I'm looking forward to it.
Mr. Chair, I want to thank you and the committee for so proactively taking up this study so we can deal with it before we adjourn for the summer.
The bottom line is that the the good Samaritan drug overdose act, is intended to save lives. We need to find a way to save precious time and get this bill through the legislative process, and this proactive study is certainly a help in that direction, because we need to start saving lives and preventing the deaths of countless Canadians. I recognize your interest and effort in moving this legislation forward.
This bill is a simple amendment, as you know, to the Controlled Drugs and Substances Act. In order to save lives, we are adding three paragraphs that will have a great impact. It provides an exemption from prosecution for simple possession when a reasonable person believes that emergency medical assistance is required in the event of an overdose. It does not provide protection for offences such as trafficking, or outstanding warrants, or any of a myriad of other possibilities. It's focused simply on possession.
We kept it focused so narrowly because we felt, and continue to feel, that extending it too far and too broadly potentially would make it difficult to pass. Keeping it sweet and simple, we believe, is a recipe for success, besides which, extending the exemptions would require considerably more study and is probably beyond the scope of what a private member's bill should try to accomplish.
At second reading, I spoke of two young men whose lives ended far too early. They died because no one called 911 soon enough. No one called for help for one reason only: they were afraid that they would get into trouble. They were afraid that they would get charged with possession or have to deal with the police, and they were scared. Delay of course in a situation like this means death.
It's a story that is far too common. The largest barrier to calling for help during a drug overdose is fear of criminal prosecution for simple possession. Bill intends to remove that barrier. This bill is intended to make it okay for you to call for help.
Later today, you will hear from the Waterloo Region Crime Prevention Council, whose report factored very heavily in my own presentation earlier. In their 2012 report on the barriers to calling 911, they reported on a study showing that 46% of the respondents, in the absence of a law such as this, would either not call for help or would call and run. That's problematic in a number of ways. Certainly, if they call and run, for example, there's no one left to help the first responders find the person or to inform them of what the problem is that they're trying to deal with. Again, it means delay, and it potentially means death, and that's tragic. That's why we've introduced the the good Samaritan drug overdose act, which is now before this committee.
We have had feedback from law enforcement agencies and first responders who are very, very supportive of the principle of this bill. In fact, Port Moody's chief constable recorded a video, complete with logo, uniform, and all that stuff, in support of this bill. A number of first responders—paramedics, firemen, and so forth—have also signified their support. That support also includes faith-based organizations in the community, which have given similar testimonials, and politicians from all levels of government, including the municipal, school board, provincial, and federal levels.
Governments across Canada have expressed their support. I've received letters supporting this bill from the health ministers of British Columbia, Alberta, Saskatchewan, New Brunswick, and Nova Scotia. Of course, as mentioned earlier in previous speeches, many states in the U.S. have legislation of this kind. At last count, 36 states plus the District of Columbia have similar legislation on the books, and these laws work. In 2010, the State of Washington passed similar legislation. A study in that state reported that 88% of respondents said they would call for help because of the protection in law.
Currently, overdose deaths are happening at alarming rates. For the period of January to May 2015, in British Columbia, we had 176 deaths, and last week, the B.C. Coroners Service said that this year, in the same time period, there were 308 deaths. That's over two a day, on average.
I think I'm out of time, so I'll call an end to it right there.
That's why I'm digging a little bit more here, Ron. I believe the Waterloo people are coming a little bit later and maybe I can ask them this question again.
All of us around the table would agree that people who are going to be calling might be in a situation where they could be impaired themselves with certain drugs or alcohol. Their judgment may not be very good anyway.
What I'm curious to note is...Your proposal does sound good and everybody would like to see what we can do to save lives, but it's also important for this committee to actually take a look at the evidence and to see if there is any evidence to support that people are actually calling more. We would like to see some statistics.
If that New York report that's rumoured to be coming out comes out, that's great, but we're trying to make a decision around the table today and see what evidence is out there today to ensure that.
What we would do, I guess.... Is it okay if I defer those questions? Would you like me to defer those questions until we hear from the Waterloo region people?
