OVERDOSE CRISIS

About

Reference number:
HC-2021-QP-00032
Date received:
2021-06-18
Organization:
Health Canada
Name of Minister:
Hajdu, Patty (Hon.)
Title of Minister:
Minister of Health

Issue/Question:

• How is the Government addressing the overdose crisis in Canada?

Suggested Response:

KEY MESSAGES:
• The Government of Canada recognizes that the overdose crisis is one of the most serious and unprecedented public health threats in Canada’s recent history.
• Tragically, the COVID-19 pandemic has exacerbated long-standing challenges regarding substance use and the overdose crisis, with most jurisdictions reporting record high rates of overdose deaths and harms.
• Our government has taken urgent action to address the overdose crisis using a public health-focused approach, guided by our federal drug strategy – the Canadian Drugs and Substances Strategy. We continue to support efforts to improve access to treatment services; increase access to harm reduction services; strengthen enforcement to help reduce the toxic illegal drug supply; increase awareness and prevention efforts; and, build the evidence base through investments in research and surveillance.
• We remain committed to working closely with our provincial, territorial, and municipal partners, frontline service providers and people with lived and living experience to advance solutions to save lives and help reverse this national public health crisis while recognizing that problematic substance use must be treated as a health condition.

IF PRESSED ON ADDITIONAL COVID-19-SPECIFIC MEASURES…
• The Government of Canada has taken swift action to address the unique challenges posed by the COVID-19 pandemic.
• We have taken urgent action to enable the health system to better meet the needs of people struggling with problematic substance use and avert the harms associated with the increasingly toxic supply of street drugs and challenges associated with accessing treatment and harm reduction services.
• For example, we removed regulatory barriers to make it easier for people with substance use disorder to access the medications they need and have also made it easier for overdose prevention sites to be established rapidly in temporary community shelters and other locations.
• We have also provided $500 million under the Safe Restart Agreements with Provinces and Territories to address immediate needs and gaps in the support and protection of people experiencing challenges related to mental health, substance use, or homelessness.
• Recently, we announced $20 million in funding for the distribution of naloxone kits and opioid overdose response training to support communities across Canada that have been particularly affected by the opioid overdose crisis.

IF PRESSED ON TREATMENT…
• Our government recognizes that improved access to treatment services can help those struggling with substance use.
• That is why we have approved the use of new medications to treat opioid use disorder and facilitated their prescribing and dispensing through regulatory amendments; supported the development of clinical guidelines for injectable opioid agonist treatment; and encouraged the provinces and territories to increase their uptake of these evidence-based treatments.
• In addition, the Government of Canada has also provided $150 million in Budget 2018 through the Emergency Treatment Fund for provinces and territories to improve access to evidence-based treatment services.

IF PRESSED ON HARM REDUCTION…
• The evidence is clear, harm reduction measures help reduce harms and save lives.
• That is why we have funded innovative pilot projects for safer supply models as an alternative to the toxic illegal drug supply; have passed the Good Samaritan Drug Overdose Act to provide some legal protection for people who seek emergency help during an overdose; have exemptions in place for 37 operating supervised consumption sites; and have increased access to naloxone, including to remote communities and isolated First Nations and Inuit communities and to the sector serving individuals who are experiencing homelessness.

IF PRESSED ON AWARENESS AND PREVENTION…
• Our government recognizes the importance of investing in prevention efforts, including awareness building.
• That is why we have invested in prevention campaigns to engage youth and young adults on the facts of substance use, expanded public awareness around opioids and the harms of stigma via public health campaigns; supported school-based approaches that enhance student well-being to prevent problematic substance use amongst youth; and supported the development of opioid-prescribing guidelines and treatment guidelines.

IF PRESSED ON SAFER SUPPLY…
• Our government is aware that the pandemic has led to a more uncertain and dangerous illegal drug supply, resulting in tragic increases in overdose-related deaths across the country.
• For this reason, we have taken a number of actions to reduce barriers to providing people who use drugs with safer, pharmaceutical-grade alternatives to the toxic illegal drug supply.
• For example, we have allowed pharmacists and practitioners to extend, renew and transfer prescriptions to make made it easier for people to access the medications they need during the pandemic.
• In addition, the Government of Canada is providing funding to support safer supply projects in British Columbia, Ontario, Quebec, New Brunswick and Nova Scotia. The evaluation of these innovative projects will continue to build the evidence base and support the scaling up of effective models.

IF PRESSED ON SUPERVISED CONSUMPTION SITES…
• International and Canadian evidence shows that supervised consumption sites reduce harms and save lives.
• These sites reduce risk of overdose death and of transmission of infection. In addition, they provide access to other health and social services for people who use drugs, including opportunities to access treatment.
• We will continue to work with provinces and territories, service providers, people with lived and living experience, and other stakeholders to take appropriate measures to maintain and expand access to supervised consumption services in communities that need them.

IF PRESSED ON ENFORCEMENT/TOXIC DRUG SUPPLY…
• Our government recognizes that the toxic illegal drug supply is the leading cause of opioid overdose harms and deaths, and that substance use requires a public health-centered approach.
• We continue to work closely with domestic and international partners to reduce the illegal fentanyl supply; equip border agents with tools to intercept fentanyl; and, work with private sector partners to address money laundering of the proceeds of fentanyl trafficking.

IF PRESSED ON RESEARCH AND SURVEILLANCE…
• Our government recognizes that in order to have an effective response to the ever-changing crisis, a strong understanding and evidence-base is required to make informed and timely decisions.
• That is why, we have collected and published data on opioid-related deaths and harms; used modelling to show how the opioid overdose crisis may change as a result of the COVID-19 pandemic; conducted rapid knowledge synthesis; and, developed a range of guidance documents to support evidence-based interventions.

