Proceedings of the Standing Senate Committee on
Legal and Constitutional Affairs
Issue No. 25 - Evidence - March 29, 2017
OTTAWA, Wednesday, March 29, 2017
The Standing Senate Committee on Legal and Constitutional Affairs, to which was referred Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, met this day at 5:15 p.m. to give consideration to the bill.
Senator Bob Runciman (Chair) in the chair.
[English]
The Chair: Good afternoon and welcome colleagues, invited guests and 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 consideration of Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts. With us today is the Honourable Jane Philpott, P.C., M.P., Minister of Health. Joining her at the table are, from Health Canada, Hilary Geller, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch; Diane Labelle, General Counsel, Health Canada Legal Services; and from the Public Health Agency of Canada, Ms. Theresa Tam, Interim Chief Public Health Officer.
I thank all of you for being with us today.
Minister, the floor is yours.
[Translation]
The Honourable Jane Philpott, P.C., M.P., Minister of Health: Good afternoon, everyone. I am pleased to be appearing before your committee to discuss Bill C-37 and update you on actions we are taking to address the opioid crisis.
As the chair said, accompanying me today are: Hilary Geller, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch; Theresa Tam, Interim Chief Public Health Officer, Public Health Agency of Canada; and Diane Labelle, General Counsel, Health Canada Legal Services.
[English]
I certainly appreciate the committee's interest in this very important issue and I look forward to your feedback and questions on our discussion this afternoon.
As you know, Bill C-37 offers concrete solutions to many challenges that we are facing as a country, particularly as it relates to an ongoing crisis of overdose deaths associated with opioids.
Our government has been eager to expedite the passage of this bill through the parliamentary process to help protect both the health and safety of Canadians and their communities.
The speed with which parliamentarians have addressed this legislation demonstrates the collective sentiments for a need to swiftly act in the face of an opioid crisis.
[Translation]
Our country is facing a public health crisis in relation to opioids, especially fentanyl. First responders have seen with their own eyes the devastation caused by that crisis.
[English]
Last year in British Columbia, as many of you are well aware, more than 900 people died from drug overdoses. That was an 80 per cent increase over the year previously. The data from 2017 shows that there are few signs of improvements and in fact we are on track for that number to continue to grow. There were 102 suspected drug overdose deaths in February 2017 and that is a 73 per cent increase over the number of deaths in February 2016. The scale continues.
British Columbia is not alone. In Alberta, 257 people died from fentanyl overdoses in 2015, and that number jumped by a third in 2016 to 343. That is just the number of deaths associated with fentanyl. There would be other overdose deaths in addition to that.
We are facing a period of time in the country where there are more people dying as a result of overdoses, let alone overdosing itself, than there are Canadians dying from motor vehicle accidents.
We see signs that the opioid crisis is expanding throughout the country. Problematic substance use can affect people of all ages and from all socio-economic groups. It has devastating consequences on individuals, families and communities.
I have visited with those who face this crisis on a daily basis. That includes first responders who are facing repeated overdoses, many times on a single shift. I have met with family members and friends who are grieving the loss of loved ones.
[Translation]
Our government's approach to drug policy is compassionate, collaborative, comprehensive and evidence-based. We are using the same approach to address the opioid crisis. We need to take a public health approach, while ensuring that law enforcement entities have the tools they need when addressing problematic substance use.
[English]
We need to turn the tide on this crisis as quickly as possible. The government's new Canadian drugs and substances strategy in which Bill C-37 plays a fundamental role will help us to turn that tide.
The new Canadian drugs and substances strategy replaces the previous approach by addressing problematic substance use as primarily a public health issue. We have restored harm reduction as a key pillar in Canadian drug policy alongside prevention, treatment and enforcement. These pillars are supported by a strong evidence base.
Bill C-37 is a legislative proposal that supports this strategy. It would do so by updating legislation to focus on harm reduction measures, while continuing to reduce the flow of illegal substances into Canada.
[Translation]
It proposes to amend the Controlled Drugs and Substances Act, the Customs Act and other acts to: improve the government's ability to support the establishment of supervised consumption sites, as a key harm reduction measure; address the illegal supply, production and distribution of drugs; and, finally, reduce the risk of controlled substances used for legitimate purposes being diverted to the illegal market by improving compliance and enforcement tools.
[English]
Streamlining the application process for supervised consumption sites is a central piece of this bill, and for good reason.
The evidence is abundant that when properly established and maintained supervised consumption sites save lives without increasing drug use and crime in the surrounding area.
Specifically regarding the application to supervised consumption sites, Bill C-37 would amend the Controlled Drugs and Substances Act in order to establish a more streamlined application process for these sites that aligns with the five factors that were set out for us in 2011 by the Supreme Court in the decision of Canada (Attorney General) v. PHS Community Services Society.
