The House resumed consideration of the motion that Bill C-37, An Act to amend the Controlled Drugs and Substances Act and to make related amendments to other Acts, be read the second time and referred to a committee.
Ms. Marjolaine Boutin-Sweet (Hochelaga, NDP):
Mr. Speaker, I will be sharing my time with the excellent member for Vancouver East.
I thank the House for allowing me to speak today on Bill C-37, an act to amend the Controlled Drugs and Substances Act and to make related amendments to other acts. Before I get into the substance of Bill C-37, I would like to remind the House of some of the events that occurred before it was introduced.
In 2011, the Supreme Court of Canada ruled that the federal government must grant Vancouver's safe injection site, Insite, and other such sites section 56 exemptions under the Controlled Drugs and Substances Act in order to uphold the fundamental right of all people to life and security. The Supreme Court added that safe injection sites will “decrease the risk of death and disease, and there is little or no evidence that [they] will have a negative impact on public safety”.
In response to this decision by Canada's highest court, the then Conservative government finally tabled Bill C-2 in 2015. With the thinly veiled intent of not allowing new supervised injection sites to open, the government put in place 26 conditions for obtaining a legal exemption, making it virtually impossible to open new centres.
As if that were not enough, the bill also gave discretionary power to the minister responsible to refuse to grant the legal exemption even if the 26 conditions were met. I always maintained that it would not be possible to obtain an exemption given the number of requirements already imposed by the law. However, this discretionary power proves that the Conservatives were not going to allow, under any circumstances, new centres to open.
I sat on the committee and heard witnesses, with supporting evidence, describe the benefits of injection sites, including harm reduction and public health, and tell us that public safety would not be jeopardized.
By refusing to consider clear and compelling evidence that supervised injection sites save the lives of many very vulnerable people, the Conservatives and their ideological approach only continued to marginalize and criminalize people suffering from addiction. This unfortunately also resulted in overdoses and deaths that could have been prevented.
A serious opioid crisis is plaguing the country, particularly the west coast, as my colleague, the member for Vancouver Kingsway, our health critic, has repeatedly stated here in the House.
In 2016, in British Columbia alone, opioid overdoses took the lives of 914 people, 80% more than in 2015. In April, the situation prompted B.C. public health authorities to declare a state of emergency for the first time in the province's history.
Although we do not have statistics for the number of overdose-related deaths in Canada, it is estimated to have been over 2,000 across the country in 2015. It is easy to imagine the death toll in 2016 being much higher because of the rapid spread of extremely powerful opioids across the country.
Overdoses and drug-related deaths are on the rise in every part of the country, and the crisis is expected to hit Ontario and Quebec this year. The opioid crisis in Canada is now officially out of control.
One of the main reasons the crisis is mounting is that fentanyl is cheap and easy to transport, and just a small amount can be used to make thousands of doses. Because this drug is so cheap, and because too few resources are invested in raising awareness and prevention, young and inexperienced users are overdosing. In many cases, they do not even know that there is fentanyl in the drug they are using.
In February 2016, when the crisis was emerging, the New Democratic Party called for the repeal of Bill C-2 to make it easier for organizations to get legal exemptions to open supervised consumption sites.
Last fall, the NDP got the Standing Committee on Health to study the opioid overdose crisis. In its report, the committee made 38 recommendations to the federal government.
We were also the first to request that a national public health emergency be declared in order to give the Chief Public Health Officer of Canada the authority to take extraordinary measures in order to coordinate a response to the opioid crisis, including the creation of injection sites on an emergency basis. Last December, after Bill C-37 was introduced, we also tried to have the bill fast-tracked in order to resolve the crisis as quickly as possible.
The Liberals say they support supervised injection sites, and yet their government has not approved a single new facility since coming to power. In fact, the Minister of Health initially argued that legislative changes to Bill C-2 were not even necessary, even though the real problem was with the bill itself, with its 26 separate requirements acting as effective barriers to any new sites, as had been pointed out by stakeholders and the NDP.
