyNEO, a product with features designed to deter its abuse and misuse. Since this transition, significant real-world evidence has been generated in both Canada and the United States that reveals: a reduction in the product’s abuse relative to OxyContin; fewer adverse event reports of overdose related to abuse/misuse; and, a marked decline in pharmacy thefts and losses of OxyNEO relative to the old formulation OxyContin. That is why products with abuse-deterrent features (ADFs) represent an important contribution by the pharmaceutical industry— brand and generic—to tackle the broad and growing issue of prescription drug abuse. On March 1, the U.S. Food and Drug Adminis- tration (FDA) reported that more than 30 such products are currently in various stages of development and that it has already approved five ADF products for use by American health-care professionals and American patients. While ADFs are not a “silver bullet” for addressing the complex societal issues of prescription opioid abuse, they are an important and available ‘upstream’ tool in a multi-faceted approach that can help to deter misuse, abuse, and diversion of these medicines. These ‘upstream’ tools complement other efforts such as prescription drug monitoring programs, prescriber education, law enforcement efforts and the broader provision of naloxone to first responders. All of these efforts are also consistent with a harm reduction approach. Converting one drug in the opioid class to a tamper-resistant or abuse-deterrent version would be expected to move abuse and diversion to non-deterrent medicines. This shift is referred to as the “balloon effect,” and in fact actually demonstrates that abuse-deterrent technologies work. Therefore, it is important that this class of drugs be converted as the technologies are demonstrated by manufacturers, and approved by Health Canada. The quicker that occurs, the quicker we will see a benefit to public health. Purdue’s commitment is to introduce technologies designed to make our medicines less attractive or vulnerable to misuse and abuse while continuing to ensure they are safe and effective for patients. In the last Parliament, both the Senate Social Affairs, Science and Technology (November 2013) and the House of Commons Health (April 2014) committees recommended that Health Canada amend the Controlled Drugs and Substances Act regulations to make 297 The Federal response to the Opioid Crisis abuse-deterrent products a Canadian reality. These recommendations were informed by experts from the fields of medicine, pharmacy, public health, law enforcement, and addiction. Philpott has a window of immediate opportunity, framed by a public health urgency, to further expand the work of the last Parlia- ment and align with the FDA by quickly introducing regulations to accelerate the use of abuse-deterrent formulations across the entire class of opioid medications. Dr. Craig Landau is the president and CEO of Purdue Pharma (Canada). He is an anesthesiologist with 25 years experience in private practice, the U.S. Army Reserve and industry. Purdue Pharma (Canada) is a member of Innovative Medicines Canada. The Hill Times

Dec. 4, 2015 “IT’S TIME FOR A CONVERSATION ABOUT DRUGS, OVER DINNER”

BY CAMERON BISHOP

Addiction and drug abuse represent a growing public health epidemic across North America. In recent years, stories ripped from the headlines tell tales not only of society’s poorest, cursed by poverty, violence, lack of shelter and inequity, but of a more often privileged suburban crowd, falling one by one into the grips of addictions. Indeed, Canada’s fondness for prescription painkillers has claimed people from backgrounds, cultures, and demographics as diverse as the Canadian landscape. Consider the following: Canada is the largest consumer of prescription opioids per capita in the world; Canadian prescriptions for high-dose opioids jumped by 23 per cent between 2006 and 2011; roughly one of every 170 deaths in Ontario, where they are tracked, is related to opioid use; for young adults aged 25 to 34 years old the rate of deaths related to opioids increases to one in eight. What is most dangerous is that the stigma associated with addiction often prevents patients, families, friends, or colleagues from engaging in conversation about drugs. It’s time for Canadians to have that conversation. And that’s where Drugs Over Dinner comes in. The idea of taking a taboo topic like substance use and creating an event around it originated with U.S.-based social entrepre- neur Michael Hebb and his Death Over Dinner project. Operating from the belief that the intimacy of the dinner table can ignite the transformative power of connection, Hebb created the project in 2012 as a way to get people talking about and processing dark personal issues. The project is an example of how communication can be a powerful driver of social change. This next phase of the dinner campaign was catalyzed by a need to raise awareness of the staggering effects of drugs and addiction on society, and the fact that the epidemic is largely being swept under the rug due to social stigmatization. The Drugs Over Dinner campaign is a powerful group of Canadian and American activists and icons, including political advisors and thought leaders in the realm of addiction, treatment and mental health. The roster includes Arianna and Christina Huffington, Gabor Mate, Carl Hart, -Tom my Rosen, Chris Blackwell, David Sheff, Michael Skolnick, Noah Levine, Lee McCormick, Hedy Fry and Alex Munter, to name just a few. The mix of diverse opinions and expertise is a dynamic recipe for spontaneous, productive engagement. Drugs Over Dinner’s goal is to inspire one million people with a wide range of perspectives—children, parents, health care professionals, employers, policymakers, and people in recovery—to convene, break bread and discuss the critical topic of drugs and addiction. The model aims to bring the tradition of family dinners back to the fore. This is significant; studies have shown that a higher rate of families eating dinner together corresponds with reduced likelihood of teens smoking, drinking and using drugs. Drugs Over Dinner formally launched in the United States in February 2015 with a night of 10,000 dinners across the country. In November 2014, as part of the pre-launch phase, the inaugural Canadian Drugs Over Dinner event was held in Ottawa. Members of Parliament from the Liberal, Conservative, and New Democratic parties took part, along with physicians, patients and community drug abuse and public health advocates. For the first time ever, the 2015 Aspen Ideas Festival included a Drugs Over Dinner event, which drew participants including actress Ashley Judd and the founder of the addiction network Shatterproof, Gary Mendell. In the coming months, Canadians from every corner of the country will gather around tables and host their own Drugs Over Dinner events. The easy-to-use dinner planner at www.drugsoverdinner.ca allows organizers to set the agenda for their dinner and their conversation based on the type of group coming together—be it friends, a family with children, a group of colleagues, or community workers. Organizers also gain access to a plethora of reading, listening and viewing resources to share with their guests to spark conversation. Canadians are long overdue for a candid conversation about drugs. One meal at a time, Drugs Over Dinner will hopefully change that. Cameron Bishop is a co-chair of Drugs Over Dinner Canada. He serves as director of government affairs and health policy for Indiv- ior Canada and is a member of the National Advisory Council on Prescription Drug Misuse. The Hill Times