The bill also seeks to improve transparency by requiring the decisions made about supervised consumption sites to be made public, including the reasons why an application would be denied.
For those communities that want and need these sites, we want to create an environment that encourages applicants to come forward.
Of particular note the bill proposes that we include the five factors I referred to in the legislation, one of which it is important to note is community support or, on the contrast, community opposition. The government is absolutely supportive of community consultations. In fact, it is critical to the ongoing success of this important harm reduction tool that communities be supportive.
Bill C-37 also includes a number of other amendments to the Controlled Drugs and Substances Act that would modernize the legislative framework. Improving the compliance and enforcement tools would reduce the risk of controlled substances that are used for legitimate purposes from being diverted to the illegal market.
Proposed legislative measures would prohibit the importation of unregistered pill presses or pill encapsulators. It would allow border officials to open international mail of any weight, should they have reasonable grounds to suspect that the item may contain prohibited, controlled or regulated goods. It would grant the Minister of Health the necessary powers to quickly schedule or control a new and dangerous substance.
[Translation]
Bill C-37 balances public health and public safety and is based on the best available evidence.
[English]
Removing components of the bill such as the provisions related to supervised consumption sites would upset this balance and significantly delay access to an important harm reduction tool for communities that need and want them to address the opioid crisis.
[Translation]
Bill C-37 is one of many important federal actions that have been taken to date to address the opioid crisis.
[English]
To give you an idea of the other things we have done over the past year, we made naloxone, the antidote to overdoes, available without a prescription. We expedited a review of naloxone nasal spray and ensured an emergency supply of that spray. We granted a four-year exemption to Insite, the supervised consumption site in Vancouver that I suspect you are familiar with, and we granted an exemption to the Dr. Peter Centre in Vancouver.
We reversed the prohibition on physician access to the important treatment option of pharmaceutical-grade heroin to treat the most severe cases of addiction. We supported the Good Samaritan Drug Overdose Act, Bill C-224, which offers immunity from simple possession charges for people who witness an overdose and call 911.
We finalized new regulations to control chemicals used to make fentanyl, making it harder to manufacture illicit substances.
I co-hosted a joint national conference and summit on opioids with the Ontario Minister of Health. We produced a joint statement of action from nine provincial and territorial health ministries and more than 30 organizations.
In collaboration with our provincial and territorial partners we have established a special advisory committee on the epidemic of opioid overdoses that includes the Council of Chief Medical Officers of Health.
In 2016-17, the federal government transferred $36.1 billion through the Canada Health Transfer to provinces and territories for their overall health services, including treatment of addictions.
In Budget 2017 we recently announced $100 million in funding to address the ongoing crisis. This includes $65 million over five years for federal initiatives, an additional $10 million in emergency funding for British Columbia, and $6 million in emergency funding for Alberta.
To address some of the causes and factors associated with the crisis, the federal government offered the provinces and territories $5 billion over 10 years for mental health and addiction supports as part of our new health accord.
In addition, Health Canada is improving access to and information as it relates to a number of medication-assisted therapies. We funded the Canadian Research Initiative in Substance Misuse to provide better evidence-based guidelines for medication-assisted treatment.
We supported McMaster University's update to the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, developed by a group of clinicians, researchers and patients.
That gives you some idea of the work done so far. Unfortunately, while we cannot end this opioid crisis immediately, we have taken swift and decisive action. We will continue, and I look forward to working with you on this, to make sure we have a comprehensive and balanced approach to deal with problematic substance use for the long term.
Making Bill C-37 law is an important step to support this approach to drug policy.
I would take a moment to respectfully urge this committee to work as expeditiously as you possibly can. Your role in this matter is critical. As you know, people are dying in Canada every day and there are measures in this legislation that will save lives.
This legislation was so important that in the other place, for the first time in its political party's history, the New Democratic Party supported time allocation to move this bill as quickly as possible through the legislative process. The health committee in the other place conducted a thoughtful study on the opioid crisis. I would be happy to circulate the government's response to honourable senators once it is tabled. Because of this investigation and the hearings with witnesses that had already been completed, the health committee in the other place was able to complete their study on this bill quickly.
I know many of you have been pressed with this issue and have already taken a number of steps to prioritize this legislation. I want to personally thank you for that. We need to do everything at our disposal to save these lives that are being cut short.
This proposed legislation would equip the federal government and law enforcement with stronger tools to address problematic substance use and the ability to support communities fighting this crisis on the local level.
We will continue to work with our party partners, including the provinces, territories, municipalities, indigenous communities and civil society to address this opioid crisis.
[Translation]
This will allow us to better protect Canadians, save lives and address the root causes of a major issue that affects our entire country.
