Health-Centred Approach to Substance Use Bill
Bill to Amend--Second Reading--Debate Continued
November 28, 2023
Honourable senators, I rise today to speak to Bill S-232, An Act respecting the development of a national strategy for the decriminalization of illegal substances, to amend the Controlled Drugs and Substances Act and to make consequential amendments to other Acts.
Colleagues, I ask you the following: What is one of the greatest moral failures of the 21st century? My answer today is the opioid crisis. I believe I can safely predict that 50 years from now, Canadians will look back on this era and ask how legislators and policy-makers could have been so blind. How could they have steadfastly carried down a road that was so clearly leading to a dead end? I commend our colleague the Honourable Senator Boniface for putting forward this bill, as she has succinctly and convincingly argued that a national crisis deserves a national response.
Fundamentally, the impact of this national crisis on Canada is clear. The war on drugs is lost, and the cost is the lives of our fellow Canadian citizens.
Between January 1 and November 2 of this year, in my home province of Saskatchewan, the coroner’s office recorded 395 confirmed or suspected drug toxicity deaths. Over 90% of those deaths were related to fentanyl or fentanyl-like substances. As with most provinces, coroners only investigate under specific circumstances and at specific locations. Also, that data doesn’t show any of the people who were thankfully revived by naloxone, or who required an ambulance to an emergency room or hospital stay.
It has been reported that a single overdose can cost as much as hundreds of thousands of dollars, but it can be even more: A long stay in an intensive care unit for an overdose can cost millions of dollars. The costs also say nothing of the personal, familial and community impacts of substance use disorders and drug toxicity deaths. Those impacts reverberate and persist.
Data suggests this assertion. For instance, the 2019 Canadian Alcohol and Drugs Survey — released at the end of 2021 — found that in 2019, 4% of Canadians reported having used at least one illegal drug. Other research found that an estimated 3% of Canadians have used one of five illegal drugs, including cocaine, or crack; ecstasy; speed, or methamphetamine; and hallucinogens. Further, almost 18% of Canadians report that they have used an illegal drug at some point in their lifetime, with hallucinogens being the most used. In 2019, 14% of Canadians reported being harmed in the past year due to someone else’s alcohol use, and 2% reported being harmed due to someone else’s drug use.
While illegal drug use is remarkably indiscriminate as to the lives it touches, some in our country are affected disproportionately through the criminalization of illegal drug use. Earlier this year, I had a discussion with two young doctors — Dr. Shayan Shirazi and Dr. Ryan Krochak — both who are students at the University of Saskatchewan. They spoke of the increased vulnerability to substance use disorders of Indigenous peoples being framed by trauma related to colonization.
Simple possession has led to over-policing and high rates of incarceration of Indigenous peoples. Over 30% of the Canadian federal inmate population is Indigenous, despite comprising approximately 5% of the Canadian population. In 2003, the Aboriginal Healing Foundation reported:
. . . the residential school system contributed to the central risk factor involved, substance abuse, but also to factors shown to be linked to alcohol abuse, such as child and adult physical, emotional and sexual abuse, mental health problems and family dysfunction. The impact of residential schools can also be linked to risk factors for poor pregnancy outcomes among women who abuse alcohol, such as poor overall health, low levels of education and chronic poverty.
I thank Senator Boniface and Senator Pate for exploring this ongoing impact and the disproportionate incarceration of Indigenous peoples, particularly Indigenous women.
I reached out to two women from my home province of Saskatchewan this year. These women — both of them mothers — share a bond forged in tragedy. They both lost sons because of tainted drugs. Marie Agioritis lost her son Kelly Best due to a counterfeit OxyContin pill laced with fentanyl in 2015. He was described as living “. . . a life full of fun, love, laughter, plans, dreams, friends, and family . . .” and had aspirations of becoming an electrician. Kelly was only 19 years of age. Ms. Agioritis pointed out to me that, in war, the first objective of peacekeepers is to deal with trauma. She also told me that there are too many talking points and not enough actions. One all-too-common and painful talking point that she hears about those substance abuse disorders is the old saw, “If you mess with the bull, you’ll get the horns.”
