Proceedings of the Standing Senate Committee on
Legal and Constitutional Affairs
Issue No. 10 - Evidence - June 2, 2016
OTTAWA, Thursday, June 2, 2016
The Standing Senate Committee on Legal and Constitutional Affairs, to which was referred Bill S-225, An Act to amend the Controlled Drugs and Substances Act (Substances used in the production of fentanyl), met this day at 10:32 a.m., to give consideration to the bill.
Senator Bob Runciman (Chair) in the chair.
[English]
The Chair: Good morning. Welcome, colleagues, invited guests, members of the general public who are following today's proceedings of the Standing Senate Committee on Legal and Constitutional Affairs. Today, we begin our hearings for our study of Bill S-225, An Act to amend the Controlled Drugs and Substances Act (Substances used in the production of fentanyl), the bill introduced by one of our committee members, Senator White.
The bill amends Part 1 of Schedule VI to the Controlled Drugs and Substances Act to add certain substances used in the production of fentanyl so that they will be regulated as Class A Precursors. We will get into a little more detail when we hear from our witnesses and Senator White as well.
For our first hour, we have with us, from the Lethbridge Police Service, Staff Sergeant Rod Klassen, who is also a member of the Alberta Law Enforcement Response Teams; and from the Levern Health Clinic, which is on Alberta's Blood Reserve, Dr. Susan Christenson, a family physician, who is joining us today by video conference from Cardston, Alberta.
We have allotted opening statement time for both of our witnesses. Dr. Christenson, we'll let you lead off with your opening statement. Please proceed.
Dr. Susan Christenson, Family Physician, Levern Health Clinic: My name is Susan Christenson Tallow. I am a family physician and a member of the Blood Band of Blackfeet, otherwise known as the Kainai Tribe, in southern Alberta, Canada.
I have deep roots here. My mother was born and raised on this reserve, and I also have a great commitment to providing medical care to this community.
I graduated from the UCLA School of Medicine in 1990, and I did training at the University of Alberta and at Harbor-UCLA Medical Center. I have been practising on the Blood Reserve since 2009.
In 2014, it became very clear that we were facing a horrific and growing crisis. Numerous overdoses and deaths due to the illicit use of fentanyl tablets, which were disguised as OxyContin, started to occur. In the first part of 2015, we lost a total of 16 young people due to accidental overdoses.
In response, a state of emergency was called by our chief and council, and with the support and encouragement of Hakique Virani, who at that time was Deputy Medical Officer at Health Canada, we created a program to distribute to and teach community members how to administer an antidote to an accidental narcotic overdose in the use of a medicine called naloxone.
Additionally, community education and awareness campaigns occurred, and in April of 2015, I started prescribing an opioid replacement medication known as Suboxone. This medication takes away the cravings and horrific withdrawal symptoms that occur with any opioid addiction and drives continued use.
Since our state of emergency last year, we've had only a very few number of overdose deaths, most of which have occurred off the reserve. All in all, I feel that our work has been quite effective.
However, it is clear that addictive behaviour will change in response to the biology of the individual and his or her environment. It is just a matter of time before another crisis will evolve, and it behooves us to prepare.
My understanding is that, currently, the vast majority of the fentanyl powder that is used in the illicit manufacture of Canadian fentanyl pills, which are disguised as fake Oxy80s, comes from China. Currently, there is international pressure on China to tighten its export regulations. Should this occur, it is probably inevitable that illicit fentanyl will be manufactured in our country. In the U.S., this has already occurred. This is a very real possibility, and any efforts to curb this illicit manufacture of fentanyl should be embraced.
Fentanyl is 100 times more potent than morphine. It can easily kill and addict its users with their very first dose.
When Health Canada restricted the precursors needed to manufacture crystal methamphetamine, specifically Sudafed and ephedrine, which were often used in over-the-counter cold preparations, I was really impressed by the graceful reduction in use that I witnessed in my community. Naturally, other drugs and problems took its place, but I could certainly appreciate the positive effects of regulating supply.
Supply reduction is recognized universally as essential to any balanced approach to drug control. It is only one part of many items that need to be addressed in managing this complex human condition.
I would like to express my support for Honourable Vern White's efforts to regulate the precursors needed to make fentanyl. This drug is deadly and heartless, and we need to step up together to limit its supply in any way possible.
The Chair: Thank you, doctor.
Mr. Klassen.
Rod Klassen, Staff Sergeant, Alberta Law Enforcement Response Teams, Lethbridge Police Service: Thank you very much for inviting me here to speak to you, honourable senators. Good morning, ladies and gentlemen. My name is Rod Klassen. I am a staff sergeant with the Lethbridge Police Service. I am currently assigned to ALERT, which is the Alberta Law Enforcement Response Teams, responsible for investigating serious and organized crime within the province. Throughout my 25-plus-year career, I have spent a lot of time investigating illicit drugs in our communities, and I'm here to talk to you today about fentanyl in our communities in Alberta and the effect it is having on the people in our communities.
Senator White's bill, as proposed, would help to limit access to the ingredients used to make fentanyl, which are being, we believe, imported from other countries, as the doctor has mentioned, such as China, into our country and made into fentanyl pills on site.
I will give you a little history about how fentanyl became a problem in our country, in our province. In 2012, the company that makes OxyContin changed its recipe, for lack of a better word, to make it difficult for end-users or illicit drug users to use their drug Oxy80s, oxycodone. They made it into OxyNEO, which once crushed could not be injected or smoked. That created a void in this market.
Enter fentanyl. In late 2012-13 we started to see some small green pills similar to this. They looked exactly like the Oxy80s which were being stolen from pharmacies and abused by illicit drug users in the past. Initially people thought these pills were Oxy 80s and they were taking them like they were Oxy80s. It wasn't too long before they found out that these were way stronger than Oxy80s and they were not that drug. They became known on the streets by different names like shady 80s and fake oxys. Users became aware they were not taking original OxyContin.
We started to see overdoses from these pills. Fentanyl, like the doctor has said, is 40 times stronger than heroin and 100 times stronger than morphine. It's extremely addictive. Once they start this drug, it is very hard for them to stop. This is not usually the only drug they are taking. They are taking it between using cocaine or methamphetamine as well, so they have a cocktail of drugs in their system when they're doing this.
At the end of 2014, the use of this drug exploded in Alberta. For the first six months in June, we saw 145 deaths in our province, and that does not include just overdoses where people were actually saved and saved and saved and saved again.
Community groups have noticed the danger and have started to distribute naloxone, an antidote, to end-users and to illicit drug users in an attempt for them to save themselves when they feel they have overdosed on these pills. They're going to overdose. It's not a matter of if; it's a matter of when.
Why is this drug so dangerous? Well, the ingredients are easily accessible on the Internet, and they can be shipped to anywhere. There are no controls on them right now. They can come to any house, any clandestine lab within the country or in the province. In these clandestine labs, people with no experience and no quality control are making these ingredients into fentanyl pills.
A very small amount of fentanyl, grains, can be lethal to people. I use the chocolate chip analogy that a friend of mine with the Calgary Police Service used. When you're making chocolate chip cookies, one cookie may end up with one chocolate chip; one cookie may end up with 12 chocolate chips. You don't know how that's going to turn out. The same thing is happening with fentanyl. They are unaware how they're distributing the fentanyl in these pills. There is a way to do it correctly, but they don't care. They are all about money.
Organized crime groups have obviously seen this, and they are making these pills for pennies. Each pill is costing them pennies to make. They are selling them for anywhere from $20 to $40, depending on the area they're in, and making an extreme amount of cash. They are not going to stop while that market is in place.
