Proceedings of the Standing Senate Committee on
Legal and Constitutional Affairs
Issue No. 26 - Evidence - April 6, 2017
OTTAWA, Thursday, April 6, 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 10:29 a.m. to give consideration to the bill.
Senator Bob Runciman (Chair) in the chair.
[English]
The Chair: Good morning 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 are continuing our consideration of Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts.
We have with us during our first hour at the table, from the Canadian Association of Chiefs of Police, Chief Mario Harel, President; he's also the chief in Gatineau; and Superintendent Paul Johnston, Co-chair, Drug Advisory Committee.
From the Ottawa Police Service, we have Craig Fairbairn, Drug Treatment Court Liaison Officer, Central Patrol Directorate.
Joining us by video conference from Vancouver is Tom Stamatakis, President, Canadian Police Association.
Welcome, gentlemen.
Chief Harel, we will lead off with your opening statement.
Chief Mario Harel, President, Canadian Association of Chiefs of Police: Thank you, Mr. Chair. Distinguished members of this committee, as president of the Canadian Association of Chiefs of Police, I am pleased to be given the opportunity to meet with each of you today. This is my first time as president appearing before this committee and I am privileged to see so many familiar faces.
I would like to introduce Superintendent Paul Johnston, who is the co-chair of the Canadian Association of Chiefs of Police's drug advisory committee and a member of the Ottawa Police Service. He is my technical adviser as we hope to answer all of your questions.
Briefly, the mandate of the CACP is safety and security for all Canadians, through innovative police leadership.
This mandate is accomplished through the activities and special projects of some 20 CACP committees and through active liaison with various levels of government and departmental ministries having legislative and executive responsibility in law and policing.
I will not repeat the obvious, except to say that we have a crisis, an opioid crisis, one that has led to the greater than 900 drug overdose deaths in B.C. in 2016 alone; one that is rapidly moving eastward, wreaking havoc on the most innocent of victims. We saw today in the paper in Montreal it is a concern that is arising in Quebec right now.
This often consumes the daily lives of our officers. The death rate, addictive qualities and potential for profit far exceed anything we have ever before seen.
The CACP has been pushing hard for a number of elements reflected in this bill and are very supportive that it be passed. We have done so in the context of reducing supply — a focus on those who manufacture and traffic opioids and other drugs, carrying naloxone and treating overdoses on our streets, in addition to ensuring the safety of our officers through education in the handling of these toxic substances. This must be combined with a focus on demand, the public health side. Users are not criminals; they are the unfortunate reality of addiction, marginalization, mental health, et cetera. Here a focus on prevention, education, intervention and treatment is necessary. From this point of view, we see it as a public health crisis.
We need the government to take action that goes beyond party lines, such as the fentanyl precursor legislation that was introduced by Senator White and quickly adopted by Health Canada.
Attitudes towards drugs are changing throughout our communities, for example, with regard to supervised consumption sites. From a CACP perspective, our position is that these are community decisions. These sites are not for every community and there must be a demonstrated need. In our view, they must be coupled with clear avenues to addiction, social programs and wraparound services.
In an effort to help reduce the supply of illicit opioids and other drugs, there are several key requests by the CACP that are included in this bill and will help better equip policing. Specifically, it prohibits the unregistered import of pill presses, encapsulators and other designated devices used in the production of these substances and designated under a new schedule in the CDSA. This is a good start, but could be strengthened through greater vetting and monitoring, for example, background checks on applicants or business and controls on resales. It removes the exception currently placed on border officers to only open mail weighing more than 30 grams so that officers can open international mail of any weight should they have reasonable grounds to suspect the item may contain prohibited, controlled or regulated goods. Temporary accelerated scheduling enables the rapid control of dangerous new substances through temporary scheduling.
The Canadian Association of Chiefs of Police also recognizes measures within this bill to assist in reducing the risk of diversion of controlled substances. In 2015, the CACP passed a resolution highlighting the important need for law enforcement and Canada Post to work together to stop the transmission of contraband through the postal system. Despite any reliable intelligence and information that points to illicit substances being moved through the mail system, it may not be acted upon by police until it is successfully delivered. The CACP will continue to advocate for the modernization of the Canada Post Corporation Act to correct this.
The CACP's long-held position is that we believe in a balanced approach to the issue of substance use and abuse in Canada, consisting of prevention, education, enforcement, counselling, treatment, rehabilitation and, where appropriate, alternative measures and diversion of offenders in order to counter Canada's drug problems.
Again, users are not criminals. They are the unfortunate reality of addiction, marginalization, mental health, et cetera.
The Chair: Chief, could I ask you to wrap up, please?
Mr. Harel: We appreciate the approach and measures included in the bill. We are committed to work with you, all levels of government, our communities and all stakeholders who share the same goal of eradicating this crisis.
Constable Craig Fairbairn, Drug Treatment Court Liaison Officer, Central Patrol Directorate, Ottawa Police Service: Honourable senators and members of the Standing Senate Committee on Legal and Constitutional Affairs, thank you for welcoming me back for a second time to speak in front of this committee. My name is Craig Fairbairn and I am a sworn constable with the Ottawa Police Service. In addition to working in the Central Patrol Directorate, I also hold a position as the Drug Treatment Court Liaison Officer.
Today's presentation will be different from my last, as Bill C-37 does not directly speak to the drug treatment aspect of the opioid crisis. In fact, the word "treatment'' only appears once in the entire 64-page document. Herein lies a major shortcoming of Bill C-37.
On July 6, 2016, the federal Minister of Health announced an action plan on opioid misuse in which five categories were announced. Category 4, supporting better treatment options for patients, has a subtext stating:
. . . greater and faster access to naloxone, expediting the review of non-opioid pain relievers, and re-examining special requirements for methadone. . .
This commitment by Health Canada to focus on treatment as strictly pharmacological is alarming. Mental health, trauma, socio-economic issues along with matters pertaining to other determinants of health are all major contributing factors of drug addiction.
Consequently, treatment for root causes of drug addiction is nowhere mentioned in the Action Plan on Opioid Misuse.
Drug-related crime accounts for a large part of the economic and social costs of illicit drug use, while also contributing to a large share of all crime. The Drug Treatment Court, DTC, program is a glowing example of how prevention and treatment of root causes of criminality result in a low rate of recidivism among participants while saving the economy millions of dollars. DTC has had a profound positive effect on individual participants and communities, and this template for success should be considered in Bill C-37 more specifically towards the implementation of supervised consumption sites.
On December 12, 2016, the Minister of Health re-implemented harm reduction as a pillar of Canada' drug policy to go along with the existing pillars of prevention, treatment and enforcement. When originally discussed publicly in 1996, harm reduction was meant as a temporary measure to help keep people alive until they received treatment.
Unfortunately, it appears harm reduction has become the foundation of Canadian drug policy while abandoning the fundamental pillars of prevention and treatment. This fundamental change in policy has made SCS a focal point in combatting the opioid crisis.
Commonly cited research has overwhelmingly supported SCS. However, critical reviews suggest that evidence regarding the success of SCS cannot be substantiated. Two separate reviews in the Journal of Global Drug Policy and Practice in 2007 clearly demonstrated the limitation of commonly cited evidence. Most troubling as a police officer is the common claim that SCS offer crime reduction to the surrounding communities.
For example, when the InSite program first opened in Vancouver in 2003, the Vancouver Police Department for one year assigned four officers at all times to InSite. In addition, the VPD also assigned 60 other officers, deployed in a five-block radius of the program. It should come as no surprise when the crime data demonstrated a reduction in overall crime in the year following the implementation of the program. One could certainly conclude that the concentrated allocation of police resources was the driving factor in the crime reduction statistics and not the implementation of InSite.
Supervised consumption sites, as they stand today in Canada, enable drug addicts and encourage criminal behaviour. Although SCS make it safer for addicts to consume drugs, it does nothing to prevent or treat the addiction and its underlying factors. Instead, SCS promote self-destructive substance abuse and enables criminality. Simply put, the user is still getting their "poison of choice'' through drug trafficking or by other means of criminal behaviour. In turn, organized crime continues to benefit while society and communities deal with the repercussions of crime and drug abuse.
Canada's renewed position on harm reduction needs to be shifted from a criminal issue towards a public health issue. An example of success comes from Switzerland and their Heroin-Assisted Treatment program. In 2008, HAT was legally recognized as a medical intervention, moving the supply and use of illicit drugs into a completely legal, strictly enforced market. In a 2016 review, HAT was found to be cost effective. The expenditures of the program were more than compensated by significant savings to society when factoring in all relevant parameters, including criminal behaviour. The HAT program reduces the illegal supply of drugs and the vast cost associated with drug trafficking.