Faced with the growing crisis across the country and mounting pressure from stakeholders and the NDP, the Minister of Health finally gave in and, on December 12, 2016, introduced Bill C-37, which we are debating here today. Specifically, the bills seeks to simplify the process for applying for a legal exemption so that communities dealing with the opioid crisis can actually open supervised injection sites.
In the preamble, the bill states:
|| Whereas harm reduction is an important component of a comprehensive, compassionate and evidence-based drug policy that complements prevention, treatment and enforcement measures;
It is in the context of harm prevention that the City of Montreal and the public health authority officially submitted their application for legal exemption in May 2015 for three fixed services in three neighbourhoods and one mobile service. They are still awaiting. It is not surprising. Not a single supervised consumption site has opened in Canada since Bill C-2 was passed.
We are not the only ones calling for the government to move forward with implementing injection services. In summer 2015, the mayor of Montreal, Denis Coderre, who wanted to get moving on this by the fall, said the following to The Montreal Gazette.
“What are we waiting for? People are dying”.
One year later, in July 2016, Sterling Downey, municipal councillor and Project Montréal critic, asked the mayor a question:
“How do you go into the media and announce over a year ago that you're going to open these sites and back off and go radio silent?”
Then, concerned organizations also tired of waiting. Jean-François Mary, executive director of the Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues, had this to say to the Montreal Gazette.
|| The organizations that are supposed to host the sites don’t even dare set opening dates anymore. We’re stuck in a grey area where, every year for the last three years, we’re told they’ll be open in the spring. But it doesn’t happen.”
We need to move forward quickly. Many groups, such as Anonyme and Dopamine in Montreal, have been waiting for too long to establish services that have been proven to save lives.
In the meantime, in Montreal alone, 70 people on average die every year as a result of drug overdoses. As I have already said, the crisis in western Canada will be coming to Quebec this year. Even without this crisis, and if only for the sake of harm reduction and public health, the services provided by supervised injection sites are vital.
In Montreal, 68% of injection drug users have hepatitis C. Opening these centres could do much to decrease the incidence of disease related to the use of syringes. Speaking of syringes, Hochelaga, the riding I represent, is the second largest area in Montreal after the downtown area, which has the largest number of injection drug users. A supervised injection site could help get needles out of parks where our children play.
I will support this bill in the hope that it will come into effect quickly.
Ms. Jenny Kwan (Vancouver East, NDP):
Mr. Speaker, there is no doubt that the opioid crisis unfolding right now in our communities, big and small, right across Canada, is nothing short of a national emergency. The suffering and damage this crisis is causing, not just in Vancouver's Downtown Eastside, the epicentre of the crisis, but in Vancouver East and cities across British Columbia and Canada, is absolutely devastating.
I am very grateful for the Herculean efforts of first responders, front-line workers, medical practitioners, family members, advocates, and activists who have and are continuing to work tirelessly to save lives in the midst of this terrible crisis.
People are dying in our communities. Both the city of Vancouver's chief medical health officer, Dr. Patricia Daly, and the provincial health officer, Dr. Perry Kendall, have declared this crisis a medical health emergency. In fact, this is the first time in the history of British Columbia that a health emergency has been declared.
It was noted by Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, that the number of overdose deaths across Canada has vastly outpaced the toll during the 2003 SARS crisis that gripped this country and was declared an emergency by the Ontario government. He stated, “Forty-four people died of SARS. We lose 70 people a week to opioids in Canada”.
Still, the federal Minister of Health has refused to declare this a national health emergency.
From the beginning of 2016 to October 2016, 338 Albertans died from an apparent drug overdose related to opioids. Fentanyl was involved in 193 of them. Two Ontarians die from opioid overdoses a day. An average of 79 people die of drug overdoses every year in Montreal. If this is not a national health emergency, I do not know what is.
