THE STANDING SENATE COMMITTEE ON INDIGENOUS PEOPLES
EVIDENCE
OTTAWA, Wednesday, October 26, 2022
The Standing Senate Committee on Indigenous Peoples met with videoconference this day at 6:54 p.m. [ET] to examine the federal government’s constitutional, treaty, political and legal responsibilities to First Nations, Inuit and Métis peoples and any other subject concerning Indigenous Peoples.
Senator Brian Francis (Chair) in the chair.
[English]
The Chair: Honourable senators, I’d like to begin by acknowledging that the land on which we gather is the traditional, unceded territory of the Algonquin Anishinaabeg people, whose presence here reaches back to time immemorial. I’m Mi’kmaq Senator Brian Francis from Epekwitk, also known as Prince Edward Island, and I am the Chair of the Committee on Indigenous Peoples.
Before we begin our meeting, I would like to ask members in the room to please refrain from leaning in too close to the microphone, or to remove your earpiece when doing so. This will avoid any feedback that could negatively impact the committee staff in the room.
I would now like to ask committee members in attendance to introduce themselves by stating their name and province or territory.
Senator Lovelace Nicholas: Sandra Lovelace from Wolastoqey Territory, New Brunswick.
Senator Christmas: Dan Christmas from the Membertou First Nation, Nova Scotia.
Senator Hartling: Nancy Hartling, New Brunswick.
Senator Coyle: Mary Coyle, Nova Scotia.
Senator Arnot: David Arnot, Saskatchewan, which has Treaties 2, 4, 6, 8 and 10 in that jurisdiction as well.
Senator Patterson: Dennis Patterson. I’ve never said this before, but I think it’s ceded land in Nunavut. However, it’s a very generous land claim. Thank you.
The Chair: Thank you, senators. I would like to ask witnesses joining remotely to keep their microphones muted at all times unless recognized, and should any technical challenges arise, please let us know in the Zoom chat.
I would like to remind everyone that the Zoom screen should not be copied, recorded or photographed. However, official proceedings can be shared via the Senate of Canada website.
Today, we’re here to continue our study on the federal implementation of the Cannabis Act as it relates to Indigenous peoples in what is now known as Canada. This meeting consists of one panel, and with that I would like to introduce our witness. From the Nunatsiavut Government, we welcome Michelle Kinney, Deputy Minister, Nunatsiavut Health and Social Development. Ms. Kinney will provide opening remarks of about five minutes, and then we’ll move into a question-and-answer session of approximately five minutes per senator. If witnesses are unable to answer a question in full, I would ask them to send a written response to the clerk before Friday, November 4, 2022.
Michelle Kinney, Deputy Minister, Nunatsiavut Health and Social Development, Nunatsiavut Government: I want to thank you for the opportunity to present to you today on behalf of the Nunatsiavut Government. Nunatsiavut, as many of you may know, means “our beautiful land,” and it’s located at the northern tip of the province of Newfoundland and Labrador. Nunatsiavut consists of five communities: Nain, Hopedale, Makkovik, Postville and Rigolet. The Nunatsiavut Government was formed in 2005 as a result of the Labrador and Inuit Land Claims Agreement. In that agreement, there are approximately 7,130 members. One third of those reside in the five communities I just mentioned in Nunatsiavut, one third reside in Upper Lake Melville, which is the Happy Valley Goose Bay area, and one third reside in the Canadian constituency.
The presentation from the Nunatsiavut Government this evening will primarily focus on cannabis in relation to the five communities I discussed in the land claims area and on two aspects: the use of cannabis as a harm-reduction tool and access to cannabis.
The Nunatsiavut Government supports a harm-reduction approach to dealing with substance use. Harm reduction is a leading practice in responding to addictive substances and behaviours. It’s intended to reduce negative health, social and economic consequences associated with addictive substance behaviour without necessarily reducing consumption. In other words, it’s built on the idea of stopping or reducing the bad outcomes without necessarily stopping or reducing use.