Senator White's bill will help to slow down the amount of ingredients coming into our country to make these pills. It will make it difficult to get these ingredients, similar to what we saw with methamphetamine. If we make it difficult, that's also going to push up the cost of these pills and make it less attractive to these organized crime groups to bring the ingredients in and distribute the ingredients. As Senator White has said, it won't stop these pills from being made, but it will definitely slow it down, make it harder for the end-users to get, and make them less available to people. In the end it will save lives very easily.
Thank you very much for your time.
The Chair: Thank you.
We will begin questions with the committee's deputy chair, Senator Jaffer.
Senator Jaffer: Thank you very much for your presentations. What you are saying is really worrying.
I read an article in the Vancouver Sun on May 29, 2016, on why fentanyl and W-18 are here to stay. Fentanyl is odourless, has no extra penetration and cannot be detected by scanners. Is this true? How do you detect fentanyl?
Dr. Christenson: Well, as a physician, if I have a patient on Suboxone and I want to make sure they're not using fentanyl, I do urine drug testing. We have urine drug tests that can detect fentanyl.
I understand that dog units might be able to detect it. On the reserve, I know that our police people are in the process of purchasing a trained dog who could detect fentanyl.
I do know that the powder is imported into the country, sometimes disguised in silicone bags. When you buy a tape recorder or a CD and there's a silicone bag, they will stuff the fentanyl in there and it won't be detected.
The only ways I know of detecting it is with urine drug testing and using dogs trained to detect it.
Senator Jaffer: Doctor, what is the trend that you are seeing with fentanyl? Are these recreational users, drug addicts, youths? Is it a social drug? Can you please explain who uses it?
Dr. Christenson: In my personal experience, I think about 75 per cent of patients who have come forward with this addiction probably had some troubles with prescription narcotics. There is an effort across the country for physicians to become more aware of this as a problem. Physicians in my community and abroad are tightening their prescribing of narcotics.
Now the problem is that will put some patients into withdrawal. They have to do something to address the withdrawal. Then they jump to purchasing drugs on the street, and because the fentanyl is there, a lot of people will start using that drug because it's easy and cheap and it gives them relief.
I'd say that's about 60 to 75 per cent of patients in my experience, and then the other 25 per cent are young people using it recreationally. It's been in the news a lot that young people are pretty fearless when it comes to using pills. A lot of times they have pill parties and they will be told by their friends to go into their parents' and grandparents' medicine cabinets and take whatever they can. They throw it into a fishbowl and then they grab a handful and take the pills, not knowing what they're taking. That's another way of getting hooked on medicines like Ativan, Restoril, Tylenol 3s and OxyContin. One thing leads to another.
There's money to be made in the community if you deal fentanyl, so the dealers make it very easy. If you have any interest in using this drug, they will bring it right to your home. It's easier to get than a prescription from a physician here.
Senator Jaffer: Obviously if something like this happens, organized crime is involved. You discussed stopping the ingredients. I'm really intrigued by what you said. We have the Internet, so you can order anything from anywhere. As long as it's not detected, how do you stop it?
Mr. Klassen: Right now that's part of the problem. There is no law against importing it. It's very simple right now just to import it over the Internet. Anyone can go online right now and import the ingredients they need. There are no controls. They're not being stopped at the borders. They're not being followed up on. We're not getting clues that these ingredients are coming in.
Controls on these ingredients will help the police to track where they are going. We need to investigate the importer and put them before the courts. I agree that we'll never stop it, but at least we can slow it down.
Senator White: Thanks to both witnesses for being here. Doctor I want to thank you very much for engaging in the opioid replacement therapy treatment. I know it's challenging as well and not everyone understands it. Also thanks for taking the long drive to Cardston so that you could be on video conference today. It's truly appreciated.
Just so people clearly understand, we're not for the most part talking about pharmacological manufactured fentanyl that is prescribed to someone who is then taking it in an illicit way or selling it to someone else. Could you just explain clearly that we're talking about the basement-made fentanyl, as I call it, that is hitting our streets?
Dr. Christenson: Yes, this is definitely basement-made fentanyl.
The fentanyl that physicians can prescribe comes in two forms: a liquid vial that anesthesiologists and emergency room doctors will use to help patients with acute pain crises or surgeries, or it comes as a patch that is placed on the body for people who have severe chronic pain, like metastatic cancer. You can replace that patch every three days.
The fentanyl powder comes in, and then it's manufactured, crushed and mixed with a compound to keep it together with a pill press that I understand is easily purchased for $10,000. You can't really regulate the amount of fentanyl in those tablets, which is another reason why it makes it so dangerous.
It is probably the same compound, but the illicit pills that are made in basements are not regulated at all, and these are not pills that are being prescribed by physicians.
Senator White: Thank you very much, doctor.
Staff sergeant, my understanding of illegal fentanyl is that it's also being used to increase the potency of other drugs. Can you explain for the committee and for people watching how that works?
Mr. Klassen: That's correct. We're also seeing fentanyl being used to make other drugs such as methamphetamine and cocaine. It is pressed in with or mixed in with those drugs to make them stronger and more addictive.
Organized crime — or any dealer on the street — wants to keep their dealers, they want to keep them coming back, and to make anything more addictive keeps their product being sold on the street.
Senator White: In essence, somebody with a cocaine addiction could find themselves taking fentanyl without actually understanding that that's what they're participating in.
Mr. Klassen: We're seeing a cocktail of drugs in the body in the deaths that we are seeing. In between cocaine hits, typically people are also taking an opioid such as fentanyl or other drugs that will kind of bring them down and steady them. It gives them a euphoric feeling and brings them down from the cocaine high that they have, which is a stimulant.
[Translation]
Senator Dagenais: Is it accurate to say that fentanyl does not necessarily come from abroad, the United States, or other southern countries, but that it's produced in Canada using drugs found here? These drugs include patches, which can be heated to extract fentanyl and make pills.
As a police officer, I know that the different police forces exchange information. Do you know about fentanyl use? Is it increasing? Is there more in Quebec, Ontario or out west? Is organized crime trying to profit from the drug?
[English]
Mr. Klassen: Organized crime is definitely involved in all drug sales in Canada at one point or another. There's a huge profit margin, as I mentioned. They are making these pills for pennies and selling them for $20 to $40.
As far as using actual fentanyl from patches or prescribed fentanyl, that's not what we're seeing right now. It's too easy to get what they need overseas and import it into Canada. To extract it from a patch is much more difficult and time consuming, so they don't get as much product as they would like from that. We're not seeing an abuse of fentanyl patches. We're not seeing them stolen from pharmacies like we were with OxyContin. We're seeing what I believe is called acetyl fentanyl — and maybe the doctor can speak to that — being brought in from other countries.
We're not seeing it brought in from the U.S. We're seeing it coming in through our ports mainly from China. We believe that is where it is coming from. It is easily ordered and easily imported into the country and then made into pills from there.
[Translation]
Senator Dagenais: When you seize fentanyl, what form is it in? Is it only in pill form, or is it also in other forms?
[English]
Mr. Klassen: Fentanyl is sold in a bulk form of powder as well, or you can buy a kilogram of fentanyl powder for about $12,000, I believe, and then make an extremely large amount of pills from one kilogram of fentanyl, turning that into millions of dollars at the end-user.
We're seeing that coming in across our borders. We're seizing it more so in pill form right now. We have had some seizures of powder, but that's not as common as the pill form right now. We're getting it at the end use. We believe a lot of that is being pressed into pills in provinces like British Columbia, where it's closer to the source country.
[Translation]
Senator Dagenais: You mentioned British Columbia. Can we thus assume that fentanyl is coming from Asian countries? I think you said China.
[English]
Mr. Klassen: That's correct. That's what we believe, yes, coming across the borders into ports such as those in British Columbia.
Senator McIntyre: To be honest with you, I don't know where to start. This is just unbelievable in my eyes.
