Mr. Chair, as most of us remember here, the motion that I put on the table last meeting read:
|| That, pursuant to Standing Order 108(2), the Committee undertake an immediate study of the current restrictions imposed on men who have sex with men (MSM) when it comes to the donation of blood to determine if the current five year ban is scientifically supported, or to determine if this restriction can either be reduced or eliminated while maintaining a safe blood supply system.
I've spoken to a number of you since then, and I hope that I have that support. There is an amendment that has to be made to this. However, because of some changes that the government has done since then, they've brought that five-year ban down to one year, which was a positive move.
However, there is still an issue with that one year. I would like to see a study done to determine whether that one year is unreasonable. Is it something that should stay current or do we take that one-year ban out altogether? I know that Rachael would propose that amendment.
Maybe I could get you to read that out, Rachael.
Good morning, Mr. Chairman. I'd like to welcome all committee members back from the summer.
I think it's an excellent motion that is certainly worthy of support. The New Democrats have also gone on record as saying that we don't see a scientific basis for the ban on blood donations from men who have sex with men. It should be a science-based decision.
The only issue I have though is the timing of this motion. I'm wondering if Mr. Webber could elaborate on the time sensitivity of this study.
We are in the middle of a pharmacare study. We had a work plan that was circulated a while back that appears to me to really chew up most of our time for the fall. We have other motions that are very important that are in the docket including studying home care, aboriginal health, microbial resistance, and others.
They're all important, and Mr. Webber's motion is very important and worthy of study, but I'm wondering if he could tell us if he sees any particular time sensitivity to it that would require us to alter the current committee business schedule.
Well, I'm afraid I don't see the urgency. I see the importance of the issue, but I don't see the urgency. As Mr. Webber has now clarified, this motion doesn't have anything to do with organ transplants. It's about blood donation.
I could make the same argument. We're in the middle of a pharmacare study. I would venture to guess that there are Canadians who are dying, probably this week, because they don't have access to their medication.
We've had testimony already about the effect of cost-related non-adherence, and there are Canadians who get seriously ill because they don't have access to their pharmacare. That's a pressing problem right now.
Quite honestly, the Conservatives were in power for 10 years and never touched this issue once. Frankly, the current government had a chance to look at this and moved from a five-year ban on men having sex with men with regard to blood donations to one year.
This is an important issue. I don't think it's urgent. I think we should be looking at it. Even if we study this issue, say a month from now, and we devote a meeting—which, by the way, I don't think a meeting is enough for this. I think if we want to have a science-based, evidence-based look at this, we're going to have to hear from a number of experts in this field: hematologists and otherwise, Canadian Blood Services.
I haven't heard whether we're going to write a report or not, which we would probably have to do if you want to have an impact with the minister. You're talking about multiple meetings, unless we just want to make a political issue out of this and have a pro forma meeting.
If we want to take a real look at whether there's a basis for this issue, we should treat it with the seriousness it deserves. It would probably need three or four meetings, I would say, to look at that issue.
If we do that, then we're pushing our pharmacare study back significantly. I'm not so sure, when you weigh the competing importance, that there's any real way to differentiate between them. As important as the ban on men having sex with men issue is, again, I think so is pharmacare.
I would urge that we pass the motion, but I'm not so sure that we need to schedule hearings on this until after the pharmacare study.
Now I welcome our guests. I'm sorry for the little delay, but this was unfinished business carried over from our last meeting. We did want to finish it, and I think we're ready to move forward.
I believe that we asked you to have a 10-minute presentation. We're going to ask you to wind it down to five minutes so we'll have lots of time for questions. It will help us get through everybody and give everybody a chance to hear what they need to hear. I don't want to miss anything, but you'll find our committee asks questions and they know where they want to go.
We have the Street Health Centre, Kingston Community Health Centres; Centretown Community Health Care; Jane Buxton, professor, University of British Columbia; and the Paramedic Association of Canada.
We'll start with the Street Health Centre, Meredith MacKenzie, physician. Please begin your presentation.
Good morning. Thank you for asking me to come to speak to this bill.
More than two years ago, this committee issued its report “Government's Role in Addressing Prescription Drug Abuse”, which recommended that the government consider overdose immunity law that would exempt individuals seeking help for themselves or others during overdose situations from criminal prosecution. Since this committee's recommendations more than two years ago, the situation in Canada has profoundly worsened. We're now the number one consumer of prescription opioids in the world. Non-medical use of prescription drugs is a public health crisis and there's an opioid overdose epidemic occurring across our nation.