On March 29, 2017, during the first meeting of this committee on Bill C-37, the Minister of Health discussed how important prevention and treatment are in relation to the ongoing opioid crisis. Unfortunately, there are no provisions under Bill C-37 for drug treatment centres, even though they are considered an integral part of the solution. Instead, the implementation of programs that emphasize prevention and non-pharmacological treatment will be the responsibility of the provinces and their municipalities.
We are facing a major opioid crisis in Canada. However, Bill C-37 is a reactive response to a problem that needs be a proactive solution. The time is now to address the root causes of drug abuse and stop the "revolving door'' of addiction and crime in Canada.
Thank you for the opportunity to speak today. I would be happy to answer any of your questions.
The Chair: Mr. Stamatakis, the floor is yours.
Tom Stamatakis, President, Canadian Police Association: Good morning, honourable senators. It's my pleasure to appear before you this morning to discuss Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts.
I am appearing this morning in my capacity as president of the Canadian Police Association, an umbrella organization that represents over 60,000 front-line police personnel, both civilian and sworn, from police organizations across Canada. To provide a bit of perspective, my comments today are also informed by my years working with the Vancouver Police Department and first-hand experience in the city of Vancouver, the location of Canada's first supervised drug consumption site.
I'll begin my remarks today by saying there are a lot of very positive measures contained within Bill C-37 that are wholeheartedly supported by Canada's front-line policing community. While I would be quite happy to answer any questions you may have with respect to areas of the bill that we might support, for the sake of time constraints and to allow for a fulsome discussion, I'll keep my opening remarks brief and confined to the area of contention, which is obviously the streamlined process to open new supervised drug consumption sites in Canada.
There is no question that Canada is facing an opioid crisis and as police professionals, we must recognize that the people being seen at these sites are medically ill and are in need of medical treatment. There is some data to support the claims made by proponents of supervised consumption sites that lives are saved when intravenous drug users are provided with immediate medical care in case of overdose. However, this unfortunately doesn't tell the entire story.
Users of supervised consumption sites still have to obtain their drug of choice before injecting any substance, and by the very nature of what they're consuming, they are committing criminal acts in the process. This is where the objection of front-line police comes into play. Having been a police officer on the streets of Vancouver, I have seen the devastation illegal drug dealing is having on our community both on addicts but also on citizens who have been the victims of the criminal behaviour needed for addicts to satisfy their demand for the product.
The simple fact is that the drugs that are consumed at these sites are illegal and harmful substances. An individual doesn't walk into their local pharmacist to obtain heroin. There are criminal and other harmful acts that occur to create the means to ultimately procure their drugs. With the grey area that has been created around InSite in the Downtown Eastside, our officers are asked to exercise incredible discretion in their policing efforts, but the drug dealers are ready and particularly eager to exploit this discretion to the fullest extent possible.
While the statistics and information around lives saved from overdose is an important consideration, where I believe this current approach has fallen well short is around the treatment and diversion aspects of drug use. Until we see increased efforts to move addicts away from this harmful behaviour, I am not convinced the proliferation of supervised injection sites in other communities will result in anything more than examples of potentially vibrant communities becoming another Downtown Eastside. There are very few unbiased observers who would walk the Downtown Eastside of Vancouver and claim, using only the eye test, that the Downtown Eastside with InSite is an overwhelming success.
My views around this have, I should note, evolved as I've spent more time considering this particular issue. While our organization does not support the present movement found in Bill C-37, we would support an amendment that has these facilities providing a pharmaceutical medical response to addicts and their addictions. In essence, we support supervised consumption sites that replace what an addict would otherwise purchase or obtain from a drug dealer for a prescribed medical replacement. This would mean a medical response to a medical issue rather than the current model. Further, such a model should continue to focus on education and treatment, and include mechanisms to ensure addicts are no longer engaged in activities that are harmful to themselves or to the broader community.
I also believe that any efforts towards establishing additional supervised consumption sites should recognize the need to emphasize public and community safety. While I understand that these sites exist to provide a health care response to a dangerous substance, I believe there should be clear rules established to ensure that those who use supervised injection sites are not to be found committing criminal offences, for example, property crimes, trafficking, et cetera. If done correctly, there is a real opportunity to provide addicts with an appropriate and effective medical response to a serious health issue while also protecting other citizens and the broader community from the harms associated with drug activity in communities across the country.
Prescribing an appropriate medical replacement would positively address the current conditions addicts find themselves in where they are left to their own devices when it comes to acquiring their drug of choice. Further, this approach would likely lead to a greater focus on counselling and treatment, and that in turn would result in more positive outcomes for addicts and for communities.
I do want to keep my opening remarks brief. Bill C-37 is important legislation and I appreciate the invitation to appear before you today. We all have a shared goal, which is the protection and safety of our communities. While we may disagree about best practices and procedures, it's important to note that there is quite a bit contained within this bill that will provide additional tools and resources to police officers from the harmful and sometimes deadly effects of drug use and abuse, and I wouldn't want you to conclude from my remarks that we oppose any of those efforts. Opening new supervised consumption sites may be a component to the overall goal of addressing the opioid crisis and the health care issues that go hand in hand, but it should be done carefully and to ensure that the end result is that public safety is never jeopardized and that the protection of our communities' most vulnerable is always paramount.
The Chair: Thank you. We will begin questions with Senator McIntyre.
Senator McIntyre: Thank you all for your presentations. My first question goes to Mr. Fairbairn. As we all know, there are positive and negative aspects to Bill C-37. The positive aspects were outlined by Chief Mario Harel. On the negative side, what bothers me, and I know it bothers you as well, is that Bill C-37 does not legislate on drug treatment centres that are considered as being an important part of the solution.
In your presentation, you also spoke about drug treatment courts. Could you elaborate a bit on that, please?
Mr. Fairbairn: Last year, I appeared before the committee and spoke about the Drug Treatment Court Program in response to court delays.
The Drug Treatment Court program we have in Ottawa is exactly what it sounds like: to help drug addicts and get them out of the normal criminal proceedings of locking them up in jail. We realize that drug addiction is not a criminal behaviour; it is a mental issue, a health issue.
What we do is take someone who has committed a crime and identify them as someone who suffers from hard-drug addiction. It has to be a hard drug. They are implemented in the program if they are able to qualify through vigorous background checks. They go through myself, as well as probation officers and federal and provincial Crowns. We flag them for anything that has to do with violent offences.
If they pass through and there is nothing of concern in their background history, they are implemented in the program, which can range from nine to eighteen months for successful candidates.
In this program, they will attend weekly treatment sessions and go to court weekly in front of a judge, along with other participants of the program. Through this program, they get the treatment they need. At the end of it, they come out. Instead of going to jail, they received the treatment. They are no longer addicted to the hard drugs and are released back into society to contribute positively.
Senator McIntyre: Mr. Stamatakis, do you wish to comment?
Mr. Stamatakis: I'm familiar with drug court programs. They're effective programs. If I heard your comments correctly at the outset, I would certainly support more rigorous legislation around making participation compulsory and also focusing more on the treatment aspect.
The challenge that we have, from our experience in Vancouver, is you often have people participating in the kind of program that my colleague described, only to find themselves again in the Downtown Eastside after they complete the program and exposed to the same kind of culture and availability of harmful drugs. The challenge often becomes that they fall back into the same harmful behaviours, if they even successfully complete the program.
Any kind of legislative support of these drug court programs is a positive thing.
Senator Pate: In previous testimony before this committee regarding supervised injection sites, you mentioned, on behalf of the Canadian Police Association, that one of the reasons you were not supporting them was that in your experience in policing the Downtown Eastside, some of the most marginalized drug users were not using InSite.
You've mentioned that your understanding and awareness of these issues has evolved. I'm wondering if that's still your position and, if so, what you see in terms of what is happening to those most marginalized drug users. Are they being arrested? Are they being criminalized? What is happening, in your experience?
Mr. Stamatakis: I think the police community has generally evolved in their thinking. We treat the most marginalized people who are drug-addicted with a lot of care and compassion, and are looking for alternatives to criminalizing their behaviour.
The problem that we have in policing is we don't have enough resources. We don't have enough access to treatment facilities. We don't have enough access, once we come into contact with that marginalized person, where to take them so they can get support, appropriate housing and access to alternatives to harmful substances.
In terms of my views around supervised consumption sites, my views haven't changed. I don't think the situation in Vancouver has changed at all. I would argue it's probably the same in any other community that currently has a supervised injection site or is contemplating having one.
You are going to continue to see the most marginalized of these drug addicts preyed upon and taken advantage of by drug traffickers, and they will continue to engage in harmful behaviour that ultimately undermines their health and well-being. That's why I think one alternative is to say, "Let's not put these people in a position where they're continuing to cause harm to the community by committing crimes and also harm to themselves.'' For example, our marginalized sex-trade workers, who are being taken advantage of by predators so they can get a bit of money to buy some illegal drugs they can use.