Dr. Christenson, you mentioned that in 1990 you graduated from the faculty of medicine. You became a family physician and then you started practising on the Blood Reserve. In your practice, you developed a program for dealing with fentanyl addictions. Could you elaborate further on that program, please?
Dr. Christenson: In my clinic, I probably started about 140 patients on Suboxone. These are patients who have come forward with opioid addictions. Most of these addictions are fentanyl related. Probably about 25 of these people have overdosed. Two have been saved by the naloxone that was administered by community members.
Suboxone is like methadone; it's an opioid replacement medication. Unlike methadone, it doesn't make you high if you take too much of it. It's very safe. If you take it by itself, it won't depress your breathing, and that's what kills people when they overdose on an opioid like fentanyl or methadone or OxyContin.
I can achieve a satisfactory dose usually within two to three days. They come to my clinic once a day for two to three days. We get their withdrawals and cravings gone, and then I see them weekly for four weeks and then every two weeks for another month, and then they start seeing me every four to eight weeks. During this time period I get random urine drug tests on them to ensure safety. I don't want them to be using any sedating medicines like Ativan, Restoril, Valium, which a lot of drug users use. As Mr. Klassen mentioned, usually these people are using a lot of other drugs.
I also have an addictions counsellor in the clinic who meets with them on a regular basis, and we try to get them into treatment as soon as possible. We also have the support of our prescription drug team who is there to train them in how to use naloxone if they don't have a kit, and they are also given information on Narcotic Anonymous meetings happening within the community. We try to help them find jobs, housing and that sort of thing. So we're trying to be as comprehensive as possible in providing community supports, as well as the medication.
When you look at the science of opioid addiction, the most important thing to offer these people is opioid replacement therapy. It has the greatest chance of long-term success. It improves their lives. They live longer; they have less infectious disease; they have higher employment; they are more involved in their family, their community and school. That is probably the single base thing that we need to achieve, and then we start looking at the other things in life that we can provide them.
Senator McIntyre: Thank you, doctor.
Sergeant Klassen, in order to support this addiction, addicts turn to crime, obviously. Would you agree with me that those crimes are predominantly property, sex and drug related?
Mr. Klassen: That's exactly where they're going. Thefts have increased; robberies have increased, as they did with OxyContin in the past. They need to support their addictions, and to do this, they steal from others.
Senator McIntyre: I was reading that fentanyl addicts can consume as much as 15 pills a day, equating to approximately a $300 per day habit. Would a $300 a day habit require thefts costing $3,000, for example?
Mr. Klassen: Keep in mind that most of these people probably have lost their jobs by now or never had a job when they started this drug. So in order to support those addictions, they need to get the money to pay for it. The only way they can do it, other than getting a job, is to steal from others.
[Translation]
Senator Boisvenu: Thank you to our two witnesses for participating in the committee's study.
Sergeant Klassen, I have a concern. The bill is obviously very commendable. Over the past few years, drugs seized in police operations have more often been chemically modified in addiction-based laboratories. I want to know how this bill will help police successfully prevent drug sales and reduce the mortality rate. The number of drugs being produced in addiction-based laboratories is steadily rising. It's easy to obtain drugs over the Internet. How will this bill make your job easier and help reduce the mortality rate?
[English]
Mr. Klassen: By seizing large quantities of the chemicals required to produce the fentanyl pills that they are producing, we will hopefully take a large amount of them off the street. We've seen it with cocaine in other countries where we've taken off large amounts of cocaine — not us but police around the world. When that happens, large seizures from the States or Mexico, we do see it in Canada.
The same thing will happen with fentanyl. If we take the product or the ingredients away from the end-users or from the pill presses and from the importers, making it more difficult to get these ingredients, we'll see a difference at the end in that people will not be able to get those pills as readily. By making it harder for the importers to get, that will also probably increase the price to get it across the border, thus making it less attractive for them to get into as well. That will decrease their market.
[Translation]
Senator Boisvenu: Dr. Christenson, the drug is lethal. It's not a commonplace substance like marijuana. We don't hear much about it. In your view, are there enough awareness and prevention campaigns aimed at the most vulnerable people?
[English]
Dr. Christenson: Definitely in the last year more and more people are becoming aware of this drug and how deadly it is. Certainly on our reservation, I would say probably 98 per cent of people know about fentanyl. They know it's deadly. They know that they should be trained in how to use naloxone to prevent an overdose. I can only comment on my experience here. In my community — and we have 5,000 members on our reserve — the knowledge and awareness of it is very widespread.
I think worldwide it's growing. This is a problem that is not specific to Canada or the U.S. They have a huge crisis in Ukraine. I think the deaths there are phenomenal.
I think because many people have been personally affected by fentanyl, by one of their family members or friends, even by word of mouth a lot of people are very aware of this drug and its potency and danger. But I also feel that there's no downside to education in general. The more that we can educate people and teach them about things that they can do to help their loved ones, friends and families in the way of support services like opioid replacement therapy, naloxone kits and addictions counselling, if we all come together and educate people, it will only help.
The other thing that I think is important is learning to recognize that addiction is a disease. It's not something that we should stigmatize people about. None of these addicts wanted to become addicts. What happens with this drug is it changes your brain chemistry. The analogy that I often use is it's not like we stigmatize people with diabetes because their pancreas has burned out. People with opioid addictions have sometimes irreversible changes in their brain and they need medication in order to function in life. If we could stop stigmatizing them, I think they would come forward and start getting the help that they need. I think that particular educational awareness would be very beneficial, and I don't think there's enough awareness in that area.
Senator Joyal: Thank you, doctor. I would like to take one of your comments and ask you an extensive question in relation to it. You mentioned that it is a worldwide problem and you referred to Ukraine. Do you know of any other country that has banned the product so that they could be better able to control the impact of it?
Dr. Christenson: I believe Australia has, and Senator White may have some information on that. I don't know specifically that the precursors have been banned in other countries — not banned but regulated. My understanding is that Australia has done that.
Senator Joyal: You're not aware that the United States might have regulated it also?
Dr. Christenson: I'm not aware of that.
Senator Joyal: What about the capacity of anyone to order the product on the Internet? As you know, the business or the trade of drugs and medicines on the Internet is widespread. It seems to me that one way to bypass national regulations is to order the product through the Internet from another country where it's not regulated — where there is freer access — and then have the capacity to resort to the drug in the dire condition that you have described.
Dr. Christenson: That's certainly an issue that we should address as a community.
In California, people could buy fentanyl online through an advertising venue called Craig's List, which some of you may recognize. The state senator was unaware of that. I believe they ended up filtering the ads. If the word "fentanyl'' with "sale'' were in the filter, it was automatically taken off. It became illegal to do that. That would be a country issue that could be addressed somewhere down the line. We have to figure out how to regulate the sale of these types of substances in our countries.
Senator Joyal: Mr. Klassen, how do you approach this issue of spreading the use of those drugs through the Internet? What kind of strategy do you have to address that?
Mr. Klassen: Right now, without speaking to specifics, we have ongoing investigations of organized crime groups that we believe to be bringing in and manufacturing fentanyl in our country, and we'll continue to do that. Regulating these precursors will give us powers, prior to them making it into fentanyl, to charge the importers or put them before the courts at the time rather than waiting for them to make it into fentanyl and possibly hitting the streets.
Senator Joyal: I was surprised that the United States and Britain have not regulated the use of the product; it seems to be one that organized crime has found it can spread more easily because it's not regulated. If the problem is as important as you mentioned, why is it so acute in Canada and not that acute in the United States, which normally has a very stringent policy against drugs? Why did they not come to the conclusion that they had to intervene in relation to that product?
Mr. Klassen: I don't have specifics, sir, but I believe they have intervened in the United States, and, as the doctor mentioned, in Australia. The rules are quite a bit different there and in the United States on how they regulate their precursors. It's a lot different than how we do it here. When they see an issue happening, they regulate it right away through one of their drug administration areas. It has happened in the U.S. as well.