I am told that the youth of today do not believe this and that their perspective is different. I believe that youth are a source of hope; at the same time, they are the low-hanging fruit in a national strategy for education that is evidence-based and not driven by misinformed public opinion or tainted by the “if you mess with the bull, you get the horns” ideology.
Like Ms. Agioritis, Jenny Churchill is a tireless advocate for public education, supports and a medical-model view of substance use disorder. Ms. Churchill lost her son Jordan in 2018 due to a fentanyl overdose.
For her, a successful national strategy will be responsive primarily to the needs of three groups of Canadians: those with substance use disorders, people who use substances recreationally and the youth cohort.
Both Marie and Jenny are members of the Moms Stop the Harm group, a Canada-wide network of moms and families advocating for evidence-based treatment and policy change. They want policies and a national strategy that would do three things effectively: one, save lives; two, reduce health care costs; and three, reduce criminal behaviour on the streets.
A partnership research project with Moms Stop the Harm reported that over 19,355 Canadians died from opiate overdose between January 2016 and September 2020. A unique aspect of this research is that it involved those who had lost a loved one to an opioid overdose, mostly moms, almost half of whom experienced stigma or judgment from their peers after the death of their loved one.
Decriminalization is not a cure-all for that kind of pain or for drug supplies that are increasingly adulterated and contaminated by fentanyl and its analogues.
What decriminalization does is provide a venue for an individual — a person, a Canadian citizen — who uses or may be addicted to illegal drugs to be seen first as an individual, a person and a Canadian citizen.
The Canadian state has a vested interest in the health and well-being of all its citizens. The federal government has a duty and moral obligation to every one of its citizens. This is evident when government agencies work hard to repatriate Canadians stranded because of a global pandemic or conflict and war.
The war on drugs, by most accounts, is either an abject failure or a losing battle. We are losing because the war on drugs is most often a war on people whose lives hang in the balance. A recent study by Scher et al. found that “. . . Canada’s drug laws may shape public attitudes toward people who use drugs . . .” and create the resulting “. . . structural, social and self-stigma experienced by people who use drugs.”
As Dr. Harry Rakowski, a senior cardiologist at the Peter Munk Cardiac Centre and Professor of Medicine, University of Toronto, asserted, “We keep losing the war on drugs because we are fighting the wrong enemy.” He argues that Canada needs to address the antecedent issues, harms, traumas and root causes. I agree that this is a necessary step. However, without a national conversation and strategy, we will not be able to address the root causes or challenge the concerns of those who argue for continued criminalization — concerns such as an increase in drug use; impacts on public safety, youth and international relations; and limited treatment infrastructure.
A truism about the justice system is that it is inherently reactive and only rarely proactive. I believe that Bill S-232 will create a national strategy for the decriminalization of illegal substances and will be an opportunity to be proactive in stopping the harm created by failed drug policies.
Dr. Shirazi and Dr. Krochak provided me with a well-researched brief in which they stated:
Canada’s drug toxicity crisis is a complex issue with no single or immediate solution; however, it is well established that substance abuse disorders are a medical issue, not a criminal one. Canada is not going to arrest its way out of its drug toxicity crisis. Ultimately, decriminalization is a policy that will save the taxpayer money, fight the drug toxicity crisis and, most importantly, save lives.
Experts have been clear, however, that decriminalization is not an ultimate solution, but may be a necessary step. This bill takes an important and necessary step toward finding solutions. It recognizes that substance abuse disorder is a public health issue and not a criminal justice matter.
Canada has a moral obligation to help individuals and our society through legislation and law, including in regard to offences under the Controlled Drugs and Substances Act.
Five years ago, the Canadian Association of Chiefs of Police released a statement supporting:
. . . decriminalization strategies such as increasing diversionary opportunities, alternate sanctions and health partnerships, while exploring the evolution of harm-reduction techniques such as safe supply and supervised drug consumption sites.