Harm reduction is an evidence-based and cost-effective way to target the risks and harms of addictive substances and behaviours. It’s built on the philosophies of dignity and compassion for those using addictive substances and behaviours. It promotes transparency, accountability and participation in positive change wherein everyone is seen as equal and collaboration is valued. This approach fits well with Inuit values and practices.
This incremental approach to change, wherein the focus is on reducing the risks and harms, is very different from the older abstinence model of substance use. Whereas the abstinence model insisted the only appropriate response to addictive substances or behaviour was to completely stop them, this model allows individuals to find the approach that works for them. Each individual is different. For some people, abstinence works; for other people, it doesn’t. This is in line with current research on addiction. Every person travels a different journey and there is no universal solution.
The Nunatsiavut Executive Council discussed the legislation related to cannabis in 2018 and was supportive and proactive in its approach.
Like many Indigenous communities, our communities struggle with the legacy of colonization, residential schools, relocation, oppression and racism. The impacts can be seen in struggles with addictions, family violence, overrepresentation in the justice system, and the list goes on. While cannabis use is fairly common, the substance of choice is primarily alcohol and the majority of the issues are related to alcohol misuse. We see the impacts of alcohol as stated above but also with the prevalence of fetal alcohol syndrome or the fetal alcohol effects and issues ensuing throughout life.
Nunatsiavut welcomed the legalization of cannabis and we’re very hopeful that this might be a means to reducing alcohol use and substituting with a less harmful substance. While we do not promote the use of cannabis, or any substance, our research led us to believe that it might be a better option than alcohol.
We were aware that, for some people, using cannabis is a harm-reduction approach all of its own. Multiple service providers in Nunatsiavut noted that candidates who switch to cannabis instead of alcohol are less likely to be violent or aggressively angry, an important consideration given the high rates of domestic violence and criminal involvement in the region.
For example, we have a 35-plus-year-old man in our Supportive Living Program who basically spent his whole adult life incarcerated with short periods in the community. When he was released from corrections, we accepted him into our program and we were told that he would require two male staff 24-7 due to his violent behaviour. Once in the program, he was able to get an appropriate psychiatric diagnosis, but, more importantly, he was supported to not consume alcohol. He smokes cannabis daily and he has been in our program in Goose Bay for eight years, living with two other males in a single staff unit with primarily female staff, and has no further incarcerations.
The issue within Nunatsiavut is that there is minimal access to legal cannabis. There are no private retailers, even though the Nunatsiavut Government has tried to encourage a vendor. We’re told that the profit margins are too low to make it profitable in our small communities. There is access to online sales but few people have a credit card for purchases.
I understand that there are jurisdictional issues and the sale of cannabis is regulated by the provinces, but I think that it is important to understand the challenges in isolated Indigenous communities.
We have completed extensive research into managed alcohol programs by substituting with cannabis. We would like to move forward with a program, but access is the issue. We feel that the benefits would be tangible and beneficial for our communities. They would include less criminal activity, less family violence and children coming into the child welfare fair system, fewer children born with fetal alcohol effects and fewer alcohol-related accidents and medical interventions required.
There is also a growing body of research regarding the positive benefits of cannabis, especially CBD, for individuals with autism and FASD. We have seen the benefits of that in our own region with those who are lucky enough to be able to access cannabis.
It is really difficult in a presentation of this length to present the magnitude of the current issues and the potential positives that come from access to cannabis in our communities, but hopefully this is a snapshot that will create dialogue.
I know it may be a bit different than traditional presentations. I kept it short and to the point, but I welcome any questions. Hopefully, I will be able to answer them to the best of my ability.
The Chair: Thank you for that, Ms. Kinney. We’ll open the floor to questions from senators.
Senator Christmas: Thank you, Ms. Kinney, for your presentation. I appreciated your harm-reduction approach — you described it very well — and the benefits that have accrued to your members because of cannabis use.