Let's find alternatives. Perhaps one is to create a safe environment for them where we prescribe an alternative, and hopefully we can intervene to get those people into a better place.
Senator Pate: Dr. Gabor Maté, who has done some work in and around InSite, has described InSite as being almost like a triage place, and what's needed is much more effective long-term and wraparound types of services.
I'm asking all the witnesses — and thank you for your work and for coming before us today — if you can comment on some of the models that have been put before this committee by other witnesses, such as those in Portugal or Switzerland, if you're familiar with some of those options, and the research that Dr. Gabor Maté has presented around the links to childhood trauma, in particular, and in particular for indigenous people who end up in the Downtown Eastside or in other areas, anesthetizing themselves with drugs in large part because of their histories of abuse.
Superintendent Paul Johnston, Co-chair, Drug Advisory Committee, Canadian Association of Chiefs of Police: Senator, as you know, in some countries the focus is on treatment, and some countries are more open to drug use.
What we're seeing, in our experience, is the focus has never been on treatment. Our front-line officers, on a regular basis, are dealing with unfortunate individuals, and it can be anybody from any population that has to address addiction. It could be athletes or anyone. Unfortunately, that's their focus.
Our experience, from a policing perspective across the nation, is that there is no opportunity. Police officers want to provide help and hand over people for treatment. Some other countries are better at doing the treatment aspect. In Canada, the frustration is that we don't have that clear link, and that seems to be the gap.
Your focus here has been on supervised consumption sites. We understand the harm-reduction model and the need for it, but we don't see that continuum of care. How do we get an opportunity? These individuals, who are, unfortunately, addicted, can be anybody, and they want help, but they don't know how to get help. It is not the opportunity of let's provide them help when we can, it's providing that help when they need it.
Our frustration is, we've had people who want help now. Unfortunately, we'll set them up with one of the health services and they'll schedule an appointment for two weeks down the road. They're not even sure what day it is, and they have trouble with their scheduling and whatnot. The focus needs to be on treatment. Harm reduction has a role.
Senator Batters: Thank you very much. This is very insightful testimony being provided here.
Constable Fairbairn, I appreciate the fact you're on the ground fighting this battle and trying to help drug-addicted people every day. Thank you for that. You made some important points that I would like you to potentially draw out more, because I know we gave everyone very limited time for opening statements.
It stuck me when you said that "treatment'' is only mentioned once in the 64-page document. That's potentially a real failing in the fact that you find that harm reduction has become a foundation here and abandoning prevention and treatment. Could you speak more about that, and also the fact that in treatment, pharmacological, mental illness, trauma and those kinds of things play a major role, and you see that every day.
Mr. Fairbairn: Absolutely. I've been fortunate enough to work in the Market area just down the street for the last eight years. Every day I deal with people from shelters who are addicted heavily to hard drugs: crack cocaine, heroin and fentanyl now.
The big issue that we have, it goes back to the word "treatment.'' It only showed up once in the entire bill and that was in the preamble.
These people don't necessarily need harm reduction. They need better treatment so they don't get to the point where they need harm reduction. Right now you have a revolving door, especially with supervised consumption sites. The addicts are buying drugs off the street from drug traffickers. To do that, they have to commit crimes because they have no money. The money they do have that's supplied by the government goes right to the drug dealers.
They then go to the supervised consumption site. They're injecting there and then leaving. They are leaving very quickly, sometimes within five minutes, and they're not getting treatment. What we propose is that it needs to move from a criminal issue to a health issue so if they go there they can get treatment.
Four years ago I broke my leg and went to the doctor. They wanted to prescribe OxyContin. How is that different than a drug addict who has a health issue who needs to get heroin or methadone prescribed? There is no difference.
Senator Batters: Exactly. We've seen, with overprescribing of those types of medications, that's how people sometimes get into this terrible, unfortunate cycle.
I have a question for someone from the national organization, perhaps, but the epidemic of opioids does not only affect cities. We have been hearing testimony from those from cities, but there are many deaths in rural areas. Are drug injection sites a solution to the epidemics we're seeing in some Canadian small towns and rural areas? If not, what other measures would you like to see used for those rural areas to help people there?
Mr. Stamatakis: It comes back to this focus on treatment and education and prevention. I've been involved in the drug discussion since 2003 when InSite was first created. I'm familiar with Dr. Gabor Maté's research; I agree with much of it. I agree we need a broader, more holistic approach that does emphasize treatment, counselling, education. I am familiar with all the programs in all the other countries. They have a very robust treatment counselling component, even in Portugal, where it is always held out as the model where they have legalized.
You're right. If you get into the smaller communities and rural areas, safe consumption sites are not going to resolve this issue. Safe consumption sites don't even address the problem in major cities. We have people dying from overdoses who wouldn't come near a safe consumption site. These are what typically would be referred to as normal people who are trying something once or twice or using something recreationally on an occasional basis.
It's not just about safe consumption sites. We need a holistic approach that focuses on education, prevention, treatment and hopefully moving to something that we've accomplished with tobacco and alcohol where we get fewer people using those substances.
Mr. Johnston: I agree with the comments. Proper education is the key point. You're seeing now with the fentanyl crisis, the youth are referring to the Internet to get their information. Some of it may be accurate; some of it may not be.
As an example, we're seeing with the advent of naloxone, which is perhaps life-saving doses that can bring someone to get medical attention, but the students and youth are talking about just bring naloxone with you and that's your solution for using fentanyl, or other high drugs. The proper education is the right way to go.
Senator Boniface: Thank you all for being here. I'm particularly interested in Mr. Stamatakis' comments around his proposed amendment. I'm interested in how you see that operating within the injection site, and, second, your view around treatment, which I totally agree with, do they have to come hand-in-hand to make that happen? What would you see as the general approach on that? as you know, that would be quite new to Canada.
Mr. Stamatakis: One of the issues with the discussion we've had in Canada around safe consumption sites and the comparison to what happens in other countries is we've forgotten about the legislation and regulation that other countries have established around safe consumption sites. In some countries, they provide the police with greater legislative authority to compel people to go to safe consumption sites where they are then prescribed whatever substances they require.
I would envision something where there are specific rules around participation. There have to be rules around ensuring that people aren't consuming harmful drugs outside of the safe consumption site. There have to be rules around exclusively using a site and having whatever you need prescribed in a controlled way. We take away the harmful behaviour where addicts need to commit crime and causing harm in the broader community by engaging in those activities.
They focus on care. If we can get people into those consumption sites where alternatives are being prescribed, there's a greater likelihood we can intervene with appropriate counselling and eventually with a view to getting treatment and coming back to society as a productive person. That has to include housing and the whole continuum of care.
I hear the term "legalization'' or "legal'' being used. That's not the right term. That's not what I'm supporting or proposing. It's a highly regulated, controlled way of replacing a harmful substance with something that we know we can quality control and administer in a very controlled way.
[Translation]
Senator Boisvenu: Welcome and thank you for your presentations. I care about minimizing the fears of citizens when a supervised injection site is established in their neighbourhood. We asked other stakeholders about the crime that could result from this type of site. We were told that crime doesn't increase or that crime decreases when a supervised injection site opens its doors. We also asked about the sources of this information, and it seems the information comes from the sites' internal sources.
Mr. Fairbairn, you work closely with citizens on the ground. Based on your experience on the ground with supervised injection sites, is there a direct link between the decrease in criminality and the presence of a supervised injection site in a neighbourhood?
[English]
Mr. Fairbairn: From my experience, no. There is no decrease in criminality from a supervised consumption site. As I stated in my presentation, often you will see cited sources. They usually go back to peer-reviewed documentation saying that it does bring crime down. Again, my example with Vancouver, yes, crime went down in that area, but you had 64 extra officers for a year. Of course, crime is not going to be in that area. It's going to get pushed out to the surrounding communities.
Often it gets referred to as the "honey pot effect.'' Again, lots of times cited sources will say that that does not exist, but that's not what I see on the front line every day.
A supervised consumption site is like a honey pot effect anyway. You want all the people injecting drugs to go to that site. Well, if they go there, the drug dealers are going to follow them. If you don't have a police presence at that site or in that surrounding area, the drug dealers and crime are going to follow. If you put officers in a five-block radius, the crime is going to spread out further. It is not going to bring crime down. The only way you're going to have success doing that is taking the criminality out of the drug user using drugs and make it into a health issue for them so they no longer have to go buy their drugs on the street. They can go and get it prescribed to them by a medical physician and get good, clean whatever they need to help them overcome.
[Translation]
Senator Boisvenu: Yesterday, Senator Dagenais asked whether police officers were still patrolling around Insite. We were told they weren't, because a police presence seemed to bother the users. I was astounded by this response. Doesn't a lack of police presence in these neighbourhoods create a form of ghetto that will attract a certain type of population? Couldn't this undermine the ability to rehabilitate these people, because they stick to themselves and they're isolated?