The national conversation Bill S-232 proposes must consider the research and data that finds decriminalization is a means of harm reduction and, in turn, of enabling positive health outcomes.
Dr. Rebecca Seliga, a member of the University of Ottawa Department of Emergency Medicine, summarized this by stating:
While some may argue that decriminalization is just a buzzword alone, we already know that its counterpart, criminalization, does not work.
Colleagues, it is time for the conversation to begin in earnest; it is time for a national response to a national crisis. I support Bill S-232 and hope it will be sent to the committee as soon as possible. Thank you.
I rise today as the critic for Bill S-232, An Act respecting the development of a national strategy for the decriminalization of illegal substances, to amend the Controlled Drugs and Substances Act and to make consequential amendments to other Acts, which was introduced by the Honourable Gwen Boniface.
Honourable colleagues, Bill S-232 addresses an alarming and worrisome public health issue in our country. Drug use continues to kill many Canadians every day, and it impacts the health of thousands more. Some of the deadliest psychoactive substances are the notorious opioid analgesics, such as heroin and fentanyl.
According to the Canadian Alcohol and Drugs Survey, CADS, 4.4 million Canadians aged 15 and up reported having used opioid pain relievers in 2019, up 12% from 2017. Of those 4.4 million people, 269,000 reported problematic use of those drugs. According to the Government of Canada, there were 3,556 opioid-related deaths from January to June 2022, an average of 20 per day. Of those deaths, 76% were caused by fentanyl overdose.
Yes, the opioid crisis in Canada is raging, but we must not lose sight of the impact of other types of illegal drugs on many Canadians. According to CADS, in 2019, 1.1 million Canadians reported having consumed drugs in one of the following six categories: cocaine and crack, speed and methamphetamine, ecstasy, hallucinogens, heroin and salvia. In Quebec, those drugs killed seven times more users than fentanyl from January to April 2022.
Drug use not only kills people, it also has major impacts on the lives and health of drug users. In addition to their harmful mental and physical effects, drugs can insidiously compromise the user’s social, professional, intimate and financial life. For some, life spirals out of control and, sadly, they end up homeless. In 2019, over one million Canadians reported that drugs had negatively impacted their own lives.
Drug use also affects crime rates linked to family violence, theft and sexual assault. Honourable senators, drug use is a serious public health problem in Canada. It deserves more of our attention so that we can come up with constructive solutions to help people struggling with hard drugs and to effectively fight traffickers, who exploit human misery for profit and must be held accountable for the many lives lost.
In Canada, we may need to consider the sale of deadly drugs as nothing less than premeditated murder. Bill S-232 is a legislative response to the substance abuse problem that I just described; according to the critic, it has two objectives.
The first objective is to require the federal government to consult with the provinces and territories in order to present Parliament with a national strategy for the decriminalization of all drugs. The second objective is to amend the Controlled Drugs and Substances Act, to repeal the provisions that make possession of certain substances an offence. In other words, we are talking about decriminalization from a purely legal point of view.
In my view, a third objective is missing from Bill S-232. It should include a provision requiring the government to develop a concrete public health strategy that provides for detox before decriminalization.
While I applaud Senator Boniface’s useful work and the laudable objectives of her bill, I believe that the approach of outright decriminalization of drugs is premature and that it only partially addresses the problem.
In her speech at second reading, the senator indicated that the part of the bill seeking the total decriminalization of simple possession through the repeal of drug law sections would be done by an order-in-council issued by the Governor in Council, and according to their wishes, after the strategy is finalized so it can be put in place, if this bill passes.
When it comes to public health, it is rare to see anyone want to decriminalize anything while waiting to see what happens later. That is this government’s strategy. Decriminalization for the Trudeau government is not a public health strategy; it is dogma.