In April 2016, British Columbia's provincial health officer declared a public emergency as more than 200 people had overdosed in the first three months of this year. In June the Coroners Service of B.C. reported that overdose deaths increased by 75% in 2016.
The situation here in Ontario is also grim, with opioid-related mortality increasing 463% between the years 2000 and 2013. This represents one death every 14 hours. Preliminary figures from Ontario's Office of the Chief Coroner show that fentanyl overdose accounted for one in every four opioid fatalities in 2014. So we see we've had 13 years of increasing and record-setting overdoses, more than double the number of drivers killed in motor vehicle collisions.
This government has acted to make naloxone available by amending the prescription drug list. Take-home naloxone programs have been available in most provinces for a few years. As you know, naloxone is a medication that is first aid for opioid overdose and can reverse fatal respiratory depression. Communities that do provide take-home naloxone and overdose prevention training have lower opioid-related overdose fatalities.
We know that 85% of overdoses occur in the presence of another person. Naloxone injections for opioid overdoses are most often given by bystanders, just like epinephrine pens are used for life-threatening allergies.
A critical step to surviving an opioid overdose is seeking medical attention. We know that more than 90% of people who have a heart attack will call 911 for help, but an Ontario study showed that only 46% of people will call 911 in an overdose situation. The primary barrier cited is fear of police involvement.
Opioid overdose is a medical emergency. Once naloxone is given to a person it lasts between 20 to 90 minutes. That means once naloxone wears off the overdose can recur. Calling 911 is a crucial step to survival and a cornerstone of opioid overdose treatment.
With the arrival of more potent opioids like powdered fentanyl and other fentanyl analogues across all communities in Canada, activating 911 is of particular importance. A shipment of one kilogram of carfentanil, an elephant tranquillizer, was seized in Vancouver by the Canada Border Services Agency in June of this year. This drug is 100 times more potent than fentanyl. Put another way, that's 10,000 times more potent than morphine, and this shipment contained enough drug to kill 50 million people. If people do not call 911, the risk of death is increased substantially.
We are also increasingly seeing drug contaminations in our communities. People who report non-opioid drug use are overdosing and dying because the drug they used unknowingly contained fentanyl. In Vancouver earlier this month there were nine overdoses in 20 minutes, in people who were using cocaine that was contaminated with fentanyl.
The best way to encourage people who have overdosed or witnessed an overdose to seek help from 911 is to provide protection from charges of possession. Early evidence in the U.S.A. indicates that 88% of people who overdose on opioids are more likely to call 911 after establishment of good Samaritan law and being made aware of its existence.
Many organizations have supported the adoption of Bill . Some of these include the Canadian Medical Association, the Ontario Medical Association, the Municipal Drug Strategy Co-ordinator's Network of Ontario, the Canadian Drug Policy Coalition, and many boards of health and police agencies across Canada. A parliamentary petition garnered more than 700 signatures from coast to coast to coast.
This time of year many of our children head off to post-secondary schools. This is a time in life when they may make some dangerous or questionable decisions as their frontal lobes mature. They may be at a party and someone offers them a pill or something else to take. This pill doesn't look too dangerous. It looks like medication. We have seen fentanyl and other drugs being pressed into pills that look like prescription medication. The potential contamination of all drugs with highly potent opioids that are readily available in all of our communities makes overdose in this setting a very real possibility. Will their friends call 911 or will they be too afraid to call?
Constable Brian Montague, the media relations officer for the Vancouver Police Department issued a statement in June of this year confirming their position that they will not send a police officer to an overdose unless one is requested. He went on to describe that calls to 911 are not just coming from what he termed, “hard-core drug users”. He stated, “We're getting calls from 16-year-olds and 17-year-olds who are experimenting with drugs.”
The Vancouver police hope that this new strategy will mean that people who use drugs won't ever be too afraid of getting into trouble when they call 911. This government has already shown its commitment to bring forward a balanced approach to drug policy. Health Canada has supported access to supervised consumption sites like Insite in Vancouver. They have also revised the federal prescription drug list for naloxone. These are just some of the actions the government has taken to reverse the tidal waves of death across Canada.
The disaster of opioid overdose deaths across the nation requires every tool we can muster. Bill is not all that is needed to address this public health emergency, but it is a critical step forward. We need to protect the most vulnerable in our society. We must ensure that people feel safe to call 911. We must help Canadians in all of our communities to do the life-saving thing and to call for help immediately, without fear that their futures will be ruined by criminal charges. Canadians need this law passed now.
I thank the committee for your work on this legislation.
Good morning and thank you for this opportunity.
I understand that you've received a great deal of evidence on the realities of overdose and the opioid crisis in Canada. I'm here today to offer a front-line perspective and talk about how Bill would improve community health.