[English]
Mr. Fairbairn: You would be putting a lot of people with a serious addiction all in one spot. We can imagine what will happen. We've seen the pictures from East Hastings and other sites.
You talked about the officers not being there anymore. There are no more officers at the site itself. From my knowledge of Vancouver, there are still officers in the area, just not necessarily assigned to InSite itself.
Mr. Stamatakis: I can tell you unequivocally that the area around the Downtown Eastside where the supervised injection site is located is a major draw on the resources of the Vancouver Police Department. We continue to patrol that area. If police were not actively present in that area, to use your term, it would very easily turn into a "ghetto'' and have a negative effect on other people who live in that area who are trying to have some measure of quality of lie.
This notion that somehow a supervised injection site is going to reduce crime in any community is ridiculous and is not borne out by the experience. I've worked in that area. My office was located in the Downtown Eastside for 15 years, and I was in that area every single day. My colleague referred to the research. I've looked at the research. I've done the literature review. There are many questions around any suggestion that a supervised injection site alone would have any effect on crime.
Let's not forget that in terms of property crime, violent crime, Vancouver is unfortunately still leading and in many regards, we're leading because of the kind of activity that's associated with the serious drug industry that we have in our city.
Don't forget, I live in the city of Vancouver. I'm also the president of the Vancouver Police Union. I can give you lots of information about our experience with that site over many years.
Senator Griffin: Thanks for being here, folks.
It struck me on looking over the bill — and this was a quick review — that it seems lacking the greater social policy reasons for the legislation. I also agree that the provision in the bill for drug treatment centres being mentioned only once, and in the preamble at that, is a major concern. It strikes me based on what we're hearing that the drug court programs in Vancouver seem to be a good way to go.
So how do we have this type of holistic treatment in other jurisdictions, and in particular, smaller sites? For smaller municipalities, as already noted, this is difficult. How do we deal with it in other jurisdictions to try and get the holistic overview?
I'm not sure whom I'm addressing it to.
Mr. Johnston: Referring to the supervised consumption sites, it's not for every location; it is based on a demonstrated need. The communities have to need this because we've heard the effects of it.
From a holistic perspective, from our point of view, there needs to be that link. And anywhere in Canada, you need to have that link where you provide those services and find an exit strategy for these individuals who are addicted to whatever substance they've chosen.
That's not in place in all locations, and it's difficult in different locations, but it has to be a clear link. Harm reduction alone is not a solution to the crisis we're in.
[Translation]
Senator Dagenais: I want to thank our guests. My question is for Mr. Harel. You lauded certain positive aspects of the bill with regard to the new powers that will help you fight drug trafficking. In addition to being the president of the Canadian Association of Chiefs of Police, you're the director of the Gatineau police service. On this side of the river, in Ottawa, we know that measures have been taken and that other measures will follow as part of the implementation of supervised injection sites. On the other side, in Gatineau, surely similar preparations are in progress. How are you preparing for the establishment of these sites within the police service? Have the people of Gatineau already expressed fears or objections regarding the matter?
Mr. Harel: On the Gatineau side, the Quebec side, the discussions are in the preliminary stage. One organization has expressed support for the creation of a supervised injection site. Obviously, the community has reacted and has expressed concerns regarding the crime that may occur around the site. As a police service, and as my colleagues said, we focus on prevention and treatment. That's how we can reduce substance use. It's a health issue.
I could mention another aspect, Senator Dagenais. This aspect was mentioned earlier. Often, when police officers are in contact with these people, the officers' only option is the courts. We all know this isn't a solution. We don't have an alternative. In keeping with the example of the program established in Ottawa, I think all communities should have this tool, this alternative to the courts, to guide people toward treatment. In my experience, the Quebec side has a huge void in this area.
Senator Dupuis: I have a question for Mr. Harel. In a previous committee meeting, we heard from Vancouver area nurses. I asked the nurses whether they had data on the proportion of illegal drug users in the Vancouver area who come from Quebec during the winter. One documented issue involves fairly young people who come to pick fruit during the summer in British Columbia and who use illegal psychoactive substances recreationally. The young people stay in the province and become regular and problem users. Are there links between the Quebec and British Columbia police forces, for example? Do you have information on the subject?
Mr. Harel: We know it's also a reality in terms of homelessness. People head to Western Canada, toward Vancouver, primarily for the climate. There are other examples, as you said, and it's a reality. Our databases and communications aren't perfect. We would benefit from better connections among police services to be able to share information.
In Gatineau, we're a privileged service. We're connected, and my police officers can ask questions and obtain answers across Canada. However, we have much work to do on maximizing the sharing of information so that a police officer from Vancouver or Halifax can quickly obtain information to respond better. Let's say a person has a history of homelessness or drug problems in Montreal or Gatineau, and the police in Vancouver are dealing with this person for the first time. If the police had access to the information, they could respond much more appropriately. The Canadian Association of Chiefs of Police has a strategy to encourage communication among police officers.
[English]
Senator Joyal: Welcome and thank you, Mr. Harel. I wonder if we are not in a conundrum here. What is the objective of an injection site? It's to allow the drug-addicted person to be in a safer environment to try to avoid death. That is the first objective.
The second objective is to try to use the fact that that person has presented him or herself at the site to incite that person to enter into a drug treatment.
We heard yesterday that about 30 per cent of the people who used to be in the Vancouver injection site have had the possibility, because of upstairs services and so forth, of being involved in treatment. But if we are to, in my opinion, have a better result, I wonder if the Swiss approach would be better. In fact, I wonder if there is an opportunity for the Minister of Health to support an initiative that would be a pilot project in relation to the Swiss approach so that we could compare the benefit and the success of both.
Mr. Fairbairn, you might have an opportunity to better explain on a comparative basis what you expect for results from the Swiss approach versus the injection site approach. Could you expand more on that?
Mr. Fairbairn: Absolutely. Some studies have been done on the Swiss approach. They found about an 80 per cent reduction in crime associated with drug trafficking. The other thing they also discovered was a 2-to-1 ratio as far as cost to society in savings. It was approximately 13,500 euros for one individual to be prescribed their heroin for a year as well as the cost of the site, the staff or the faculty. They found it was about $24,000 per person savings in cost to the economy when you factor in all the different criminal behaviours that come with it; that is, victims of crime, the justice system itself, police departments and things like that.
Senator Joyal: What about the capacity on the site to offer the person medicine to help him or her switch from drugs like OxyContin and other drugs, to ersatz drugs for the heavy drugs that are really killing people? How would it be possible to put that into practice? When they are under the influence, they don't think about justice or whatever. You know them better than I do. The impulse to get the drug is so great they are ready to do anything and they forget about everything.
We have to bring some rationality to those persons to help them change their consumption. That doesn't happen by instinct. It is a process. It is in that process, in my opinion, that bringing these people to treatment might be successful.
I am trying to understand what we have to change in our approach to the injection site that would give better results and could be seen as a model that could be developed and perfected from experience.
Mr. Fairbairn: For one, we have to move away from harm reduction as being the primary focus. It has to become a focus of treatment.
As far as how you're going to get a drug user to sit down for treatment at a supervised consumption site or a treatment facility that they turn into, that's up to people such as doctors. There are a lot of smart people who can speak to that more than I can.
We see success in the Drug Treatment Court program by doing this. They go to mandatory treatment programs and court and we have a lot of success. Our graduation rate is about 35 per cent, which is well above the national average. That's 35 per cent more people who have gone through the program, were addicted to hard drugs and are not once they leave the program.
That being said, we do need to get better treatment for them when they do leave the program.
As far as your question about how we are going to develop a system for these people instead of going there to consume their drugs and then leave, which is what a supervised consumption site is right now, that's going to be up to policy-makers and it will be up for discussion. We can look at the Drug Treatment Court success and take some things from there and implement it towards a drug treatment facility instead of supervised consumption sites.
Senator Joyal: Have you conveyed that option to the provincial Department of Health or the other authorities that could be open to such an initiative taking place?
Mr. Fairbairn: Again, I'm speaking as a police officer on the ground and as the Drug Treatment Court Liaison Officer. The federal Crowns and judges I work with in Drug Treatment Court concur with what I'm saying. We need treatment and prevention to be the main factor, if we want to solve this opioid crisis.
The Chair: Before we move to a brief second round, I'm not sure it will impact the decision of the committee ultimately, but I have a comment, Mr. Stamatakis, which was referenced by Senator Boisvenu. We had another resident of Vancouver appear here yesterday, a city councillor, who indicated quite the opposite from what you've indicated today about the deployment of policing resources and the crime rates.
We're going to be dealing with clause-by-clause consideration of this bill next week. If you have any supportive materials with respect to the testimony you've given today, if you can get it to our clerk, it would be helpful, perhaps, during our deliberations next week.
