“One or two hits of meth will last you hours and hours and keep you up for days. With opioids, you can totally predict what the course of treatment is going to be. We can totally handle anyone going through opioid withdrawal. With meth, in the blink of an eye it switches.”
Madame Chair and committee members, thank you for inviting me here today. What I just read to you was a quote from a registered psychiatric nurse at Health Sciences Centre, the largest health care facility west of Toronto and east of Calgary. This facility is at the forefront of managing the crisis.
I wanted to begin with it because it addresses one of the unique challenges that nurses face in treating users of methamphetamine and why addressing it will require some unique policy changes.
Nurses know that the rapid increase in meth consumption has reached crisis levels in Manitoba. The impacts are ravaging many of our communities and putting significant strain on our health care system. It's time for the federal government to show leadership on this critical public health issue. I hope that some of the information I will provide today will help you make an informed decision towards action.
Let me begin by addressing the impacts on our emergency departments and mental health units. Unfortunately, emergency departments are often the only place that methamphetamine users can access treatment. Some arrive in distress, escorted by police and gripped by a drug that can change their behaviour at any moment. Others present freely, and while they can appear calm at the outset, erratic and violent behaviour can emerge in an instant. This is not only a danger to the patient. It's also a danger to the nurses, doctors and health care providers who provide care. It is also a danger to other patients in the facility, many of whom also need emergency care. They are forced to wait longer as resources are dedicated to patients suffering from meth-related psychosis and other symptoms. In Manitoba, we lack consistent security standards at our urban and rural facilities. Although ERs in Winnipeg hospitals have security guards, training and presence varies between facilities.
Health Sciences Centre has the strongest security presence, but the nurses there will tell you that security are often overwhelmed and have been told not to intervene by management. Rural facilities are left especially vulnerable. In Portage la Prairie, Virden, Thompson and many other communities, nurses are reporting a large increase in the number of meth-related presentations. These facilities typically have no security. Nurses are directed to call the RCMP, who are also stretched thin and are often unable to respond as quickly as they are needed. Too often we hear stories of nurses who have been punched, kicked and spit on, and the meth crisis has made this situation worse.
One nurse described intervening when a patient began choking a clerk who was simply there to restock supplies. The injury that the nurse suffered as a result limited her to light duties for the next several months. A nurse from Brandon told us, “I've had a patient take their IV out of their arm and try and stab me with it. We've found knives on people. We have had people destroy our rooms.... I did emergency medicine for eight years and the last three years we saw an increase in meth, and in the last year it's just exploded.”
At HSC, nurses report seeing four to five patients per shift with meth-related issues. They used to see that many per month. Data released by the Winnipeg Regional Health Authority proves what nurses are telling us. Since 2013, there has been a 1,200% increase in the number of patients presenting to the ER under the influence of methamphetamine. The increase puts real pressure on nurses and other health care professionals. Often these patients require multiple people to observe or restrain them. One nurse told us that they've had to order more restraint supplies, that it takes a whole team of people—doctors, nurses, health care aides—and that all of the other patients are usually scared, too, which adds to the problem.
We know that the emergency departments are overcrowded. For some nurses, this crisis is pushing them to the breaking point and forcing them to think of leaving the profession or leaving units, such as emergency departments, that are increasingly focused on dealing with the drug. Chaotic environments often predicate violent incidences. The meth crisis has amplified this issue for nurses, but there are broader factors to consider as well.
I applaud the health committee for launching a study into security and violence against health care workers, and particularly Dr. Eyolfson from Winnipeg for championing this issue. This study is an important step forward, which I hope will lead to federal investment in security services at health facilities.
The meth issue goes much further than our emergency departments. Infection control is a concern. Addiction often hinders patients from getting treatment before the problem becomes acute. We know that many users inject the drug intravenously, which can lead to infections in their heart valves that require surgery.
I tell you these stories with reservation. We must not allow these patients to be stereotyped or stigmatized. They are suffering from a terrible illness. As nurses, we want our patients to get the care they need, first and foremost.
We see broader social factors at play, as well. One nurse described the struggle by saying that there aren't enough recovery programs out there. She said that 95% of patients who come in with a meth-related complaint are observed until they're capable of walking out the door and then discharged. For these nurses and for all of us, it's heartbreaking that we can't provide more care for these people.
Public housing and poverty reduction must be part of the solution to this crisis. The province has stalled on building more social housing units. The federal government's support and leadership on this file is desperately needed.