I want to preface my statement by imploring this committee to hear from the community of folks who are most directly affected by overdose and criminalization, and that is the community of people who use drugs. I am here with one member of that community, my colleague, Christine Lalonde. I'm a front-line harm reduction worker at Centretown Community Health Centre, just 10 blocks from Parliament Hill. Every day I provide safer injecting and safer smoking supplies to people who use drugs in this city. In addition to distributing supplies and offering health education and referrals, I also listen, support, and build trust with people who use drugs. At times I am the first and only point of health care contact for folks who use drugs.
Nearly every person I talk to about overdose has had a personal experience with it. Either they have overdosed themselves or they have been present at an overdose. I have worked with people who have overdosed and died in Ottawa's parks, overdosed and been resuscitated in shopping centre washrooms, and folks who have had peers overdose and die in their homes. Community members continue to be apprehensive about calling 911 in overdose situations. Calls occur less than 50% of the time, according to Ottawa Public Health, due to concerns about police presence, fear of arrest, or being implicated in the overdose. Individuals who do call 911 often report being heavily questioned by the police, assumed to be suspicious rather than praised as quick-thinking witnesses.
If you are someone who has regular contact with police and the criminal justice system, you may be reluctant to involve the police in an overdose situation. Past charges and criminal records have a way of influencing police behaviour. One man I work with who has a long history with the police in Ottawa has instructed his partner to never call 911 if he overdoses. He knows he will face charges if that happens. The last time he overdosed, his partner ran to the nearest fire station and asked them to help but not to involve police. Criminalization impacts this community's health. People who use drugs are incredibly stigmatized in our culture. They are frequently judged for their behaviour and perceived as undeserving of care. This stigmatization plays out in health care settings and impacts people's decisions to seek care, be it with their own doctor, or by calling 911 for an overdose. While our law and law enforcement need to adjust their attitudes towards people who use drugs, so too do we as Canadians. Bill challenges criminalization and stigma by prioritizing public health and safety at overdose scenes.
There are a great many drug policies that you as decision-makers can implement to address the opioid crisis in Canada, which include decriminalizing the use of all drugs, supporting the expansion of supervised consumption services and take-home naloxone programs, increasing access to drug and alcohol treatment, opioid substitution therapy, and medical marijuana. The good Samaritan drug overdose act is just one of a multitude of strategies this country desperately needs to respond to the current public health crisis.
Like some of your previous witnesses and members of this committee, I feel the immunity outlined in this bill needs to be broader than possession. Nevertheless, I support this bill as a first step and I applaud MP McKinnon for proposing it and using his position to support the lives of people who use drugs. Bill is a harm reduction strategy that this committee has the influence to pass into law. A common definition of harm reduction is “any step towards greater safety is a step in the right direction”. Bill C-224 is a step towards greater safety.
Thank you for the opportunity to present today. I'm a public health physician and a professor at the School of Population and Public Health. I'm also the harm reduction lead at the BC Centre for Disease Control.
I wish to provide some evidence about the overdose crisis in B.C., the emergence of fentanyl, and the importance of calling 911.
The BC Drug Overdose and Alert Partnership was developed following an increase in illicit drug overdose deaths in 2011. Members include stakeholders from health enforcement, emergency services, coroners, researchers, and people with lived experience. The goal is to coordinate communication and action to enable timely alerting and responses to illicit drug issues.
The B.C. take-home naloxone program was introduced in 2012 and provides overdose training and naloxone to people in the community. It enables naloxone administration by bystanders while waiting for any emergency health services to arrive. We've had over 2,000 overdose reversals reported.
An opioid overdose crisis is occurring in Canada. A public health emergency was declared in B.C. in April 2016 due to rising opioid overdoses. In 2015, there were 505 illicit drug overdose deaths, which is the highest number ever recorded, and in the first seven months of 2016, there have been 433 deaths. We're on route for 750 deaths in the current year.
The proportion of deaths where fentanyl has been detected increased from 5% in 2012 to 30% in 2015 and to a staggering 62% in 2016 year to date. Fentanyl is also increasingly identified in Alberta and across Canada. Fentanyl is a synthetic opioid often described as 80 times more potent than morphine. In an unregulated market, there is no control of the amount and dose of fentanyl in illegal drugs. The Health Canada laboratory has found pure fentanyl in powder sold as heroin and in varying, and sometimes fatal, concentrations of fentanyl in fake OxyContin tablets.
Although some people may intentionally take or seek out fentanyl, many don't know they have taken it. In a study performed in B.C. last year, we found almost three quarters of those who had fentanyl detected in their urine were unaware that they had taken fentanyl.