IF PRESSED ON DECRIMINALIZATION…
• Our Government recognizes that substance use is first and foremost a health issue.
• We have lost too many Canadians to drug overdoses, and an increasing number of stakeholders are saying criminalizing personal drug possession is hurting, not helping.
• We are looking at ways to divert people who use drugs away from the criminal justice system and towards health and social supports, such as supervised consumption sites and drug treatment services.

• The Public Prosecution Service of Canada has issued a directive to only pursue charges for possession of illegal drugs in the most serious cases. In addition, this Government has announced amendments to federal drug laws in Bill C-22 that would further support actions to treat simple drug possession more as a health issue, rather than as a criminal one.
• We will continue to work with other levels of government and stakeholders to help save lives and better support the needs of people who use drugs during this crisis.
IF PRESSED ON THE SECTION 56 EXEMPTION REQUEST FROM THE CITY OF VANCOUVER AND BRITISH COLUMBIA THAT WOULD DECRIMINALIZE THE PERSONAL POSSESSION OF DRUGS…
• Health Canada is working with the Province of British Columbia and the City of Vancouver. We will continue our work to get Canadians who use substances the support they need.
• Health Canada is committed to carefully reviewing any request for an exemption under the Controlled Drugs and Substance Act on a case-by-case basis, including evidence of potential benefits and risks to the health and safety of Canadians.

IF PRESSED ON THE DEPARTMENT OF JUSTICE’S PROPOSED AMENDMENTS TO THE CRIMINAL CODE AND THE CONTROLLED DRUGS AND SUBSTANCES ACT (BILL C-222, INTRODUCED FEBRUARY 18, 2021)…
• This Bill represents a step forward in treating substance use as a health issue and addressing systemic issues in the criminal justice system that disproportionately affect Indigenous peoples and Black Canadians.
• The Bill would require police and prosecutors to consider alternative measures - including diverting individuals to addiction treatment programs, giving a warning or taking no further action - instead of laying charges or prosecuting individuals for simple possession of an illegal drug.
• We understand that many stakeholders are continuing to call for full drug decriminalization.
• We remain committed to saving lives and better supporting the needs of people who use drugs during the overdose crisis.

IF PRESSED ON PAIN…
• Our government recognizes the close links between people who live with pain, substance use and the overdose crisis.
• That is why we created the Canadian Pain Task Force to better understand these links and to identify potential actions to better prevent and manage chronic pain in Canada.
• In early May, the Canadian Pain Task Force published their final report which includes recommendations on key areas to ensure people with pain are recognized and supported, and that pain is understood, prevented and effectively treated across Canada.
• We will continue to work with our partners to explore implementing the recommendations and potential next steps.
We have also invested over $175M in pain-related research through the Canadian Institutes for Health Research and close to $19M in funding for 12 initiatives focused on improving opioid prescribing practices and pain management through the Substance Use and Addictions Program (SUAP).

Background:

BACKGROUND
Most recent national data indicates that 19,355 apparent opioid toxicity deaths occurred between January 2016 and September 2020. Fentanyl and its analogues continue to be major drivers of the crisis with as many as 82% of accidental apparent opioid toxicity deaths in 2020 (January to September) involving fentanyl. While Canadians of all walks of life are affected, there are striking patterns, with death most common among males and individuals aged 20 to 49 years old.
The COVID-19 pandemic is compounding the ongoing overdose crisis, and people who use drugs are experiencing increased risks related to an increasingly toxic illegal drug supply and reduced access to treatment and harm reduction services. Available information indicate at least five provinces and territories have observed record-breaking numbers of deaths in April to September 2020.
Although these increases have been observed across the country, Western Canada continues to be the most impacted region of the country. In 2020, the British Columbia Coroners Service reported 1,724 illegal drug toxicity deaths, a 75% increase over the number of deaths in 2019. Additionally, the crisis in BC continues into 2021 with 680 illicit toxicity deaths recorded in the first four months, a 73% increase from the same period in 2020. This is the largest number of suspected deaths ever recorded in the month of April (176 deaths). Tragically, overdose deaths among First Nations people in BC have also surged, almost doubling between January and May 2020 compared to the same period in 2019. In 2020, Alberta also experienced a 61% increase in opioid overdose deaths among First Nations people, as compared to the same time period in 2019.
Other jurisdictions across the country are reporting similar trends. Ten provinces and territories (ON, AB, SK, MB, QC, NB, PEI, NL, YK, and NWT) are also reporting increases in toxicity of the illegal drug supply, overdose deaths and/or emergency department or medical service (EMS) calls.

FEDERAL ACTIONS TO ADDRESS THE OPIOID OVERDOSE CRISIS
Since 2017, the federal government has taken significant actions and made investments of nearly $700M to address the opioid overdose crisis and problematic substance use. Additional actions to date include: improved access to treatment and harm reduction, reduced regulatory barriers to treatment; strengthened law enforcement, developed of educational products and tools for the public and health care providers, and research and surveillance to build the evidence base.
This includes Budget 2019 investments of $106.7M over five years with $1M ongoing and $66M announced in the Fall Economic Statement (December 2020) to help support community-based organizations responding to substance use issues address the additional challenges posted by the COVID-19 pandemic. In March 2021, the government announced $20 million in funding for the distribution of naloxone kits and opioid overdose response training to support communities that have been particularly affected by the opioid overdose crisis and are experiencing challenges in improving health outcomes of their residents.
In addition to these investments, the Government of Canada has also taken action to make it easier for people being treated for substance use disorder to access medications and for frontline service providers to establish overdose prevention sites in temporary shelters.

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