Today I am here once again urging the government to do what is right and what is necessary: declare a national public health emergency. Let us remember as we debate Bill C-37 that people in communities across the country are still dying.
Bill C-37 came on the heels of an announcement by the B.C. government, which was no longer willing to wait for federal approval and decided that it would take “the extraordinary measure” of signing a ministerial order making the provincial operation of temporary overdose prevention sites legal.
For those who want to put up roadblocks to harm reduction initiatives, including supervised injection facilities, I say this. It has been more than a decade since Insite, the first supervised injection facility in North America, was established. There has not been one single overdose death in that facility. Insite has saved countless lives. It has reduced the spread of diseases. The evidence is clear, and it is irrefutable.
Van East led the way, and I am so proud of the progressive forces and the movement in a community that cares so deeply that it took this issue and drove it until we had the first supervised injection facility in North America.
I still recall vividly the imagery of 1,000 crosses planted at Oppenheimer Park in our community, what we call the killing fields. Each one of those crosses bears a name, the name of a person who somebody loved in our community, a daughter, a son, an aunt, an uncle, somebody's child. I still recall how family and friends came together and mourned those preventable deaths. It was a call to action, and we drove the issue and eventually Insite was established.
It is sad to me that despite this irrefutable evidence-based outcome, there are still those who want to block this critical health measure.
The former government took every step possible to undermine the work of Insite. Even after the Supreme Court of Canada's 9-0 decision that ordered the government to exempt Insite from prosecution, stating clearly that the government cannot close Insite because of its ideology, the Harper government passed Bill C-2, the ill-named Respect for Communities Act, which introduced near insurmountable barriers to opening new supervised injection sites in Canada. The roadblocks have been widely condemned and no doubt have contributed to preventable deaths.
After more than a year of foot-dragging, thousands of overdoses, and hundreds of needless deaths, the Liberal government today is finally bringing in measures to address the ideological relic of the years past.
While I support Bill C-37, to be clear, I would much rather that the bill was about repealing Bill C-2. Nonetheless, this is a move in the right direction. It is a step forward, so I am here to support it.
Bill C-37 has to get through the House, then it has to be sent to committee, then has to go to the Senate. It will be some time before the bill passes. I want to applaud my colleague, the member for Vancouver Kingsway, the NDP's critic for health. His proposal to try to get the bill through all stages as quickly as possible, sadly was rejected.
Many concerned citizens and organizers are so frustrated by the glaring absence of substantive action on this that they have felt compelled to act unilaterally with pop-up supervised injection sites. Extraordinary times call for extraordinary measures. This is a testament to those individuals' courage and dedication to saving lives in our community.
Let me take a moment to thank them and acknowledge the numerous volunteers and activists; the leadership shown by Ann Livingston and her peers at VANDU; Sarah Blyth, the former Vancouver Park Board chair; and many others for their incredible dedication and caring. Were it not for their efforts, I can say with confidence that many more people would have died.
In going forward, as we wait for Bill C-37 to become law, what action can be taken to save lives? Let me start with a shout-out to all the tireless first responders for their incredible efforts.
I heard first-hand from firefighters about their experiences in this crisis, particularly from those men and women at Fire Hall No. 2, with the incredible overload of calls that came into that hall and the stresses firefighters had to face each and every day as they had to witness death. Imagine that as their work every single day.
It is not limited to Fire Hall No. 2 in my riding. In fact, all the other fire halls in my community across East Van have had an increase in calls with respect to overdose challenges and issues. I heard from firefighters who told me that during their shifts, sometimes they would have two, three, four, or more calls to go out and try to save lives. That is what they are faced with. Imagine the stress.
The BC Coalition of Nursing Associations hosted an emergency forum on the nursing response to the opioid crisis. Like so many, they are devastated by this medical health emergency, and they themselves are suffering from stress, trauma, and exhaustion. All first responders, nurses, health care workers at emergency rooms, and front-line workers with NGOs are overextended, and they deserve our support.