In an opioid overdose, the breathing slows and a person becomes unconscious. Lack of oxygen to the brain even for a short period of time can cause brain damage and death. The onset of a fentanyl overdose is much faster than other opioids. As we've heard, the effect of naloxone wears off after 20 minutes, and the high concentration of fentanyl in drugs requires large and often repeat doses of naloxone. It's vitally important to restore breathing as soon as possible and seek professional help for immediate and ongoing assistance.
People who administer naloxone in B.C. complete an administration form. The program emphasizes the importance of calling 911, and although the proportion that call 911 has increased over time, in 2015, 30% of people responding to an overdose did not call 911. It varies by region. Approximately 82% of people in Vancouver call 911, but less than 60% in regions outside of Vancouver do. The differences by region may reflect previous interactions with the police and policing policy, and the influence of other bystanders.
Enforcement members of the Drug Overdose and Alert Partnership have shared that most police would not make an arrest for simple possession of drugs in B.C., but this may vary by province. A good Samaritan act would ensure consistency across the country.
We also found people were more than 10 times more likely to call 911 if the overdose took place on the street rather than in a private residence. That may be because they're concerned about the residence being identified and the ability to flee if police arrive.
To explore reasons why people didn't call 911, we interviewed 20 naloxone program participants. They shared the barriers to contacting emergency services during an overdose, which included concerns about being arrested for illegal activities such as drug possession, breach of probation or parole, and outstanding warrants. Police were noted to be collecting the names of those present at an overdose scene and checking the police database.
We also heard stories about people who had overdosed being dragged down stairs into the street before 911 was called, and people calling 911 and then leaving the scene rather than staying with the person until first responders arrived.
According to a review by the U.S. National Conference of State Legislatures, good Samaritan or 911 drug immunity laws are enacted in 37 states and provide immunity from supervision violations and low-level drug possession and use offences. However, a recent study of young adults in Rhode Island found fewer than half were actually aware of the good Samaritan law.
It's important if Bill were to be enacted that this would be communicated broadly to the populations at risk of witnessing or having an overdose. Dissemination will require different approaches for youth experimenting with drugs and afraid of arrest and parents being informed compared to those with substance use disorders.
In summary, fentanyl prevalence in illegal drugs is increasing. Fentanyl has a rapid and long duration of action and overdoses may need large and repeat doses of naloxone. Therefore, it is imperative to call 911 and receive rapid and professional help. There is evidence that fear of arrest deters people from calling 911, and that good Samaritan laws can increase the likelihood of calling for medical assistance if people are aware. Expanding immunity in Bill beyond simple possession to include supervision violations could increase the rate of calling 911 and thus prevent further brain damage and save lives.
Thank you for your attention.
Good morning. Thank you for the opportunity to speak today. My name is Pierre Poirier. I'm the executive director of the Paramedic Association of Canada.
There are approximately 40,000 paramedics in this country, and we respond to almost three million calls annually. I want to note that there are different classifications or designations within the term “paramedic” that cover different scopes of practice, and that's an important detail that I'll refer to later.
The Paramedic Association of Canada absolutely supports Bill , although we have concerns about its application or whether it sufficiently meets the intent to save lives in a timely manner.
I've taken some excerpts from other presenters and have parsed some of their words.
Opioid overdose deaths are preventable with timely intervention. Good Samaritan legislation is one component of a comprehensive public health approach to overdose within a harm reduction paradigm. We need to improve the community response of Canada as part of a comprehensive response to overdose deaths. The community response must involve a comprehensive approach.
Let's make naloxone available, absolutely. Let's provide naloxone to the overdose victim in a timely manner, because seconds count. Let's coordinate the health care system on this important issue—and that's an important piece that I want to make reference to—with consideration of the alignment of a federal initiative with the provincial mandate in the health care system and with the way we approach health care.
This is an important piece that I want to spend a couple of seconds on. I have to admit that change has been rapid, but I still don't think our addressing of this issue has been fast enough. Paramedics regularly respond to incidents in which an individual has overdosed. We provide medical care. This is a life-and-death event.
Let me explain how a patient is treated. There is the 911 call, and paramedics are requested. Police are often asked to attend for safety and security reasons. Recognizing the triage system and that for a medical emergency it is the paramedic who is called and not necessarily that police go to attend to every call is, I think, an important point.
The paramedic will assess the patient and determine an overdose. This is the important piece: often the paramedic is required to call a physician for permission to administer naloxone, and oftentimes some paramedics may not have permission to provide this drug in this country. That's an important distinction. We have this law that approaches it in good Samaritan terms and as a public health issue, but we should also recognize that the individual providing care may not be allowed to provide the care that is really intended or that is life-saving. This is important as an issue.