298 The Federal response to the Opioid Crisis

LOBBY MONITOR STORIES June 13, 2017 “ON QUEEN STREET: FCM ELECTS NEW PRESIDENT”

BY SHRUTI SHEKAR

The Federation of Canadian Municipalities has elected a new president who plans to ensure that municipalities are considered a “respectful place of equal partners” of the federal government. Winnipeg city councillor and deputy mayor Jenny Gerbasi, was elected on June 4 during FCM’s annual general meeting, she said, adding her term would be for one year. “It’s a good time for [FCM],” Gerbasi said. “What I really hope to achieve this year is…to remind all Canadians just how much municipalities achieve for their everyday life with the limited tools at their disposal. We really want to expand this historic engagement with the government.” Since Prime Minister Justin Trudeau took office there was a heightened involvement of municipalities in the federal government decision-making process on issues concerning infrastructure, clean tech and energy, as well as the opioid crisis, many media outlets reported. Gerbasi will be replacing Clark Somerville, who served as president for one year, a press release from FCM indicated. “Under Clark’s leadership, we’ve seen local governments taking their rightful place at the nation-building table,” Gerbasi said in the June 4 press release. “From Hamilton to Hay River, cities and communities are where the best of this country unfolds. This is where we work, live and raise our families. And this is where we’ll tackle our 21st century challenges on the road to a better Canada.” Speaking to the Lobby Monitor, she noted that before becoming president she held several other positions, including first, second and third vice-president of FCM. “It’s really a five-year elected process where you get elected as third vice-president and then you move up,” Gerbasi said. “You’re very prepared as possible when you get there.” Gerbasi noted FCM is the voice of local government and her duty is to serve member interests and advance the group’s overall objective, which is “to reinforce FCM as a full partner with our federal government to achieve shared goals.” “It’s a really important time where we really need to ensure the new infrastructure program [the federal government] launched and the funding announced in Budget 2017...are designed so municipalities can turn those dollars into real outcomes,” Gerbasi said. While Gerbasi noted the long-term goal was to focus on economic growth, climate change, infrastructure, and transit, in the short term the group also has the opioid crisis and cannabis legalization top of mind. With respect to the opioid crisis, Gerbasi said that “the issue continues to be extremely important” to FCM and the group continues to build on their relationship with the federal government to find solutions. “Work to [fix the crisis] is intensely being done and we are really appreciating that relationship we have. We want to be equal partners with the government in these things,” she said. “We may have a smaller role in some issues…but we want to be there and provide help and advice.” In February, FCM launched a task force to help the federal government find a solution to the ongoing opioid crisis. “The federal government has taken a lot of action on this front,” said Carole Saab, senior director of policy and government relations at FCM, in a March interview. “They see the necessity in working with the folks who are on the front line and are very open to the conversation.” Gerbasi, who has been a city councillor for almost 20 years, also sat on FCM’s board of directors for 10 years, the press release said. “I’ve always been a champion of various issues from transit to good local planning, the environment, community safety and things that [are] on the front lines of local issues we face,” she said. “Before I was in politics I was in the frontlines as a community health nurse working in downtown Winnipeg and I was teaching nursing as well at [University of Manitoba].” The press release added that Sylvie Goneau, Gatineau, Que., councillor, will be first vice-president; Bill Karsten, Halifax, N.S., councillor, will be second vice-president; and Garth Frizzell, Prince George, B.C., councillor will be third vice-president. The Lobby Monitor

299 The Federal response to the Opioid Crisis

May 18, 2017 Excerpt from “AHEAD OF NEW BILL, TRANSPORTATION TOP-LOBBIED ISSUE IN APRIL”

BY SAMANTHA WRIGHT ALLEN

As is the case each month, organizations that hold lobby days on the Hill score the most meetings with MPs. The Canadian Chi- ropractic Association logged 31 reports over two days, meeting with 25 Parliamentarians, including 13 Liberals, 9 Conservatives and three Bloc Québécois, some who sat on health, finance and veterans affairs committees. While CCA didn’t meet with anyone in cabinet, it met with two parliamentary secretaries and chief of staff to President of the Trea- sury Board Scott Brison. It’s an annual event for the group, which held its lobby days last March, reporting 33 meetings. CEO Alison Dantas said the group spoke to government with three objectives in mind: addressing better approaches to pain management in light of the opioid crisis, including chiropractors on the disability tax credit list, and making MPs aware of ongoing research on the effect of chiropractic care with the Canadian Armed Forces because, she noted, active soldiers have a much higher rate of mus- culoskeletal disease, neck pain, back pain than the general population. The group was at the table in November for Health Minister Jane Philpott’s Opioid Conference and Summit and one of five signatories on the joint statement looking for solutions. “The way we frame it is that it has to include why opioids are being prescribed and the leading reason for that is back pain and what we can do to create better alternatives to mitigating the pain people are experiencing without the use of pharmacology,” said Dantas, whose group in the intervening months has chaired a coalition for safe and effective pain management. She said the solution should not focus entirely on harm reduction, but rather on other ways to manage back pain. “We felt like it was important for us to take leadership and bring together health system experts, patient organization and professions to prioritize alternatives to opioids,” she said, adding it was launched after the summit and looks “upstream to help mitigate” the number of people with chronic non-cancer pain. “We just heard from [Philpott] that she wants these recommendation to be part of the action plan which is very exciting.” Chiropractors currently aren’t on the government’s list of practitioners who can sign disability tax credit certificates, which Dantas said they are trying to change. “Our priority from CCA to remove the current systemic barrier for those Canadians who have reached the point of disability due to chronic spine… conditions and respect their choice of provider,” said Dantas, who is registered to lobby for the group and has filed 36 communication reports. It is also signed on with five consultants from Impact Public Affairs. Government has said “it’s under consideration” but Dantas said she’d like to see it resolved because other levels of government already recognize chiropractors in certain programs, like worker’s compensation. The Lobby Monitor