Senator Joyal: You don't know when that happened.
The Chair: We will move on to Senator Batters.
Senator Batters: Thank you very much to both of you for being here. I thank my colleague Senator White for bringing this important bill forward because this is a dangerous drug. We've been hearing so much about it lately in news reports. It's a real scourge on Canadian society.
Staff Sergeant Klassen, I see that recently Alberta passed legislation dealing with fentanyl. Both of you are from Alberta. I'm wondering why you think this particular federal legislation is needed to help protect Canadians.
Mr. Klassen: We're looking beyond Alberta. This is a Canadian problem. It's not just coming into Alberta. It's not starting in Alberta. It's starting in other places in the country and being made in other places in the country as well and brought into Alberta. The problem is not specific to Alberta. This is a far-reaching issue. I could speak to the Western provinces where it's a big issue, particularly in our area. I know from talking to my colleagues through the ALERT response teams that every area in Alberta is facing this issue. The fact that Alberta can make a law against even cocaine will not stop cocaine coming in from Mexico, Columbia or wherever.
Senator Batters: It's necessary to have a pan-Canadian approach to dealing with such a serious problem in criminal law.
Dr. Christenson, I was struck by the comment you made in your opening statement when you said that fentanyl is easier to get than a prescription from a physician, which is terrifying. I want to thank you for all the work you do to help people struggling with addictions and substance abuse. Ativan to me is a scary enough drug. It's an extremely addictive benzodiazepine. Fentanyl is a massive step up from Ativan, so much so that I think you were saying that some use Ativan as a way to detox from fentanyl. That's extremely frightening to me. I'm wondering if you could tell us a little bit more about that, the dangers of it.
Dr. Christenson: We actually refer to the combination of opioids and medications like Ativan, Restoril and Valium as a death cocktail. Before opioid replacement medication like Suboxone, patients would present in acute withdrawal, wanting to get off these drugs desperately, and would often be prescribed Tylenol 3, a little Ativan and clonidine, which is a blood pressure medicine that helps with the anxiety and shakes that come with withdrawal. But the addictions experts have red-flagged this as very dangerous prescribing because that is a potentiated risk of respiratory depression if you use an opioid and a medicine like Ativan.
In the drug screens I do with people on Suboxone, if they have Ativan or Restoril on board, they have to make a decision that this medication may not be right for them as it puts them at risk for overdose. Yes, Ativan, Restoril and alcohol are all respiratory depressants and if taken with fentanyl is sometimes just enough to push the patient over the edge and kill them. A lot of experts feel that most of the overdoses probably involve fentanyl plus something like Ativan or Restoril.
Senator Batters: Ativan, Restoril and Valium are all in the benzodiazepine class, correct?
Dr. Christenson: Yes, and Mogadon, which is an old-fashioned sleeping pill, but you still see it out there every once in a while.
Senator Batters: The three I mentioned, Ativan, Restoril and Valium, are widely used prescription medications in Canada; is that correct?
Dr. Christenson: Correct, with just one caveat. Doctors are all learning better and practising better. It's a slow change. There's probably no real good indication for needing more than one Ativan or Restoril every four nights if you have a sleep disorder. So you shouldn't really get more than seven to ten a month. That's probably a safe barrier. But the days of prescribing Restoril, 30 to 60 a month, to help somebody sleep are coming to an end because that is dangerous.
Senator Plett: Staff Sergeant Klassen, I'm not sure if I heard you correctly, but did you say in your testimony that actually importing the ingredient is not illegal?
Mr. Klassen: That's correct. Right now there are no controls over the ingredient. They're not scheduled at all.
Senator Plett: So I could go to China and come back with a bagful of the ingredient. At what point does the drug become illegal?
Mr. Klassen: When it's made into fentanyl. Mixing the ingredients together will form fentanyl. I'm not a lab person or a scientist to tell you how they do it, but mixing the ingredients together will form fentanyl, which is then mixed into pills with other binding substances.
Senator Plett: You told us what the cost was and how much they sell it for. Is that a more economical drug for a drug user than heroin or cocaine?
Mr. Klassen: Yes. On both ends, it's probably the most profitable drug out there right now and one of the cheaper ones to get for what the end-user gets out of it.
Senator Plett: Dr. Christenson, in that respect, that it's probably a more economical drug, is it more prevalent on reservations than it is in other areas?
Dr. Christenson: I don't know the statistics. There are certainly huge fentanyl problems in the inner cities of Edmonton and Calgary. I think Alberta Health Services pooled its data for overdoses, and Edmonton was number one and southern Alberta was number two.
Certainly troubles with addictions are much higher among First Nations. I think dealers probably recognize this and probably target our people because of the addictions issues. I don't know the statistics, but I practised in southern California for about 15 years before I came up here. I never saw anything quite like this, proportionately.
The Chair: Doctor, you talked about the days of over-prescribing coming to an end. A UN study said that Canada, in terms of per capita consumption, has the highest levels of opioid use in the world. In terms of your profession, how big a contributor has your profession been to this problem?
Dr. Christenson: I think doctors are doing their best with what they know and understand, but our education on addictions and prescribing in medical school is void. Hopefully that's changing. But of my patients who have come forward with fentanyl addictions, about 75 per cent had prescription opioid addictions before they got into fentanyl.
The Chair: I didn't read the story. There was an article today — I'm not sure if it was the Canadian Medical Association — about establishing new standards in terms of prescribing opioid use in the future. Maybe you're not aware of that. I didn't have time to read the article, but there's something happening there.
Dr. Christenson: I think all of the colleges here, in the U.S., and all over are trying to address this issue in a very active way.
Another area — and I've seen this with some of the young people — is they will buy over-the-counter Tylenol 1s. There are 8 milligrams of codeine in that. Pharmacists will have a young person come up and say, "How much codeine will $40 buy me?'' and they buy it over the counter. Even regulating Tylenol 1s I think is coming. The consciousness of the medical community is growing in this area. I think it will get tighter and tighter, and we'll do better and better, but I don't think we'll see real results for probably five to ten years, realistically.
Senator White: Doctor, if we're able to reduce the amount of illicit drugs on the street, do you not see an increase in individuals coming in to see you so you have an opportunity to engage in opioid replacement therapy?
Dr. Christenson: That's a great point. Yes, absolutely, because I think the people who are still using — and there are quite a few — somebody who wants to actually get a grip on their addiction we say wants to grow up. Then there are some that are still in the rat race of wanting to get high and party. I think if it becomes too expensive and too difficult, they will come forward. I see those people coming forward.
Senator White: Thanks again for being here today.
Senator Jaffer: Staff Sergeant Klassen, I have the briefing from the Canadian Association of Chiefs of Police. One of the things that concerns me is that it says there is a risk to the public but also to first responders. They can get hurt as well when they arrive. Can you clarify that, please?
Mr. Klassen: Depending on the form it's found in, fentanyl can be absorbed into the skin as well. It can be breathed in. If we find clandestine a lab, for instance, it's a biohazard and will be shut down right away. An expert will be brought in to take care of it and properly dispose of this.
The danger to first responders is in that they might not know what they're getting into and possibly breathe in this chemical or possibly handle it in some fashion. One of the dangers is our undercover operators handling these pills when they're purchasing them for prosecution. There are some dangers there. We find that's at the lower end of the scale. Possibly the doctor can speak to how that can be absorbed. The information we have is there's a smaller chance of that happening.
The Chair: We'll close on that. I want to thank both our witnesses for appearing before the committee today and contributing to our consideration of this legislation. It is much appreciated.
For our second hour, we have joining us, from the Canadian Association of Chiefs of Police, Trevor Daroux, Deputy Chief, Calgary Police Service; from the Ontario Centre of Forensic Sciences, Dr. Karen Woodall, Toxicologist; and, appearing as an individual, Marie Agioritis. Thank you all for being here today.
