In the collaborative spirit of the way we do all our work around controlled substances in Canada, I'll be giving remarks on behalf of my colleagues, but we're all happy to answer questions, obviously.
Thank you very much, Mr. Chair.
My name is Suzy McDonald. I am the assistant deputy minister for the opioid response team at Health Canada, but I'm also responsible for the regulation of controlled substances in Canada and the federal government's approach to drug and alcohol use under the Canadian drugs and substances strategy.
Problematic substance use is an ongoing health and safety concern in Canada. While the opioid crisis and cannabis legalization and regulation are often top of mind for Canadians, Health Canada is very much aware that a growing number of people are also struggling with methamphetamine use. In particular, we know that provinces such as Alberta, Manitoba and Saskatchewan are seeing increased reports of methamphetamine use, hospitalizations and interactions with law enforcement. Some first nations communities are also reporting significant health and safety issues related to meth use.
Methamphetamine is generally an inexpensive drug that can produce a short-term or a long-term effect, depending on how it is taken. It can be smoked, snorted, swallowed or injected. It can increase attention and energy and create an overall feeling of well-being or euphoria. However, its use can also lead to addiction and harmful effects, such as paranoia, aggressiveness and even psychosis. A methamphetamine overdose can cause convulsions, cardiac arrest, stroke and, in some cases, death.
We know that people use stimulants for a variety of reasons. These can include for personal enjoyment, to relax, to socialize, or to cope with pain, stress or other related trauma. Compared to other substances used in Canada, such as alcohol, cannabis and opioids, rates of meth use are relatively low. However, we are seeing reports that other drugs are sometimes mixed in with meth, including highly potent opioids like fentanyl, which further increases the potential for harm and increases the risk of fatal overdose. In fact, available data for some jurisdictions suggest that meth may be playing a growing role in overdose deaths where polysubstance or dual-substance use is involved.
The Government of Canada is concerned about all forms of problematic substance use, and we are taking action through the Canadian drugs and substances strategy, through our four pillars of prevention, treatment, harm reduction and enforcement.
In terms of prevention, we know that we need to take a broad approach, which includes both informing Canadians about the risks of meth use and addressing the underlying social determinants related to its use. This is a role that all levels of government undertake in Canada, along with a large number of non-governmental organizations.
We also know that public awareness campaigns will not suffice, as social determinants of health often underlie problematic substance use. For example, we know that homeless individuals or lower-income individuals are at greater risk of harm related to problematic substance use.
We also know that substances can be used as a coping mechanism by those who have experienced trauma, violence, social marginalization and loss of cultural identity. For aboriginal people, that may include the loss of language and culture, racism, discrimination and the intergenerational trauma of residential schools.
Through the Canadian drugs and substances strategy, the federal government is committed to working collaboratively to better address the social determinants of problematic substance use and develop upstream efforts to help prevent problematic substance use before it begins.
Moving on to the issue of treatment, the evidence clearly shows us that problematic substance use is a health condition that can be managed and successfully treated for those who are ready. Unfortunately, methamphetamine use is a very difficult condition to treat. To date, the most effective treatment options for methamphetamine use include psychosocial counselling and behavioural management approaches. Unlike opioid use disorder, where medication-assisted treatment is available, there are currently no drug-based therapies to treat problematic meth use. This is an area where more research would be useful.
I know from my experience in managing the federal response to the opioid crisis that there are simply not enough drug treatment services in Canada to meet the demand. To help address this gap, the federal government committed $150 million for an emergency treatment fund to help improve the availability of treatment options in Canada, including for those struggling with methamphetamine use. To date, five provinces have signed bilateral agreements with the federal government under the emergency treatment fund, including Saskatchewan, which is using some of the funds to enhance treatment services for people seeking help for substance use disorders, including crystal meth use.
ln addition, the federal government has made a number of investments in federal budgets to support expanded mental health and drug treatment services in first nation communities, including $200 million over five years, and $40 million ongoing, provided in budget 2018.
Harm reduction is a key factor of the federal approach to the opioid crisis. Unfortunately, there is no similar range of options for harm reduction related to methamphetamine use. More specifically, there are no drugs that can reverse the effects of a methamphetamine overdose, as in the case for an opioid overdose, which can be treated with naloxone.