May 8, 2017 Excerpt from “DAY AT THE REGISTRY: NALOXONE COMPANY LOBBIES FOR WIDER USE OF NASAL SPRAY”

BY SAMANTHA WRIGHT ALLEN In the face of the worsening opioid crisis shaking the country, the producer of the overdose-reversing drug naloxone has registered to lobby the government to widen access to its nasal spray form. Adapt Pharma Canada Ltd. created a file in the federal lobbyists’ registry May 4 to discuss NARCAN Nasal Spray, which has been available since July 2016 and since October has been authorized for non-prescription use Billed as “a ready-to-use, needle-free alternative,” the company said it wants Canada to make it “more widely available across Canada to facilitate immediate treatment to individuals suffering from opioid overdose,” according to its file with Sheamus Mur- phy of Counsel Public Affairs Inc. Just over a week before Murphy created the file, the company praised Health Canada for updating its medical coverage to include the spray under the Non-Insured Health Benefits Program

300 The Federal response to the Opioid Crisis

“It is important for Canadians to have access to emergency naloxone treatment in case of an opioid overdose, and adding NARCAN Nasal Spray to the NIHB program makes it more accessible to those who need it,” said David Renwick, the company’s general manager, in the April 24 press release. The spray can be administered by frontline workers, first responders and more in case of accidental contact with fentanyl - and the far more potent carfentanyl - as well as to temporarily reverse the effects of opioids, the release said. The Lobby Monitor

March 21, 2017 “FIRE CHIEFS CHAMPION MENTAL HEALTH”

BY SHRUTI SHEKAR

Thirty-seven fire chiefs in uniform went to the Hill over two days to talk to parliamentarians about creating a mental health initiative to help first responders in large and smaller communities across the country. The Canadian Association of Fire Chiefs had their annual “government relations week” and went to about 80 meetings with elected officials and government workers from March 20 to 21. “We were received very respectfully and have had some good traction on issues that we brought forward in the past and certainly we hope to continue that momentum,” said the group’s president. Ken Block added the CAFC was particularly advocating for a mental health initiative to help first responders deal with the stress that comes with their career. “Mental health stress injuries are probably the number one occupational illness that we are dealing with even above cancer, which is significant and there’s much good work and political support around cancer,” the fire chief for Edmonton Fire Rescue Service said during the group’s parliamentary reception on the Hill Monday evening. The group is currently studying the issue in order to identify best practices which may lead to a training module that would have a significant effect on volunteer and full-time firefighters across the country. Along with other health groups, Block will be paying attention to any mental health dialogue in Budget 2017, released March 22. “We certainly are hoping there’s something for mental health initiative for first responders across the country,” said Block, adding that there were some areas of concern that don’t think will make it into the budget. “We have got a volunteer firefighter tax credit that’s been embraced very well across the country. There’s been some speculation that may be affected negatively and we hope that’s not the case because it means a lot to volunteers, who comprise 80 per cent of the country’s firefighter services,” Block said. Line 362 of the Canada Revenue Agency Tax Return rules states firefighters can claim $3,000 for the volunteer firefighters’ amount or the search and rescue volunteer’s amount “but not both.” Despite concerns, Block said the group has been in constant conversation with Public Safety Minister Ralph Goodale; Block added Goodale has “done a nice job of advocating.” The CAFC is registered to lobby with Greg MacEachern and Pascal Chan, both of Environics Communications, as of July 5, 2010 and June 7, 2016 respectively. The group has not filed any monthly communication reports, its file in the federal lobbyists’ registry said. Natural Resources Minister Jim Carr said in an interview during the reception that meeting first responders from the CAFC was a way of getting to know their issues and concerns that affect their towns. “They do very important work in our communities and when they want to come to Ottawa to tell us about that and to get to know them a bit better, it’s our pleasure to greet them and listen to them,” Carr said. He added the government is very aware of mental health issues and noted that there were funds allocated to help. “We’re giving more money to the provinces particularly to mental health,” Carr said. “When we hear from people on the ground who can tell us stories about the impact of mental health on the people with whom they work and on communities it’s very important that politicians listen to them.” In December, the federal government agreed to offer $11.5-billion over 10 years, allocating more in health funding for homecare and mental health care, and promising to raise annual Canada Health Transfers. At the time provinces pushed back and were not happy with the deal. Since then every province has signed onto agreements, with Manitoba as the lone standout. While mental health was the overarching theme over the two days, Calgary Fire Department’s assistant deputy chief said support for first responders dealing with the fentanyl crisis hitting communities is a growing concern. “The opioid crisis is absolutely unbelievable,” said Ken McMullen, who also sits on the board for the CAFC. “The numbers are staggering…[and] the mental effect that it’s having on first responders is something that we haven’t scratched on understanding.” 301 The Federal response to the Opioid Crisis

Some fire departments are getting 20 to 30 calls a day, he said, adding it’s pertinent for first responders to get the best support and training in mental health. “All services are working on [it], so police, firefighters, EMS, we’ve banded together and we are working to try and enact legislation and training to ensure that first responders have that mental health training to ensure that they can do their job,” McMullen noted. McMullen added opioids and mental health were discussed during their meeting with Goodale, and said the meeting also included John McKearney, the fire chief from Vancouver. During the parliamentary reception, McKearney said it was heartbreaking to see young men and women facing the crisis in his city, causing grief to families but also to first responders. “We try to understand it a little because it helps our firefighters and police officers and paramedics to understand how a thriving son or daughter finds themselves in this way, and we build relationships with them, but it’s really quite challenging and it’s really tough when you’re going back sometimes twice, sometimes three times a day reviving the same person,” said McKearney, who also sits on the board of the CAFC. In the fall of 2016 Vancouver firefighters were receiving 1,300 calls a month, he said, most dealing with overdoses. He said it is important to tackle the opioid crisis from a health standpoint as opposed to a criminal one. He noted that he on three occasions has spoken about the problem with Prime Minister Justin Trudeau, who was very responsive. “We are hoping that our government will take a strong leadership role in working with the provinces and the cities because [while] the epicentre is Vancouver, it’s a tsunami going across the country,” McKearney said. The Lobby Monitor