Perhaps, deputy chief, I could ask you to lead off, and then we'll just move across the panel.
Trevor Daroux, Deputy Chief, Calgary Police Service, Canadian Association of Chiefs of Police: Thanks for the opportunity to be here today. I'm not going to go over some of the history and some of the effects of fentanyl because you've heard that. Mr. Chair, as you said, I am representing the Canadian Association of Chiefs of Police and also, as a deputy chief, representing the Calgary Police Service.
In 2015, more Calgarians died from fentanyl overdose than homicide and traffic collisions combined in Calgary, and that doesn't account for those who were permanently disabled or hurt as a result of this.
The majority of fentanyl seizures have been in pill form. The pills are made to resemble OxyContin, as we'd heard. The pills are green and marked CDN on one side, 80 on the other. They are virtually indistinguishable from pharmaceutically produced pills. In Calgary, the current price is $20. Fentanyl pills are referred to on the street as green apples, shady 80s, greenies and fake oxy. Fentanyl powder looks very similar to heroin or cocaine. But it is odourless, and that's the difficulty in detecting it. The largest pill seizure thus far in Calgary is 11,000 pills.
The acquisitive crime, which was spoken about a little bit, is due to its highly addictive nature, as you've heard. A habit can be $300 a day. Most people, because of the issues around addiction, are unable to raise that, so they're doing it through crime, whether it's sex crimes, drug-related crimes or property crimes.
The return on the dollar for property crimes is about 10 per cent, so for a $300 habit a day, that's $3,000 worth of crime. We've seen, in Calgary, one particular instance where a stolen vehicle was traded for a single pill of fentanyl.
You're seeing the acquisitive crime graph that I've drafted and how crime actually mirrors it. The cost of addiction isn't just the drug itself but the crime that follows it, and I'm certainly happy to speak to that later.
The profitability of fentanyl is something we've never seen before. I've been involved in policing for 28 years, a lot of different areas within the drug unit. A $12,500 investment will get you a kilogram of fentanyl. That will produce a million pills and, at $20 a pill, at the minimum price, $20 million profit. As long as there's that kind of profit with this kind of drug, there's going to be organized crime involved.
Illicitly manufactured fentanyl pills have no quality controls, as we've heard. As such, hotspots are common. I think the chocolate chip cookie is a good example. A hotspot occurs when the fentanyl powder is not mixed thoroughly, resulting in a lethal concentrations in pills. The disparity in this batch combined with the lethality of fentanyl makes it unpredictable and deadly. One person can take a fentanyl pill from the same batch and be fine. The second person, right beside them, will take it and will overdose.
Fentanyl overdoses occur on a daily basis, the majority of which, I think it's important to note, are unreported to police. In the three-year period between 2011 and 2014, the number of fentanyl deaths increased almost 20 times in Alberta. In 2015, there were 272 fentanyl-related deaths, 90 of which occurred in Calgary.
In British Columbia, there were 152 fentanyl-related deaths in 2015, and in the first three months of 2016 there were 98 fentanyl-related deaths. In Canada, between 2009 and 2014, there were 655 deaths in which fentanyl was determined to be a cause.
Currently, the powder in fentanyl analogues is easily imported into Canada through Internet purchases, the majority of which are sourced through China. In October 2015, the Chinese government passed legislation to regulate fentanyl and several fentanyl analogues. However, this has resulted in Chinese-based pharmaceutical chemical companies diverting to other non-regulated fentanyl analogues. If the importation of powder becomes more difficult through enforcement actions in China, organized crime groups operating in Canada will turn to domestic production of fentanyl and fentanyl analogues and the use of currently unregulated precursor chemicals.
Effective drug strategies must focus on many things — prevention, education, intervention, treatment and enforcement. Each element is necessary in order that the harms of the illicit drug trade are better controlled. While the challenges associated with the illicit sale of fentanyl are similar to those of other illicit drugs, the death rate, the addictive qualities and the potential for profit far exceed anything ever before seen.
Controlling precursors is paramount to this strategy. As enforcement more effectively controls the importation of fentanyl, criminal efforts will shift to domestic or local manufacturing. Additionally, the demands for the precursors will increase in direct proportion to the efforts by the United States to control these precursors, which they do right now. If Canada fails to match the prohibitive actions by the U.S., the U.S. demand for precursors will be met through Canadian sources and suppliers.
In order to enhance public safety in Canada, prohibiting precursor chemicals required to synthesize fentanyl and fentanyl analogues will greatly enhance law enforcement's ability to impact the distribution of illicit counterfeit fentanyl in our country. Keeping on top of further synthetic drug trends is paramount to ensure future regulation is timely and effective.
We've heard how the U.S. can react much quicker than we can. This is important. This is the drug of today, and there's another one coming tomorrow.
Thank you very much for your time.
Dr. Karen Woodall, Toxicologist, Ontario Centre of Forensic Sciences: Good morning. Thanks for inviting me to speak here today.
I work for the Centre of Forensic Sciences, which is an Ontario government laboratory that provides independent testing for the whole province. We perform work for investigative agencies that include law enforcement, Crown attorneys, defence attorneys, coroners and pathologists. The main goals of the Centre of Forensic Sciences are to support the administration of justice and also public safety programs in the province.
My background is in the study of drugs and how they affect the body. I've got a PhD in Pharmacology. Then I came to Canada to do post-doctoral research at the Centre for Addiction and Mental Health in Toronto. During that time, I studied the neurochemistry of drug abuse. After my post-doc, I joined the Centre of Forensic Sciences, and I've worked there for over 16 years as a forensic toxicologist.
My work in the toxicology section there involves many different case types, but they include death investigations and also some criminal cases. The two most common case types that I work on that involve fentanyl are death investigations and then also some drug-impaired driving cases in recent years. We've started to see fentanyl increase in those types of cases, and I think it gives a good indication that it's being abused out in the province — the fact that we're seeing it even in impaired driving cases.
My personal interest began with fentanyl over 10 years ago because I started to see an increase in the number of fentanyl deaths in the province. I worked with another colleague and the Chief Coroner for Ontario, and we looked at the fentanyl deaths that had occurred. We published a couple of research papers because we felt that we needed to alert the scientific and medical community about the dangers of fentanyl, as well as the different ways that fentanyl is being used.
Since the time I became interested in fentanyl, we have started to see an increase in the number of fentanyl deaths that occur every single year. The first year I have data for was 2002, and we had 20 fentanyl-related deaths. In 2013, which was the last year the data was published, there were 111 fentanyl-related deaths. Since 2013, it still appears to be increasing every year.
Also, in 2008 we didn't have a single driver that had fentanyl in their system when they were arrested for impaired driving. In 2011, we had 4 drivers, and last year we had 43 drivers that were under the influence of fentanyl and were arrested for drug-impaired driving.
Over the last few years, not only have I seen an increased number of deaths associated with fentanyl, I've also seen a shift in terms of it's not people who have prescribed their own fentanyl anymore but people who are abusing fentanyl. Because fentanyl is such a powerful drug, it's not just people who have long-term drug abuse problems who are dying due to fentanyl; we see cases where it may be the first time somebody's ever tried fentanyl, and because it is so toxic compared to many other medications, unfortunately it causes death because they have no tolerance and they're not aware of the dangers of the drug they're taking.
As part of my work, I testified in numerous criminal cases involving fentanyl, and I have been qualified as an expert to talk in general about the effects of fentanyl, such as why it's so toxic and how toxic it is. Also, I discussed the different forms of fentanyl from prescription to the illicit forms that we're seeing increasingly now over the last few years. I also talked about the routes of the administration of fentanyl. It can be very dangerous with people abusing fentanyl because they're injecting and snorting it, and they're very toxic routes. In my job, unfortunately, I see the most extreme cases that come in as death investigations.