Meth is impacting all communities, and users are presenting from all walks of life. A public health nurse who works in our wealthier suburban communities, such as River East and Transcona, told me that she has seen a dramatic rise in meth use. A nurse in Portage la Prairie told me, “It's all races, all ages. Even the people that you least suspect who drive the fanciest vehicles, who have the best jobs, they are even trying it. It's a problem.”
Some users don't realize what they're taking. Recently a group of nurses doing harm reduction by testing drugs at parties reported that they hadn't seen a positive cocaine test since the summer. People thought they were taking cocaine, but 90% of it was actually meth.
What's the solution?
Harm reduction is a critical part. Ensuring access to clean needles is important. We need to ensure access beyond business hours. Safe injection sites can also reduce the risk of infection.
We also need treatment spaces for those suffering from addiction. The Manitoba Nurses Union is a strong supporter of the Bruce Oake recovery centre, which is a long-term treatment centre being established in west Winnipeg. At our last annual general meeting, we raised $30,000 for the centre. However, even Scott and Anne Oake will tell you that this centre won't be enough to meet demand. They are a private foundation inherently dealing with limited resources.
That's why we need the federal government to step up its support to combat this crisis. We need the resources to respond. Reducing the health transfer payments from 6% to 3% was a serious mistake. Targeted mental health funding is welcome, but the current level is simply inadequate and the situation is getting worse.
In Manitoba, our addiction and health care programs and mental health programs are overwhelmed with demand. Emergency departments and addiction programs need more support to deal with the unique challenge of meth use.
Nurses have suggested dedicated facilities and programs for users of meth. Patients need a place where they will be safe when coming off the drug, and then they need access to a recovery program.
Finally, we do need federal support for security. We need dedicated, adequately trained personnel in our cities' hospitals and enhanced services rurally. Patients and their caregivers need to be kept safe, so that we can focus on treatment. Unfortunately, the longer we wait, the higher the risk that one of these violent situations will result in a more serious injury than what we've seen.
In Manitoba, the provincial government is imposing significant health cuts, including the closure of three emergency rooms in Winnipeg. To date, they have failed to offer a significant response to this crisis.
In contrast, there is an opportunity for the federal government to take leadership by offering real support and resources earmarked for addictions, mental health and security.
Thank you. I am pleased to answer any question the committee may have.
Good morning, ladies and gentlemen. On behalf of Bear Clan Patrol Inc., and our board of directors, thank you for welcoming our voice into your house.
Bear Clan Patrol is a community-based, volunteer-driven safety patrol. Our mandate is to protect and empower the women, children, elderly and vulnerable members of our community. We do this non-violently, without judgment, and in harmony with the communities we serve.
This second coming of Bear Clan Patrol began in September 2014 in the wake of the death of Tina Fontaine, a young girl that was exploited and murdered while in the care of Manitoba's child welfare system. Our goal at the time was to interrupt the patterns of exploitation in our community to ensure that what happened to Tina would not happen to anyone else ever again.
Our role in the community has evolved, however, to include many new ways to support our community. Today's Bear Clan Patrol is active five and six nights a week doing 11 and 12 patrols per week respectively. We are active in three distinct inner-city communities in Winnipeg, and our footprint keeps growing.
Our model has been shared with communities locally, nationally and internationally. Our volunteer base has grown from 12 volunteers in 2014 to nearly 1,500 Winnipeg-based volunteers today.
So far this year, we have provided more than 30,000 hours of service to Winnipeg's inner city. We act as mentor, first responder, janitor and liaison between the community and service providers. We bring a sense of belonging and connectedness to our community members, and moreover, we provide an opportunity for our marginalized community members to step out of that role into the role of stakeholder. Amazing things can be accomplished by people with purpose, and we try to provide that purpose.
We have seen many positive outcomes as a result of our efforts, but in spite of our best efforts, we still feel the pain of loss. Even within our own ranks in the month of August of this year, we lost two of our own. Not strangers, not casual acquaintances, but two of our own Bear Clan family members were lost to addiction and overdose. Methamphetamine did play a role in both of those tragedies.
On the subject of meth abuse in Canada, I have travelled extensively in Manitoba, and to a few locations nationally. I have seen first-hand the increased rates of consumption, the increase in the level of destruction, and havoc wreaked in the lives of all of our community members. There is not one person I know that is untouched by this epidemic. The effects are being felt outside of the inner city these days, and without appropriate supports, it's only going to get worse.