I'm going to talk fairly quickly.
My name is Michael Parkinson, and I am with the Waterloo Region Crime Prevention Council. It's my pleasure to provide evidence discerned from our research investigating the barriers to calling 911 during an overdose emergency.
The Crime Prevention Council mandate is to address the root causes of crime, fear of crime, and victimization. We work collaboratively with partners in a variety of fields, including social services, justice, health, enforcement, and so on. We've done that since 1995. We're the Canadian model for crime prevention through social development within Canada and beyond.
We began working on drug-related issues in 2006, knowing there's a relationship between problematic substance use, crime, and victimization. While likely most people will never engage in criminal behaviour because they're using substances, prescription medications, alcohol, or illicit drugs, we know that Canadian prisons are filled with people who have a connection to substance use. Correctional facilities, as you know, are an expensive intervention. They consume half the cost of the Canadian criminal justice system, and they have questionable outcomes for individuals, communities, and taxpayers upon release.
When health and social service systems fail to treat the root causes, the justice system is left to punish the symptoms, and drug-related issues provide a poignant example. We can do better, and indeed we must.
Canada is experiencing the worst drug safety crisis in our nation's history. It's not often reported in the media, but I assure you that is absolutely the case and not just recently either. In the U.S., the Centers for Disease Control and Prevention say that Americans are in the middle of the worst drug epidemic in U.S. history.
For both countries, the substances driving those overdose fatalities to record-setting levels are a class of pain medications called opioids, which are essentially pharmaceutical-grade heroin, and substances of known dependency for more than a century. There's a relationship between opioid sales, overdose deaths, and addiction. Canada holds the dubious distinction of being a global leader in prescription opioid consumption. The U.S. comes in for the silver medal.
In my province of Ontario, a person dies every 14 hours of an opioid-related death. That's a rise of more than 500% since the year 2000. That's more than 6,000 dead Ontarians. Deaths from acute drug toxicity surpassed fatalities on Ontario's roadways five years ago. Now we have what I would call the bootleg opioids, which is a class of high-potency opioids the Waterloo Region Crime Prevention Council first advised about in 2013. They're produced exclusively and distributed exclusively on the black market. They're being detected in substances in a variety of formulations across Canada and the U.S., and they are now responsible for driving overdose fatalities up, even as prescription opioid fatalities plateau.
In Alberta, from 2011 to 2015, the rise in overdose deaths was 4,500%. That's not a typo; it's 4,500%. In British Columbia, overdose deaths in the first five months of this year have risen 75% compared to the same period last year. You've heard they've declared a public health state of emergency for overdoses, but most provinces have no monitoring, and there are no emergency preparedness plans, much less interventions, in place.
Some of the fentanyls, and these are the bootleg fentanyls, are essentially weapons-grade substances. A kilogram of powdered fentanyl...there was a kilogram of powder seized in Quebec City a couple of months ago that contained enough lethal doses to kill every resident in Quebec City, or about half a million lethal doses. Multi-kilogram seizures are no longer unusual in Canada. The profit margins for the black market are absolutely extraordinary.
From research in B.C. we know that most people who tested positive for fentanyl are completely unaware of ingesting it. People who used substances occasionally and daily are at a significantly elevated risk of death. Canada's overdose crisis seems certain to get worse before it gets better. Bill is a key life-saving tool in our nation's first aid kit.
It is always worth remembering that an opioid overdose is a medical emergency, whether the victim was using it as prescribed or not. Opioid overdose victims cannot save themselves. They depend on a witness or a good Samaritan. Seconds do matter. It's the difference between life and death, or between a lifetime of brain injury or not. The best medical advice from the colleges across Canada always includes calling 911 and providing resuscitation to the victim.
In 2008 we provided a first glimpse into the extent and typology of overdoses in the Waterloo region. We combed through hospital data. We combed through coroner's data. One of the significant findings was that more people showed up at hospitals for an overdose than were brought in through 911. That's what we call the “dump and run” strategy. You want to do the right thing, but you're not going to call 911 because of fear of entanglement with the criminal justice system. You do the next best thing you can think of in the moment. You drive to the hospital, dump the victim off, and you split right away.