Thank you.
Marie Agioritis, as an individual: I'm honoured today to be able to address this Senate committee on the topic of Bill S-225, changes to the Controlled Drugs and Substances Act (Substances used in the production of fentanyl).
My name is Marie Agioritis, and my husband and I have long careers that we're proud of. However, our greatest joy and certainly our toughest challenge has been safely raising our five children. I'm here today as a Canadian citizen but first and foremost as a mother to stress the importance of this issue in the lives of our young people and, indeed, all Canadian families who have so desperately been adversely affected by this terrible plague of deadly drugs.
Our oldest son Kayle was introduced to OxyContin at a party in Grade 12. Until that time, some pot smoking had been his only foray into the world of what we might consider recreational drugs. He was an athlete, captain of his football team and scholastically successful. He loved his sports, yet nothing prepared him for his new-found passion for prescription medications. Like the rest of us, Kayle was not aware that these drugs could capture him so swiftly, and when they did, his love for the "high'' far exceeded his reasoning. He thought he could quit.
I can go into great detail about the hell that we've lived with Kayle, watching OxyContin destroy him — homelessness, numerous overdoses, jail, suicide attempts. It was surreal and heart-wrenching. I loved my son beyond, and watching this thing called addiction steal him from me was incomprehensible. It was destroying both of us and our family.
In addition to the emotional toll, the financial one exceeded anything that we could have imagined. Fortunately, we could afford private treatment, where public help was overcrowded with long waitlists. We could afford counselling and had connections for employment and places to live. But what I know now is that all the money and the love served only to keep him alive until he was ready to give sobriety a chance on his terms. Sobriety did come to my son Kayle, but at a cost that we never would have imagined.
Now to our second son, Kelly — sweet, kind, funny, loving, handsome, compliant. He was loved. He was 19 years old, worked at the Keg and was going to start working with an electrical company in March 2015. He wanted to be an electrician.
On the night of January 2, Kelly went to Kayle's apartment and secured a pill from a dealer who was crashing there for a few days. The pill was crushed and Kelly snorted half of it in front of his brother. Kayle made him stay with him for 20 minutes to ensure he was safe. Apparently, that's what responsible drug addicts do.
The second half of the drug was sent home with Kelly, the problem being the concentration of the drug, fentanyl, was in the second half of that pill, and it killed him.
I can't describe to you what it's like to get a phone call telling you that one of your children is dead. I can't describe to you how hard it is every day to live without him. The vivid memories of him walking through the front door night after night after work, the sensation of hugs and the sound of his voice — it's a nightmare, really — tragically complicated by his brother's addiction.
So what does the future hold? We cannot bring Kelly back or the four other young men that live within a few kilometres of our upscale neighbourhood. They also died within a six-month period from the same drug. We can, however, make a difference in the lives of families still struggling or the ones not there yet. Education awareness, harm reduction strategies and a bucketful of opportunities exist. These are imperative.
However, we need to look at root causes and eliminate the sources wherever possible. Fentanyl is far too easy to secure. It's cheap and the return on investment too tempting for a drug dealer to pass up. It's a dream product from the viewpoint of a criminal mind. If we choose to have a wait and see response, I can tell you now with absolute certainty that you won't need a crystal ball to predict the future. The bodies will pile up. The health care system will be pushed beyond its over-spilling borders that exist today, and more and more families will be destroyed.
As the mother of two amazing young men, and on behalf of all mothers, I will ask that the Senate support the passage of this bill. We need hope. We need to know Ottawa cares enough to join us in this fight to keep our communities safer. I believe strongly that the children who have already died from this epidemic cannot be left with legacies that suggest they were simply foolish pill takers. They deserve a legacy where their deaths serve a greater purpose. Today you have an opportunity to bring that legacy to life.
Thank you for your time.
The Chair: Thank you. We'll begin questions from senators beginning with our deputy chair, Senator Jaffer.
Senator Jaffer: Thank you very much, chair, and thank you to all three of you for your presentations.
Ms. Agioritis, you are a very brave woman to come here today to share with us such sad challenges faced by your family. I know I speak for all my colleagues when I say thank you. What you have said to us will help us make up our minds. Thank you.
Is there was one thing that could have been in place that would have made the difference for your two sons?
Ms. Agioritis: If there was one thing in place, I believe it would be early education when it comes to what is on the streets. I found in our own community, there's a fear when it comes to talking about drugs, the effects of serious drugs, and being real about it in the school system.
We need to start early and make it age appropriate, even at Grade 5, move it to Grade 8. If we're waiting until Grade 10 to talk to these kids in school about drugs, it's too late. They know more about it on the street than any of us will by the time they're in Grade 10. That is number one.
Senator Jaffer: Thank you very much.
Dr. Woodall, heard from an earlier panel about the strength of fentanyl. It's 50 to 100 times stronger than morphine and 40 times stronger than heroin. What happens to a user when an overdose occurs?
Ms. Woodall: If somebody takes too much fentanyl, it depresses the respiratory centres, so breathing becomes harder and harder. It also is a central nervous system depressant, so it slows down the way the brain functions. The brain starts to slow down, the breathing starts to slow down, and if you have enough of it, then eventually it will cause death.
Unfortunately, sometimes people taking fentanyl are also consuming alcohol or perhaps other drugs that are also central nervous system depressants, so you get this additive effect, and it increases the toxicity.
Senator Jaffer: How do we stop the ingredients? It's not completely foolproof, but what do you think legislators should have in place to try and deal with this issue? It's a very serious issue.
Mr. Daroux: Marie, I just want to say thank you on behalf of policing as well. You remind us why we do the job we do. Thanks for being here.
That is a very good question, senator. This will not stop it. This is a very difficult battle. That's why we need every bit of support we can get.
There's so much profitability in this business. There is the ability to make a $20 million return for a $20,000 investment, including the purchase of a pill press. It's too much for a drug dealer to pass up. As long as there's that kind of profit, it will continue. We've never seen that type of return in cocaine, crack cocaine or methamphetamine. That profit has never existed before. As long as there's that kind of profit, organized crime will be involved, so we have to look at every possible avenue we can to reduce the supply. If we reduce the supply, we reduce usage and we reduce addictions.
If we keep attacking that side, we also have to hit the demand side and work very hard on that. We know that if we're not talking to kids before they leave elementary school, that we need to be talking to them truthfully at that time, preparing them for the eventuality when they will be offered illicit drugs. It has to work at both ends. We have to work at the demand side of this. We have to reduce the demand, but we also have to reduce the supply. The bill allows us the tool necessary to reduce the supply at this time.
Senator White: Thanks to all of you for being here.
Thank you very much, Marie, and again my condolences on your loss.
Deputy Chief Daroux, there was a question earlier from Senator Joyal regarding whether or not any of the precursors are listed for exclusion or require permits. Do you have a response to that question as to whether or not the United States has taken action against these precursors?
Mr. Daroux: Thank you, senator. That is a very good question.
Yes, absolutely the United States did. As far back as 2006, supplies were coming up from Mexico, and the precursors were coming. The drugs were being brought in from Mexico. It was at that time, within a year after that, that they actually began to control and regulate the precursor substances for fentanyl. They have the ability to react quickly, and that's exactly what they've done.
Senator White: Is it true that as a result of that action they don't have a huge issue with precursors coming from Mexico? Instead they have it coming from where?
Mr. Daroux: That's exactly the problem. As the U.S. became more restrictive with respect to the precursors in fentanyl, the organized crime groups are now looking elsewhere, and they're looking to Canada and drawing from Canada. That's why it's so important that we look at what's going on within our borders. We have to be careful that we're taking the same strategies as in the U.S. We could very quickly become the source country otherwise.