The most common evidence-based approach in methamphetamine harm reduction focuses on reducing the risk of blood-borne infections, such as HIV and hepatitis C, which can be contracted by sharing drug-using equipment, such as syringes and pipes.
The Canada Public Health Agency is investing $30 million over five years through the harm reduction fund to reduce those risks by supporting projects in Canada that will help reduce the transmission of HIV/AIDS and hepatitis C among people who share equipment for using drugs by injection and inhalation.
Another key component to harm reduction is addressing stigma toward people who use drugs. In particular, the visible physical effects of methamphetamine use, coupled with sometimes very erratic and unpredictable behaviour, create a highly stigmatized image. This perception creates barriers when accessing treatment and other harm reduction and social support services, and it is something that we are committed to working to reduce to help ensure that people get the support they need.
For example, the encourages people to seek help in the event of an overdose by providing some legal protection for those who experience or witness an overdose. We hope this act will reduce the fear of police attending overdose events and encourage people to help save a life. As part of budget 2018, the federal government invested $18 million over five years for actions to address stigma toward people who use drugs, including a national anti-stigma campaign, which has just been launched, and training for law enforcement officers. Although much of what Health Canada is doing on stigma is done in the context of the opioid crisis, we are confident that it will also have a positive impact in other areas.
Drug regulation and enforcement is the fourth pillar of the Canadian drugs and substances strategy and remains a critical part of the federal government's approach. It encompasses a wide range of activities, including enforcement, regulation of activities with controlled substances and precursors, border control, financial surveillance and tax audit measures to reduce the profitability of drug trafficking.
Methamphetamine is controlled under the federal government's Controlled Drugs and Substances Act, as are many of the chemicals used in its production. Given that many of these precursors are legal substances, it can be difficult to control their availability and diversion. The RCMP is working in close partnership with chemical industry partners through the national chemical precursor diversion program to identify suspected criminals and organized crime groups that attempt to acquire precursor chemicals that can be used to produce methamphetamine. Health Canada continues to work with its partners, including the Canada Border Services Agency and the Royal Canadian Mounted Police, to examine options around scheduling and control of novel precursor materials.
While some methamphetamine is produced in Canada, a proportion of methamphetamine consumed in Canada is likely trafficked into Canada from other countries such as Mexico. The Canada Border Services Agency continues to work closely with its international and domestic law enforcement partners to disrupt the methamphetamine supply at the border.
Our partners at Correctional Services Canada are also taking a number of actions to reduce the demand for illegal substances, including methamphetamine, among the federal incarcerated population. These include preventing contraband from entering federal prisons, increasing awareness of the harms from problematic substance use and supporting innovative and effective treatment and harm reduction approaches, such as the recent implementation of a prison needle-exchange program.
I'd like to touch on one final area of the Canadian drugs and substances strategy, and that is the serious role of evidence. Evidence is the foundation of everything we do.
Supervised sites are another part of the government's harm reduction approach. Although the use of meth in supervised consumption sites varies widely across the country, preliminary data shows that up to 40% of visits to some sites in western Canada are by people who come to use methamphetamine.
The federal government supports high-quality research on substance use through the Canadian Institutes of Health Research and the Canadian research initiative on substance misuse.
The Canadian Institutes of Health Research are currently supporting a pilot project to identify effective interventions to reduce methamphetamine use among men who have sexual relations with other men, an activity that has been associated with an increased probability of contracting HIV/AIDS.
In addition, the substance use and addictions program is a federal grants and contributions program that provides $28.3 million annually to provinces, territories and non-governmental organizations that support evidence-informed and innovative initiatives targeting a broad range of legal and illegal substances.
While it is difficult to paint a detailed picture of the scale of the methamphetamine problem in Canada, we are committed to working with provinces and territories and key stakeholders to fill gaps in our knowledge. Health Canada, the Public Health Agency, Stats Canada and other organizations are exploring targeted data and research initiatives to better reach marginalized populations.
We are also working toward developing and implementing a Canadian drugs observatory that would act as a central hub to provide a comprehensive picture of the current drug situation in Canada, identify emerging drug issues before they escalate, track public health interventions and other control measures, and facilitate data sharing.