In 2012 we sought to determine the barriers to calling 911 during an illicit overdose emergency by conducting primary research in an area of southern Ontario that we thought might be representative of Canada in the main. We surveyed 450 people who were using substances or were on a path toward recovery from addiction. Almost 60% had witnessed an opioid overdose emergency. We found that despite the best of intentions, witnesses to an illicit overdose—and most often there's at least one witness—will call 911 and wait with the victim just 46% of the time. In contrast, 911 call rates for cardiac arrest are above 90%. We found that the primary reason for not calling 911 was fear of the police presence. We found that 83% of those surveyed thought they might face criminal charges if 911 was called. We could find no literature suggesting that one could educate people into calling 911.
These findings that 46% of witnesses would call 911 and that fear of the Canadian criminal justice system is the major barrier are consistent with some newer, albeit limited, data from across Canada. They are consistent with findings from across the U.S. and are the primary reason that most states in the U.S. have a good Samaritan law.
Thank you. My name is Donald MacPherson. I am a board member of the Pivot Legal Society. I am also, I have to confess, the director of the Canadian Drug Policy Coalition, and Pivot is one of our coalition members. I'll try not to repeat many of the statistics that have been thrown around here.
Canada is in the grips of an overdose epidemic; there's no doubt about it. One simply has to look at the numbers that Michael just told you. B.C. has indeed declared a public health emergency; other jurisdictions might consider doing the same. At a time like this, we need all hands on deck across institutional contexts, political parties, and the broader community. These deaths are preventable with timely intervention. We know that.
We know that naloxone has reversed thousands of overdose deaths since the epidemic in B.C. in the early 1990s. We know that no one has ever died on a supervised consumption site from an overdose even though many non-fatal overdoses take place in these facilities.
We know that psychosocial treatment and substitution treatments such as methadone, buprenorphine, hydromorphone, and heroin-assisted treatment can be successful in assisting people with substance use disorders. All of these interventions need to be scaled up in Canada as part of a comprehensive response to overdose deaths.
This brings us to Bill , the good Samaritan drug overdose act. We see good Samaritan legislation as one component of a comprehensive public health approach to overdose that fits within a harm reduction paradigm.
Harm reduction is part of a spectrum of non-judgmental strategies aimed at reducing the harms related to drug use and connecting individuals with health and social services that they might not otherwise access. Harm reduction also places a priority on the protection of human life and strives to improve health and safety in our communities for everyone.
Most overdoses occur in the presence of other people. The chance of surviving an overdose, like that of surviving a heart attack, is almost entirely dependent on how fast one receives emergency medical help.
Michael covered some of the other data on the Waterloo-Wellington overdose response survey. I won't repeat that. However, I will add that the survey found that in over half of overdose cases, 911 was not called or the respondents did not know if it was called. In addition, recent amendments to the Controlled Drugs and Substances Act which stipulate mandatory prison sentences for some drug-related offences will unquestionably intensify fear of prosecution for witnesses of drug overdose and increase rates of preventable overdose deaths.
The good Samaritan legislation in the U.S. has parallelled efforts to improve layperson access to naloxone. The United States have scaled up since 2007, as you have heard. Good Samaritan laws complement the tremendous efforts taking place within health authorities, provincial governments, and the community to maximize the availability of naloxone, a life-saving drug which when administered to a person suffering an opioid overdose immediately reverses the overdose.
Overdose response at this level, which is perilously close to the end of life, must involve a two-pronged approach: having naloxone available and getting it to the overdose victim in a timely fashion. Seconds matter.
Good Samaritan legislation can be enhanced by operational policies within local police departments that address attendance at overdose situations. The Vancouver Police Department has an explicit policy of non-attendance at routine overdose calls. The VPD policy document reads, “There is little value in police attendance at a routine, non-fatal overdose. It would be a rare circumstance for criminal charges to arise from attendance at a routine overdose call”.