I am still not clear, however, about your challenges in Nunatsiavut about limited access. Obviously, you still have some access to some product. Would you please describe what your access is at the present and what you would recommend to increase access to cannabis?
Ms. Kinney: Sure. Perhaps I was a bit unclear. When I started the presentation, I spoke about a third of our beneficiaries being in Nunatsiavut. In those Nunatsiavut communities, there is no access to cannabis unless it is through mail order. Few people have the financial means to do that or access to a credit card in lots of cases.
There is also an issue of cost for mail order and those kinds of things, which is a deterrent. In Upper Lake Melville, where a third of our beneficiaries live, we do have a cannabis retailer. That is where we have seen the benefits of being able to access legal cannabis and access the right type of cannabis for the right person. There are individuals who are greatly benefiting from CBD and experiencing decreasing behaviours and anxiety, particularly in individuals with fetal alcohol syndrome. We have seen the benefits of that. I guess that encourages us even more to find a means to access it within our smaller communities, where there is no access.
As to solutions, we have approached businesses to see if they would be willing to come into the community. We have even looked at trying to provide a location and removing some of those deterrents. Our communities are just too small to make it financially viable for most individuals. We have even looked at the possibilities that we, as a government, might be able to do something. However, as a government, we’re not really permitted to be in the retail business. We have looked at a variety of solutions. We have not given up. We are looking at a managed alcohol program where cannabis would be used as a substitute in ways that we can purchase and distribute in the community but, again, that is a whole complicated piece around being able to distribute legally.
Senator Christmas: That was the solution that popped into my head while you were speaking: Why isn’t the government opening a cannabis retail location? What would the challenges be if your government did so? I’m trying to understand why you can’t sell directly.
Ms. Kinney: I am probably not best one to answer that. The best thing I can tell you is that we really keep business separate from government. We have an arm’s-length business development office and we have tried to promote that to them in the communities.
At the present time, we’re looking at the possibility of doing that as a not-for-profit sort of thing, but there are a whole lot of legal pieces and discussions that have to happen within the province that are making that rather challenging.
Senator Christmas: Thank you, Ms. Kinney.
Senator Coyle: Thank you very much, Ms. Kinney, for your very interesting presentation.
I have been asking other witnesses questions around the harm-reduction line about substituting alcohol for cannabis and seeing whether that has had any benefits on the social side in reducing family violence, et cetera. It is interesting to hear what your experience and your intention is with your program.
I want to come back to the access issue that you have identified. Obviously, that is a big obstacle. Also, I want to talk about your harm-reduction approach.
First, on the access, I will mention to you that my son-in-law used to work for the Nunatsiavut Group of Companies, so I know some of what the business arm does. I know they are not involved in this kind of retail at all, but how do people in those more remote, mainly coastal communities — almost outports really — get alcohol?
Ms. Kinney: There are retailers that sell beer only. There is no hard alcohol sold in the communities at all. In order to access alcohol, you have to buy it from the liquor store and have it shipped into the community. Unfortunately, illicit alcohol is a big business — bootleggers and that kind of thing.
Senator Coyle: Okay. Pardon my ignorance, but is the liquor that is brought in by mail order through a provincially regulated retailer?
Ms. Kinney: Yes, it’s through the Newfoundland Labrador Liquor Commission.
Senator Coyle: I’m from Nova Scotia, and there, you get your cannabis at the liquor store. Is that the case in Newfoundland?
Ms. Kinney: No, it is not the case. It is a completely separate entity, and there are very few distributors within the province. There’s basically one distributor, called Tweed, and they distribute through retailers in various parts of the province. There is one in Happy Valley-Goose Bay, which is the only one in Labrador.
Senator Coyle: Okay. So that access issue is a very serious one that requires some creative solutions, obviously.