Here is the problem. I noted earlier that seconds matter in this life-and-death situation. In the event I described, paramedics may not have permission to administer naloxone. That could happen in Saskatchewan, Ontario, Nova Scotia, and Newfoundland.
Also, if they do have permission.... They may be required to call for permission to administer. A paramedic who administered without permission would now be subject to discipline by the health care system or by a regulatory agency to which they report. This is a significant issue.
On the one hand, then, we would have legislation that supports an individual's providing it, but by the same token a paramedic on scene may not have that permission. How do we resolve this? There are a few things.
I have to admit that I'm not familiar with all the nuances of the prescription drug list and its relationship to the Controlled Drugs and Substances Act, but if we were to remove naloxone from schedule I of the Controlled Drugs and Substances Act, that might actually help the situation.
One question is whether there is really a need that naloxone continue to exist within schedule I. I think there are important lessons to learn. Paramedics often work under medically delegated acts or things with that description. When we went through the last 40 years of experience with AEDs, automated external defibrillators, we came to a point at which we made them publicly accessible, but we removed the designation of their use being a medically delegated act, which really benefited the community and all health care providers in that situation.
I'm not sure that we can consider Bill is applicable to all Canadians, and that would be a motivation behind this, because if you look at good Samaritan legislation, if there's remuneration, there is no longer the cover of the good Samaritan legislation. Paramedics in the performance of their duties are deemed to be providing a service and therefore being paid to provide that service, and therefore are not provided the cover of the good Samaritan legislation. That's an issue, and I think it can be resolved.
Last, we should consider other applications of the drug, and look at the provision of naloxone in a similar manner to the development of EpiPens. You don't need to provide it as an injection; it can be provided as a nasal spray or by other methodologies. That wouldn't require it to be a medically delegated act, and it would be a simpler, more accessible, easier way of providing a service to our community.
Thank you for the opportunity to speak today.
I want to thank everyone here because this is an extremely important bill. I want to thank the witnesses for being here today because it's vital that we all work together to combat drug overdose and help save the lives of those who have lost their way or, as was mentioned, people who are just experimenting.
I want to thank Mr. Poirier for pointing out a loophole that maybe we have overlooked something in regard to the paramedics who, as you quite correctly pointed out, Mr. Poirier, you guys are the guys on the ground. We do have the parliamentary secretary here who is monitoring the committee, and we also have an emergency care physician which we are very fortunate to have.
If there's some type of a regulatory change that could be made that would make your job on the ground better and not give your members a situation where they could be confronting a risk for actually saving a life, that's something we could all support. Thank you for pointing that out.
I also want to thank you for pointing out that this bill is really important, but it's only part of a comprehensive and coordinated approach to work with our provinces and territories. I thank you for your positive suggestions to improve the bill.
We can't ignore that a major issue when it comes to overdose is that there's currently nothing in the pipe. You mentioned prevention. There doesn't appear to be a lot in the pipe to prevent overdose. We're facing this crisis. We're looking at Canadians, as was pointed out, being number one in the world with opioids. Something needs to be done.
We can enable addiction by providing, whether it's a syringe or heroin, whatever, but it does nothing to treat the problem.
I'd like to read a quote from the International Task Force on Strategic Drug Policy, which stated:
|We oppose so-called `harm reduction´ strategies as endpoints that promote the false notion that there are safe or responsible ways to use drugs. That is, strategies in which the primary goal is to enable drug users to maintain addictive, destructive, and compulsive behaviour by misleading users about some drug risks while ignoring others.
We must not forget that addiction is a treatable and, in fact, a curable disease. Putting bills like this one forward is a positive step in the right direction. There's still little being done by governments to actually help treat drug addiction, and we need to address that.
With that statement, I do have some questions for you. Maybe I'll start with Mr. Poirier.
When an overdose happens, who would you say that your members see? Who is more likely to call for help? Is it the avid drug users, individuals battling addiction or familiar with overdosing, or is it just basically somebody who is around there? Who do you see as the major people who are actually calling you in?
Again, this is a very difficult question.
From a paramedic's perspective, we are always caught between the public safety and the health care models. We are absolutely, first and foremost, advocates for the patient we treat. I give you the scenario of somebody who may be impaired, who was at the scene and now wants to drive a vehicle. There is an imperative on the paramedic to prevent that, so there may be a call to the police, in terms of assistance.