March 3, 3017 “FCM LAUNCHES OPIOID-FIGHTING TASK FORCE TO HELP GOVERNMENT”

BY SHRUTI SHEKAR

It’s been one month since the Federation of Canadian Municipalities launched a task force to help the federal government find a solution to the ongoing opioid crisis and the group says there is a lot more work to be done. “The federal government has taken a lot of action on this front,” said Carole Saab, senior director of policy and government relations at FCM. “They see the necessity in working with the folks who are on the front line and are very open to the conversation.” Saab said the task force met Feb. 24 and spoke by phone with Health Minister Jane Philpott and Public Safety Minister Ralph Goodale. The conversation focused on access to treatment. “Minister Philpott agreed to engage the mayors through the Federal Special Advisory Committee, which is traditionally the federal government and provinces, [but] they’ve agreed to engage local public health officials - so to bring the cities into that conversation so that better information can be shared across all orders of government,” Saab said, adding that the ministers also agreed to have an in-person meeting scheduled for the spring. The task force was launched Feb. 3 immediately after the Big City Mayors’ Caucus meeting to “tackle an epidemic of fentanyl overdose deaths.” “Cities are dealing with the fentanyl opioid crisis on the front lines, but the tragedy is escalating and we’re at a breaking point,” said Vancouver Mayor Gregor Robertson, chair of the task force, in a press release from FCM. “We urgently need a nationwide emergency response as opioid addiction devastates families and communities and overdose deaths reach an even more horrific toll,” he added. “In Vancouver, our front-line workers are tireless in their heroic efforts to save lives, but the intensity of overdose response is overwhelming.” B.C. saw 914 overdose deaths in 2016, with 142 in December, the release said. In Calgary, it said firefighters trained to administer the overdose-revival drug naloxone have had use it roughly once a day in January. Saab said the task force has two purposes. First, it can “serve as a venue for cities to share best practices.” Cities can learn from what others are doing, she said, so some can plan ahead and others suffering from the crisis can adopt different solutions. The second is to work with all levels of government to help find a solution to the crisis. Saab said the first meeting the mayors and ministers had was helpful because it provided more knowledge about key barriers. She added that the task force will provide recommendations that will be helpful to the government. “What FCM is doing is also really canvassing and compiling data from across the country, from cities facing the crisis across the country,” she said, adding the team is pulling information that would be helpful to share to federal and provincial ministers when they take action.

302 The Federal response to the Opioid Crisis

But getting that information has been a challenging task, Saab said. “There are barriers to local efforts, the predominant ones are delays to access to treatment and the data that local public health officials and cities are getting,” she said. “Access to [information] is really inconsistent across the country. In some provinces like B.C. for example, they have very updated and timely information that’s being shared with public health officials so that cities can respond, but that’s both in terms of how up-to- date information is and how easy to access it is.” As such, Saab said FCM has been working with their members in all cities to try engaging with local networks, including first responders and public health officials. “We are really leveraging those connections and information and data that we are getting through our members from stakeholders who are active on the ground,” Saab said. The issue has been at the top of the municipal agenda, she added, and when the mayors held their caucus meeting, they raised the issue to a responsive Prime Minister Justin Trudeau. Trudeau travelled to Vancouver Friday morning and spoke with first responders who are dealing with the crisis. “We need to recognize the challenges faced day in and day out of users,” said Trudeau, adding there was “much work to do,” as reported The Abbotsford Times. Philpott has also led the charge. She co-hosted with Ontario Minister of Health Eric Hoskins the Opioid Conference and Summit in Ottawa on Nov. 18 and 19 last year. The conference brought together individuals and organizations “that have authorities and commitment to take action to combat the opioid crisis,” a news release about the summit said. Ontario also recently announced a strategy to help with the addiction and overdose crisis by appointing Dr. David Williams, the province’s Chief Medical Officer of Health as “Ontario’s first ever Provincial Overdose coordinator to launch a new surveillance and reporting system to better respond to opioid overdoses and inform how best to direct care.” “I think on a political level, everybody knows that this is a real crisis and we have to look past jurisdictional issues and get everybody together and solve the problem,” Saab said. The Lobby Monitor

Feb. 14, 2017 “MEDICAL STUDENTS MEET MPS, CALL FOR OPIOID CRISIS SOLUTION”