If I could just turn to your evidence-based harm-reduction approach, are you plugged into a network of others working in the health and social development area across Indigenous communities, or even Inuit communities exclusively, that are taking a similar approach?
What is being done to gather data on the impact of the approach you’re taking? You have told us some very interesting stories. Thank you.
Ms. Kinney: We actually employ a harm-reduction specialist, who is the beneficiary, who is well connected through ITK and other Indigenous organizations, as well as other non-Indigenous organizations right across Canada.
We have put quite a bit of emphasis on any research that is out there. We have a number of statistics. I actually have a pretty basic flowchart that provides a lot of information around substituting cannabis for alcohol and those kinds of things that I would be more than willing to share with you, if that is appropriate.
Senator Coyle: That would be wonderful. Thank you for that.
Ms. Kinney: You’re welcome.
Senator Hartling: Thank you, Ms. Kinney. This is a very interesting topic. I’m really interested in what you are saying to us. I come from New Brunswick, so there is a little bit of a different process there.
If you did have products available, how would these assessments be done to match up people with what they needed and to follow up with them? In New Brunswick we have a vehicle where, through medicare, we can have an assessment, they make a recommendation and it is done by a nurse practitioner. How does it work there, or how do you do this now?
Ms. Kinney: It would work very similarly. In the managed alcohol program that we use, we have a nurse practitioner who does the prescribing. She does an assessment and looks at what is required by that individual and that sort of thing. There is also a physician in St. John’s who can provide assessments through video conference, and there is someone very similarly specific to cannabis who is able to prescribe. We actually have clients through our Non-Insured Health Benefits program now — although it is not paid for through that program — who access medical transportation for that assessment piece. He prescribes, and they can purchase at the local cannabis retailer.
Senator Hartling: I thought it was interesting what you said about the reduced use of alcohol — the harm reduction — and that there was less domestic violence and things like that. But are people smoking marijuana? Is that what you are saying?
Ms. Kinney: Yes, primarily they are smoking marijuana.
Senator Hartling: I’m just wondering about that, because we know that smoking is bad, so I am wondering if there are other ways for them to take it.
Ms. Kinney: If we had access to it, it would be better. In Happy Valley-Goose Bay right now, we have other people using edibles and other options for them. In the coastal communities, the only data that we have that we can compare to are the number of individuals who are arrested for being under the influence of alcohol. The RCMP are able to confirm that the numbers that are arrested after using cannabis are very, very minor. I have the statistics, but it is like 95% for alcohol and 11% for cannabis. It is drastically different in the statistics.
But on the coast, it is all illicit cannabis use too. Very few people have access to cannabis. What they are getting in that cannabis is hard to tell because it is a street drug. Would that number be even less if it were regulated? It is difficult to know.
Senator Hartling: Thank you.
The Chair: Ms. Kinney, in your view, should cannabis for medical purposes be covered under the Non-Insured Health Benefits program?
Ms. Kinney: The Nunatsiavut Government is one of the few Indigenous groups across Canada that actually manages our own Non-Insured Health Benefits program for our 7,000 beneficiaries, regardless of where they live in Canada. We have a fairly lengthy history of administering those benefits.
My personal belief is that it should be covered under the Non-Insured Health Benefits program. It is a lot less costly than a lot of other medications. I will talk about my own personal experience. I have an adult son who was adopted. He is Indigenous and has a lot of medical issues, as well as autism. There are a lot of behaviours that we have been struggling to manage for a lot of years using other prescribed medications, and the thing that has worked best for him is CBD from cannabis. It is a very low cost compared to other drugs that the Non-Insured Health Benefits program has provided to him.
So yes, I think that it needs to be used in very particular situations. It needs to be prescribed by a physician, and it needs to be matched well with the person’s medical condition, but it should be paid for under the Non-Insured Health Benefits program.
The Chair: Thank you for that.
Senator Patterson: Thank you for a very impressive presentation, Ms. Kinney.