The scenario for someone who is engaged in what is termed “criminal activity” provides the same kind of difficult ethical dilemma for paramedics, but for the most part, paramedics fall on the side of patient first and patient care first.
In terms of answering your question, I would offer no expertise in terms of how the legislation is crafted. I would just say that we should promote it in the best way to recognize, in how it is finally drafted, that health care providers are also protected, in terms of recourse.
Thank you to all the witnesses for being here today.
I come from British Columbia. I represent a riding in Vancouver, where, in our province, Dr. Perry Kendall has declared the opioid overdose a public health emergency. I think we're looking at about 800 people who are expected to die this year in British Columbia. That's more people than will die from motor vehicle accidents. It's been estimated that 2,000 people will die in Canada this year from opioid overdoses. I think we have a crisis on our hands that is not being given the seriousness that it really ought to be given.
I'm in favour of this bill. The purpose of this bill is to save lives. It's to encourage people at the scene of a drug use to call 911 in case of an overdose, and it's to remove impediments to doing so. I'll be supporting this bill because of that.
Also, I want to drill into this a bit from a devil's advocate point of view, because if we are going to treat this crisis as a crisis, then I think it behooves us all as legislators to actually bring in a law that will be as effective as it can possibly be. Where I'm going to drill into is whether this bill actually will accomplish what we want it to accomplish, and whether or not we can and should do more.
I'm going to read a brief excerpt from a letter from deputy chief Mike Serr, who is the chair of the Canadian Association of Chiefs of Police drug abuse committee. He says:
||In consultation with those working in the addiction field, it was learned that the premise under which the bill was written may not be accurate.
||Specifically, during a recent tour of Vancouver's East Side, staff of INSITE...were asked if clients were fearful to call police. The staff responded that the hesitation to call police was based on outstanding warrants or fear of breaching court imposed provisions, not fear of being charged with simple possession.
Dr. Buxton, in an article published in The Province on May 29, you are quoted as saying:
||“...people aren't concerned they're going to be arrested so much for possession...more likely when, if the police do arrive, then they may run their names through—whoever's there—and find that they're in breach of probation or they have outstanding warrants.”
Finally, Dr. MacKenzie, if I had your testimony correct, you said that people aren't calling 911 for fear of police involvement.
My question is this. If we really want to encourage people to call the police at the scene of drug use, and this bill only grants immunity from charges for drug possession, why in God's name do we not take this opportunity right now and broaden this bill to include a broader suite of offences, including immunity from being arrested for any kind of outstanding warrants or breach of probation having to do with drug use? Would you agree with me that this would actually have a broader and more immediate impact? Is it needed?
Yes, I agree with all the concerns you've identified.
My concern would be that this would stymie this bill and the progress might be regressive. I have no legislative or legal opinion that would matter. However, is there a way to move forward with the existing wording and then make an amendment at some future time? I think that if we bring this back, as Sarah said, it may take a very long time to actually get the wording correct.
While we're waiting for the wording to get corrected, more people will die because they're not calling 911, especially in the context of what we discussed this morning, which is that we're seeing something new. There are drugs that are contaminated with substances that people do not know they're using. You get people using stimulants who are overdosing on opioids and who wouldn't even maybe have a naloxone kit around to give them that few minutes of time they needed to call 911. In addition, the way people are taking drugs is changing a bit.
I think if we wait to get it perfect, more lives will be at risk.
I agree. It's the old phrase, “let's not let the pursuit of perfection get in the way of progress”.
I am concerned, and I do want to make sure we're hitting the target. If we pass a law that grants immunity for something that is not the reason people aren't calling 911, then we're not doing too much. We might make ourselves feel better, but we're not addressing the barrier to calling 911.
Could you give me and the committee an idea of what is the barrier? If there are people shooting drugs in an alley in east Vancouver right now and someone overdoses, what is the barrier for them calling 911? Is it the fear of being charged with possession, or is it the fear of being charged with breach of probation? Can you give me an idea—it's probably both—of the relative weight of each. What is the real problem here?
Thank you for saying that, because that's exactly my fear. It's the law of unintended consequences.
If people think they have immunity, but it turns out the police come, they end up not being charged with possession, they get their names run through the system, and they're charged with breach of probation, then could this have a boomerang effect the other way and cause, on the street, people not to call? They don't have the sophistication, necessarily, at the moment of overdose to weigh through, “Okay, what could I be charged with, and what can't I be charged with”.
Vermont has a law that has a broad suite of immunities. Would you not agree that we should amend this law right now in this committee to use the more broad Vermont standards that cover breach of probation and other drug-related offences if we're going to make a dent and take immediate action to deal with this crisis? Would that not be your recommendation to this committee?