Senator McIntyre: My question has to do with mobile drug consumption sites and it's addressed to the RCMP. Does the RCMP support the use of mobile drug consumption sites? If so, what would be the implications, if any, for police services having to work in the context of mobile drug consumption sites? To this, I would add: Does the budget provide you with sufficient funds to increase the training of your officers and the number of officers working with drug consumption sites?
Mr. Johnston: From a mobile perspective, we've actually seen some opportunities where some of the folks have actually looked at a scattered model for a supervised consumption site. That can be problematic. Again, it's the community need and addressing a location where a consumption site could be located is dependent on the need.
If they're going to go with a mobile response, there has to be a demonstrated need for that.
In regard to training, our officers do get a bit of training on treatment and addiction, but certainly never enough.
Senator Griffin: I have a question for our guest on video. This goes back to the question I asked earlier. How can we jump from the experience in your city to a whole treatment system in other jurisdictions in our country?
Mr. Stamatakis: I'd like us to move away from a discussion about stand-alone supervised injection sites to how do we utilize the existing infrastructure so our existing medical health facilities, as has been mentioned, could look at this as a health issue and prescribe an alternative quality control substance to deal with whatever the addiction issue is.
Much has been made about InSite in Vancouver, but not much is ever talked about with respect to another facility that is embedded in one of our local hospitals, the Dr. Peter Center attached to St. Paul's Hospital. I'm not an expert around it and I might have the terminology wrong, but it is attached to an existing health facility and it is quite successful. You don't have the controversy that is associated with safe supervised injection sites. We have medical health facilities in every community across this country, big or small. If we move to a model where we're prescribing, I think that would go a long way.
One of the challenges of drug consumption based on my experience as a police officer is that these addicts are chasing the high. They are desperate. They have to do a lot of work to steal the property to get the money to buy the drugs. By the time they get to the trafficker to get the drugs, they're desperate. They're going to administer the drug wherever they get it, as soon as they can, because they're desperate. If you get them into a controlled model where they are being prescribed an alternative, you take away that desperation and it becomes more controlled. There is not that sense of urgency or panic around the next fix. In that context, hopefully you would have more success with the intervention and getting to that treatment program and moving people away from their reliance on drug addiction.
The Chair: I want to thank all of our witnesses for some very interesting and informative testimony. It is much appreciated, gentlemen.
Now joining us for our second hour, from Safer Ottawa, Chris Grinham, Co-Founder of that organization; from the Rideau Bakery Limited, David Kardish, who owns that business; and from Recovery Ottawa, Dr. Mark Ujjainwalla, Medical Director.
Gentlemen, thank you all. Do you all have opening statements? I believe you do. We will go from my left to right, beginning with Mr. Grinham.
Chris Grinham, Co-Founder, Safer Ottawa: Thank you for the opportunity to speak here today. I am Chris Grinham, and my wife Lisa and I founded a grassroots non-profit organization named Safer Ottawa. We began in 2007 in response to the out-of-control and dangerous situation of discarded needles, glass stems, also referred to as crack pipes, and other harm reduction equipment found in parks, schoolyards, community centres, businesses, private residences and on the sidewalks of Lower Town, Sandy Hill and the Byward Market.
Over the course of three years, my wife and I picked up close to 7,000 needles and over 27 gallons of harm reduction equipment. Ironically, the very equipment that was intended to reduce harm was creating harm in our community. We liaised with Ottawa Public Health, Ottawa police, the City of Ottawa and the major homeless shelters to change how needles were being handed out, to make sure that clients were being properly educated on safe disposal techniques, to ensure disposal boxes were available in high-use areas, and we worked to create the rapid needle response program that encompasses multiple city divisions, including bylaw, surface ops, parks and roads, Ottawa police and, of course, the Needle Hunters, so that when needles are found in public areas that properly trained and equipped individuals were on site to quickly clean, catalogue and dispose of the hazards.
In 2010, we decided that all we had been accomplishing for the last three years was cleaning up the spillage, the side effects of a much larger problem, namely addiction. We concluded that unless we wanted to spend the rest of our lives picking up needles, we were going to have to tackle addiction head-on, and we began researching and advocating for effective, affordable and available addiction treatment.
We have made no effort to hide the fact that we have been opposed to supervised injection sites in the city of Ottawa, not from a "drugs are bad'' or "drugs are illegal'' ideological standpoint but from a pragmatic one. With the research and evidence we have done and the evidence we have seen, the supervised injection site does not appear to be an effective tool to deal with addiction. In fact, it can be a detriment.
There is a limited pool of resources allocated to addiction treatment, especially for street-involved addicts. Therefore, we must make sure that whatever measures we implement are as effective as possible.
Supervised injection is at best an ineffective temporary stopgap measure that, much like we had in 2007 and 2010, is only dealing with the symptoms of addiction. Keep in mind that Vancouver has had a supervised injection site for 14 years and despite that, despite the close to $360 million a year, roughly $1 million a day that we spend on social services in the Downtown Eastside of Vancouver, the DTES is arguably North America's and certainly Canada's worst postal code, with the highest rates of addiction, HIV and hepatitis C in this nation.
Addiction is a difficult, dynamic and multi-faceted problem that takes time to resolve. There is no magic bullet or one-size-fits-all cure, and therein lies the danger of weakening Bill C-2. The point of the 26 measures of this bill was to make sure that cities, health authorities and governments of all levels collaborate, consider and consult to make sure that the best solution is implemented and the best and most effective services are being established. They insure that people who need services are getting them and that programs are implemented because they are effective and not because they make good headlines or have good optics.
This is why we supported Bill C-2 and why we do not support and would go so far as to caution strongly against the proposed changes. We cannot afford to get this wrong. We certainly cannot afford to make this process superfluous. We must make sure that due diligence is done and that, at the end of the day, lives literally depend on it.
The plain truth is the only way to effectively eliminate harm from drug use, to reduce disease transmission and overdose is by tackling addiction itself. As long as somebody is using, they are at risk. It is time that the government commits to tackling addiction head on with sufficient resources and the support needed for such a devastating problem.
There is a saying on the streets of Ottawa that the rich get treatment and the poor get harm reduction. This inequality needs to change. It is time to tell those living in the shelters, on the streets, in the alleys and abandoned buildings that we will provide them with affordable housing. It is time to tell those using a drug so addictive they must beg, steal and prostitute to pay for it that we will provide them with an effective treatment program, that they no longer need to live a nightmarish existence of poverty, pain and hopelessness, and to tell our most vulnerable citizens that they are not forgotten, that they are not worthless and that we as a nation care.
Dr. Mark Ujjainwalla, Medical Director, Recovery Ottawa: Thank you for having me at this hearing. I'm a little different. I'm actually a physician. I'm an addiction medicine physician. I'm a board-certified American Society of Addiction Medicine physician, and I have been doing this for 30 years here in Ottawa.
Previous to my working in the area of opioid dependency, I only dealt with people like yourselves — physicians, politicians, accountants and dentists — and my job was to assess and treat them, and I typically used American resources to treat them. We rarely used any Canadian resources because there weren't any.
Five years ago, I decided I needed a change, and I went down to Vanier, close to here, and I started a program called Recovery Ottawa, based on a program based in Kentucky called Recovery Kentucky, and my plan was to help all the suffering opiate- and amphetamine-addicted patients and give them an opportunity to get immediate access to treatment because, having worked in this system for 30 years, I know personally that you cannot get treatment, a psychiatrist or an addiction medicine specialist, despite what anybody tells you. I deal with it all day long. We went from zero patients to 1,500 patients in less than three years. I have seven physicians working for me now. We have two nurses, five administrative staff, and we're growing by the day. Today I saw 80 people before I got here, all of whom are desperately asking for treatment that isn't available to them.
Let's be perfectly clear. There is not one person in this room who would use an injection site. There is not one person in this room whose family member will ever use an injection site. There is not one person in this room whose friends will ever use a supervised injection site. That will be true. Yet 10 to 15 per cent of people in this room will require treatment for addiction or mental health. Sadly, if you're a Canadian without the finances to pay for a private rehabilitation program, you will suffer serious consequences or die.
It wasn't always like this. I have been doing this for 30 years. In the 1970s, 1980s and 1990s, as an addiction medicine physician, I was allowed to refer you, the patient with an addiction, to best practice evidence-based treatment programs in the United States, such as the world renowned Betty Ford Centre. In essence, the Ontario government purchased services for the treatment of addiction without having to pay the billions of dollars required to develop their own centres for the treatment of addiction.