BY SAMANTHA WRIGHT ALLEN

Medical students flooded the Hill Monday calling on government to commit to upstream solutions for the national opioid crisis. The Canadian Federation of Medical Students met with MPs from every political party to discuss two key demands of government: increased access to multidisciplinary chronic pain centres and investment in mental health programs and research to better understand the interactions between mental illness and opioid misuse. “Just as tackling the opioid crisis will involve a multidisciplinary health care approach, it will also require a multi-tier government intervention health services approach,” said Jessica Bryce, vice-president of global health at CFMS, in a statement Monday. “Students are already working on local and provincial initiatives to combat the crisis - it is only fitting that we now approach the federal government as well.” The federal government hasn’t done enough, CFMS said in its press release, offering “inadequate access to effective treatment for chronic pain “and a “lack of understanding” around mental illness and substance misuse. Physicians write 53 prescriptions for opioid drugs for every 100 people in the country, the federation said, noting the connection between drug availability, addiction and demand. The group raised the possibility of the federal government declaring a public health emergency as provinces deal with the rising death and overdose numbers. B.C. was the first province to declare a public health emergency last April, prompting advocates in other provinces dealing with their own opioid overdose surges to question why their governments hadn’t made similar statements. By the end of 2016, B.C. reported 914 illicit drug overdose deaths - a 79 per cent increase over the number of deaths the year before. December’s death toll - 142 - was the highest ever record and more than double the average number of drug overdose deaths since 2015. “As medical students, we regularly encounter the devastating effects of the current opioid crisis - in emergency departments, on the wards, during clinics and sometimes within our own personal circles,” said Henry Annan, national officer of human rights and peace 303 The Federal response to the Opioid Crisis for CFMS, which represents over 8,500 medical students at 15 medical schools across Canada. “We see it as our duty to advocate on behalf of our future patients and contribute meaningfully to the current conversation.” CFMS members met with representatives, including Conservative MPs Todd Doherty, Kevin Waugh, Dan Ruimy, John Brassard; NDP MPs Carol Hughes and Jenny Kwan; and Green Party leader Elizabeth May. Health minister Jane Philpott tweeted Monday her thanks for the group’s “good discussion on upstream solutions to the national opioid crisis.” The Lobby Monitor

April 11, 2016 “INDUSTRY ASSOCIATIONS COME OUT AGAINST HEALTH CANADA’S TAMPER-RESISTANT RULING”

BY MARCO VIGLIOTTI

Health Canada overlooked considerable academic evidence in ruling that mandating tamper-resistance for oxycodone medication would raise prices for consumers without significantly helping to curb prescription drug abuse, according to the makers of a patent-protected tamper-proof version of the drug. “The basis of the decision appears not to have taken into account the wealth of available published evidence,” Purdue Pharma Cana- da said in a statement released April 6. “We continue to believe products with features designed to deter misuse, abuse and diversion, can and do have a positive impact on public health, based on the abundance of published evidence,” it said. Health Canada announced April 4 it would not require all iterations of powerful painkiller oxycodone be produced in a tamper- resistant format, citing concerns about costs and limited evidence of the efficacy in combatting abuse. Under the Conservatives, the federal health department began consultations on a proposed set of regulations for tamper-resistant forms of the opioid drug in the summer of 2015, including provisions requiring therapeutic products containing controlledrelease oxycodone be made tamper-resistant before they could be sold. A Health Canada spokesperson said the response from the consultations and a review of available research showed the prospective regulation would instead push addicts towards other drugs. “Based on public consultations, and Health Canada’s review of the latest scientific evidence, it was concluded that this specific regulatory approach would not have had the intended health and safety impact – most likely creating a ‘balloon effect’, in which measures to control one drug lead people to other drugs,” André Gagnon said in an emailed statement to The Lobby Monitor. Prescription drug abusers often crush or snort oxycodone pills for an immediate high, and eliminating iterations of these drugs that can be readily exploited by addicts has been touted by advocates as crucial to curbing abuse. Several U.S. congressional members argued in a letter to Health Minister Jane Philpott earlier this year that the availability of non-tamper resistant opioids in Canada had contributed to prescription drug addiction south of the border. The U.S. Food and Drug Administration has already approved five tamper resistant products and reports suggest another 30 were under consideration as of March 2016. Purdue said Minister Philpott has a “window of immediate opportunity” to expand the work of the last Parliament and align Health Canada with its counterparts in the United States by “quickly introducing regulations to accelerate the use of abuse-deterrent formulations across the entire class of opioids.” “We urge Minister Philpott to reconsider this decision of regulatory inaction and move swiftly to avoid any further unintended consequences to the benefit of the public safety of Canadians and our healthcare system,” the company said. An advocacy association for Canadian pharmacists also condemned the decision, calling mandating tamper-resistant drugs an important pillar of any strategy to address the country’s ongoing “opiate crisis.” “We are very concerned that Canadians continue to suffer from the inherent risks of these medications, as a result of their purpose- ful misuse and abuse,” said Phil Emberley, director of professional affairs with the Canadian Pharmacists Association, in a prepared statement. The trade association, he said, viewed the prospective tamper-resistant regulation as a “positive move to create a level-playing field for all long-lasting opiates and to address the potential risks of opioid misuse.” Innovative Medicines Canada, an industry group that represents Purdue and other major pharmaceutical companies, also expressed concerned about the Health Canada decision but promised to continuing working with the government to “find ways to mitigate the risks associated with the inappropriate use or abuse of medicines.”

304 The Federal response to the Opioid Crisis

“Our members will continue to make advances on the safe use of prescription pain medications which assist in the reduction of prescription drug abuse in Canada,” it said in a statement distributed to The Lobby Monitor. Critics worry the previously suggested regulations would have squeezed out generic producers and increased costs for consumers by preserving a monopoly for large pharmaceutical companies who produce tamper-resistant versions protected by patents. Representatives from the Canadian Generic Pharmaceutical Association did not reply to requests for comment before publishing. Purdue is the maker of OxyNEO, a tamper resistant version of oxycodone pain reliever OxyContin. The company pulled OxyContin from the Canadian market in 2012 after it became seen as the popular drug of choice for opioid addicts. Had the tamper resistant regulations been approved, rival drug companies would have been shut out of the generic oxycodone market until the last of Purdue’s patents on its abuse-deterrent technology expire in 2027, according to reports from The Globe and Mail. Health Canada’s Gagnon said the absence of competing generic drugs would lead to significant prices hikes for consumers as brand name oxycodone products are far more expensive. “The price for the name brand controlled-release oxycodone product is anywhere from double to four times the price of the generic equivalent, depending on pill dosage,” he said, noting the impact would be felt greatest by those who pay out- of-pocket for medication. The Lobby Monitor

April 5, 2016 “HEALTH CANADA AXES POTENTIAL TAMPER RESISTANT REQUIREMENTS FOR OXYCODONE PRODUCERS”