Policy should tend to restrict police attendance to overdose calls only in the event that there is specific need for public safety. Restricting police attendance at routine overdose events would support the intent of Bill .
We would also add that we would encourage the government to look at the broader context and explore the idea of decriminalization of all drugs, such as has been implemented in some jurisdictions and is being contemplated in others in order to better focus our response to overdoses with health responses rather than with criminal justice ones. That's a discussion for another day.
The Pivot Legal Society is supportive of the direction of Bill . The benefits of this bill include a strong signal from political leaders that the protection of life is a priority in these situations and that the imperative to call for help trumps the fact that criminalized drugs may be a part of the context of the call for help.
We don't think the legislation goes far enough and it could be improved.
We would like clarification of the language of the bill, similar to a previous statement. It wasn't clear to us that the actual person overdosing was protected under this bill.
Another shortcoming that we see is that the bill covers only possession, and not possession for the purpose of trafficking, which is quite a broad provision and would include people sharing drugs, which is common since drug use is often a social activity.
We are concerned that the immunity provided by the bill is not broad enough to maximize the chances that a call would be made in a timely fashion.
We also believe it would be in keeping with the spirit of the bill to ensure that people who have outstanding warrants, particularly for non-violent crimes, don't hesitate to make a call that could save a life, and they should be covered under the immunity provided by the bill.
Okay. Don't cut me off.
Voices: Oh, oh!
Ms. Christine Padaric: My name is Christine Padaric and I live in Heidelberg, Ontario.
I'm honoured to be invited to speak to you today and share my story of loss in an effort to save people from going through a similar experience.
We're all aware that drug usage is rampant in our country and shows no signs of slowing down. With the introduction of bootleg fentanyl, it will only result in more deaths.
Passing would help make strides towards improving the relationship between citizens and police. I know that it would save lives.
On April 12, 2013, my sweet, funny, affectionate, handsome, stubborn, athletic, pot-smoking, 17-year-old son died. He died from a pointless, unnecessary prescription overdose, which I've since learned is the leading cause of accidental death in North America. If this tragedy can happen to me and my family, it can truly happen to anyone.
The night my son overdosed, it was witnessed by a group of six individuals in their twenties. They watched him exhibit every symptom of overdose and did not do anything. That is how deeply ingrained the fear of legal involvement is when drug use is concerned.
Briefly, this is an account of the events that happened the night of April 5, 2013, from witness statements.
Austin was administered a lethal dose of morphine in the early hours by a drug dealer who crushed and held morphine to my son's nose and demanded that he snort. My son was already high from a previous tablet and so obeyed. Around 3 a.m., Austin went into medical distress. Everyone was aware of this. The six young adults discussed the situation. They put him in a tub of cold water. They talked about calling 911. However, the dealer, who was also the owner of the apartment, wanted no part of that. The dealer threatened the lives of others if anyone called 911 and because of the dealer's perceived authority, others were intimidated and feared reprisal from the dealer himself.
As well, the young people did not fully understand the signs and symptoms of an overdose or even what it means to be overdosing. They had allowed themselves to be manipulated by the drug dealer, and rolled Austin on his side on the couch in the hopes that he would sleep it off. The six individuals all slept in this one bedroom apartment that night, right next to Austin.
When the first person woke up at 7:30 a.m., she described him as looking dead. Panic ensued. The cowardly drug dealer fled his own apartment. At that point the others called 911. EMS worked on Austin for about 30 minutes, shocking him repeatedly, trying to get a heartbeat. He eventually succumbed to his injuries six days later in hospital and peacefully died with his family surrounding him.
On a positive note, Austin was able to save five adult males from terminal illness due to organ donation.
Today my mission is to shed light on the devastating reality of abuse of prescription drug use, which is rampant in our country, and find solutions to overcome this problem and save lives. I facilitate a chapter of GRASP, which stands for Grief Recovery After a Substance Passing. It's a peer support group to help others recover after the loss of a loved one due to substance abuse. Regretfully, four of the five regular attendees in our Waterloo chapter all lost sons under circumstances where a call to 911 would likely have resulted in a life saved.