While the Minister of Health said that the Liberals would take action and provide support to first responders, we are still waiting. Let us get on with it.
I want to say that we need to do much more. We need to move to a longer-term resolution. Real effort needs to be made to provide addiction treatment. For some, traditional treatment works; for others, not so much. We need to move forward with providing treatment that deals with the addiction, including opioid prescriptions and opioid substitutes. The goal of stabilizing people and getting them away from the illegal market saves lives.
We also need to look at the issues around the social determinants of health. We need safe, secure, affordable housing. We need to address poverty. We need to look at the issue of breaking that cycle. We need to address aboriginal child apprehension.
We need a comprehensive approach so that we can move forward once and for all and save lives.
Mr. Randeep Sarai (Surrey Centre, Lib.):
Mr. Speaker, I am pleased to rise today to speak in support of Bill C-37, an act that would better equip both health and law enforcement officials to reduce the harms associated with problematic substance use in Canada.
One of the many important amendments proposed in the bill is to streamline the application process for communities seeking to establish supervised consumption sites. Supervised consumption sites are controlled hygienic settings where people can bring previously obtained drugs to use under the supervision of health care professionals and gain access to or information regarding other health and social services, including treatment. In other words, supervised consumption sites are a harm reduction measure and have been proven to be effective for communities where they are needed.
Our government, since the beginning of its mandate, has been very clear in its support for harm reduction measures. These measures have been proven to reduce the negative health and social impacts associated with problematic substance abuse.
Addiction is a complex issue. I also want to be clear with my fellow members in the House that addiction is a health issue and not a criminal one. Not every individual will respond positively to the same treatment and not every individual is even willing or able to enter treatment on any given day. Evidence demonstrates that individuals who are outside of treatment are at increased risk of major health and social harms, including overdose and death. This is why we must be pragmatic in our response and must let evidence guide us to effective solutions. Now, more than ever, as our country grapples with an ever-increasing opioid crisis, it is essential that evidence-based harm reduction measures be part of the government's comprehensive drug policy.
On December 12, the Minister of Health announced the new Canadian drugs and substances strategy, which restores harm reduction as a key pillar alongside prevention, treatment, and enforcement. Officially including harm reduction in Canada's new drug strategy was the first step. Putting that commitment into action to save lives is the next step.
The evidence available on the effectiveness of properly establishing and maintaining supervised consumption sites is indisputable. These sites save lives without having a negative impact on the surrounding community. Let me be clear. This commitment will save lives, including in my community.
Surrey and, more broadly, British Columbia face a health crisis. I take solace in how neighbourhoods, communities, cities, the province, and now the federal government have stepped up to respond. I often hear stories in my riding of how this drug has devastated lives and families, but for every one story I hear, I hear three more about how folks have stepped up and responded, whether it is local soup kitchens or the newly created Surrey RCMP Outreach Team, which, in the last two weeks, responded to over 55 overdoses. It is heartening to see how Canadians have come together to respond to this crisis, and this new drug strategy is the next step.
I should have mentioned earlier, Mr. Speaker, that I will be sharing my time with the member of Parliament for Victoria.
This legislation is widely viewed by public health experts as a barrier to establishing new supervised consumption sites in communities where they are wanted and needed to help prevent the spread of disease and countless overdose deaths. It is time for these barriers to be removed and I am proud that Bill C-37 proposes to do just that.
Bill C-37 would support the establishment of supervised consumption sites by assuring communities that their voices would be heard and that each application would be subject to a comprehensive review, while, at the same time, starting from a position that would recognize and acknowledge the compelling evidence that supervised consumption sites work.
In 2011, the Supreme Court of Canada considered this same evidence and concluded that where a "site will decrease the risk of death and disease, and there is little or no evidence that it will have a negative impact on public safety, the Minister should generally grant an exemption."