BY THE LOBBY MONITOR

Health Canada on Monday said it would not pursue regulations to mandate the sale of controlled-release oxycodone only in tamper resistant forms, arguing the change would not achieve important health and safety goals. In a statement, the department said requiring oxycodone medication to be produced in a tamper-resistance format “would not have had the intended health and safety impact,” citing the results of a consultation on the proposed regulation and scientific data. “Specifically, requiring tamper-resistant properties on all legitimate preparations of controlled-release oxycodone would have served to eliminate certain lower cost drugs from the market, increasing costs for patients and the health system, while having little to no effect in the fight against problematic opioid use,” read a statement on the Health Canada website. Under the Conservatives, Health Canada began consultations on a proposed set of regulations for tamper-resistant forms of the opioid drug in the summer of 2015, including provisions requiring therapeutic products containing controlledrelease oxycodone be made tamper-resistant before they could be sold. Instead of new regulations, the department said it would work to curb painkiller abuse by increasing inspections of pharmacies, better labeling, educating prescribers on abuse risks, improving surveillance data on problematic opioid use, making overdose antidote naloxone more available and working with First Nations partners to enhance prevention and treatment services, among other measures. It also pledged to support efforts to develop strategies that can address problematic opioid use, including other “industry efforts to develop tamper-resistant formulations of drugs.” Prescription drug abusers often crush or snort oxycodone pills for an immediate high, and eliminating iterations of these drugs that can be readily exploited by addicts has been touted by advocates as crucial to curbing abuse. The Canadian Pharmacists Association has called on Health Canada to ensure that all extended-release opiate and stimulant drugs are available in tamper resistant forms. Several U.S. congressional members echoed this call in a letter to Health Minister Jane Philpott earlier this year, saying the availability of non-tamper resistant opioids in Canada had contributed to prescription drug addiction south of the border. But some opponents say this will squeeze out generic producers and increase costs for consumers by preserving a monopoly for large pharmaceutical companies who produce tamper-resistant versions protected by patents. Purdue Pharmaceuticals withdrew its oxycodone painkiller OxyContin from the Canadian market in 2012 and replaced it with tamper-resistant drug OxyNEO. Had the regulations been approved, rival drug companies would have been shut out of the generic oxycodone market until the last of Purdue’s patents on its abuse-deterrent technology expires in 2027, according to reports from The Globe and Mail. The Lobby Monitor

305 The Federal response to the Opioid Crisis

Feb. 2, 2016 “HEALTH ADVOCATES LOOK FOR POLICY ANSWERS TO WORSENING FENTANYL CRISIS”

BY MARCO VIGLIOTTI

The federal Liberal government must employ an expansive multidisciplinary response leveraging relationships with stakeholders and expediting concrete policy actions to address Canada’s increasingly urgent opioid abuse situation, according to health-care advocates. Most stakeholders, however, acknowledge that Ottawa has limited tools at its disposal to tackle the ever-evolving opioid challenge that transcends jurisdictional boundaries, and has even evoked debate about the sorts of drugs prescribed by healthcare professionals. Despite these challenges, the Canadian Pharmacists Association (CPhA) is calling on the federal government to establish a national narcotic strategy in hopes that directing resources and attention will help spur broader action on the file. “We’ve been very vocal in the last few years. This problem with prescription drug abuse, especially opioids, has been really gaining momentum, and we’ve been very vocal in addressing the risks of abuse and misuse,” said Phil Emberley, the advocacy association’s director of pharmacy innovation, in a phone interview with The Lobby Monitor. “We are really trying to highlight the significance of it. When we engage with stakeholders, such as the federal government, we want to be really solution-driven,” he said. Abuse of prescription opioids has emerged as a major public health challenge in recent decades, with Canadians increasingly turning to the notoriously addictive pain-relievers in rates among the highest in the world, according to a 2012 article from the Canadian Medical Association Journal, which also cites concerns about the creation of medical dependent addicts. This refers to how many opioid abusers first encounter the drugs after being prescribed one of them by their physicians, rather than recreational experimentation. The 2012 journal article references an estimate pegging the number of Canadians currently addicted to painkillers at about 200,000. Specifically, synthetic opiate fentanyl has become a major concern for health-care providers and first responders as overdose deaths linked to the powerful drug – which is occasionally mixed with other illicit drugs – surged in several Canadian jurisdictions in 2015. According to the B.C. government, fentanyl was detected in 30 per cent of the province’s 465 illicit drug overdose deaths last year, up 27 per cent from 2014. In Alberta, there were 213 overdose deaths with fentanyl detected in the first nine months of 2015, almost doubling the 120 mortali- ties recorded throughout the previous year, government statistics show. That’s a significant increase from the 66 seen in 2013, the 29 in 2012, and 6 in 2011 in the province. Collectively, the Canadian Centre on Substance Abuse determined in a recent report that there were 655 deaths in Canada between 2009 and 2014 – or roughly one every three days – where fentanyl was the cause or a contributing case. In response, authorities are ringing alarm bells and seeking ways to curb this troubling trend, namely by improving access to naloxone, an antidote-type drug that can reverse fentanyl-induced overdoses. Both Alberta and B.C. now permit first responders to administer naloxone, while Health Canada announced last month that it would fast-track the process for allowing non-prescription use of the drug, specifically to treat opioid overdoses outside hospital settings. The public consultation on the change runs until March 19, and if no protests are raised, the federal department said it intends to waive the usual six-month implementation period and change naloxone’s status as soon as feasible. “It’s a very positive move; it’s proven to be a safe drug. It’s proven that with limited training, average people, non-health-care professionals can administer this drug,” said Ian Culbert, president of advocacy group the Canadian Public Health Association, in a phone interview. The CPhA is also lending its support to the proposal.

RENDERING DRUGS TAMPER RESISTANT SEEN AS CRUCIAL But distributing the antidote is only part of the solution, according to advocates, who stress the importance of educating unfamiliar users about the dangers of opioids and making the drugs tougher to exploit.