I've created an organization called SKATE For Austin. SKATE stands for Save Kids Abusing Thru Education. I use SKATE as the acronym because of Austin's love for hockey and skateboarding. Under this organization, along with assistance from Region of Waterloo Public Health, I teach an overdose awareness class to high school students. I will teach it to service groups. I'll teach it to anyone who will actually listen.
I believe drugs are part of our society today and we need to equip our young people with the knowledge to make informed decisions and to recognize an overdose if they witness one. The steps are basic: quiet stimulation to determine if the person can be aroused; call 911; perform rescue breathing and/or administer naloxone, if available; put the person in the rescue position until help arrives.
I've done my own informal study during these training sessions with the students and I've learned that girls are far more likely than boys to call 911. I've also been told on two separate occasions that teens were at a party where someone went into distress. In one case 911 was called, and in the other case the individual did regain consciousness. Both individuals who approached me said that everyone is more careful in Elmira.
Elmira, Ontario, is the town where my son died, and also where he went to high school. Everyone in Elmira is much more careful at parties today since Austin's death, and the revelation that he did not have to die.
I am also a member of a number of harm reduction committees with the Region of Waterloo. I've created an overdose map of Canada online where I post details of those lost to overdose to show visually the crisis we are in.
I strongly support Mr. McKinnon's proposed bill, Bill . It's one more step we can take toward harm reduction in our country. Because people fear being arrested, risking parole, being charged with drug possession, having their parents notified of their actions, etc., a lot of work will be required to educate the public if this bill is passed. It will take time for law enforcement to gain trust. I was told by doctors that in all likelihood, my son Austin would be alive and well today had one of the six people present that night called 911 at the first sign of distress instead of allowing Austin to suffer for seven long hours.
I'm speaking on behalf of all parents when I say I do not want to see anyone lose their child because someone else was afraid to call 911.
Thank you for allowing me to speak.
Today would be the second best time to undertake that kind of endeavour. Christine is an exception in Canada in that she has talked about losing her son, Austin.
There are 6,000 victims in Ontario in a 15-year period, and 99% of them are not speaking out. The work that Christine and others have done in Elmira to provide that education in collaboration with public health really makes a difference. It makes it okay to talk about this.
To answer your question, yes, absolutely.
I've met too many parents who thought they'd just let their daughter sleep it off, or a wife who thought her husband was just really tired: he's snoring; she'll just let him sleep it off. The next time they check on their family member, they're dead or in deep distress.
I'm aware of a small study out of Massachusetts, and it was a hospital-based overdose prevention intervention program. People who went through it were informed about the good Samaritan law in Massachusetts, and the call rates jumped close to 90% from 41% upon entering this kind of program. That's a small survey.
To your point about putting officers at risk or people getting off scot-free, I think Christine's example is one of tens of thousands across Canada that lives would be saved. If there's something more important than saving lives of Canadians, then I think communities across Canada would like to know what that is.
When we did our report in the Waterloo region, we convened, as we always do, a multi-sectoral table. Senior management from all first responders were there. The medical community was there. Community services and social services were there. What we learned in those discussions was that police want to attend in an overdose emergency. There may be evidence; it may be things go wrong, but their first priority is the preservation of life, and I absolutely believe that to be true.
But we have situations in Ontario, in Nova Scotia and so on where people do get charged with possession, and that sometimes includes the victim. It has a chilling effect.
One story out of Halton spread through Ontario within two weeks. Everybody knew about it. So I think at the end of the day, you're on the right side of history to pass Bill .
I really want to re-emphasize the need for education. In Austin's situation, just going back to that, the drug dealer in that case was charged with manslaughter. None of the witnesses was charged.
In the teaching I do within high schools to students who are ages 15 to 17, we talk about the signs and symptoms of overdose so that they're aware and they understand what's actually happening. Then I bring in 911 as being one of the steps to follow, and we talk about that.