You said that you have some statistics about crime rates involving alcohol and cannabis. The committee would be most interested if you could share those with the clerk, please. Would you also have any data about how things have changed since the legalization of cannabis?
I understand it is not easily accessible, although you did say it is in fairly widespread use. Has your government had the opportunity to do a comparison on social issues, particularly crime, before and after the bill was passed in 2019?
Ms. Kinney: The statistics that we gather are primarily from the RCMP. I have statistics around the crime rates and the types of crime — all of that sort of thing — back quite a few years. We could easily pull that out, I think.
The issue is that the statistics we have show when someone committed a crime under the influence of alcohol; they don’t always indicate if someone had been using cannabis. But I can certainly show you the impacts of alcohol and where there was no alcohol present. We can definitely provide those statistics to you.
Senator Patterson: That is very much appreciated. You probably know that there is going to be a statutory review of the cannabis legislation by the government within three years of legalization. It will start this year. Our committee is getting a head start on that with this study. What you have told us and what you are going to share with us would also be of great interest to the committee.
You spoke about the barriers to access. You said that the profit margins do not seem to be high enough and that it does not seem possible for your government to open a store or a distribution system under the present regime.
Do I understand that the problem there would be getting permission or dealing with the province of Newfoundland and Labrador?
Ms. Kinney: That is the bottom line, yes.
There are a number of issues that we are trying to work through with the province. We have looked at a number of possible solutions. It just seems that there are constant barriers, even around the transportation of cannabis. In the wintertime, and for most of the year, the only way into our communities is via airplane. It is difficult to secure cannabis products through the air terminals. I’m not saying that it is not possible, but they have placed all kinds of roadblocks in the way of doing that through Transport Canada and those pieces.
Storage in the community is another issue and all of the hoops that we need to jump through. I should not be bashing the province, but they are really looking at a few distributors and a larger scale. I do not think that we need the range of products that you would have in a regular retail store. We could be looking at fewer options that would be more practical. I’m not saying it’s not possible. We are still trying to negotiate and trying to look at solutions, but to this point in time a lot of barriers have been put in place to make it happen.
Senator Christmas: Ms. Kinney, I want to make sure that I understand one of your previous comments. You mentioned the Non-Insured Health Benefits program does not cover cannabis. I want to be sure on that point.
Even if a physician prescribes cannabis or CBD — even with a medical prescription — am I correct in understanding that the Non-Insured Health Benefits program would not cover cannabis?
Ms. Kinney: Yes, you are absolutely correct. We have cancer patients who have been prescribed medical marijuana and medical cannabis by a physician. My understanding is — and we have been down this road a lot of times — that there is no DIN, or drug identification number, for cannabis. As there is no DIN for it, there is no way to enter it into the system or to pay a vendor for that drug. That is a requirement in order to be able to pay for it. Yes, even though a physician prescribes it and they feel it is the best medication for that individual, there is no way under the Non-Insured Health Benefits program for us to be able to pay for that. It is not even an exception; it is not even possible.
Senator Christmas: And is this in spite of cannabis and cannabis products being far less costly than other drugs?
Ms. Kinney: Absolutely.
Senator Christmas: Thank you. I just wanted to be sure.
The Chair: Ms. Kinney, could you comment on how many clients have benefited from this program since cannabis was legalized?
Also, have you had to decline people who wanted to use the program due to the lack of availability of cannabis?
Ms. Kinney: Right now, the only place that we are able to deliver the program is in Happy Valley-Goose Bay. We deliver it through our homeless shelter and our Supportive Living Program. A limited number of people have been able to access it; I would say it’s about 28 individuals at this point in time.
The Chair: Thank you.
Senator Patterson: Ms. Kinney, thank you for sharing your experience with your own child with autism and having had some success with the use of CBD, as I understand it.