Thank you for asking me to join you today. We would be happy to take questions.
[English]
The Chair: Thank you, minister. We have roughly 45 minutes remaining for questions. I know that many senators want to participate. I will encourage concise questions and comparable responses, if possible.
Senator Batters: Minister, it is my understanding that a number of the measures in this bill were tabled by our Conservative government's Bill C-70 in June 2015. This included measures like giving Canada Border Services Agency increased powers to inspect suspicious mail and allowing Ottawa to limit the importation of devices like pill presses.
We are in the midst of an opioid crisis and have been for many months. Children are dying. Knowing that, why did you wait 18 months to introduce legislation containing measures that were already drafted and ready to go in 2015?
Ms. Philpott: Thank you for the question. You are absolutely right. There are pieces of this legislation that had been previously introduced in the previous government. They were not the areas where we were being most pressed but they were areas where people were concerned.
When we came to government the area I was immediately asked about most frequently was the matter of supervised consumption sites. We took some time to consider the process that had been put in place by the previous government. We had hoped it would be workable to allow access to supervised consumption sites as quickly as possible, but it proved onerous and I was under tremendous pressure to address that.
As we moved forward in putting in place measures to expedite the process for application of supervised consumption sites, we looked to these other measures that had been in the previous government's Bill C-70 and added those in.
In retrospect, things take time and one can never move quickly enough in a process like this. However, as soon as we recognized that we needed to put legislation in place on drugs and substances we added these additional measures.
Senator Batters: Like you referred to, you have significantly altered the requirements put into place by the former Conservative government for the applications of drug consumption sites.
Some of the criteria that Bill C-37, your bill, now abandons include letters of opinion and concerns from significant community stakeholders such as the local government and the head of effective policing services. Instead, your legislation requires only the vague "expressions of community support or opposition.''
Without the input of the local government or police services in an area, what would qualify as an "expression of community support or opposition'' for the purposes of your bill? Would one positive letter, for example, from a supportive community organization or leader suffice?
Ms. Philpott: My officials may want to add to this, as well, but the reality is that the approach that we went to in this puts a significant amount of discretion in the hands of the Minister of Health to make a decision based on the particular circumstances of that community.
We wanted to include the measures that the Supreme Court indicated needed to be taken into consideration, including community support. On a case-by-case basis the Minister of Health may choose to look to require additional items like that to be able to document the community support. The Minister of Health, especially in turning down an application, would be required under this legislation to explain, for example, that there were members of the community who were opposed to it.
I have certainly been impressed with the reality we are facing on the ground from the beginning of the time that I took office. Many cities and communities across the country desperately want to be able to open supervised consumption sites. The community support is overwhelmingly pushing for us to be able to allow that authority to provide an appropriate exemption. People are dying in the streets on a daily basis and people are looking for every possible mechanism.
Within the Minister of Health's discretion, assuming that there is support in the community, the burden of pressure and need was to be able to provide support for these in communities that need them. You will see included in the five factors that there has to be a demonstration not only of community support but also of community need.
Senator Jaffer: Thank you, minister, for being here, especially on a week that you are not sitting. We appreciate your presence.
Minister, the last legislation that in the previous government put in place there were 27 conditions. It was very onerous and very difficult, especially in my province of B.C. We heard from many people that it was virtually impossible to open another site. You now have five. I looked at them. This is something people can do, but people need time to do this.
I would like to hear from you as to why you did not consider that in an emergency, in a case where a 56(1) exemption cannot apply because there isn't the time to empower the provincial minister to open a temporary site, for example in B.C. with all the problems that are happening, why couldn't the minister of health provincially open for a short time to deal with this issue? Did you consider that provision?
Ms. Philpott: That is an excellent question and it is indeed something that we considered. You are absolutely right that the process under the current legislation as it exists is tremendously onerous. The binders my department received to meet the 26 criteria are quite remarkable, considering the fact that the people who are filling these out are dealing with the front lines of the overdose crisis at the same time.
I have urged my officials to be as helpful as possible in helping people to fill out the application process. That will continue under the new criteria, so that even though we have moved it to five factors I will encourage them to be as helpful as possible. In fact they have sought to do that to support communities that are feeling this desperate need.
We felt that the idea of passing on his responsibility to the provinces and territories would put us at risk where there may be inconsistency across the country. When we are dealing with a matter of drugs and substances and dealing with prosecution, for example, it made sense for there to be some cohesiveness and coherence across the country. Yes, indeed we did discuss that.
I have made it very clear to those communities crying out for help that we will make sure we do everything within our power to work with our provincial partners to be able to support the communities that want these.
Senator Jaffer: I have a very quick question. All the five, according to the Supreme Court of Canada, I accept those. The one requirement that I have a bit of concern with and think will be time consuming is the resources available to support the maintenance of the site.