I really believe that it helps for people to have a plan in place before they're put into that type of extremely stressful situation. We talk about what they would do in that circumstance. What I find the kids are doing is they're brainstorming with each other, and they're coming up with solutions, like they would leave the apartment and call, or they would go into the washroom and make the phone call. They're brainstorming ways to do it anonymously to get around that issue.
We have to keep in mind, too, that yes, there are a lot of drug dealers out there. But there are a lot of kids just at simple house parties where pills are present. So to come out with a trafficking charge.... I have no idea what percentage of deaths occur in that type of environment. Austin, yes, he was in a drug dealer's apartment, and it was filled with drugs. Again, a lot of these emergencies have been just outside in a park or in someone's parents' basement.
I don't believe that circumstance is common around the country. Vancouver's Downtown Eastside is unique. It's one of the poorest postal codes in the entire country. It has a high percentage of drug users.
Insite has operated there for the last 12 years, and very successfully. They've had many, many drug overdoses on their premises with zero loss of life. That's another arrow in this harm reduction quiver. The police in the area are very supportive of efforts of this kind. These are not problems that are really solvable by police action. These are public health issues, and we have to start thinking about them as public health issues.
I'd like to comment further that certainly this bill could have been broader, but we were looking for something that we could achieve with a very strong consensus. I know that one of the most common charges is possession for the purposes of trafficking. I'd love to see that in there, but if we put that in there, I'm not sure we would have the continued support of the government. Right now we have support from everybody throughout the House, pretty much, as far as I can tell.
It's a very strong first step.
First of all, I'd like to address my sympathy to you, Madam Padaric. I'm very touched by your testimony. If we can do something through this bill to improve this for some generations ahead, that would be great.
I would like to ask a more technical question about the legal aspect, but I don't know whether Mr. Saint-Denis could answer it.
I don't want to make any waves, but subsection 4.1(1) talks about “a physiological event induced by the introduction of a controlled substance...”. It is implied that the individual introduced the substance into their own body or that they agreed to have that substance introduced by someone else.
I can't really know how it happens, since I don't have those kinds of experiences, but I assume that, at injection sites or crack houses, people help each other inject illegal drugs into their bodies. The Criminal Code could apply in some cases. In fact, this bill's intention is to save lives. However, as we know, no bill is perfect, but there may be a shortcoming in this area.
Am I wrong to bring up this aspect?
I have a couple of things.
Number one, to refer to your comment here, I asked Mr. McKinnon outright whether or not first responders were asked, and he said no. I don't need to consult his website; I heard it from his mouth tonight.
Mr. Kang, your argument is weak, with all due respect, when you say where are we going to stop. You're saying we're going to throw our commitment to evidence-based decisions out the window because it might take too long or because we can't define where to start and stop.
I don't think that's good policy-making. At the end of the day, this committee was put in place to assess, among other things, bills that are put forward that have to do with health. That's part of our responsibility at this committee: to do due process. We need to hear from experts in this field, and in this case part of that would be front-line workers.
I just want to go with what my colleague, Madam Harder, said. I believe that there's support for an initiative in this regard. We heard around the table that this approach could save lives. I was asking very specifically if there was any evidence out there. None of them could say. Dr. Eyolfson said that just because there's no evidence to say that it's not working does that mean that it won't be working.
We're talking about evidence-based decisions, and your government has been very strong on evidence-based decisions. As Madam Harder rightly said, the people on the ground weren't even consulted on this bill. The mover of the bill said, you know, they were looking for something; he wanted to get something put in, and he did. He worked with a couple of stakeholders. The people from Justice said that there were significant issues with the bill. If it were a government bill, they would have drafted it differently.
You guys are in government now. We're in opposition. Our role is to oppose. If we're going to be putting this bill forward, because the House wants something along these lines, because there is a crisis and there's a problem in certain parts of the country, at least let us do our due diligence. There doesn't appear to be evidence, or at least what I would call evidence, in front of this committee that would guide us to say that, yes, this really is a good idea. We're kind of taking a bit of a chance here.