When we studied the cannabis legislation, we got some advice from health research that there was perhaps even a higher susceptibility in Indigenous people — at least in some — for adverse effects from cannabis such as anxiety, depression and even schizophrenia.
You have presented a positive picture of the favourable impacts of the legislation compared to alcohol. Are there any risks that you would share with us in your experience along the side of the symptoms I mentioned?
Ms. Kinney: We have a number of individuals in our Supportive Living Program who, after using street cannabis, have early psychosis and those kinds of things. I do not know. I have not heard that piece around Indigenous people being more susceptible. However, I think there is a higher chance of comorbidity and of other addictions, so I would say that it does increase their risk.
When we are talking about cannabis, there are a whole range of products. There is a whole range of strengths of cannabis. I would not be giving my son cannabis with high concentrations of THC. He has anxiety already. I am giving him cannabis with CBD to reduce his anxiety.
Yes, there are risks with any medication that you take. A lot of this is around harm reduction. We’re not saying that there is no harm. We are looking at the least harm. Every situation is different. What is prescribed in each situation would be different. However that is managed — whether that is smoking cannabis which, I agree, is not healthy; or whether there are other alternatives — you do it in a way that involves a nurse practitioner, a physician and a lot of those kinds of pieces to reduce the risk. But there is always risk.
Senator Patterson: Thank you for that. Again, you have given us some valuable insights into the shift from alcohol and crimes of violence to fewer impacts of that kind with individuals who use cannabis. Is there any risk that cannabis and alcohol use together can be harmful, and that one can fuel the other and cause problems?
Ms. Kinney: Absolutely. Combining any drugs is going to increase risk; there is absolutely no doubt about it.
Again, we talk about harm reduction. If I had more time, I could go into a lot of things. Hopefully, I can present that on paper or something.
But even reducing the harms around poverty can be helped through cannabis as opposed to alcohol. In our communities, as one of the senators asked, there is no liquor store, so liquor has to be brought in. There’s a whole bootleg industry. The cost of alcohol in our communities is astronomical.
Right now, cannabis is illegal, but it’s lighter, easier to bring into the community and there are fewer costs, so people are spending less on a high from cannabis than they are on alcohol. Even from a food security and poverty perspective, there are benefits in reducing harms.
We’ve had a discussion about this for several years and looked into a lot of aspects, so I would welcome the opportunity at some point to be able to present in more detail.
Senator Patterson: Thank you.
The other thing that intrigued me about your evidence was that you’ve got a third of your population in Nunatsiavut who I think you said are living in Canada; did I get that right?
Ms. Kinney: Yes.
Senator Patterson: Does that mean they are outside the settlement area, and is that a trend that is growing?
Ms. Kinney: We have approximately a third of our beneficiaries who live in Nunatsiavut — the five communities I talked about that have no or very little access to cannabis. We have a third up in Upper Lake Melville, which is Goose Bay and North West River — they do have access to cannabis through the retailer here — and then we have a third of our beneficiaries who live outside of those two areas, in the rest of Canada. I should have made that clear.
Is that population growing? Not really. Since we became a land claims organization in 2005, it has basically stayed rather stable. We actually have a fair number of beneficiaries coming back to the land claims area for positions and that sort of thing. Within our government, 87% of employees are beneficiaries.
Senator Patterson: That’s so impressive. Would the out-of-territory residents be in St. John’s, primarily?
Ms. Kinney: They are spread right across Canada: St. John’s, Ottawa and Edmonton would be the three top places. We have a fairly large population in Ottawa working for the federal government or ITK in lots of cases, but we also have people who have transitioned there. For the individuals living in what we call Canada, outside of the areas I mentioned, yes, they would be primarily focused in those three areas.
Senator Patterson: Thank you very much.
The Chair: If you’d like to send us any further information, Ms. Kinney, certainly feel free to do so.
The time for this panel is now complete. I want to thank you again, Ms. Kinney, for your testimony. We really appreciate it.
(The committee continued in camera.)