I believe it is vague. How long? Is it for a year? Is it for six months? Could you elaborate on that?
Ms. Philpott: I may not be able to go into specifics in a short answer, but a good example of this is in Ontario where Toronto and now Ottawa have applications in process. In Toronto's case, for example, they had three sites where they were enthusiastic to get sites open to people. One of the pieces that held us at bay, as it were, in approving those was that we needed to make sure they had the resources to be successful. We were thankful when the provincial government announced they would put the resources behind and announced that money would be there.
We put this in there because the Supreme Court had put this in as a factor to consider, but I think it is a reasonable factor. So far, these sites have been highly successful. They have been able to save lives, make sure there is no increased crime and make sure there are no challenges in the surrounding area. We have to make sure they continue to be successful and having the resources to function well will be important in that.
Senator McIntyre: I have to admit I am concerned that your bill would reduce from 26 to only 5 criteria, which severely weakens Bill C-2, the current regime under the Respect for Communities Act. You have explained the rationale behind reducing considerably those criteria. Hopefully, it will tackle the present national crisis we are facing today.
My question has to do with the drug treatment centres. In reading your bill I note that it does not contain provisions on drug treatment centres that are considered as being an important part of the solution. Could you enlighten us on why Bill C-37 does not contain provisions on drug treatment centres?
Ms. Philpott: I may need some further elaboration on whether I am getting at the right point, but let me make an attempt. If I haven't got your question quite clear, maybe you can clarify it for me.
I think you are asking about treatment for problematic substance use and medication-assisted therapy to go along with the supervised consumption sites.
Senator McIntyre: Yes.
Ms. Philpott: This is an incredibly important question. As you may have heard me say, the response to drug policy and the response to this overdose crisis have to be comprehensive. It requires all of those pillars.
Prevention is incredibly important. We need to talk about why people end up with problematic substance abuse to begin with. It is often related to unresolved trauma, mental illness and a whole bunch of other social issues.
We need to make sure they have harm reduction facilities, including that supervised consumptions are available, but you are absolutely right that treatment has to be an essential part of this.
Treatment involves things like counselling, mental health care, housing support and social support. It also includes medical treatment and medication-assisted therapy in many cases that may take the form of opioid substitution therapy like Suboxone, for example. Sometimes in certain circumstances it will involve things like access to pharmaceutical-grade heroin.
There is nothing in this bill that would prevent a provincial government from being able to associate a treatment centre with a supervised consumption site. In fact it's a very good idea in many cases.
One thing that grieves me tremendously is that people will come into a supervised consumption site. Their life will be saved if they overdose and they will be introduced to the health care system, but very often they are sent right back out into the street. They have a recognized opioid dependency.
In order to maintain that dependency and deal with the health condition they are associated with, they will often seek more drugs. Those will be drugs that they will seek on the streets and commit crimes sometimes in order to access those.
Being able to find ways to introduce people to treatment in connection with these sites is a fantastic idea, and I'm certainly encouraging my provincial partners to consider that.
Senator McIntyre: Overall, as you know, minister, three models of drug consumption rooms are operational in Europe: integrated, specialized and mobile facilities. Are mobile injection sites covered by this bill? If not, are you considering mobile injection sites?
Ms. Philpott: Thank you for an excellent question. Mobile supervised consumption sites would certainly be able to apply under this bill. In fact we have two applications that are in process. They are slightly more complicated applications in order to demonstrate that they would meet the criteria, but as you've indicated in Europe these have been found to be helpful. We're open to considering those according to the appropriate legislation.
[Translation]
Senator Dupuis: Minister, thank you for making yourself available to meet with us today.
I have a question about the minister's new authority to make an order that would add a designated substance to the list for a maximum of two years, even though the legislation already grants the Governor in Council the power to make an order and even though we — lawyers — generally do not like to resort to ministerial discretion, as that means both adding an element and removing it.
Can you enlighten us on the justification for using that particular process?
[English]
Ms. Philpott: I think I will turn to my officials to clarify the specifics. You are absolutely right. In many cases the Governor-in-Council authorities can allow for these products to be listed or delisted. Hilary or Diane can respond to that.
Hilary Geller, Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Health Canada: The section that we refer to as allowing for temporary accelerated scheduling is similar to authorities that exist in a number of other countries. It's designed to address an emerging problem of new psychoactive substances. Where in the past you might see one or two new substances a year, over the last number of years that has increased rapidly to where we are now seeing one or two a week in some cases.
Instead of going through the normal regulatory process, as you indicated, senator, this authority allows the minister a much quicker scheduling. If it runs its typical course it can take between 18 and 24 months. That's a long period of time when dealing with a dangerous substance.