306 The Federal response to the Opioid Crisis

In hopes of curbing abuse and misuse, CPhA’s Emberley is calling for the federal government to ensure that all extended release opiate and stimulant drugs are available in a tamper resistant form. In addition, Culbert, who also supports that proposal, urged Ottawa to accelerate the implementation period for the tamper resistant procedures, noting that his public health advocacy group told the former Conservative regime that the three years it took to produce an incorruptible iteration of OxyContin was “much, much too long.” As the abuse issue worsens, another debate has opened up over the legal usage of opiates, with the number of prescriptions for the pain relievers steadily growing in recent years. Opioid prescriptions in Canada rose to 21.7 million in 2014, an 18.6 per cent increase from 2012, when notoriously addictive Oxy- Contin was delisted from provincial drug plans in favour of tamper-resistant OxyNEO, according to an analysis from The Globe and Mail, using data from industry tracker IMS Brogan. In response, some activists are urging restraint on the part of healthcare professionals when prescribing opiate pain relievers, considering their addictive quantities. Emberley, though, counters that rooting out medicinal use of these products is counterintuitive because it would prevent thousands of patients from accessing important medication. “These drugs … have legitimate medical uses. We do not want to create a situation where these drugs are more difficult for these types of patients [with significant pain] to access,” he said, framing it as a balance between permitting access for those in need and prohibiting abusers from readily acquiring the drugs. Rather, the pharmacist association, Emberley said, supports bringing in more “patch-for-patch” programs, already seen in several municipalities in Canada, which require fentanyl users to return any used patches to pharmacies in order to get a refill. The system has been promoted as a way to prevent exploitation, as even after use the patches can retain as much as 90 per cent of the drug. Referencing the need for a “multi-pronged” solution, Emberley also touted the importance of improving e-health records, which would allow doctors to more easily track prescription history; enhancing addiction strategies and services to ensure more clinics tailoring to opioid addicts; and encouraging pharmacists to better track purchasers of these drugs.

OTTAWA LIMITED IN RESPONSE BUT MUST TAKE LEADERSHIP POSITION: ADVOCATE The federal government is limited in how it pursues these recommendations by jurisdictional and capacity issues, as health care is predominantly a provincial responsibility. But while the federal Liberals will need to cooperate with provincial, municipal and industry stakeholders when championing national healthcare and pharmaceutical reforms, they can unilaterally assume an important leadership role by starting the conversation to better understand what drives opioid abuse, according to Culbert. Calling other solutions “Band-Aids,” he said Ottawa must head up national discussions to discover “what really is the heart of the problem” and what can be done to address the drug abuse epidemic. The importance of better understanding what compels addicts has taken on additional importance, as local authorities and first responders begin to take stock of the difference in composition between victims overdosing from fentanyl and prescription opioids and those involved in more traditional “street-drugs” such as heroin. Whereas intravenous drug users are often perceived as street-wise and experienced in narcotics and crime, Culbert framed the fentanyl epidemic as the “suburban crisis,” with many overdosing from the pain relievers unfamiliar with harder substances and coming from more stable living situations. He expressed doubt about what the federal government could do itself to address the problem aside from providing support to front-line service workers employed in on-street outreach and education programs. Emberley, of the Pharmacists Association, however, was far more optimistic about what Ottawa could accomplish, saying that the group has been impressed by the federal government’s renewed commitment to the health-care file and pledges from Health Minister Jane Philpott to address the opioid issue. He also stressed the importance of reaching out to provincial and territorial partners, and praised last month’s gathering of national health ministers as offering a valuable opportunity to set a pan-Canada healthcare agenda. The industry association, Emberley noted, sent an open letter to the assembled ministers outlining its priorities, in turn allowing the group to “insert” itself into the discussion. He said that the health ministers are “very attuned” to the opiate crisis and that these meetings offer an opportunity to work towards an aggressive “pan-Canadian” approach to the file. The Lobby Monitor

307 The Federal response to the Opioid Crisis

POWER & INFLUENCE STORY Spring 2017 THE ESSAY: “THE WAR ON DRUGS”

BY BILL BOGART

The War on Drugs has been a failure. It has not succeeded in its main goal: to end the drug trade and to create a drug free world. Rather, it has given rise to an illicit market with huge social and economic costs to society: unjust incarceration, an untaxed industry run by the lawless, tainted substances, and exploited children. The watchwords for governments controlling the consumption of alcohol, tobacco, junk food, and gambling are “permit but discourage.” All are legal, but harmful consumption is addressed by targeted regulatory strategies. The same approach should be adopted for non-medical use of drugs. Legalization and regulation can attack the underground economy; drive down excessive use; provide revenue for prevention, treatment, and counselling; and better-protect children. What is the path away from criminalization amid the calls to legalize, generally, and the urgent need to address the opioid epidemic, in particular? There are three sets of challenges, each of which requires a different strategy. The first involves marijuana: this drug will be legalized and regulated in Canada in the next few years. As marijuana is legalized, we will learn lessons; not only in terms of that drug, but also in terms of how to regulate non-medical use of drugs generally. The second involves a variety of drugs that are receiving less attention because the spotlight is so focused on marijuana and opioids: such substances as cocaine, LSD, crystal meth, etc. They, too, can be dangerous, including being tainted by those in the illicit market. These drugs give rise to a range of issues (what would be the source of legal supply?) and may come to be regulated in different ways because of patterns of use, risk involved, availability of legal markets, and so forth. It could also be that the path away from criminalization, at least for some of them, could be staged: first, decriminalization (i.e., no sanctions for possession and use); then, after a period for assessment, legalization and regulation. Drugs were, generally, decriminalized in Portugal about 15 years ago. That move is widely regarded as successful based on a number of measures. The third challenge focuses on opioids. Responsible voices are taking a public health perspective on the opioid crisis rather than seeing the criminal law as any solution. There aren’t cries to arrest users and lock then up as a means of ending the epidemic. Rather, actions are being taken— some of which require changes to the law—to address the emergency in the name of “harm reduction”: naloxone is being distributed to immediately deal with overdoses, more safe injection sites are being opened, good Samaritan laws are being passed so that people can call for help for an overdose without fearing prosecution, and so forth. The central question should be: what does the public health approach require to confront this epidemic? If medical experts determine that a course of action is needed, then any legal barriers that stand in the way should be removed. If the prime minister and others want to characterize these changes as part of “harm reduction” rather than “legalization,” so be it. An immediate example of what needs to be done is the provision of medical grade heroin (an opioid) to some of those who are dependent; an option which has existed in Switzerland for some years. As experts determine such availability is the right course for some individuals, any legal and other roadblocks should be ended. Meanwhile, the alarm bells are ringing. The goal of a drug-free world (including alcohol and tobacco) is lofty, and unrealistic. The human appetite seeks comfort in -sub stances. It has been ever thus. A drug-free world is as unlikely as a food-free one. Endless pursuit of that goal has left a trail of blood and destruction in its wake. Endless pursuit of that goal has been a magnificent gift to the lawless who preside over abounding underground trade and who treat human life as a cheap commodity. We need a thoughtful, national discussion of the legalization and regulation of recreational drugs. It is the path that is, as characterized by the Economist, the “least bad policy.” Bill Bogart is a law professor at the University of Windsor, and author/editor of eight books, including his latest, Off The Street. He has developed international knowledge and expertise in the optimal mix of regulation and health/social supports to reduce harm from risk behaviours such as smoking, excessive gambling and alcohol consumption, and poor diet and lack of physical activity related to obesity. P&I