The senator’s approach is certainly prudent. However, I would like to state an important caveat on this point: Nothing in the bill states that this strategy, which is apparently complete and takes all challenges and perspectives into account, has to be implemented and analyzed first before the possibility of decriminalizing all drugs can be considered.
I think it is premature and even dangerous to consider passing a bill that proposes repealing sections of the law that criminalize simple drug possession at this stage of the process, when no complete strategy has been implemented, which might well take years to happen.
This is an important point, colleagues, because the bill we are studying does not set any legislative framework to decriminalize drugs. As a result, any possession of any illicit drug for personal use will no longer be considered criminal, regardless of the nature of the substance and the quantity in possession.
It is important to keep in mind that the purpose of the bill is to prevent drug overdose deaths, which are largely attributable to a bad supply that is extremely dangerous.
People use illicit drugs without knowing what is in them or where they came from. Often the user is not aware that those drugs may contain all sorts of harmful or deadly substances, such as fentanyl-type opioids or fentanyl analogues. That is especially true of crack.
I would like to share with you a sad incident that occurred last Friday in Laval to demonstrate how dangerous Bill S-232 is and how it could give drug users and the population in general a false sense of security.
I am talking about the murder of 61-year-old Mireille Martin. I want to take this opportunity to express my deepest condolences to her family and friends. Mireille Martin led a quiet life in an apartment building near her nephew, Jérôme Frigault, an ordinary young man in his 30s. According to his best friend, Jérôme regularly took methamphetamine tablets, commonly known as speed. Late last Thursday, the Laval police went to Ms. Martin’s address after receiving a complaint about excessive noise coming from her apartment. They left without taking any action. Two hours later, Mireille stumbled out of her apartment bleeding and died on the sidewalk after being stabbed to death by her nephew, who was in a psychotic state.
She was yet another victim, another case of femicide. To date, 2023 has been a record year in Quebec for this type of criminal death. Was this murder preventable? Possibly, given that the police who arrived at the scene two hours prior to the tragedy would have likely noticed the murderer’s agitated state. Why did they not remove him from the building or take him to hospital until he calmed down? The investigation will undoubtedly shed light on this horrible tragedy, or at least I hope it will.
This is a compelling example of why I fear decriminalizing all drugs, especially the deadliest ones. This bill gives drug users and politicians alike a false sense of security. What is more, it throws the door wide open to drug dealers.
It is all the more disturbing to note that the more lethal the drug, the smaller the quantity consumed. Therefore, most of the time, it is difficult to prove that the quantity of drugs seized was for the purpose of trafficking.
I would like to give you another example of how young people interpret the decriminalization of dangerous drugs as normalization. According to today’s edition of La Presse, the number of Quebec teens using illegal vapes to consume cannabis has exploded over the past four years, tripling since 2019. According to doctors, vaping cannabis increases the risk of addiction and mental illness.
According to a 2023 survey of approximately 24,000 adolescents, 12% said they use cannabis, compared to 15% in 2019. However, 66% said they vape cannabis, compared to 20% in 2019. Teens acquire cannabis vapes on the black market because it is illegal to sell them to anyone in Quebec, even adults.
Some of these devices are rechargeable, while others, called wax pens, are disposable. Some schools report students fainting after using them. The fact is, the vape juice these young people are consuming can contain as much as 90% THC, compared to the 30% maximum in products sold by the Société québécoise du cannabis.
This desired decriminalization, regardless of its potentially deadly risks, will undoubtedly lead to the same outcome as the legalization of cannabis, a drug with an illegal market that still controls 50% of sales today. This means that 50% of consumers buy cannabis of uncontrolled quality and origin.
This highly touted decriminalization will have little impact on death tolls or lethal drug trafficking, because, for the past eight years, the federal government has failed to implement any kind of strategy to guide consumers to public health services for detox support, like Portugal did when it introduced a detox strategy prior to decriminalization. Portugal’s strategy was a success. To do otherwise and believe we could achieve the same result is totally irresponsible.