Unfortunately, in the mid-1990s, the Ontario government at the time decided to stop all out-of-country referrals and payments. They claimed that with the money they save on all these out-of-country payments Ontario could build and implement their own state-of-the-art facilities. Unfortunately, this never happened. As I said, I've been doing this for 30 years, and I can tell you none of the resources are better. They're worse since 1980. Compared to every other type of medicine, we are the gold standard treatment in Canada for cardiology, ophthalmology, cancer — it doesn't matter — but when it comes to addiction and mental health, we're at the absolute bottom.
Unfortunately, we're now left with nothing for patients suffering from the disease of addiction. To put this in perspective, a good analogy would be if the government decided to close all of its cancer clinics and fund only palliative care centres, in essence, the message would be: If you get cancer, you die. Or if we shut all eye institutes and instead said, "When you're blind, we'll give you a white cane''.
Obviously, this would be ridiculous, but the point is that patients suffering from the disease of addiction are not given the treatment they deserve. These patients have a highly treatable disease with an excellent prognosis. As a physician, my oath is to treat people who can be treated.
Instead of developing comprehensive evidence-based best care treatment centres for addiction, the government decided the new treatment for the disease of addiction would be called "harm reduction.'' Instead of being a medical problem treated by physicians, it would become a social problem treated by administrators and bureaucrats. In essence, the government, in its lack of knowledge and insight, has condemned the unfortunate victims of this disease not to be treated properly and get healthy. Instead, the term "harm reduction'' became the government's answer to the treatment of addiction, especially opiate dependency. In other words, they were stating that these poor, victimized, hopeless, untreatable people do not deserve appropriate treatment.
Encouraging injection sites is a monumental step backwards in the treatment of both addiction and mental health. It denies these sick individuals the appropriate and meaningful treatment they deserve. Enabling already sick IV drug users to use illicit opiates and amphetamines is essentially palliative care and they are destined to die.
As an addiction physician of 30 years, I am deeply saddened and ashamed of our lack of support and availability of treatment for these poor victimized patients who have a highly treatable illness with an excellent prognosis. I was embarrassed, and so should all of Canada have been, when Prime Minister Trudeau sent Minister Philpott to the UN to proclaim Canada's support of supervised injection sites.
The Chair: We're going to have to end it there.
Mr. Kardish, go ahead.
David Kardish, Owner, Rideau Bakery Limited: Good morning. My name is David Kardish and I want to thank you for permitting me to be a witness with respect to this important issue. I'm a local business owner of a small family- owned business here in Ottawa. It has been in operation for 87 years now. Over that time, we have been located on the same block on Rideau Street, just 15 minutes from where we are gathered today.
My perspective is as a stakeholder in a neighbourhood where we are facing a real and concerning prospect of having a safe injection site approved on our block. My perspective is representative of many people who live, shop, walk and bike in the neighbourhood, as well as many businesses and property owners.
Over the years, we have experienced a number of significant changes that have negatively impacted the character and safety of the neighbourhood. Within a four-block radius of my business, the following social services and medical organizations have opened up: The Shepherds of Good Hope, the Salvation Army, the Ottawa Mission, the Capital City Mission, the Indian friendship centre, the Rideau Pharmacy with a methadone clinic right next door, and the Sandy Hill Community Centre down the block. While these organizations provide valuable and needed services to the vulnerable members of our society, they also attract to our neighbourhood a large population of people who are homeless, drug-addicted, alcoholic and have a serious mental illness.
Since the opening of these social services organizations, our business and employees have experienced more than our fair share of worrisome incidents. For example, we have been constantly finding used needles and condoms in our back lane; watching drug deals go down in front of our store on a daily basis; having individuals removed by the police from our washroom because they have passed out from the drugs they took inside the washroom; having employees chased out of our parking lane by drug addicts who are either living or hiding in our dumpster; having our employees' vehicles broken into on numerous occasions to obtain a small amount of change; and witnessing numerous physical altercations around our store.
Tourists and visitors to the city comment on how they are uncomfortable and do not feel safe being exposed to drug deals, arguments and physical altercations only minutes away from Parliament Hill.
Most people are concerned about confronting the addicts, particularly when they appear to be high or unpredictable. They are also fearful of contracting diseases such as HIV and hepatitis C, which are more common among intravenous drug users.
By creating safe injection sites, you would be condoning not only hard drug use but also the crime perpetrated by them for the purpose of obtaining illegal drugs. At the safe addiction site, addicts will be required to provide their own illegal drugs. Their daily drug habits can range from $50 to $1,000 a day per addict. In most situations the addict's only legal source of income is Ontario disability income, which provides them with between $700 and $900 per month. Any extra money that they require for drugs must be obtained through illegal means such as prostitution, selling more drugs, petty thefts and break and enters.
As a stakeholder in one of the proposed safe injection site communities, I am greatly concerned that these additional crimes are going to be perpetrated against the neighbourhood's residences, property owners, businesses and their respective employees and customers or clients. Furthermore, opening up a safe injection site will attract all the drug dealers in the neighbourhood because they will know exactly where to find their easy prey. These drug dealers are devoid of any conscience and are only driven by the money they receive for peddling their poison. They do not care if you are a child, an adult, White, Black, rich, poor, addicted or mentally challenged. They just don't care.
In our specific neighbourhood, not only would the dealers have all the existing addicts as a great supply of revenue but also a great potential source of future customers. Within two blocks of our proposed safe injection site are two public schools — so there are kids 14 and under — and two university residences. The residences, customers, tourists, business and property owners in the neighbourhood and community do deserve better. Many residents and customers already do not feel safe on the streets and having a safe injection site only makes things worse.
I'm not against harm reduction, but we already have free needle exchange programs and methadone treatments that are meant to reduce the harm of HIV and hepatitis C caused by intravenous drug use.
In my opinion, the Portuguese approach to curbing illicit drug use and medical dangers resulting therefrom should serve as a good model as to how to address Canada's current drug woes. In 2001, Portugal decriminalized the possession of small amounts of drugs. The government approached the drug problem by providing needle exchanges, using methadone as an opioid substitute and providing counselling and treatment to address the underlying addiction and mental health problems. Both the needle exchange and methadone treatments helped to reduce the spread of communicable deceases. In the last 15 years, the rate of HIV in Portugal has fallen by 90 per cent and the death rate from overdoses is only 20 per cent of the EU average, which is 17.3 people per million. The drug offenders have dropped from 44 in 1997 to 21 in 2012. Nowhere in Portugal's approach have they advocated for safe injection sites.
[Translation]
Senator Boisvenu: First, thank you for your very eloquent presentations. I have a question for Dr. Ujjainwalla. I'll read the last sentence of your brief, which you didn't have enough time to say out loud.
[English]
In closing, it is my opinion by voting for Bill C-37 as it stands to make injection sites available will be the death of any opportunity to develop the appropriate treatment all Canadians deserve.
[Translation]
Can you explain this excerpt, please?
[English]
Dr. Ujjainwalla: My point is that the problem that we face is that the individuals suffering from the disease of addiction are not getting the treatment they deserve. As a physician, in all other areas of medicine, if you have a heart attack right now they will get you, you go to the Heart Institute and you will have a stent put in. This is what should be happening with addiction.
I have travelled the world. In Europe, the United States and all these other jurisdictions, they have the appropriate treatment programs. In the portfolio I gave you, I have given you Recovery Kentucky and how they have done that. They now have over 2,000 beds. I've also given you something on the Betty Ford Center.
I believe, as do those in the addiction world, that the government is using injection sites as a smokescreen to prevent the input of money into the appropriate treatment of addiction because that amount of money would be in the billions of dollars, if the provincial and federal government departments of health were going to do this properly. They haven't put money into this in a meaningful way since the 1980s. That's what I mean. If we get focused going down this way, namely that injection sites are the treatment of addiction, we will never think about this ever again in our lives and that's the end for everyone.
[Translation]
Senator Boisvenu: Yesterday, the witnesses told us that an urgent problem must be solved, and that the problem is now endemic from east to west.
A media article in Quebec this morning said that fentanyl has arrived in the province and that deaths are starting to occur, although not in the same proportion as in Vancouver. Do you think the bill before us is a mistake from a medical perspective?
[English]
Dr. Ujjainwalla: In the summary page of the bill that is before us, the only thing I disagree with is paragraph (a) and "simplify the process.'' I agree with everything else. In the summary, the first page of Bill C-37, paragraph (a) says, "simplify the process of applying for an exemption that would allow certain activities. . .'' I don't agree with this. I think they should leave it the way it was. The rest I agree with and I think we should expand on them. I think we should add one to say that the government should put in as much money as it needs to get our addiction treatment to the standards of the rest of the world and not be blindfolded by a bureaucratic comment that addiction sites treat addiction.
We're on the right path. I believe that people like myself who work in the addiction field haven't been heard enough to explain and give the knowledge and insight the government requires to do the right thing. Our American counterparts are light years ahead of us, but not in cardiology, not in oncology or in any other thing. In addiction, however, they're light years ahead of us.