To guide the making of future decisions, the Supreme Court set out five factors that must be considered. These include: evidence, if any, on the impact of such a facility on crime rates; the local conditions indicating a need for such a site; the regulatory structure in place the support the facility; the resources available to support its maintenance; and expression of community support or opposition.
Bill C-37 respects the decision rendered by the highest court in Canada by proposing to replace the 26-point criteria currently in legislation with these five factors.
Reducing the number of criteria applicants would have to address would relieve the administrative burden on communities seeking to establish a supervised consumption site, but it would do so without compromising the health and safety of those operating the site, its clients, or the surrounding community.
To help applicants through the supervised consumption site application process, our government would post an application form and simplified guidance document online. The application would indicate the type of information that would support the five Supreme Court criteria and would reduce unnecessary burden on applicants.
With respect to other stakeholders, such as the municipal government and local police, their views would continue to be considered through the requirement for broad community consultation, thus removing the need to attain formal letters from these stakeholders.
The proposed amendments will also simply the information required to support an application. For example, applicants will no longer be required to submit evidence that supervised consumption sites are effective and have public health benefits. The evidence in this regard is clear. Instead, applicants will need to demonstrate the need for the site and the public health benefits of the proposed site for their local community.
Further, with respect to renewals, existing supervised consumption sites would not longer require application. Instead, a renewal would simply be requested by informing Health Canada of any changes to the information that was submitted as part of a site's last application. This proposal will ensure that the existing sites can focus on serving the needs of their community rather than filling out onerous application forms.
Beyond the criteria, the Respect for Communities Act also includes specific principles that the minister must consider when evaluating an application.
Bill C-37 proposes to remove these principles so that decisions on applications can be based on evidence. It will also increase transparency around the decision made on applications for supervised consumption sites.
If passed, the bill will require decisions on applications to be made public including, if applicable, the reasons for refusing an application.
Our government is committed to making objective, transparent, and evidence-based decisions on any future application to establish supervised consumption sites, and we are committed to making those decisions within a reasonable time frame.
I can assure the House that the review process would continue to be comprehensive, but it would no longer present unnecessary barriers.
These proposed changes will introduce flexibility into the application process so it can be adapted and updated over time to reflect new science and allow communities to respond more quickly to emerging health issues.
I hope all members of the House will support this important legislation so we can better support communities in their effort to address this serious public health issue.
Mr. Murray Rankin (Victoria, NDP):
Mr. Speaker, let me begin by saying a few words about how this affects the people of Victoria who sent me here to speak on their behalf. Where I come from this is not an academic debate; it is a crisis across our community.
In the first 11 months of last year, my community lost 60 people to overdoses. I personally know families who have lost loved ones. None of us remain unaffected. We have been robbed of far too many people who might still be our friends, our neighbours, and coworkers today if we had the services to prevent overdoses and provide the treatment that is so desperately needed in our community. Still, people in Victoria and across British Columbia have taken what action they can in the absence of leadership from their federal government.
Last April, British Columbia declared the first public health emergency in our history. In December, the provincial health minister authorized temporary overdose prevention sites. There are now three such sites in my city of Victoria.
On January 4, thanks to the hard work of so many in our community, the Vancouver Island Health Authority submitted an application for the first full service safe consumption site in Victoria, and there will be more. That application is now before the Minister of Health, and I hope that she will do everything in her power as I will do everything in mine to see that this life-saving community initiative is approved without further delay.
The hard work of those who are fighting to save lives on the streets of Victoria has not been in vain. Because of their efforts, we have three small overdose prevention sites in place. In its first month, one such site reported an overdose nearly every day. But because the right services were available, not a single life was lost. That is the difference these services make in the real world. That is why we called for this legislation a year ago. That is why we will not allow it to be delayed any further.
To understand the scale and urgency of this crisis, we need to look beyond our own communities. My home province, British Columbia, lost 914 citizens to illicit drug overdoses just last year. That is not only the deadliest year on record for us, it is on par with the highest overdose rates among the American states. Last year, Ontario lost two citizens a day. That many lives are now lost each and every day in the city of Vancouver alone.