Senator White: The Canadian Association of Chiefs of Police has had these discussions about crystal methamphetamine precursors, about bath salts precursors, and now fentanyl, and next W-18 and something I'm sure the day after that. Have you discussed a process by which this could occur more quickly than a continuous legislative response? If so, can you explain to us what that might be?
Mr. Daroux: Well, the discussion is how to do that. The Canadian Association of Chiefs of Police has a drug abuse subcommittee, which I sit on. We have representatives from all across the country, so we can see very quickly the trends developing throughout the country. In fact, what we're seeing with fentanyl began on the West Coast, and what was happening in Ontario was significantly different. Now it's starting to move across the country, as is the devastation.
So the focus is how to streamline the ability to actually start regulating as we're identifying those trends. That's a challenge before us.
Senator White: Thanks to all of you for being here.
Senator McIntyre: Thank you all for your presentations.
First of all, Ms. Agioritis, thank you for sharing your story with us. My warmest sympathies for the loss of your son. I can assure you that my colleagues and I were all touched by your statement.
Deputy Chief Daroux, in Canada, unlike in the United States, there are no restrictions or regulations governing purchase or import. For example, in Canada it is rather simple to import a pill press, so I understand that the Canada Border Services agents have no authority to seize presses. That must cause a big problem.
Mr. Daroux: That's a very good question. That's a significant problem. Alberta passed Bill 205 in May of 2016 and has now restricted the purchase of pill presses in Alberta.
The problem with that is if we don't have federal legislation on this, those pill presses will be coming across a provincial border, just like the U.S. is coming into Canada to be that source area. So it's critically important. Without the ability to utilize the pill presses, it's just another cog that makes it a little more difficult to produce illicit fentanyl.
As our restrictions and our work become more effective in terms of preventing its importation from China and the restrictions become more effective, the move will be to local production.
Senator McIntyre: Therefore, it's important to regulate fentanyl as soon as possible.
Mr. Daroux: Absolutely.
Senator McIntyre: Dr. Woodall, could you briefly explain to me what lab analysis reveals? For example, is it mixed with other drugs such as low-quality heroin or cut with caffeine and animal tranquilizers?
Ms. Woodall: In the analysis we do in our laboratory, we do have the ability to see lots of other drugs and cutting agents. Some of the deaths will just involve fentanyl, but in recent years it's becoming more and more common to see other drugs combined with it. We're increasingly seeing deaths where people don't even realize that they're taking fentanyl. They think they've been taking oxycodone or heroin, and instead of those substances we're detecting fentanyl. We do sometimes see cocaine. We see caffeine, lidocaine and other cutting agents with fentanyl.
[Translation]
Senator Boisvenu: Ms. Agioritis, I am very sorry for the loss of your son.
I have a question for Mr. Daroux. Despite the unclear regulations, is this drug being seized more and more often?
[English]
Mr. Daroux: Yes, it is. That is a good question. It's more prevalent. We're seeing more of it all the time. We have yet to be able to identify it.
When you talk about the lab that would be making fentanyl or taking powder and converting it into fentanyl pills, it's not a laboratory that any one of us would think of. In fact, it's smaller than the lab that's required to make methamphetamine, for instance. It could be done on a little table, very easy to do. We have yet to detect the laboratory in Alberta, which is alarming in and of itself. We have information about labs in B.C., but we haven't detected them yet.
We are seeing an increase because of the profitability. I think a lot more people are becoming involved. A lot more organized crime groups are recognizing this. As was stated earlier, the fact that they see the profitability in this and they want to increase the likelihood of addiction, that's their goal.
[Translation]
Senator Boisvenu: Also, the products used to make the drug are legal. Once the drug is produced in Canada, it becomes illegal. Does the drug move between provinces, or is it produced in the provinces relatively independently?
[English]
Mr. Daroux: No. This is across this country. We're seeing the products move. A lot of the cases are coming in through B.C. and coming in across the country.
[Translation]
Senator Boisvenu: Have the Sûreté du Québec, RCMP, municipal police forces and Aboriginal reserve police forces established a common strategy? It's a recent drug. To address the problem, have various individual strategies or an overall strategy been established?
[English]
Mr. Daroux: I can assure you that there isn't a single police agency in this country, and I would argue in North America, that isn't concerned about the issues around fentanyl. We're working together very closely not only across this country; we're also working with the U.S. In fact, through the UN there were sanctions on China in 2015, restricting fentanyl exportation. Everybody is concerned about this. When we say it's at a level we've never seen before, it is something we have never seen before.
[Translation]
Senator Boisvenu: Ms. Woodall, who are the people who typically die after using the drug? Can you describe them and tell us their age and gender? Can you give us an idea of the people who die after using the drug?
[English]
Ms. Woodall: In terms of the cases we get in the centre, so the deaths due to fentanyl, it's all different types of people. That's one of the scary things about fentanyl. Teenagers would be the youngest age. People in their fifties and sixties are dying of fentanyl overdoses. Sometimes it is people who have long-term drug addiction problems. Other times it is people who aren't known to be drug users at all, but they've gone out and somebody has said, "You should try this.''
Sometimes the history we get is that it's the very first time they've ever tried this drug. Because fentanyl is 100 times stronger than morphine, sometimes people don't stand a chance. Because it's so strong, they don't have any tolerance to the drug. It affects males and females. Really, it's a whole wide range of population that we're seeing.
[Translation]
Senator Dagenais: My first question is for Mr. Daroux. We know the police forces are working together. In Quebec, the drug has been seized many times recently. Drugs are often sold in small communities where everyone knows each other. Is the public helping report these crimes to the police? As Ms. Agioritis told us, her son died from taking the drug. Please accept my condolences, Ms. Agioritis.
Do young people have problems reporting these crimes? Tips are often received through informers.
[English]
Mr. Daroux: That's always been a problem, not only in small centres. I would argue that's a problem we see in schools and educational institutions with young people. That's why enforcement alone is not going to solve this problem. We have to have a robust education component as well, a prevention component.
This is far too complex for just police to be responding to this. This takes a multidisciplinary response where we have education, working with the schools, with medicine, with the health service boards as well, getting that information out to the children. Our best defence against this is when the child stands up and says, "I know what that is, and I'm not going to go near it.'' That's how we have to reduce that actual demand for this drug. As we've said, as long as there's that kind of supply and profit, there will be a supply. It's going to be very difficult to challenge. Education and prevention is the key to this, as well as treatment.
[Translation]
Senator Dagenais: I have a question for Ms. Woodall. You aptly described how the drug hurts young people in particular. The product's quality should also be considered. It's called poisonous and deadly, so how does it attract young people?
[English]
Ms. Woodall: People take drugs like fentanyl because they get high from it. It's well known that opioids give people that euphoric feeling. That's why they're so widely abused all around the world. Unfortunately, in recent years — and I've seen it more and more in casework — it seems to be more socially acceptable for people to use opioids such as fentanyl. Because a lot of these drugs are available by a prescription and they're therapeutic medications, a lot of people don't even seem to associate it with abusing drugs.
I've seen cases where friends of the deceased have actually said things such as, "Oh, no, they don't abuse drugs; they just take a bit of fentanyl once in a while.'' I found so shocking the first time I read it because I felt: Seriously? We're in a world now where taking opioids to get high isn't even considered abusing drugs?
I think people view it separately, for example, from heroin abusers who have to inject heroin. A lot of people would never do that because it's serious drug abuse, whereas taking a tablet or a fentanyl patch is something that doctors prescribe, so it has a different stigma attached to it.
Senator Batters: Thanks very much to all of you.
Ms. Agioritis, thank you so much for being here. You said something very profound when you said that your son deserves a legacy, where his and other people's deaths from this deserve a greater purpose. I think you're helping to ensure that that happens with this particular bill. You will save people's lives by this.