In closing, I would just like to say that we are deeply concerned about the growing number of Canadians who are struggling with methamphetamine use. Through the Canadian drugs and substances strategy, we will continue to work with provinces, territories, indigenous leadership and communities, people with lived and living experience and key stakeholders to address the issue using a comprehensive, collaborative and compassionate public health approach based on the latest available evidence.
Last, we have recently launched an online public consultation to inform potential next steps on the Canadian drugs and substances strategy. This consultation closes on December 4. We look forward to feedback from Canadians on how we can improve our approach to substance use issues in Canada, including our actions to address methamphetamine. At last count, I think we had more than 1,200 responses to that, so we expect a fair amount of analysis to happen.
In closing, thank you again for the opportunity to appear before you today to discuss what we believe is a very important and growing issue in Canada. We look forward to the presentations to this committee from other stakeholder groups and to the committee's forthcoming report and recommendations.
My colleagues and I would be happy to answer any questions you may have.
The evidence we have is not necessarily related directly to opioids. It's related to people who come into supervised consumption sites to use those various products.
Indeed, you are right. There have been a fair number of studies done and we have a very good literature to indicate that supervised consumption sites overall reduce harms and don't increase crime. There's no increased level of activity around those sites.
The emergence of supervised consumption sites in Canada is relatively new, and we are collecting data. As part of the work we do with each supervised consumption site, we ask them to report in so that we'll be able to have a much better understanding as time flows about the use of methamphetamine and harms related to that.
What I can say is that if you are using a substance within a supervised consumption site, you have immediate access to harm reduction measures. While naloxone indeed works for opioids, having practitioners present if you're having another type of overdose is very helpful in terms of being able to call for help or for immediate assistance. Those harms we expect will be reduced, but there have been no studies directly related to that, to my knowledge. Michelle might be able to correct me on that.
I think the other piece that's interesting to note is that people who are using methamphetamines are using supervised consumption sites. I mentioned that in my remarks. In fact, we are seeing increased methamphetamine use at supervised consumption sites in Kelowna, as an example. In areas where opioid use had been quite prevalent, we are seeing some shifts happening, and we're monitoring that very closely.
The other piece related to supervised consumption sites and harm reduction, as you know, is that because methamphetamine is used in a whole variety of ways, including through injection drug use or sharing of products, the ability to have drug-related items available for people coming into supervised consumption sites drastically reduces the risk of any kind of infection happening. Furthermore, it often puts people into contact with direct treatment providers or other health care providers.
The ability for people to come into those supervised sites, whether they're using an opioid, methamphetamine or cocaine, means that they have access to a wide range of services. That's why we have been putting a real emphasis on trying to ensure that people are not using alone and that we're able to get help for them immediately if needed.
My name is Ginette Poulin. I am the medical director of the Addictions Foundation of Manitoba.
It is a great honour for me to be here to discuss this issue we are currently facing in Manitoba.
While we do understand that there are issues with methamphetamine across the nation, certainly in Manitoba we've been seeing significant impacts that have been stressing not only our health care system but our social system and our justice system. We want to share a few reasons why we are seeing these particular impacts.
I will note that we prepared some packages for you. Although some of the information has been translated and is in both French and English, our apologies, not all of the material is in both languages. We will distribute those for those who wish.
In terms of some of our numbers, certainly from the Addictions Foundation of Manitoba, which services most of the addictions services within the province, we are seeing growing numbers of concern. For instance, 48% of persons seeking help for addictions are reporting methamphetamine as their number one substance of use within the past year. That is in our youth population. We've also seen an increase of about 104% in our adult population reporting methamphetamine use. We've had a threefold to fourfold increase in deaths either contributed to or caused by methamphetamines.
We're seeing a product that is certainly more toxic and more potent. It certainly has longer devastating effects in terms of aggressivity and psychosis, leaving a lot of concern. We've had a reported 1,700% increase in presentations to emergency visits in the Winnipeg Regional Health Authority. From AFM's perspective, across the province there's been an increase in the proportion of use of methamphetamine in the southern region.
