441-00037 (Health)

The Government of Canada recognizes that the overdose crisis is one of the most serious and unprecedented public health threats in Canada’s recent history, which is having devastating impacts on individuals, our friends and families, and communities across the country. Tragically, most recent national data indicates that 24,626 apparent opioid toxicity deaths occurred between January 2016 and June 2021. Fentanyl and its analogues continue to be major drivers of the crisis with as many as 87% of accidental apparent opioid toxicity deaths so far in 2021 (January to June) involving fentanyl.

The Government of Canada also recognizes that the complexity of this crisis has only increased due to the ongoing COVID-19 pandemic, leading to a more uncertain and dangerous illegal drug supply, resulting in tragic increases in overdose-related deaths across the country, as well as reduced access to health and social services, including life-saving harm reduction and treatment. Health Canada and the Public Health Agency of Canada have been working with provinces, territories, municipalities and other partners, including researchers, advocates and people with lived and living experience, to ensure that people who use drugs can continue to access the treatment, harm reduction and other services they need during the pandemic.

With respect to the request for a declaration of a national public health emergency, such a declaration is not required at the federal level to access important responses to the opioid overdose crisis. The comprehensive federal response has included legislative and regulatory enabling measures, new prescription guidelines, marketing restrictions, awareness campaigns, improvements to the knowledge base, and emergency funding to provinces and territories. These measures were all put in place without a formal declaration of a public health emergency.

The Government of Canada’s approach to substance use issues aims to be comprehensive, collaborative, and compassionate, guided by our federal drug strategy – the Canadian Drugs and Substances Strategy (CDSS). The CDSS takes a public health-focused approach, and lays out our framework for evidence-based actions to reduce the harms associated with substance use in Canada.  It includes four key pillars – prevention, treatment, harm reduction, and enforcement. In the context of the worsening overdose crisis, the Government is placing particular focus on:

• ensuring that life-saving harm reduction measures are available to Canadians who need them;
• working with stakeholders to reduce stigma directed at people who use drugs, which acts as a barrier to accessing critical health and social services and often leads to social isolation and further risk of harms;
• continuing to work with provinces and territories to improve access to evidence-based treatment options;
• continuing to address illegal production and trafficking, with a focus on organized drug crime; and,
• implementing additional surveillance and research activities that will further build the evidence base and allow us to pursue innovative solutions to this public health crisis.

Since 2016, the Government of Canada has taken urgent action to address the overdose crisis through significant investments of over $700 million. Recent examples of key federal investments in this area include:

• over $182 million in support of community-based organizations responding to substance use issues, including investments to help them provide frontline services in a COVID-19 context and to scale-up key lifesaving measures and increase access to a safer drug supply as an alternative to the contaminated supply;
• $150 million through the one-time Emergency Treatment Fund to provinces and territories, which, when cost-matched, resulted in an investment over $300 million to improve access to evidence-based treatment services;
• $200 million, with $40 million per year ongoing, to enhance the delivery of culturally appropriate addictions treatment and prevention services in First Nations communities;
• $13 million over five years to launch a new national, multi-year public education campaign to help reshape Canadians’ attitudes and perceptions about people who use drugs; and,
• $116 million over two years, beginning in 2021-22, building on $66 million invested in the 2020 Fall Economic Statement, to support a range of innovative approaches to harm reduction, treatment, and prevention at the community level.

In addition to these investments, in order to prevent and reduce substance-related harms, the Government of Canada has undertaken a broad range of policy, legislative and regulatory actions, such as:

• approving exemptions to establish supervised consumption sites (with 38 currently in operation across Canada), and providing provincial and territorial class exemptions to facilitate the establishment of Urgent Public Health Need Sites (commonly known as overdose prevention sites);
• supporting the passage of the Good Samaritan Drug Overdose Act, which encourages people to seek emergency help at the scene of an overdose by providing some legal protection against simple drug possession charges;
• establishing effective Federal, Provincial and Territorial public health emergency governance, including the Special Advisory Committee on the Epidemic of Opioid Overdoses and the Federal/Provincial/Territorial Assistant Deputy Minister Committee on Problematic Substance Use & Harms;
• collaborating with provinces and territories to better understand the evolving crisis, and undertaking timely monitoring and reporting of opioid-related deaths and harms in Canada; and,
• deploying public health officers from the Public Health Agency of Canada to support public health surveillance systems in provinces and territories.