What you were saying earlier about early education about drugs, I think that's so important, especially here, when you're talking about something that's as dangerous as fentanyl, where half a pill can kill someone.
Would you agree that part of that education needs to be that drugs are not equal? A drug like marijuana is not the equivalent of a drug like fentanyl. Getting high one time on marijuana will not kill you, but a drug like fentanyl can. Do you think that's part of the education, especially for very young children in elementary school?
Ms. Agioritis: I think most certainly that we have to be very real with the drugs that are out there, real with their process. I'm not an expert in what a child can handle, but I think those are the people you engage at the early levels to ensure that the message is being sent in the softest and strongest way. But by the time they get into the eighth grade, we need to look at the process of the drug, the availability and the consequences. As for just simply saying that it will kill you, my son knew it would kill him, and he still tried the drug. He'd seen the hell our family went through. I'm not saying early education would have saved him; I don't know. However, I do know it will prevent a lot of children from getting involved in the drugs if we get real with it.
Senator Batters: Mr. Daroux, why does the U.S. have the ability to act so much more quickly to ban precursors? Is it because they don't need to go through a legislative framework like we do in Canada in order to ban them?
Mr. Daroux: I'm not an expert in how that moves through, but what I understand is through the DEA they have the ability to identify the trends quickly, as we do here.
Senator Batters: Through the Drug Enforcement Agency in the U.S.
Mr. Daroux: Absolutely, and they move those requests forward and are able to respond quicker than we are. As we said earlier, it's fentanyl today and will be something else tomorrow. We need to be prepared for that.
Senator Batters: I'm not sure if that's information that either you or perhaps Senator White could get us. I'm curious as to how we in Canada can move more quickly on some of these things. As you say, they're escalating on a daily basis.
Thank you.
Senator Joyal: Ms. Agioritis, I would like to extend to you our great admiration for what you do. I think it's due to people like you that legal conditions in Canada evolve for the better, and to protect those who are more vulnerable to the bad influences, unfortunately, that schoolyards and social life can bring to people. Your message does not fall on deaf ears.
Each one of us around the table has families, relatives and loved ones, and some of the time we have had bad experiences. It's not for us to tell our stories here around the table, but we need people like you to come and tell the story that brings home the real life aspect of the legislation we are purporting to adopt. I would like very much to thank you for that.
Staff Sergeant Daroux, I'm always preoccupied by the importance of the Internet and the use of the Internet, especially by young people, in relation to the spread of the use of drugs. It's so easy now to convince another person that is in your network of connections that he or she should try this or that. How would you approach this aspect of fighting against drug use amongst youngsters, even among young adults, in relation to those drugs that are tragic in their use?
Mr. Daroux: Thank you, senator, for a very good question. It's been said that our youth are growing up in a toxic environment. Often when people look at that environment, they're looking at the Internet. Obviously I don't have to tell anyone here that it is difficult to control.
With respect to fentanyl, the Internet serves multiple purposes. One, it absolutely does provide the ease of access to purchase. Even just googling fentanyl, you will be able to find out how to bring it in, including importation forms, if necessary. It serves that purpose for a wide distribution like we've never seen before.
It can also exploit those vulnerable in our population. Whether it's exploitation into fentanyl use, exploited because of vulnerability, whatever that is, or into violence or gang life, we see that through the Internet as well. I'm not saying that trying to put a cap on the Internet is an exercise in futility, but it's something we need to be looking at.
Equally and more important is the need to provide resilience to our youth, our children, as they're growing up, to be able to resist these types of things, identifying what is creating those vulnerabilities, whether it's sexual abuse, poverty or social isolation for newcomers into this country. Whatever it is, we have to be able to identify that and work through it.
Again, yes, the Internet is a challenge. It's a very difficult challenge and one that we alone will not solve. We have to create that resilience in our youth going forward.
Senator Joyal: In terms of supply and getting the product from outside sources, how much is the Internet a source of supply if there is a deal in the street? You know what I mean. People who trade visibly make it much easier for you to trace them. But on the Internet, unless you try to monitor an organized crime group, whereby you might have access to the supplier, it seems to me to be almost unsurmountable.
Mr. Daroux: It's significantly different, and that's what we saw with fentanyl that we hadn't seen. There are fairly established supply lines for cocaine and crack cocaine as it comes into this country. It generally goes to organized crime groups and is controlled at the distribution level as well.
We started to see with respect to fentanyl were people not on our radar who we hadn't thought of or were concerned about importing fentanyl, and the vast majority of that was coming through the Internet. Until organized crime reacted to it to see where the profits were actually going, it provided the opportunity for people to be involved in this that weren't before.
The Chair: I know that education is one of the answers, but the society that kids grow up in today, not just the Internet but also the entertainment world, for example, with the accepted use of drugs in movies and their promotion in rap music, is such a huge challenge. I know about the policing efforts and an attempt to control importation. I guess this should be looked at by most Western societies, especially North America, as a significant crisis that governments have to play a much greater role in in getting that other message out there. I think it's something that this committee can look at in the future: How do we come to grips with this in a much more effective way than is the case at the moment?
There is a special CBS series in the United States focused on heroin use and families like yours that are losing their kids. It's a huge challenge throughout many parts of the world, and certainly in this country and the United States. I just wanted to add my special thanks to you for bringing your family story to us and emphasizing the impact this has on so many families. I very much appreciate it.
Senator White?
Senator White: We keep talking about addictions and people who are long-term users of drugs. Had your son used fentanyl before that you know of?
Ms. Agioritis: Kelly, the one who passed?
Senator White: Yes.
Ms. Agioritis: I suspect that he may have. In December we started to notice some changes. He had been hanging with somebody that I had asked him — well, it was less of an ask — not to hang with anymore. I think during that time he had started to use it.
Senator White: But it was a fairly quick progression from being vibrant and compliant and happy-go-lucky to actually dying as a result of a drug overdose.
Ms. Agioritis: Right — for example, the fact that it was half a pill, when his brother was taking probably eight of them a day. That half pill also spoke to how much he had experience with the drug itself.
Senator White: Thanks again for being here today.
Senator McIntyre: Chief Daroux, I would like to go back to the issue regarding the importation of fentanyl. As I understand, the powder is primarily sourced from China. In the fall of last year, my understanding is that the Chinese government passed legislation to regulate fentanyl.
Mr. Daroux: Yes.
Senator McIntyre: The importation of this powder then becomes more difficult. If the importation becomes more difficult through enforcement actions in China, then obviously, as you stated a while ago, organized groups in Canada will step in and turn to domestic production of this powder. This is a scary story, let me tell you. Could you elaborate briefly on that, please?
Mr. Daroux: It is a frightening story that's driven by the massive profits that are involved. It's critically important that China was able to restrict the exportation of fentanyl. That's an important piece. We have to keep moving with what's going to happen next. This is predictable. We know it's occurring and we know it will happen. It's a matter of being able to move with it.
Reducing the supply in this country will reduce the devastation that's being caused. It will reduce the number of addicts and the profitability to these organized crime groups.
On the other side of that, as we reduce supply and the demand stays the same, we're going to increase the price of this. It's everywhere right now, and we're seeing it, because it is a very inexpensive drug.
Senator McIntyre: As you've indicated, the actions of the Chinese are not sufficient. Canada has to move in and regulate this drug as soon as possible. Also, we have to be careful of U.S. addicts moving into this country and trying to provide this drug.
Mr. Daroux: We are fearful as well of organized crime groups recognizing that they can't source the precursors in the U.S. coming to Canada and then relying on the labs here.
The Chair: Thank you all, witnesses. We very much appreciate your appearance and your testimony here today.
A special thanks to you, Ms. Agioritis, for bringing us your very tragic personal story.
Members, before we adjourn, I would ask our steering committee members to remain for a few minutes. We have some quick business to deal with.
(The committee adjourned.)