Senator McIntyre: Thank you all for your presentations. I totally agree that counselling and treatment is the key to drug addiction; no question about that.
I have a question regarding Bill C-37. The bill embodies both the drug consumption sites and the drug injection sites. Under the current regime of drug consumption sites, we have 26 criteria. Bill C-37 would drop from 26 to 5. That's the first thing.
The other thing is that the bill also changes the discretionary 90-day public consultation period to a discretionary consultation not to exceed 90 days. Finally — and you have touched that point as well — the bill does not legislate on drug treatment centres, which are considered an important part of the solution.
May I have your thoughts on those three points, please?
Dr. Ujjainwalla: I agree with what you said. I think that the idea of the bill is a good one. It shows that this government is interested in this opiate crisis that we have. My problem as an addictions physician, for example, I'm a national expert but I wasn't even invited to the opiate summit that was held here in Ottawa not long ago.
So I'm not sure the confusion around the appropriate treatment is the issue. I believe the government could become extremely knowledgeable on this, and I think they should take as much time as it requires to do it properly and have a bill that makes sense so that our strategy in Canada is going to amount to something and deal with your issue, for example, of carfentanil or all the issues that my colleagues are talking about.
At the end of the day, the bill is necessary but the bill needs to be appropriate in managing addiction and it's not really in there. The treatment isn't in the bill, and the first part of it is really, in my opinion, throwing a smokescreen into saying that's treatment. Injection sites or consumption centres are treatment. But as Mr. Carter says, you ought to follow these people around and see what actually happens. In Ottawa it will be probably only 20 to 50 people; the same people who live in these shelters, they're going to wander over there. They can have $500 today; they live in a shelter; they don't have to prostitute, steal and commit crime; they're going to inject, and so what? They're already dead in a sense spiritually. We're not saving lives by having them just breathing again because they're just going to walk out there and have to get their own stuff and break the law, and they're going to die.
You have to see these people as human beings who are suffering from a disease that's highly treatable. In other parts of the world, if these people had the money, I could take them, put them there and they'll be normal. They will be taxpaying citizens who are happy and healthy.
Senator McIntyre: We're not making them better by giving them more drugs.
Dr. Ujjainwalla: Absolutely not; you're enabling them to continue a behaviour that's killing them. It's illogical. It's logical if you don't understand addiction. If you understand addiction, and I'm an expert in that — I've gone to school for many years and I've treated thousands of people — it's not about the drug. It's about your mind, your body, your spirit, and it's a very deathly illness if untreated.
Senator McIntyre: Another thing that bothers me about the bill is the fact that we're not only going to have maybe five drug injection sites, but this will mushroom across the country. We may end up with 50, 500, and then have we really solved the problem? That's what I'm concerned with.
Dr. Ujjainwalla: And that's my point to my last statement with your colleagues. I think we're just going to lose sight of it and we will be in big trouble. What you're suggesting with injection sites is actually aggravating the opiate dependency problem. When you're addicted to opiates, it doesn't matter. When we cut out OxyNEO they just went to the next one. The reason we have carfentanil is because we cut out OxyNEO.
I'm telling you, that's what happens. I deal with this all day long. I've had 10 people die in the last three weeks who are patients of mine. They can't get treatment and that's why they're dying. In saving a life, you've got to understand what a life is. If you're dying of cancer in palliation, they want to live. My father died at Bruyère in agony.
So that's how these people live. They're HIV positive, hepatitis C positive; they have no teeth, no nutrition; they sleep under a bridge. That's no life. So when they breathe again, when they wake up after they've injected, you didn't save a life. As a physician, I don't think that's fair. Then you toss them out anyway. You just rescued them from drowning and you toss them back out on the street and they've got to prostitute and get more fentanyl. I don't get it. It doesn't make sense.
Senator Joyal: I think you have put your finger on the conundrum that I mentioned to the witnesses we had the privilege of hearing earlier on this morning, which is if the government's answer is only, as you say, to multiply the number of injection sites, it doesn't address the fundamentals of the problems. When I say the fundamentals of the problems, I mean the problems and solutions ahead of somebody being addicted and after you recover that person from, as you say, the streets, the ditches and everywhere.
I think we should be very concerned as a committee to alert the government. Of course, when governments are facing crises, they want to do something. There is public pressure, public opinion; people are dying and they have to do something. But we have to be smart about our approach.
As much as injection sites may be needed in some circumstances, if we give all our emphasis and put all our money and effort with the provinces on multiplying the number of sites but not really on investing in the treatment part, or taking initiatives to address the treatment part, we're not really doing much to solve the problem.
The medical community has to be very involved in the definition of the treatment site. The treatment site side of it will not come from civil servants. It will come from people in the field like you and like Mr. Kardish, who knows on a daily basis what it is amounting to not to have treatment possible. It's just multiplying the problem. As you said, it's to keep the living dead still living, but we don't really address the issue.
On the basis of your experience of what the United States does, how do you see the initiative we should be taking to promote the treatment aspects of that approach to fight the opioid crisis in Canada?
Dr. Ujjainwalla: Thank you for your comments. It's very refreshing to me to hear somebody acknowledge what I do.
I tried to get a comment from Jack Kitts, who is the CEO of the Ottawa Hospital and a friend of mine, and as the top person at the Ottawa Hospital he said he had to defer a comment. That's saddens me that the physicians, my colleagues, aren't doing what they should do.
How do we change? We start with attitude, insight, knowledge and willingness. If we could, as a group, recognize all the things you just said as true and say, listen, we need a working committee to work together to say what would be the appropriate medical treatment for a medical problem with an excellent prognosis; how do we create an evidence-based best practice program such as the Betty Ford Centre? Then we would have to collaborate and develop this type of comprehensive program, which I would be thrilled to be part of and I know other people around here would.
I think in the United States the reason that it happened, that they went towards more treatment centres and drug treatment court, is because they ran out of money. I've been in several states, in Georgia, Florida and Hawaii, where they just basically ran out of money putting everybody in jail and then realized that the treatment of addiction is not incarceration. So they developed these innovative programs and integrated with existing treatment centres.
I spoke to Dr. Keon about this at one point because I wanted his opinion. We have to do what Dr. Keon did for Ottawa with the Heart Institute. We have to do that for the addiction institute. When I started in the 1970s here we didn't have CHEO; we didn't have a heart institute, cancer clinic, Eye Institute, nothing. Now we have all that.
We have to put in the same effort, enthusiasm, intelligence and money to create an addiction foundation or centre that's equivalent to our Heart Institute. And we could do it. All we need is the support. There are lots of people in our community, such as Mr. Kardish, who would be more than willing to put his time and money into it. I know that.
In answer to your question, I think it's the willingness of the government to allow people like us who are experts in this field to have a voice at the table and to do the right thing logically and then start looking at results.
In most of the LHIN programs there is no accountability on outcomes — zero. There are $120 million a year spent in Ottawa at the Champlain LHIN on addiction but 90 per cent of it is salaries. That hasn't changed since the 1980s.
I have to get a seat at the table and people have to say physicians are important in this. The medical treatment of the medical problem is there, it's available, and we can do it. Why couldn't we? We did it with the Heart Institute and with the cancer clinic. We can do it. People will do it. It's just that the political will, in my opinion, has been to provide a smokescreen again to say that injection sites or harm reduction become the treatment of addiction and we're the leaders in the world in this. In fact, we'll go to the UN and tell people how excellent our programs are. To me, that's embarrassing as a Canadian. We wouldn't do that with the Heart Institute or we wouldn't say that with the eye institute.
The Chair: Mr. Kardish, you mentioned problems with some of your staff and your customers being confronted. Could you be a little more explicit? Maybe you could give us a few examples of the more worrisome incidents that have occurred.
Mr. Kardish: There are a large number of drug-addicted people on the streets around our place. That's just the way it is. Early in the morning, at seven o'clock, six o'clock, they open the bakery. They went to the open the garbage container, the dumpster, and there's a guy shooting up in there. It's frightening, really. He was scared; she was scared.
I had another situation where a girl parked her car in the laneway at eight o'clock in the morning and out from the dumpster came this wild-looking girl who was high on something, chasing her down the street.
This goes on all the time. This is Rideau Street. We have a lot of these situations arise. At the methadone clinic next door you have a lot of people fighting. It's embarrassing for tourists who come in, for customers who come in. They just can't believe that it is 15 minutes from downtown, from Parliament Hill, and they're experiencing these things. It's frightening.
The Chair: Doctor, you indicated you've started your own business, Recovery Ottawa, to provide treatment. Saving lives should be the priority, I think you said earlier. I also heard you say people can't get treatment and you referenced that "three of my patients died last week.'' Maybe you could talk a little bit about that.
Dr. Ujjainwalla: They died because they didn't get treatment.