Thank you, all, for coming. I'm the emergency physician that Mr. Carrie referred to. I have worked in an inner city emergency department in Winnipeg, where there's a lot of violence and a lot of drug use. I also spent six years as the medical director of Manitoba's EMS system.
Mr. Poirier, maybe offline, I'd like to talk to you about the regulatory changes. I didn't know there were still jurisdictions in Canada where you had to call the doctor to give naloxone. Every provincial director I've spoken to said it was offline, and it was a delegated act with offline control. I'm curious about that.
Dr. MacKenzie, we talked about marginalization and stigma in regard to drug use. We know that many people in society think those who use drugs just made “bad choices” and treat people like that accordingly. Do you think this stigma affects people's willingness to seek help in regard to drug issues, including overdose?
If we look at the example of what Washington state did when they enacted their good Samaritan legislation in 2010, they followed that up about a year later with a survey of all the Seattle patrol officers during roll call. That survey had an incredibly high response rate of 97%. I've never seen a survey with that high a response rate. They asked those officers if they were aware of the good Samaritan legislation.
To give the committee some context, 67% of those officers who presented had an overdose in that prior year. Only 16% of those roll-call officers were aware of the good Samaritan legislation and of those 16%, only half of those were aware that it included bystanders as well as the victim in that legislation.
The police force took that information, and realized this wasn't good, and they started an education initiative that involved the narcotics police officer, public health, and the legal people to all get together. They made a video that they would show at every roll call for all new officers. I think roll call is mandatory; other people probably know more about that than me. That got the message out to every new recruit and it was repeated over and over again to police officers to make them aware of that. Federally we're lacking a drug czar, for lack of a better word, who can quarterback the need for a national response to this opioid overdose crisis. I think a part of that response would be something like getting the word out on good Samaritan legislation. That would include police, harm reduction people, and people with real lived experience, and people who are doing opioid substitution therapies. Public health would be a part of that as well.
There are a number of ways that we can communicate if this bill is passed. We can communicate this bill to people who use drugs. I am one of maybe 30 people in the city—maybe 40 or 50 really—who have daily contact with people who use drugs. We also have a very large peer network of people who are doing research, like Christine, who are working in harm reduction fields. That's a really great network to disseminate information about this bill. Methadone clinics offer another opportunity, as do pharmacies.
I think my concern with communication around this bill is that police are communicated to about the passage of this bill and the immunity outlined in this bill, that police are aware of this and that they actually follow through with it.
I'm a bit concerned. There was something mentioned earlier about police discretion. I actually worry quite a bit about police discretion and would like to see them have a bit less discretion.
My other concern is for the community of experimenters, people who are newer to the drug scene, and we've alluded to that at this meeting as well, younger people, people who are trying drugs for the first, second, or third time, people in party situations. They are not people that I see. Most people that I see daily are well established in their drug use. The folks who are newer to it need to be communicated to. I suppose in that instance it would have to be a much larger public message, perhaps through advertising, perhaps through billboards.
Thank you, all, for being here today.
Dr. MacKenzie, you mentioned that Canada is the number one country using opioids in the world. You also mentioned that there's been a 75% increase in deaths due to opioid overdose usage, one death every 14 hours. That's shocking.
Ms. Brown, you mentioned that this is the first step, Bill , but that this is one of a multitude of strategies that can be implemented.
Dr. Buxton, you mentioned that there are 750 deaths in a year due to fentanyl and that we need to act now.
Mr. Poirier, you mentioned that this should be a federal initiative for a provincial mandate, that we need a national strategy, and that this is an epidemic.
I would ask Dr. MacKenzie first, is this a public health crisis?
I suspect that everyone on this committee also sees this as a public health crisis, the use of deadly fentanyl, and so notwithstanding normal practices and procedures for introducing a motion, I'd like to seek unanimous consent to discuss this issue promptly before this committee, in the hopes that we can save lives.
I would ask that I receive unanimous approval to table the following motion for debate, and then I would also ask my colleagues that we move immediately to a vote, so as to not belabour this, and allow the clerk as much time as possible to plan for such a meeting.
My motion is that, pursuant to Standing Order 102(2), the committee undertake an immediate study of the fentanyl and opioid crisis in Canada, in light of the alarming and growing number of deaths caused by these substances, to determine what action can be taken by this federal government.
That is the motion I have now put on the table, Mr. Chair.
I'd like to thank you all again for being here today. I hope that this committee will support this opportunity for me to table this motion.
I thank you for being here with us this morning. I think that everyone here recognizes the goodwill and the possibility for action that this bill represents. We would like to do more, but in doing so we might prevent actions that could be taken more rapidly in order to save lives.