308 The Federal response to the Opioid Crisis The Look Forward

ill C-37, An Act to amend the Controlled Drugs and Sub- these centres in Bill C-37, provincial governments are at liberty to stances Act and to make related amendments to other Acts, associate a treatment centre with a supervised consumption site. received Royal Assent in May 2017. While this legislation is Canadian lawmakers and healthcare workers could also ben- Bthe Liberal government’s attempt to stabilize the crisis and to stop efit from best practices abroad, learning how other nations are deaths from overdoses, politicians and experts agree more must handling the opioid crisis and whether those treatment programs be done to prevent and treat the underlying issues of addiction. could work in Canada. In November 2017, Health Canada released its report, Actions Speaking to the House committee, Dr. Mark Ujjainwalla, Med- on Opioids 2016 and 2017, which includes a new five-point action ical Director at Recovery Ottawa, explained how rehab facilities plan including: in Sweden and Kentucky, USA, divert addicts from jail and into • removing regulatory barriers to treatment and harm reduction; work programs where “individuals are given a sense of self-esteem • supporting innovative approaches to sharing data effectively, and order. They have high productivity.” Rehab facilities such how to share best practices more broadly, adding drug check- as these could be the next step in addiction treatment following ing services at supervised injection sites; opioid substitution therapy. • developing a new protocol for temporary supervised injection The federal government could also consider creating a national sites in areas with urgent need; database for physicians prescribing highly addictive medication, • increasing access to treatment for first nations communities; preventing addicts from “doctor shopping” in order to stock up addressing the stigma related to addictions; on drugs. On behalf of the Canadian Medical Association, Dr. Jeff • and improving the data collection on overdoses. Blackmer told the health committee on Oct. 18, 2016, that he supports the implementation of a national prescription database: “it’s Both the Conservatives and NDP continue to call on the critical that prescribers be provided with access to a real-time pre- government to declare the opioid crisis a national public health scription-monitoring program. Such a program would allow phy- emergency. The NDP has largely been supportive of the govern- sicians to review a patient’s prescription history for multiple health ment’s efforts, while the Conservatives have been critical of the re- services at the point of care, prior to prescribing medications.” peal of Bill C-2, remaining consistent on their “law enforcement” The government may also consider changing the rules for opioid position regarding the use of illicit drugs. pain management prescriptions, preventing the over-prescription Appearing before the Standing Committee on Health on Dec. of opioids and other addictive medications. According to Blackmer, 13, 2016, then-Health Minister Jane Philpott said it is important “Physicians are on the front lines of this epidemic in many respects” to understand the big picture in terms of amendments to the and they are still responsible for “supporting patients with the man- Controlled Drugs and Substances Act in contained in Bill C-37: agement of acute and chronic pain.” He recommends that, along “It is fundamentally taking a health-based approach to problem- with addictions treatments, the government must “significantly atic substance use, and the new Canadian drugs and substances expand the availability and access” to pain management programs, strategy replaces the former national anti-drug strategy.” including education resources for physicians and patients alike. With Bill C-37 in place, the government can now include su- The opioid crisis has affected many Canadians from all walks pervised injection sites and harm reduction as part of its four-pil- of life; however, it is still important to gather data on addicts and lar strategy to stopping the crisis. The other three pillars include deaths from overdoses in order to fully understand the crisis, prevention, treatment and law enforcement. not only for prevention but also how to properly care for addicts. The government’s approach going forward will be to address Réjean Leclerc with Syndicat du préhospitalier told the health the other three pillars, specifically addictions treatment and committee on Oct. 18: “we have to continue collecting data on this prevention. subject, and even improve the work being done on that, in order to The federal government is already funding a number of mental get a better picture of the situation and react better in real time.” health programs and initiatives, but a more targeted approach is Given that addiction is a complex disease with many factors, the needed if preventing additions and curbing the opioid crisis is federal government has no easy fix for the nation-wide opioid crisis. It really a priority. will require continued study, discussion and cooperation with all levels Health Canada has acknowledged that going forward, treat- of government. No amount of legislation will help stop overdose deaths ment and (to an extent) prevention must involve things like coun- or prevent addiction. What will help is a targeted approach to addiction selling, mental health care, housing support and social support. prevention and treatment. Canadians from all backgrounds are eagerly But treatment centres fall under provincial jurisdiction. So waiting to see what next steps the federal government will take and while the federal government was unable to include measures for look forward to when the opioid crisis is no longer front-page news. 309