We're thinking possibly as quickly as eight weeks, depending on the circumstances, but that would be limited to cases where a substance poses a significant risk or alternatively may pose a risk and we know it has no legitimate purpose.
It's a renewable authority. It can't continue for more than two years. We anticipate that at the same time this process is used we would also be going through our usual regulatory analysis to replace it with that process for its long-term scheduling.
[Translation]
Senator Dupuis: Do the offences designated in the bill include physician-prescribed opioids? There is talk about possession for purpose of consumption, but is there talk about what is partially causing the opioid crisis — prescription by health care professionals?
[English]
Ms. Philpott: You are right. Some of the roots of the crisis are related to prescription opioids but that's not the matter being addressed in the particular bill. We are responding to that in our more broad strategy, including the work that we did at the opioid summit where we brought together national stakeholders, including regulators of doctors and pharmacists, et cetera. That's not the subject of the particular legislation.
Senator White: Thanks to the minister and staff for being here. It's appreciated.
My first question will focus on the work of Health Canada and whether or not they are proactive enough in identifying what drugs are coming and what other possibilities we would have.
I appreciate that you need the new legislation to be able to be proactive, but I do think that we are behind most countries if we look at Australia. The U.S. listed precursors for fentanyl in 2006. We did so in 2016. With bath salts we were behind most of the countries.
I guess I'm asking what we anticipate seeing going forward from Health Canada when it comes to being proactive. Eight weeks is a long time in Vancouver. It probably means about 175 people have died. That's a long time for some of these issues. Do we anticipate seeing activity happen more quickly?
Ms. Philpott: Thank you for the question and thank you for your particular interest in this issue. Again, Hilary or Ms. Tam may want to add to this.
This requires our working closely with our partners in public safety, including law enforcement officials who are doing a large part of the work on this. Some of the new resources we are providing through even the money that I talked about earlier are around laboratory testing and toxicology, to be able to get better information about the substances that are being intercepted on the street. That also allows us then to be able to identify the new substances, as this is a rapidly changing environment. I don't know whether you want to add to that at all, Hilary.
Ms. Geller: I guess I would just add that this new provision will work in concert with an existing provision under the Food and Drugs Act, which is perhaps not as well understood as it could be. It means that any substance sold that is not approved under the Food and Drugs Act and that alters a mental process is in fact illegal right from the beginning. Even before something is temporarily scheduled law enforcement can move against it. I think one of the things we need to do is work with our colleagues at public safety to ensure that is better understood.
Diane Labelle, General Counsel, Health Canada Legal Services, Health Canada: There is an additional tool being proposed with the amendments to section 7.1 where we capture anything being used with the intention that it will produce a controlled substance. Between the accelerated scheduling, the backstop offered by the FDA prohibitions on selling and 7.1, I think there is a much enlarged capacity to deal with new substances.
Senator White: I spent last Sunday night and Monday night in East Hastings with police officers and health officials walking up and down those streets and visiting some of the facilities. The biggest concern raised by community members who aren't addicts and by police officers and health officials is the use of illegal drugs.
I notice that we did see a regulatory change that will allow for the use of medical-grade heroin, but we did not see any regulatory changes that will allow for the medical use of other than medical-grade heroin.
My perspective and that of most people around supervised injection sites is that they move to the relationship between a doctor and an addict, not organized crime, a drug dealer and an addict who is committing crimes but an addict and the doctor which is where it is now. Will we see regulatory change that will allow for greater use of prescriptive pharmaceuticals rather than illegal and illicit poison? I don't want to call them drugs because they're not that.
Ms. Philpott: Thank you for the question. It is a very good one. I encourage honourable senators to work with us in ensuring that access to all range of treatments and responses to this health problem are there. Some of this requires the decisions of provinces and territories as well as medical practitioners who obviously make decisions about what appropriate treatments are.
There is nothing in the bill and nothing in the law that would prevent provinces from expanding a treatment centre associated with a supervised consumption site to be able to allow these kind of treatments to which you are referring to work closely. I think it is an outstanding model and it's a model that we have to perhaps talk about a little more in public.
I know, senator, you are well aware of the work done in other countries. Switzerland is perhaps the best example of that. When people are determined to have opioids use disorder and/or have legal problems associated with their substance use disorder they are introduced to the possibility of being able to be prescribed medications. It certainly has been effective in decreasing crime rates in those areas, very dramatically decreasing overdose rates and treating this as a health issue.
Senator Joyal: I am concerned with section 52 of the act that amends the Customs Act. The purpose of the legislation is to abolish two sections of the Customs Act, one of which provides for the exception. I am concerned because I think the bill could be challenged on Charter grounds because you totally eliminate the exception without qualifying that you have used the least intrusive means. You have not taken means other than giving blank authorization for any opening, invading the privacy of citizens. In my opinion that could be challenged on Charter grounds because there is no nuance on the reason why the postal agent would be able to do the operation of opening.