Certainly, when it comes to treatment, we are under-resourced. Many of you might be familiar with our Peachey report. That report came out about three years ago on our health system transformation. That's another particularity that's happening in Manitoba. We're undergoing new strategies, in the global health system as well our mental health and addictions, with the Virgo report that was released in the spring, looking at providing a less siloed effect, which is currently the case. The geography of Manitoba is very much concentrated. Over half of our population is within Winnipeg and the southern area.
What came out of both of those reports is that we need more funding. We need more services. Of our health budget, only 5.2% is allocated to mental health and addictions. The national average is about 7.2%. The recommendation from the Virgo report was to increase it to 9.2% to meet some of the gap that has been there. Damon will speak a little bit further about some of the funding. We have been experiencing cutbacks in terms of our climate currently, too, which is a challenge.
When it comes to crystal meth, for withdrawal management services and ongoing care we do have limited resources within the province. We're advocating for withdrawal management services for a longer period of time, given that the detox period for crystal meth requires a longer phase of that safe environment.
Certainly, we're seeing the impacts from the female and family perspective. Manitoba, as you may know, has some of the highest rates of children in care, secondary to apprehension. Again, when we look at our data, we're certainly seeing that women are more affected in both our youth and adult population. This is something that is of great concern for us as well.
I know that safety was brought up earlier. This is certainly a concern on the front of individuals, health care providers, and our judicial and legal services. Winnipeg Police Service is facing significant challenges on the street, facing a lot of aggressivity. You might have heard of claims of machetes tied to the hands, and of the health care provider stabbed with a pencil. When we're looking at safety concerns, that is a real risk. It's certainly something we are facing.
Again, for individuals, many who are under the influence are experiencing harm. We're seeing an increase in IV injection rates. This has gone up at least double in the last few years. There are also the rates of hepatitis C and other infections, such as infective endocarditis, that are secondary to use. Again, the longer this goes on, the more impacts we'll see in terms of that.
I think I'll pass it over to Damon.
Good afternoon, Mr. Chair and members of the committee.
My name is Matthew Young. I'm a senior research and policy analyst at the Canadian Centre on Substance Use and Addiction, and an adjunct research professor of psychology at Carleton University.
CCSA 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.
With me today via video conference is Dr. Sheri Fandrey, knowledge exchange lead at the Addictions Foundation of Manitoba and member of the Canadian Community Epidemiology Network on Drug Use. We welcome the opportunity to speak with you today and to assist you in your study of the impacts of methamphetamine use on Canadians.
To respect your time constraints, my presentation today will be brief. Many of the statistics I refer to are included in the methamphetamine summary that was released earlier this month. It was provided to the committee in advance of today's meeting.
Methamphetamine is a synthetic drug classified as a central nervous system stimulant. The immediate effects of methamphetamine include alertness, energy and self-confidence. It is important to note these effects differ from the sedation and respiratory depression produced by opiates.
Since 2015, approximately 0.2% of Canadians report in self-report surveys using methamphetamine in the past year; however, national survey data tells only a very small part of the story. There is considerable variation across jurisdictions in rates of methamphetamine use and problematic use tends to be concentrated among populations that are unrepresented in national surveys.
Although there are gaps in the data, what data we have suggests that since about 2010 there's been an increase in the availability, use and harms associated with methamphetamine in most provinces in Canada, but mainly in the western provinces. Specifically, between 2010 and 2015, the rate per 100,000 people seeking treatment for stimulants in hospital settings increased over 600% in Manitoba, almost 800% in Alberta and almost 500% in British Columbia. During the same time frame rates of those hospitalized for poisonings in Saskatchewan, Alberta and British Columbia doubled. Though these hospitalizations include other stimulants besides methamphetamines, data from other sources lead us to believe they are largely driven by increased harms associated with methamphetamine use.
We feel some unique considerations about methamphetamine are important to mention to the committee. In contrast to people under the influence of opioids or other depressive or sedative drugs, individuals using methamphetamine can be animated and energetic early on and feel increasingly lethargic, dysphoric, depressed and hopeless with intense craving as the drug wears off. This means that people who use methamphetamine can be challenging to treat, and when in public spaces can attract attention from the public or authorities.