Some 2,000 Canadians died of this in 2015. We know that many more died in 2016 as powerful opioids like fentanyl spread across the country. I know it can be hard to give meaning to numbers like that unless we know some of the victims by name.
Consider what my colleague from Vancouver Kingsway, our NDP health critic, reminded us of yesterday. In 2003, we lost 44 Canadians during the SARS crisis. During the opioid crisis, we are now losing that many fellow citizens every week. If 40 or 50 Canadians were dying of an infectious disease every week, this House surely would not stand idly by. So let me address something head-on.
There are some in this place who think there is nothing we can do to stop the crisis, who think that addiction represents a moral failure, that it has always existed on the margins of society, and all that has changed is that the drugs just get stronger.
For too long, that outdated view guided government policy, and refused to bend to evidence from doctors, courts, and front-line workers. So let us be clear. What we are facing today is unlike anything Canada has ever experienced before.
This is not just about Downtown Eastside Vancouver. It is about suburban kids experimenting with recreational drugs that turn out to be laced with opiates 100 times stronger than heroin, and then they die. It is about athletes and office workers becoming dependent on prescription painkillers, folks who have never struggled before with addiction, but now have nowhere to turn but the street.
It is about firefighters and paramedics who have to wear masks to stop inhaling drugs so powerful that a dose no bigger than a grain of salt can be deadly. Opioid use disorder is a disease and it should be treated as such. One of those firefighters is Chris Coleman. He came from Vancouver to testify before the House health committee. He said this:
|| It takes a toll...to work extremely hard but to feel that you are having little or no impact on a problem that is growing exponentially, like a tidal wave, on the streets of your city.
||...our brothers and sisters who work in the Downtown Eastside are in trouble. They feel abandoned and they feel hopeless.
It has taken the government far too long to act, but now we have a bill before us that can begin to help. By passing this bill we can lift the barriers, some of them at least, that prevent communities from establishing life-saving safe consumption sites. We can send a signal to provinces, like British Columbia, that the federal government will step up and do its part. We can show people like Chris Coleman, and the thousands of firefighters and paramedics, police officers, and front-line workers like him, that they are not abandoned, that their work does matter, that we do care, and that their community has their back.
We have to be realistic. This bill alone will not solve the opioid crisis. We are here because government after government has failed to invest in detox, treatment, education, and prevention. The government has failed to put in place that foundation of services that would save lives and connect drug users to the support they need to stabilize and begin the long journey out of addiction.
Hundreds of Canadians are now dying in the gaps that governments have let grow year after year. For more than a year, we have been calling for a bill to repeal the Conservatives' Bill C-2 and lift the barriers that the previous government erected to make it harder for communities to open life-saving safe consumption sites. When I spoke to that bill, I called it the “24 ways to say 'no' act”.
It has taken far too long to get here. I regret that the government took so long to come around to our point of view and accept that legislative action repealing Bill C-2, or replacing it, was necessary. Thankfully, here we are.
Bill C-37 would save lives. We must pass it as soon as possible. For that reason, the NDP moved in December to fast-track the bill right to the Senate. It was blocked. I want to make sure that does not happen again and that we get this done.
I will continue to urge the minister to declare a public health emergency and allow emergency overdose prevention sites to operate legally across the country. I will continue to call on the government to use the powers it already has and expedite applications from cities like Montreal, Victoria, and Toronto, that have been gathering dust as Health Canada sits around and looks at them for months at a time. I will continue to ask why the government continues to ignore the recommendations from major cities, medical authorities, and even Parliament's own health committee, on other steps to turn the tide on this crisis.
In conclusion, passing this bill is not sufficient, but it is necessary. Therefore, on behalf of a Canadian community at ground zero in this crisis, I urge all members to support this life-saving bill and pass it now before more Canadians are lost to this preventable crisis.