I have not gone through all the implications of this but since it also removes the possibility for somebody to file a declaration according to the universal postal convention you might be in breach of the postal convention in doing so. I am really concerned about that.
I know the objective is sound. It is to prevent trade through mail but on the other hand I think that you move too much on the ground without the safeguards to protect the privacy of citizens in specific circumstances.
Ms. Philpott: That's an excellent question. It was discussed earlier that this was also part of previous legislation. As we came forward it was something that the provinces were very much interested in.
Diane may want to comment on this now, but I would urge you to bring this up specifically with the folks from Canadian Border Services that will be here with you I believe tomorrow. They will be able to give detail as to how they propose to address this.
I absolutely respect your concerns in terms of making sure this does not impose on people's rights and privacies, but it is felt to be extremely important and that the risks of that can be appropriately dealt with.
Ms. Labelle: I can confirm that the Department of Justice did scrutinize the bill for consistency with the Charter and privacy legislation. Had there been an inconsistency a report would have been tabled with the clerk at the time of tabling the legislation.
Having said that, I think that tomorrow's officials will be in a better position to explain the implications you have raised with the international agreements.
Senator Joyal: I realize the minister is not responsible for that and I totally respect that. Now the authorization is for fighting drugs through mail, but once you give a blank authorization it could be open to anything and there is no longer protection.
That's why I have a real concern about it. The intention is good, but its impact and the way it could be used without balance is open to challenge.
Ms. Philpott: It is certainly one of the issues where we have to find the balance between making sure we protect the security and safety of Canadians while not infringing inappropriately on the rights and privacy of individuals.
The Chair: The Privacy Commissioner is appearing tomorrow as well.
[Translation]
Senator Boisvenu: Minister, I have a comment that may be seen as somewhat cold. We will make a tremendous effort to thoroughly examine this bill. From the outset, you said that you were open to our suggestions. I hope that our concerns will be taken more into account than the case was for Bill C-14, for which the Senate made substantive recommendations that were considered only to an extent. We will come back to debating that issue, and I hope that you will show a great deal of openness.
I have a question about communities. I spent 20 years with the department of the environment. Every time decisions had to be made, including for establishing water treatment centres, when the citizen consultation period was shortened, as the case seems to be with this bill, local communities' reluctance increased.
Canadians become very concerned when we talk about drug consumption and about creating supervised consumption sites. We are faced with citizens who are very opposed to those issues.
In the context of this bill, why did you not include a transparent consultation process with Canadians, mayors and police forces to ensure that the decision is not being made strictly by Ottawa, but rather by local communities, as they will have to deal with those issues? It's the communities and not the federal or the provincial health department that will have to manage very serious problems.
Why did you not consider a highly structured and, most importantly, highly transparent consultation process in the context of this bill?
[English]
Ms. Philpott: Thank you very much for that question. I certainly agree with you that it's absolutely essential the community be consulted. This is very much a part of this bill. It is one the requirements that the Supreme Court put in place and it's absolutely essential. The Minister of Health will be required to document that there has been appropriate community consultation.
I urge honourable senators to consider looking at the history of supervised consumption sites in Canada, particularly in communities where they have been successful in the past. Of course Vancouver is the best example where communities have been highly supportive of this.
In fact when there have been documentations in the process of opening injection sites such as Insite some people were somewhat skeptical but agreed to move ahead with approval of an exemption for Insite. If you go to those communities now you will hear widespread support for what it has done to improve the safety of the community, to decrease crime and to decrease the drug paraphernalia that might be found in hallways and parks in the area.
Another piece of assurance I can give is that in the communities most severely affected by the opioid crisis, including in the western part of the country in particular, I would encourage you to speak to chiefs of police and mayors, including the mayor of Vancouver, the mayor of Calgary and the mayor of Edmonton.
All of the big city mayors that are most severely affected by this are highly supportive of making sure that we have the facilities available and that their communities are safe, not in spite of these but because of these measures that are available.
[Translation]
Senator Boisvenu: You are confirming that the obligation to consult communities will not be ignored in your bill.
[English]
Ms. Philpott: The duty to consult communities is deeply written in this bill. As long as I'm the Minister of Health community consultations will be an essential part of this process and it's written into the bill.
Senator Omidvar: My question was asked by Senator Joyal. I will pass.
Senator Unger: I have a separate but related concern that fentanyl is being mixed with marijuana. The marijuana at parties is used to convince young people that this safe drug can be used and then fentanyl-like substances are being mixed in.