In our travels through the streets of Winnipeg this year, we have recovered approximately 40,000 used syringes. We have seen a tenfold increase in the recovery of needles, year on year since our inception in 2015, from 18 syringes in 2015 to 40,000 in 2018.
We deal on a daily basis with community members in the throes of addiction, people experiencing meth psychosis, and an increase in violent crime and property crime. We're daily seeing more vulnerable people, and supports are just not keeping up.
There have been some new resources made available in Manitoba with the recent opening of rapid access addiction medicine, or RAAM, clinics. This started up at the end of August of this year. These clinics provide services to addicts on a walk-in basis, which is good, and we have referred many community members already. The only problem is that they operate two hours a day, five days a week. Given the scope and urgency surrounding the meth epidemic and the simultaneous opioid crisis that our communities are facing, those hours are terribly underwhelming.
Our patrols are conducted in the evening after most service providers are gone home for the day. When we come across people in crisis, there are very few options for us to offer. Typically, police or ambulance do a wellness check. Our main street project provides only the most basic services, essentially three hots and a cot. Even there, community members experiencing meth psychosis are not welcome because of the associated violence.
There are many things we need in our communities if we're going to make it through this epidemic. We need reliable access to resources in a timely fashion. Community development is not done nine to five, Monday to Friday. There needs to be a greater commitment. We need mental health supports to be more readily available. We need greater access to emergency shelters space. We need access to more affordable housing.
A community constantly existing in crisis mode is a community prone to all sorts of social abuses. I'm sure it's no surprise when I tell you that the biggest issue we keep coming up against is the blinding poverty that affects us and so many other communities around the nation. The poverty and disconnectedness in our community triggers addiction in our community members. That addiction feeds the random violence, feeds the rampant poverty, property crime, and it self-perpetuates: street, hospital, prison, repeat.
Safe consumption sites, needle exchange programs, 12-step programs, treatment opportunities, these are all good things, but if you're hungry or you woke up on a friend's couch that's another challenge. If you can't afford transportation to and from programming, job interviews, doctors' appointments, and even banks and shopping centres, these are beyond the reach of many of our community members.
If those underlying issues related to poverty are not addressed, there will be no meaningful progress. If poverty alleviation is not part of whatever strategy we employ, we are not going to get anywhere.
For the record, it is easier to get bongs and crack pipes in my community than it is to get good and healthy food, and by that I mean we have two chain stores in our community that sell produce and wholesome foods, but we have two dozen stores or more that sell bongs and pipes in our community. The store at the corner of my street even sells the Brillo piece by piece to feed that. This is a problem.
For our part, we have begun to collect and distribute produce and baked goods directly to community members. Last year we did 21 tonnes. This year we've done 55 tonnes so far, and I fully expect we'll deliver 60 tonnes by the end of the year. Last year we provided $35,000 in temporary work placements through our volunteer base. This year we did more like $90,000 in temporary work placements. We're very proud of these stats but, sadly, we're only scratching the surface. The need in our communities far outweighs our capacity to provide currently. It's time to change the way we value people. It's time for us to start working together in a much more meaningful and collaborative way. There needs to be a real shift in our thinking and it needs to happen now.
Thank you, Madam Chair.
Thank you for having me here today.
I want to start with a personal story about going to California in the nineties to work and living with a bunch of young people. Lots of people went to school. Everybody had jobs in the sports, entertainment and music industries, and everybody was using meth and speed in order to get through school and the pressures of working all the time.
I think what had happened was that it just became so common and so easy. Now all across the States people are using crystal meth, and it actually just recently came here. It's actually quite easy to access in the schools, as well, these days. My son's in school, and he says drugs are just so easy for young people to get access to that it's incredible. Also, it's not surprising that if young people are using drugs, they would use them later on in life.
I'm the executive director of the Overdose Prevention Society, located in the Downtown Eastside of Vancouver. Our facility includes an outdoor smoking area that seats 13 people, and it's one of only two in Canada. We also have an indoor area that seats 13 people, which is an injection area. We see up to about 700 people a day at our site.
We're located in one of the two alleys that are most used by drug users in Canada. It's one of the busiest sites. It's on par with InSite right now.
At our site, no one's ever died. Around half of our participants use crystal meth now. Many use it in conjunction with heroin and fentanyl, including speedballs, which are both at the same time.
The reason people use crystal meth is that obviously it takes away some of the pain and suffering, but it's cheap and lasts longer than most other drugs. In the Downtown Eastside, many of the drug users are most regularly using what's cheapest and easiest to attain, and crystal meth is definitely one of those.