Bill S-232 takes a somewhat simplistic and especially dangerous view of Canada’s illegal drug market. We have a duty to do better. Most importantly, we have an obligation to avoid making the situation worse by putting more lives in danger.
Bill S-232 in no way addresses the issue of minors. I would remind my colleagues that the Controlled Drugs and Substances Act and the Criminal Code apply to anyone aged 12 or over, and that the Youth Criminal Justice Act does not contain a specific provision criminalizing drug possession. Without important clarifications, Bill S-232 will allow adolescents to possess any type of psychoactive substance in undefined quantities, without giving the police or judicial authorities any powers to prevent or dissuade teens from using them. This important aspect must not be overlooked, in order to avoid any unintended consequences to Senator Boniface’s desired objective.
Honourable senators, I will quote another passage from Bill S-232, but first I would like to point out that I’m opposed to the very principle of this bill.
In my opinion, the decriminalization of all drugs runs contrary to the balance that is needed between the problem of drug addiction and criminal justice objectives.
Now I’d like to talk about how the justice system has already adopted diversion measures for drug possession over the past 10 years.
Currently, our justice system is adapting more and more to the drug addiction issue. You will recall that Bill C-5, which we passed on November 17, 2022, provides diversion measures for simple drug possession in the Controlled Drugs and Substances Act.
Three new paragraphs that came into effect with the passage of Bill C-5 read as follows:
(c) criminal sanctions imposed in respect of the possession of drugs for personal use can increase the stigma associated with drug use and are not consistent with established public health evidence;
(d) interventions should address the root causes of problematic substance use, including by encouraging measures such as education, treatment, aftercare, rehabilitation and social reintegration; and
(e) judicial resources are more appropriately used in relation to offences that pose a risk to public safety.
I would also remind senators that the Criminal Code and the Controlled Drugs and Substances Act already contain provisions granting discretionary power to the justice system to delay sentencing so that a person who has been found guilty of an offence can participate in a drug treatment court program. If that program is successful, the offender may receive a reduced sentence. What is more, if the offence is punishable by a minimum term of imprisonment, the court is not required to impose that minimum prison sentence.
I would like to quote subsection 10(4) of the Controlled Drugs and Substances Act, which states the following:
(4) A court sentencing a person who is convicted of an offence under this Part may delay sentencing to enable the offender
(a) to participate in a drug treatment court program approved by the Attorney General; or
(b) to attend a treatment program under subsection 720(2) of the Criminal Code.
Finally, the Public Prosecution Service of Canada Deskbook already contains directives on how to deal with the opioid overdose issue. Here is one of them:
The Guideline seeks to avoid short durations of incarceration for violation of bail conditions by accused with a substance abuse disorder. This Guideline was created in order to address the epidemic of opioid overdoses through a targeted focus upon the risk of opioid-related overdoses by those with a substance use disorder.
The examples I have just cited demonstrate the pragmatism currently being shown by the Canadian justice system. The balance it has subtly attempted to strike over the years between the problem of drug addiction and the objectives of criminal justice shows a willingness to adapt to the addiction situations experienced by drug users. In my opinion, it is inappropriate to remove the important role played by the justice system and to treat the problem of drug addiction as a public health issue. In fact, this bill is almost a decade behind the Canadian justice system.
Honourable senators, possible exemptions under the current law already exist. These exemptions allow the Minister of Health to identify cases and conditions under which possession of narcotics for personal use can be acceptable in our society. These exemptions help ensure some degree of control, with an opportunity to set guidelines for drug possession, while recognizing specific needs and authorizing the tools and means to support harm reduction among certain populations, for example, by establishing safe injection sites.
These injection sites exist almost everywhere in major Canadian cities. People can show up to these sites and consume narcotics. These centres provide people with a safe place, with sterile consumption equipment, where health professionals are on hand to respond to emergency situations.
The exemption set out in section 56 of the Controlled Drugs and Substances Act allows the staff to possess small amounts of controlled drugs in the course of their professional activities. Analyses to test the composition of a drug can also be performed before clients of these centres consume their drugs, thus preventing accidental deaths due to the presence of undesirable substances. Some users can also obtain medical prescriptions for the consumption of controlled substances under medical supervision, under this exemption to the law.