I understand the government is doing this rapid response to the crisis but I'm concerned that legalizing marijuana will create another crisis. We know that marijuana seriously and adversely affects the brains of young people up until the age of 25.
The Chair: Senator Unger, I am going to jump in here. I understand your concerns but I want to focus on this legislation. If you can pinpoint your question as it relates to the legislation it would be helpful.
Senator Unger: I will. Thank you.
My question is: Why would you still be considering legalizing marijuana when we know that there is a direct correlation here?
Ms. Philpott: Thank you very much for the question. I will try to keep it pertinent to the bill. I know there will be an opportunity to discuss cannabis at a future date. I would appreciate the opportunity to clarify that there have been rumours of the possibility of cannabis that has been laced with fentanyl.
In fact there is zero evidence. It is very important that everyone understands that. We have confirmed this with chiefs of police and law enforcement officials across the country. There is zero documented evidence that cannabis has ever been found laced with fentanyl in this country. It is important that we make sure that message is clear.
I will tell you that there are cases where cocaine, for example, has been found to be laced with fentanyl and that fentanyl has been sold in a way that it's disguised to look like OxyContin tablets, for instance.
You are on the right track in terms of the fact that other drugs may be laced with fentanyl, and that is why the public education portion of our approach is extremely important. However, I think we need to make sure that we don't perpetuate the somewhat widespread stories related to this being connected to cannabis.
Senator Unger: I will look into that.
Senator Sinclair: Minister, I want you to know that I support the principle of the bill. I think expanding the use of safe injection sites is good policy. I've supported it for many years. I note that moving to a medical model is something that occurred recently. It is something that should have been done years ago but now we are moving there.
I have a little concern about the categorizing of offences as minor, serious or very serious as set out in various provisions of the bill. Can you explain to me why that approach was taken and what you wish the consequences to be by doing that?
Ms. Philpott: I think that is a perfect question for my legal counsel to clarify.
Ms. Labelle: The proposed amendments to the Controlled Drugs and Substances Act will introduce a system of violations and penalties known as administrative monetary penalties. These will be applied mostly to regulatory non-compliance as opposed to what we call the Part 1 offences. These monetary penalties do not apply to trafficking, possession, illegal production, import or export. It is in the context where a regulated entity has a certain compliance history that these degrees of severity will be examined. That is where the criteria will be applied.
The Chair: We have a few minutes remaining. We have one senator who has indicated interest in a second round. We will begin with Senator Batters.
Senator Batters: Minister, how you answered my earlier question made me wonder if it is actually more onerous to turn down the approval of a safe injection site under your bill than it is to approve a safe injection site.
Ms. Philpott: I'm not sure. There is a requirement within the legislation for transparency. The requirement is that the minister will have to be accountable for a decision that's made as to whether it is turned down or whether it is approved. One would assume that when an application comes forward that there has to be evidence for that need in the area as is outlined here.
I don't know that there is anything in this bill which would indicate that the requirement to turn it down would be any heavier than the requirement to approve it.
Senator Batters: It was how you phrased your answer. I will move on then.
Ms. Philpott: I think it depends a bit on what perspective the interested party has in seeking this, but I can certainly tell you that the overwhelming desire from these communities where overdoses are a daily reality is that they are urgently desirous of having all resources available to respond and to save lives.
Senator Batters: Right and they may well be. However, obviously we need to consider the seriousness of what we are dealing with here. It is a safe injection drug site, but I will move on from that.
Minister, there was a front page The Globe and Mail story this week that stated:
Despite a national epidemic of opioid abuse and overdoses, prescriptions for painkillers — as well as therapies for treating dependency — have increased, new figures show. . . .
Overprescribing is behind the epidemic. . . . A Globe and Mail investigation found that Ottawa and the provinces have failed to take adequate steps to stop the indiscriminate prescribing of opioids.
Minister, why isn't your department taking adequate measures, then, to address this major part of the opioid puzzle?
Ms. Philpott: That is an excellent question. I will say it is very important that we recognize the overdose crisis has many roots. There are a whole range of reasons how we got ourselves to where we are. Some of them are related to laws and policies; some are related to prescribing practices; and some are relate to how prescription opioids were marketed, for example. Many of the roots that we don't talk enough about are roots in social challenges that people are faced with.
I hope that all honourable senators are pressed with the fact that people use substances like opioids because they are in pain. Many times it is physical pain that got somebody started, but very often it is emotional pain, it is unresolved trauma, it is history of domestic violence or it is adverse childhood experiences. People do not desire to become addicts. They develop an opioid dependency because of issues in their lives which are beyond their control. We need to respond to that in a compassionate and comprehensive way. We need to respond to this.
I heartily agree with you that overprescription of drugs is one of the roots of this crisis but there are many other roots including social issues, untreated mental illness, and all kinds of things.