The Government of Canada has worked to implement a number of measures to divert people who use drugs away from the criminal justice system and towards health and social services. For example, the government passed the Good Samaritan Drug Overdose Act in May 2017, which provides some legal protection for individuals who seek emergency help during an overdose. On August 18, 2020, the Public Prosecution Service of Canada issued guidance to prosecutors, directing that alternatives to prosecution should be considered for personal possession offences, except when there are serious aggravating circumstances. In addition, Health Canada is currently funding a three-year project in Peterborough, Ontario, to develop a multi-sector response to direct people who use drugs away from the justice system and into care.

In March 2021, the Minister of Health commissioned an Expert Task Force on Substance Use, whose reports provide important advice with regards to alternatives to criminal penalties for simple possession of controlled substances and federal drug policy.  Further to the Government’s commitment to reintroduce former Bill C-22 in the first 100 days of their mandate, on December 7, 2021, the Minister of Justice and Attorney General of Canada introduced Bill C-5, which proposes amendments to the Criminal Code and to the Controlled Drugs and Substances Act. Among other measures, this Bill would repeal mandatory minimum penalties for drug related-offences, and would require prosecutors to consider alternative measures to laying charges or prosecuting individuals for simple possession of drugs, including diversion to treatment programs, giving a warning, or taking no further action. The Government of Canada will continue to work with provincial and municipal officials on options to address their regional needs and help people who use drugs to get the support they need.

The Government of Canada has taken actions to reduce barriers to providing people who use drugs with a safer, pharmaceutical-grade alternative to the toxic illegal drug supply. On August 24, 2020, the Minister of Health sent a letter to Provincial and Territorial Ministers of Health and regulatory colleges to encourage the provision of a full spectrum of care options to people who use drugs, including access to a safer supply. In addition, Health Canada has issued class exemptions to ease restrictions on the transportation of controlled substances and reduced barriers for pharmacists to make it easier for people to access the medications they need during the COVID-19 pandemic while following public health advice, such as physical distancing. Through Health Canada’s Substance Use and Addictions Program, the Government of Canada is supporting 18 safer supply projects across 29 sites in British Columbia, Ontario, Quebec, and New Brunswick for a total investment of over $60 million. Seventeen of these projects are providing medications to people with substance use disorders as an alternative to the toxic illegal drug supply, and one is a National Community of Practice that focuses on the sharing of best practices and knowledge dissemination between providers of safer supply.

The Government of Canada has also taken a number of steps to provide options for those seeking treatment for severe substance use disorder. On April 25, 2019, the Minister of Health added diacetylmorphine to the List of Drugs for an Urgent Public Health Need. This addition makes it possible for provinces and territories to import this drug for the treatment of opioid use disorder. Amendments to federal regulations have also allowed health care practitioners to provide diacetylmorphine-assisted treatment outside of a hospital setting, if permitted by their province or territory. In addition, on May 1, 2019, Health Canada approved the use of injectable hydromorphone by qualified health care professionals as a treatment for adults with severe opioid use disorder. This is the first approval of injectable hydromorphone for this purpose in the world.

The Government of Canada is also providing guidance and leadership on the prescribing, dispensing, and delivery of opioids and other narcotics during the pandemic. For instance, through funding from the Canadian Institutes of Health Research, the Canadian Research Initiative in Substance Misuse developed a series of national guidance documents related to substance use in the context of COVID-19. Health Canada has also assembled a toolkit to provide clarity on prescribing for the treatment of substance use disorder and/or to provide a safer supply. Furthermore, the Canadian Agency for Drugs and Technologies in Health published a rapid review of clinical and cost-effectiveness of injectable opioid agonist treatment for patients with opioid dependence.

The Government of Canada will continue to take a comprehensive, collaborative, and compassionate public health focused approach to addressing substance use. We will continue to work with civil society organizations, front line responders, academics, people with lived and living experience, and other key stakeholders to reduce opioid-related overdoses and deaths, and improve the health and wellbeing of Canadians who use drugs. The Government of Canada believes that substance use is a health issue, and is committed to examining all options and evidence to respond to the tragic increase in overdoses and to help save lives, while also ensuring the safety of communities across the country.