The Chair: But you said they were your patients.
Dr. Ujjainwalla: What I do with methadone is called opiate withdrawal management. People who are addicted to fentanyl, they can't get into a treatment centre. The reason I started this in the first place is because I went down to Rideau Street and saw what a mess it is. I said, "I have to do something about this.'' I personally — myself and a pharmacist — started Recovery Ottawa at our own expense. Unlike Médecins sans Frontières, nobody is helping these people; it is a disaster.
I go down there and I see them without an OHIP card, the same day, and put them on a drug called methadone. Now they don't have to use drugs. We take them out of withdrawal. That's all we do. Now they need treatment. They need to deal with all their other psychiatric issues, life issues and career issues. That's what treatment is. Your point is important. People don't even know what treatment means. They think methadone is treatment. It's not. It's opiate withdrawal management so at least they don't have to prostitute and steal and wreck things. If you come to my clinic, it's the opposite. Everybody is polite, friendly and does what they're supposed to do because I've made it that way. The problem is I have to watch them die because they don't get any more help because they have serious psychiatric problems and life issues.
Recovery Kentucky, I've been down there and they want to come here and start their program. They now have 2,000 beds for homeless people in the state of Kentucky. If we could do that in our area here in the Market, wouldn't that be a nice thing? No drugs; people are polite and friendly. I see that vision and I know we could do it. We just have to have the will to try.
The Chair: How are you funded?
Dr. Ujjainwalla: We're not funded at all. We pay ourselves. I pay like any other doctor. My salary is funded by OHIP; that's it. We don't get any funding from anyone.
The Chair: Is it like a family health team concept?
Dr. Ujjainwalla: Yes, but I pay for everything myself and the pharmacists pay for everything — the rent, the phone, everything.
The Chair: Are you familiar with the Swiss model that has been referenced by a number of witnesses?
Dr. Ujjainwalla: Swiss model?
The Chair: Yes.
Dr. Ujjainwalla: I had people from Sweden come and visit my program and they want to start a program. But I'm not aware of the Swiss model.
[Translation]
Senator Boisvenu: My question is for Mr. Grinham. First, congratulations on the admirable work you have done with your spouse. You didn't refer to Bill C-37 at all in your brief. What's your position on this bill?
[English]
Mr. Grinham: I have the same position as most of the people who spoke today. The majority of the bill is fine. It's the weakening of the criteria for the supervised injection or consumption sites. There is also change of the verbiage; instead of requiring "proof,'' it's requiring "information.'' Information is not proof. It doesn't guarantee that a solution that has been put into place is going to be effective. We are talking about a situation where people are literally dying while waiting for us to come up with the right solution.
My wife and I have been working on this for 10 years, and for 10 years nothing has changed. In fact, things have gotten worse. Anyone who watches the news saw the stabbing that just happened the other night at the McDonald's on Rideau Street. That was drug-related. We see shootings all across the city of Ottawa, within steps of Parliament Hill. That is majority drug-related.
If we make it easier to put into place supervised injection sites or supervised consumption sites, much like Dr. Ujjainwalla has said, we're going to lose the vision on treatment. We have been screaming for treatment for 10 years.
I have been trying to get people to look at a treatment centre in Italy called San Patrignano. If you have a moment, please look into that. We're talking about 30 per cent through our drug court being a success. They have a 71 per cent success rate going back five years because they learned that treatment is not about getting you off drugs. It's about dealing with everything that drove you to drugs. Treatment is a very personal thing that has to be customized to each user and has to be done properly. If we do it probably, if we get 71 per cent of the addicts off the streets of Ottawa — by the way, San Patrignano does this at no expense to the Italian government, at no expense to the Italian taxpayers.
Fifty per cent of their funding comes from donations and the other 50 per cent comes from goods and services produced at San Patrignano because part of the treatment is to give you training in a new job. And as you're training and working and doing things in that position but still attending San Patrignano, then the money you would be paid for that job goes to pay for your treatment. So it's not a drain on society either. It is a very amazing model.
Again, they have indicated more than once they would be willing to come here and show us how it's done. We just need the political will to make that happen.
[Translation]
Senator Boisvenu: I gather that you're comparing Bill C-37 to a place for people to die. People will die a slow death by injecting themselves. Do you recommend that the bill be split in two, to manage treatment on one side and supervised injection sites on the other side, in order not to lose sight of the rehabilitation priority and not to focus on continued substance use?
[English]
Dr. Ujjainwalla: I think that would be a fantastic idea. That would be suggesting to the people that you understand a problem, and then we could put that front and centre into a solution that is going to be meaningful.
I had the same experience as what Chris has just said. A group from Sweden came to see me with exactly that same program and they wanted to come here and implement it. I told you the Recovery Kentucky group was coming here. I've been down to see them. They would be happy to come here and implement it for free. We have people who would be willing to put personal money into this in Ottawa to create these types of things.
As Chris says, we just need the political will to take this seriously and say we need treatment of addiction. This is the proper thing. It has nothing to do with injection sites. Nothing would make me happier than to pull that out and put in a new bill that says we need treatment to solve our problems.
Senator Joyal: I'm trying to visualize in my mind how what you're doing as an initiative could be linked to social agencies and drug court operations. That seems to be certainly an important player in an approach that would be more comprehensive than just focusing on injection sites.
What's your experience? I have difficulty understanding that the work you do is not recognized by any Ottawa social agencies, that you have no connection with them to try and coordinate the effort and better reach the results that you're aiming to achieve.
Dr. Ujjainwalla: If I could comment on that, I think that's the problem. It's almost like oil and water. If we exist in medicine, they don't exist as social or bureaucrats or administrators. It's so dysfunctional I can't even begin to tell you.
The problem with that is the people who need the services are not getting them. We have a meeting right after this with the LHIN. I'm going to create the whole thing. I'm not going away with this. This is my life mission now.
In the package I gave you, I had a presentation that I gave to the police chiefs of Canada, and in there is a presentation on what a collaborative comprehensive program would look like and all the different resources would be working together. Again, I've been in other parts of the world, in the U.S., in Sweden, and it seems in Italy they already have this going. We're all working in conjunction, just the way a hospital should work. It's just that we're not part of it for some weird reason.
When I go to a party, I have to spend 10 minutes explaining what an addiction medicine physician is, and I have a degree in it. The cardiologist doesn't have to do that.
This is a problem we face generically in our system, that addiction and mental health is kind of an afterthought, yet 50 per cent of our population is affected by it, and nice people like this, who pay out big taxes, have people in their dumpster in the morning. It's ridiculous.
Senator Joyal: But how the Drug Treatment Court operates by agreeing to send somebody for a cure, if there is no infrastructure to receive those people, the judge in the court says, "Okay, you go to treatment,'' but who is in charge of that person when the person leaves the court? Where is the social infrastructure?
Dr. Ujjainwalla: Absolutely. You will see I have all that in my presentation.
Drug Treatment Court is an integral part of what we do. People should be going to drug treatment, but at the same time come back at night and stay in a sober-living facility, so we need that facility. They need one month, three months or one year of treatment and then three years of aftercare and on and on. It's all integrated together.
Drug Treatment Court does 36 people a year. In my opinion, they should be doing 3,000 a year.
Senator Joyal: Absolutely.
Dr. Ujjainwalla: It costs so much to put people in jail. I've got a guy in jail for 10 years for theft or something. It's $150,000 a year to put somebody in jail.
We could take that money and put it into an appropriate Drug Treatment Court, which is integrated into appropriate treatment, ongoing management, aftercare and, like Chris is saying, you start people working.
In Sweden, the state owns the companies. They have a roofing company; they work for the state. All the money goes back to the state, and then they become part owners. It's excellent, and it works. People are happy. There's reduction in crime, and the jails are closing because they don't need jails any more. Eighty per cent of the people shouldn't be in jail.
I would encourage everyone to go to Drug Treatment Court, Tuesdays at 2 p.m. It will break your heart. It's the only courtroom where people are happy. The judges and the police are hugging the patients. If you want to lift your spirits on a rainy day like today, go down and you will see how excellent it is. You'll ask, "Why don't we have more of this? This is how it should work.''
A guy was charged with two grams of cocaine, and now he's going to do three months at OCDC. It makes no sense. Put him in an appropriate treatment centre. Educate him, teach him, treat his health, give him a job, encourage him, treat him like a human being and it will come back to us in spades. Canada could be the leader in this. It wouldn't be that hard to do.
The Chair: Thank you all for your obvious passion and caring about the community. The committee appreciates that. We thank you for your testimony. It's very helpful.
Mr. Kardish, I also got an email during your testimony. Someone watching CPAC, I guess, says that you make the best rye bread in the world.
Mr. Kardish: Thank you.
The Chair: It's now on the record. Thank you again, gentlemen.
(The committee adjourned.)