Senator Batters: I agree with you but I want to get your answer. What are you doing to address this?
Ms. Philpott: Yes, we are doing this. We brought together 30 organizations from across the country. We brought together regulatory colleges, colleges of nursing, colleges of pharmacy, and colleges where people are training, regulating and teaching doctors, nurses and all other health care professionals. We brought together people who deal with chronic pain.
I think about this day and night. I work on this and try to ensure that we bring a comprehensive response to this. Bill C-37 is an essential part of that response but only one part of an extremely broad response.
Senator Batters: We need more action and less talk.
Senator Joyal: Following the decision of the Supreme Court on the injection sites the previous government came forward with a bill that was studied by this committee. One of the major concerns shared by a certain number of senators was there were so many conditions to it. I think there were 27 or so, if I remember.
Ms. Philpott: There were 26.
Senator Joyal: I am not far off. There were 26 conditions. When you put all the conditions together it was almost the equivalent to negating the intention that the Supreme Court expressed in relation to section 7 of the Charter, which is the right to security and life.
Which one of those 26 conditions are you reviewing in this bill to lighten the approach to getting authorization to open an injection site?
Ms. Philpott: You are absolutely right. There were 26 criteria under the previous legislation. Many of them in and of themselves made sense but put all together they became incredibly daunting and far too onerous. We've been in government 15 months or something like that and we were able to move along and finally approve three sites in Montreal, I believe. However, they were in that process for 18 months to be able to work through those criteria.
I am hearing every single day about people dying. It became impossible. I had to force people to continue to work with that legislation. We looked at a number of possibilities and how we could do this best. We went to the Supreme Court decision. The Supreme Court laid out quite succinctly five factors that the government, the Minister of Health, had to take into consideration to provide an exemption. What we have done is that we repealed the 26 and put in the five factors.
Many of the things it will take to prove those five factors have been considered. They will be some of the same kinds of things that were in the 26 criteria but it will be in a much more cohesive way. The minister will be able to take into consideration, as Senator Jaffer said, the circumstances those communities are facing on a daily basis to say, "Given the emergency that you are facing and given that I have considered all five of those factors, I will provide an exemption under the circumstances.''
Senator McIntyre: Minister, the Supreme Court specified five criteria that you must take into consideration in considering an application. I note that the bill modifies the wording of the third criteria. In other words, it replaces the words "the regulatory structure'' with the words "administrative structure.'' That said, are you satisfied that this modification is in accordance with the Supreme Court of Canada decision?
Ms. Philpott: That's an excellent question and a good observation. This was actually an amendment that was made in the other place.
If I am not mistaken, and my officials can clarify it, we went in with the exact wording of the Supreme Court including regulatory structures. There was an amendment made in the process in the other place where they felt that a clinical site like that might not have regulations but might have administrative policies. In describing this as administrative structure, maybe Hilary can give examples of the kinds of things. I would need to see that a particular site had appropriate policies in place in terms of how hazardous products like needles would be dispensed of and did they have rules that meet the requirements.
Senator Omidvar: This is a brief question relating to the fifth of the five criteria, which is the requirement to show an impact on crime rates.
Can you describe that to us? You are requiring evidence and documentation. What shape does it take? What capacity do the local applicants have to do this? I wonder if that is one of those criteria that may make it quite difficult.
Ms. Philpott: I will ask Hillary to give some specific examples of that.
Many of the advocates of supervised consumption sites have said the evidence is there. There are academic papers that have documented this. There is already lots of evidence that these sites do not increase crime rates. Because it was one of the Supreme Court factors we felt that it made sense for it to continue to be in place.
Given the abundance of overall evidence that crime rates are not adversely affected, the Minister of Health should have no reason to believe that it might be otherwise in this particular circumstance.
Ms. Geller: Simply put, we would anticipate that in the context of describing the model of the supervised consumption site they would point to local conditions, for instance. What are the crime rates like now? What are the patterns of overdose and of drug use? Then they would point to studies, to which the minister has referred, where it's clear that if it's established in a certain way it has no negative effect on the crime rates.
We would anticipate a description to the extent that they are able of what the environment is like now and probably references to studies about what they anticipate the effect would be based on previous studies.
Senator Joyal: Would it come from the police?
Ms. Geller: No, it would come from the applicant.
Senator Joyal: Only from the applicant, but the applicant would find the information where?
Ms. Philpott: They could go to the police.
Ms. Geller: Yes, they could go to the police.
The Chair: I thank the minister and her team for being here today and assisting the committee in its deliberations.
Ms. Philpott: Thank you. I greatly appreciate your work on this.
The Chair: That concludes our meeting. The committee will adjourn.
(The committee adjourned.)