In addition to public health concerns about dependence and other harms directly arising from youth, methamphetamine is sold and bought in an unregulated market. Therefore, methamphetamine can contain adulterants and contaminants that can cause health harms. There is evidence from drug-checking programs across the country that there have been samples of methamphetamine testing positive for opioids. This fact is a significant concern as overdoses are more likely among people who do not and are not expecting to use an opioid. It is challenging, however, to know how common this is or why this may be occurring. Many suspect inadvertent cross-contamination.
However, as noted, the data we have at the national level is poor and the data we have at the provincial level is often very different from province to province. As a result, not only is it difficult to accurately assess the harms associated with methamphetamine use in Canada, but it is challenging to know where to target our efforts aimed at reducing these harms.
Finally, it is important to note that methamphetamine use is a very stigmatized behaviour, not only among the general population but among service providers and people who use drugs. This stigma further increases the marginalization experienced by people who use methamphetamine and places additional barriers to those seeking and accessing help.
I'll now turn to Dr. Fandrey to speak about the impact of methamphetamine use at the community level. Sheri is a member of the Canadian Community Epidemiology Network on Drug Use, or CCENDU, led by the CCSA. CCENDU is a nationwide network of community-level partners who share information about local trends and emerging issues in substance use, and exchange knowledge and tools to support more effective interventions in data collection.
One consequence of there being abundant, high-potency and inexpensive methamphetamine widely available in Manitoba is the increased likelihood of those individuals injecting methamphetamine using very large doses. This likelihood increases the potential for challenging behaviours and serious overdose.
Further, powdered cocaine is frequently adulterated with or substituted with powdered methamphetamine. This substitution can lead those who purchase a product, thinking it is cocaine, to use too much, with an increased potential for adverse physical and psychological effects.
Manitoba systems and services struggle to address the harms of methamphetamine on several fronts. Emergency room visits related to methamphetamine have increased in Winnipeg from an average of 10 per month in 2013 to 240 per month by the end of July 2018. Presentation at the emergency room is frequently related to psychiatric symptoms, including paranoia, delusions and aggressive behaviour. These psychiatric symptoms generally result from high doses of methamphetamine and can distract from critical and potentially life-threatening effects on the heart and brain. This complex presentation requires a coordinated response from medical, mental health and social services.
For people who use methamphetamine at a high intensity, intravenous injection is the preferred route of administration, further stressing both medical and harm reduction services. Injection poses risks related to sexually transmitted and blood-borne infections such as hepatitis C, HIV, and bacterial endocarditis.
People who use methamphetamine at a high intensity and who are street involved can be reluctant to engage with medical services due to stigma and the requirement to be abstinent. Not completing the course of treatment reduces its effectiveness and can increase the possibility of treatment resistance with corresponding increases in intensity and the cost of the treatment. Enhancing supportive harm reduction services is critical to increase awareness of risk, reduce harmful practices and engage a reluctant, transient population in accessing further services, including treatment for addiction.
The first two to three weeks after stopping methamphetamine use present a range of challenges including volatile mood, profound depression and excessive need for sleep as well as cognitive and memory deficits. The window of opportunity for someone using methamphetamine to access detox or addiction treatment can be short. Ready access to non-medical detox can be a critical step in the process of recovery, as it allows an individual to withdraw from methamphetamine in a supportive environment, which increases the potential for success.
Increasing the length of detox to provide support to an individual throughout this vulnerable period would enhance the potential success of the next steps in addiction treatment and recovery. Ensuring smooth transitions from detox to treatment or supportive housing is key to success.
Prior or ongoing trauma is common in people who use methamphetamine at a high intensity. In many cases, methamphetamine use is a direct response to experiences of physical and sexual abuse and trauma. Restricting services and resources to those requiring abstinence ignores this reality. All services for this population need to be trauma-informed and must include resources for those who cannot or will not stop using.
Methamphetamine use occurs across a spectrum, from occasional use of snorted powder to daily intravenous injection. While attention and resources must be allocated to those experiencing the greatest harms, effective prevention and early intervention are key to limiting the scope of use and ensuring lower intensity use does not escalate.