That is the approach taken by British Columbia, which requested and obtained an exemption to be able to experiment with the decriminalization of drugs at the provincial level. That exemption is valid until January 31, 2026.
British Columbia is being hard hit by fatal opioid overdoses. Thanks to this exemption, in British Columbia, any adult can possess 2.5 grams of four types of illegal drugs: opioids, cocaine, methamphetamine, and MDMA. Moreover, this exemption does not apply in certain locations, such as elementary and secondary schools, child care facilities, airports and aboard Canadian Coast Guard ships and helicopters.
Honourable senators, given that exemptions already exist in the Controlled Drugs and Substances Act and that the justice system is adapting each and every year to the problem of addictions, I do not consider it either useful or responsible to remove the role the justice system plays in addressing this problem.
I agree with Senator Boniface that we need a national strategy that provides better social services and more support to users, who should also be offered medical treatment.
Decriminalization could never be the ultimate solution to the drug addiction problem for the reasons I have already outlined.
In my analysis, Bill S-232 in its current form is a far too simple a response to a very complex problematic situation.
Most importantly, it does not include plans for a real public health strategy to combat drug addiction. This bill risks creating even bigger problems if a comprehensive strategy is not developed before we think about decriminalizing drugs.
Decriminalization should only happen if it is truly a desirable solution, after comprehensive studies and analyses have been conducted. That is not yet the case.
Let’s hope we will have the opportunity to address these issues in committee soon. Thank you very much.
Would Senator Boisvenu take a question?
Would you take a question, Senator Boisvenu?
Absolutely.
Let me first say thank you very much for your speech and for your ongoing passion on issues within the criminal justice system.
What I would like to really speak about is the Canadian Association of Chiefs of Police, or CACP, report, particularly from the perspective that I think we actually think more similarly than we do differently. In the CACP report, which this bill is placed on, it said:
. . . It will be key in a Canadian context that treatment facilities are established and operational ahead of decriminalization and have the capacity to take in individuals diverted through police contact. . . .
So the point of the bill — and perhaps this will be the important aspect the committee looks at — is to make sure that strategy, what we have learned from the strategy and the systems are in place to better accommodate people who are running into issues with drugs.
If I heard your speech correctly — I want to make sure I’m clear — my sense is that you see the importance of having those systems in place before moving to decriminalization, which is what the bill is intended to do.
Yes, indeed.
Since marijuana was legalized in 2016, I have studied the decriminalization approach taken by many countries, beyond marijuana. Some U.S. states have also decriminalized or legalized certain drugs, but none of them went forward with legalization before establishing a national public health detox strategy.
Basically, what users are being offered in those states is first a health-based approach and then a legal approach. Here, however, we do the opposite. We say we will decriminalize drugs and then wait and see about adopting a public health policy later.
My problem is that I see a risk here. I do not believe that if this bill passes this fall or next spring, this government will implement a detox strategy in the next two or three years. I do not see how it could. I see that the government has taken no action on other major issues like spousal violence or sexual violence, even though both are major national issues. The way I see it, one plus one equals two.
May I ask a follow-up question?
Would you take a supplementary question, Senator Boisvenu?
Yes.
Would you agree with me, Senator Boisvenu, that that’s exactly the issue that a committee should look at in terms of this? I think we share the same view in terms of having this in place, and if the committee looked at it from that perspective, I think it would be beneficial. Would you agree?
Absolutely. You know that drug treatment programs are health care services that fall under provincial jurisdiction. This government has made the most cuts to health care transfers. Because of the way Canada’s immigration policy works, all of the provincial health care systems are overwhelmed. It seems to me as though we are giving the provinces a responsibility without knowing exactly what that responsibility is and what kind of funding there will be for it. That is why I am saying that we are putting the cart before the horse. Could we do the opposite?