People who use stimulant drugs like meth and cocaine are also at risk of overdose from fentanyl and other contaminants. Safe supply means pharmaceutical-grade stimulants that are easily accessible to people. Therefore, getting people safe access to drugs that include crystal meth would probably be one of the better things you could do just in terms of a stimulant that's not going to be contaminated with everything under the sun. A lot of the behaviours and illnesses people are experiencing are from the contamination.
They use laundry detergent and pig dewormer. There's fentanyl in the crystal meth. There's everything you could possibly imagine, and we have no idea how some of these affect behaviour or even people's livers. The long-term health effects of that are just incredible.
It's really in the Downtown Eastside, especially, that everything's made out of garbage. Anything you can imagine is in there, and it's really quite horrible. We know that, because we test the drugs. We do testing of drugs and we can test up to, I think, 100,000 different things, so we can see that they're highly contaminated.
We see people who have been awake for days quite frequently. This can lead to psychosis, paranoia, violence, hallucinations and hospitalization. Unfortunately, hospitals don't have the capacity to deal with this.
The other night we brought in a woman who's homeless and who uses our site frequently. She also volunteers with us. She uses a combination of drugs. It took one of our volunteers four hours waiting at the hospital for her to get in, and she was released immediately untreated and came back to us. I've been down there working for 12 years, so I'm capable of helping people in these situations, but it's really challenging.
It's really difficult that the hospital system can't accommodate it. It's just overwhelmed with other situations, including the overdose crisis in general.
Recommendations to improve health outcomes for drug users would be safe alternative prescriptions with known potency and ingredients, safe harm reduction supplies, safe smoking sites... People are turning to shooting drugs because there's no place to be seen safely using smoked drugs, so they're injecting them or just learning to inject them. It's really important that we give people a safe smoking area, which in B.C.... Actually in Edmonton they have a state-of-the-art facility, which I don't think is necessary. You can have some of these as really basic pop-up services in the crisis that can help people immediately and are not that high a cost.
The truth is that the high cost is to continue on with these crises the way that they are, criminalizing people and having people do crime and survival sex trade, women putting themselves at risk. That's going to be the high cost for Canada in the long term. Really what is needed is to do the right thing by giving people safe places to use, treated by professionals, safe access to drugs that won't harm them or cause damage to them. It will reduce crime, all these things that I think would be really important.
Rehabilitation includes a safe supply and detox that includes safe drug alternatives, getting people onto something that's not going to hurt them long term. There are a lot of people who we see who have mental and physical health conditions, permanent conditions that are really painful, like terminal cancer, who may need something for the rest of their life. They're self-medicating with things that are going to hurt them and actually make things worse for them. We really need to figure out how to help these folks. There are a lot of simple ways of doing it.
Thank you, and we'd like to thank the committee for the invitation.
My name is Vaughan Dowie. I'm the CEO of Pine River Institute. I'm here with my colleague Dr. Victoria Creighton, who is our Clinical Director.
We thought that the best contribution we could make to the committee's deliberations is to talk to you about the importance of adolescent treatment services, particularly residential treatment for youth in need of service for addictive behaviours. To provide you with context, let me tell you a bit about Pine River Institute.
Pine River Institute is a residential treatment program for adolescents with addictive behaviours and, frequently, other mental health concerns. We serve a population of adolescents between the ages of 13 and 19. We are mandated to accept both girls and boys from across Ontario. Our main campus is located just outside of Shelburne, Ontario, about 100 kilometres northwest of Toronto. We operate 36 beds, 29 of which are funded by the Ontario Ministry of Health and Long-Term Care. For those 29 beds, we have a wait-list of more than 200 youths.
Our program is unique in Canada. All our students begin with the wilderness phase of the program, either in Muskoka or Haliburton, depending on the time of year. We're now in the Haliburton time of year. They then move to our campus. After a time there, they spend increasing amounts of time back in their home communities to practise what they learned in the program.
After transition from the residential program, we offer aftercare support. Our program works not only with the youth. Family involvement in the program is a requirement of admission. We require our families to be engaged in the program through workshops, retreats and regular parent groups over and above the work they will do with their child.
Pine River is involved in ongoing research. In particular, since our inception 12 years ago, we've invested in ongoing outcome research. We track a number of indicators, particularly those involved with substance use, school or workplace engagement, contact with the legal system, hospitalizations and other crisis indicators such as running away. We track these indicators pre-admission and after discharge and every year thereafter until the youth turns 25 to measure whether the change that takes place is maintained. We publish these results annually as a way to inform our funders, potential clients and other stakeholders of our outcomes. I have brought a few copies of the most recent report with me if anybody would like a copy.