We are really talking about drug possession, and not about illegal acts like trafficking. We are talking about legal mandates for people who sometimes use these drugs or people who help them to obtain these drugs or medications, or to inject them.
My question is addressed to all of you.
What should we do? Should we legalize a group of drugs while specifying all of the ones that would be included?
Firstly, I fear that we will be opening the door to certain behaviours. Our primary purpose is really to save lives. However, this could affect the behaviour of some drug traffickers or people who live in illegality and contribute to the problem. We do not want to persecute certain people.
What is your opinion?
Let's begin with Ms. Brown.
Oh, I'm sorry, the chair calls clause 2.
(Clause 2 agreed to [See Minutes of Proceedings])
The Chair: Shall the short title carry?
Some hon. members: Agreed.
The Chair: Shall the title carry?
Some hon. members: Agreed.
The Chair: Shall the bill carry?
Some hon. members: Agreed.
The Chair: Shall the chair report the bill to the House?
Some hon. members: Agreed.
Thank you to all my colleagues.
Essentially what I want to do is propose an amendment to the bill at proposed new subsection 4.1(2).
I'm going to preface my comments by congratulating Mr. McKinnon and thanking him for bringing this important bill to Parliament's attention. As I said before, I will support it in any event.
My amendment would be to broaden the exemption in 4.1(2), to exempt people at the scene of a drug overdose not only from being charged with possession but from being charged for any violation of pretrial release, probation, furlough, or parole related to a drug offence.
As soon as people have internalized that, I'll speak to that.
I don't have it in writing, so we'll have to fit it in now. I know they don't have to be put in writing, and certainly not in either official language either.
It's kind of awkward, because with 4.1(2), it's hard to see where it actually does exempt from possession.
I would propose, then, that after the words “to be charged” in the third line, adding the words “with any offence concerning a violation of pretrial release, probation,”—tell me if I'm going too fast.
—“, probation, furlough, or parole relating to a drug offence,” and then I think the rest of the paragraph can continue.
I'll speak to that briefly, colleagues. We've all heard the evidence, so I won't belabour the point, but Mr. McKinnon's very laudable goal in this is to save lives, and we want to remove impediments to people at the scene calling 911.
We've heard directly from the witnesses. In fact, I think we've heard that being charged with possession is one factor, but it actually may not even be the main factor for people at a drug scene not calling 911. I believe that if we're going to make a dent in this, we should actually be evidence-based. The evidence that we've heard before this committee makes it very clear that those are the reasons people are not calling 911, and we want to do everything we can to encourage doing so.
I think it's an easy amendment. If we're going to be giving immunity to people for having possession of heroin, then a breach of probation for being in possession of heroin should also be a factor. Many people come out of jail. Just about every single person who comes out of jail on probation has a condition that they have to stay away from drugs and alcohol. Very often those people are drug addicts.
In fact, the public safety committee several years ago did a study and found that 80% of offenders inside our federal corrections system suffer from an addiction. It's epidemic. They come out of jail. Very many of them, not having access to treatment, start using drugs again. If they're shooting drugs in Vancouver or Ottawa or Toronto and are in breach of their probation for being in possession of them and can be arrested for the breach of probation, then this bill is not going to do anything. It's not going to encourage that person to call the police.
You can't. I have the floor right now, Mr. Oliver. I'm speaking. You can't interrupt to call the vote.
I'm speaking to my amendment. The reason that this is particularly important is that if we pass this bill and, as the evidence suggested, people are only immune from possession, and then it turns out that we give people a false sense of immunity and they then are arrested for these other offences, we may run the risk of spreading among drug users the idea that they shouldn't call police. That's counterproductive to what I believe Mr. McKinnon's objective is.
We have an opportunity to act on this right now. For people who say this will cause delay, it won't cause delay. We can vote on this right now and get the law right, right now. I can't think of a principled reason for anybody's being opposed to broadening this to include the suite of reasons for which people don't call 911, when the evidence before us is that this is why they don't.
May I say just one thing?
We have been quite loose in procedure, but there are a few things that are not working well in this committee.
First, people are talking when they're not recognized, and second, we keep going out of order. We have an order of business on the floor. I appreciate that Mr. Oliver may not like what we're dealing with here and may want to rush to the vote, but we have business that precedes that on the floor. We can't just dispense with it because we want to get to the end.
I have put forward an amendment, and apparently we have advice from the clerk that this is not within the scope of the bill. I challenge that. I'd like to hear an explanation of why this is outside the scope of the bill, given what I've just said.