Pine River's clinical philosophy centres on trying to increase the maturity of the youth who we see. We believe that the youth in the program have delays in maturity. This can be caused by trauma or other obstacles. We define maturity to include a future orientation; a social ethic; emotional regulation; the ability to be autonomous and not be part of a puppet relationship, either as a puppet or as a puppeteer; empathy; plus, a lack of narcissism. Often these elements are also described in some literature as part of “healthy emotional intelligence”.
The Pine River program has a variable length of stay. By that, I mean that unlike other programs in the sector with a fixed time for treatment—21 days, 90 days, four months, whatever—we allow our students to complete the treatment at their own pace. Our average length of stay is about 14 months.
As for substance use, the majority of our students are polysubstance users. They will use whatever is available. We do ask about the drug of choice. The number one drug of choice is cannabis, but of interest to this committee for the purposes of this hearing, we ask parents prior to admission what substances the youth is using, and the results for methamphetamine were the following.
In 2015, 2% of our parents reported meth use for their child. In 2016, again it was 2%. In 2017, it was 5%, and in 2018, it was 16%. Contrast that to our students' self-report of what they are actually using: in 2015, it was 18% for meth use; in 2016, 53% reported meth use; in 2017, the number was 22%; and, so far this year, we're at 16%.
We take from that a couple of conclusions. First, generally speaking, the use of methamphetamine has been much greater than suspected, even by parents who are really concerned about the behaviour or the habits of their kid. Second, while the numbers seem to fluctuate with our clientele, it's a significant factor in the drugs they choose to use.
As the committee tries to integrate the various perspectives regarding the issues that arise out of methamphetamine use in Canada, here are the take-aways we'd like to leave with the committee.
One, it is imperative to invest in services for young people in order to address the underlying issues as soon as possible. Not only is it the right thing to do, but it makes good economic sense.
We work with the DeGroote School of Business at McMaster University to look at the social return on the investment made in the youth in our program as a result of government funding. The answer was somewhere between seven and 10 times return on investment. I've also brought copies of that report if anybody would like to have it.
There needs to be a significant expansion of accredited residential resources aimed at youth. Our waiting list of over 200 speaks eloquently about the lack of quality resources for youth in this age group. Very often, governments hesitate to invest in residential programs because it's the most expensive end of the continuum, but working with youth who are abusing substances is so important because, as time goes on, the problems become more ingrained, thereby making change in their lives and brains more difficult. This approach is as important—if not more so—for methamphetamine as for any other substance.
Public education should always be a component of any substance use approach and should provide real and believable information about the impact of the substance to young people. Otherwise, we rely on word of mouth and bad information that often minimizes potential harms.
We commend the committee for its interest in this important subject. The complexities of the issues that are linked to meth use and abuse require a multi-faceted response. Within that response, we ask the committee to remember the need for effective youth treatment services as part of our national approach.
Thank you, Madam Chair.
Thank you all for being here. I can tell that your front-line experience dealing with the full gamut of substance use and addiction is powerful and something that this committee really needs.
I'm going to do something a little bit different.
You have all answered all the questions I had by describing very accurately what the roots of the problems are, so I'm going to pick up on something that was said. I think Ms. Blyth said the words “doing something we haven't done”, and someone else mentioned that we need a fundamental policy shift.
Here are the answers I heard you give that I was going to ask, but it's redundant now.
I heard that there is widespread contamination of drug supply across this country. I have numbers and figures. It was 39% of the drugs tested recently in British Columbia that were not at all what the person purchasing the drugs thought they were. I heard Ms. Jackson say that cocaine is actually meth, so we know there's widespread contamination.
We know that there is—let's just call it what it is—grossly inadequate access to timely treatment in this country across the board, every modality, every population, from indigenous people to women to young people. Whether you're dealing with alcohol all the way to heroin, people can't get access when they need it. If there's one thing we know about addiction, it's that when a person is ready to seek treatment—if they are ever ready to seek treatment—you have to get them in now or it's a death sentence.
I think, Mr. Favel, you described this endless cycle, this 19th-century approach to drug use and addiction, treating it as a criminal issue as opposed to a health issue.
I'm going to get right to what I think are some of the foundational solutions and get your opinion on this.
To each one of you, isn't it time that we stop treating drug use and addiction as a criminal issue and start dealing with it as a health issue?