Question Period Note: OPIOID OVERDOSE CRISIS

The opioid overdose crisis continues to be a serious and unrelenting public health threat whose effects are being felt by people, families, and communities across Canada. In recent years, Canada has experienced an unprecedented increase in opioid-related overdoses. Between January 2016 and March 2019, there were 12,813 apparent opioid-related deaths across the country. Life expectancy in Canada has stopped increasing for the first time in over four decades; this is largely attributable to the opioid crisis.

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

• The opioid overdose crisis continues to be one of the most serious and unprecedented public health threats in Canada’s recent history.

• Tragically, between January 2016 and March 2019, 12,813 people across the country lost their lives to apparent opioid-related overdoses. This crisis has devastated families, and communities across Canada.

• Our Government has responded with significant action. We have invested nearly $600M since 2017 to support improved access to treatment and life-saving services; education and awareness among the public and health care providers; research and surveillance to build the evidence base for further action, and have strengthened law enforcement efforts.

• We remain deeply concerned about the opioid overdose crisis in Canada and are committed to a collaborative, compassionate, comprehensive, and evidence-based response. We will continue to work with stakeholders and partners, including provinces and territories, to bring forward solutions to save lives and help reverse this national public health crisis.

IF PRESSED ON INVESTMENTS AND ACTIONS TO DATE

• The investment of nearly $600 million committed by our Government in response to the opioid crisis has focused efforts on prevention, treatment, enforcement and harm reduction. This includes $150 million provided directly to provinces and territories through the Emergency Treatment Fund.

• As part of Budget 2019 and additional funding commitments, our Government committed to investing $106.7M to scale up key life-saving measures, help circumvent the toxic illegal drug supply, and identify and address emerging drug threats.

• Our Government has also made legislative and regulatory changes to encourage people to contact emergency services in the event of an overdose, reduce regulatory barriers to harm reduction services, and make certain medications to treat severe opioid use disorder more accessible.

• However, we know that more needs to be done. We are committed to expand access to drug treatment and address opioid and methamphetamine use disorder, including expanding community-based services, scaling up effective programs, building more in-patient rehab beds, and making drug treatment courts more available.

IF PRESSED ON SUPERVISED CONSUMPTION SITES

• Evidence clearly shows that supervised consumption services are effective harm reduction measures that help reduce harms and save lives.

• In December 2016, Canada had two operating supervised consumption sites. Since December 2016, the number of operating supervised consumption sites across the country has increased to 41.

• These sites reduce the risk of overdose death and transmission of infections. In addition, they provide access to other health and social services for people who use drugs, including opportunities to pursue treatment.

• Since June 2017, these sites have received over 859,000 visits, more than 26,500 referrals to health and social services have been made, and more than 7,800 reported overdoses have been reversed without a single death.

• Given the seriousness of the current opioid crisis, we will continue to take appropriate measures to maintain and expand access to supervised consumption services as part of a public health response to the crisis.

IF PRESSED ON TREATMENT FOR PROBLEMATIC SUBSTANCE USE

• The evidence is clear that problematic substance use is a health condition that can be managed and treated.

• Our Government has taken significant steps to improve access to substance use treatment services across the country, including increasing access to medications that can be used to treat severe opioid use disorder, making regulatory changes to reduce barriers to treatment, increasing treatment in federal correctional facilities, and enhancing the delivery of culturally appropriate substance use treatment services in First Nations and Inuit communities.

• Notably, we have invested in an Emergency Treatment Fund, which provided one-time, matched emergency funding totalling $308 million for provinces and territories to improve access to evidence-based treatment services. Provinces and territories are required to report on progress to date, and we are awaiting feedback on how PTs are delivering on their commitments.

• We are committed to continuing to work closely with provinces and territories as well as other partners and stakeholders to address persistent gaps in substance use treatment services across the country.

IF PRESSED ON PHARMACEUTICAL ALTERNATIVES TO THE ILLEGAL DRUG SUPPLY (“SAFER SUPPLY”)

• The evidence shows that the risk of harm from the use of illegal drugs, particularly those containing opioids, continues to increase. Highly potent synthetic opioids, such as fentanyl and carfentanil have permeated the illegal drug supply, and are fuelling the unprecedented rate of overdoses and deaths.

• Many stakeholders and public health experts have been calling for a secure and predictable supply of pharmaceutical-grade drugs as an alternative to the toxic illegal drug supply, also referred to as “safer supply”.

• Our Government has taken steps towards this objective, including reducing regulatory barriers, funding the development of guidelines for injectable opioid agonist treatment, and supporting safer supply pilot projects.

• Our Government will build on these efforts to expand access to a safer supply of prescription-based opioids by supporting pilot projects and consolidating and sharing best practices. Doing so can help provide pathways to care and treatment.

IF PRESSED ON ADDRESSING CHRONIC PAIN

• Chronic pain is a serious health issue impacting one in five Canadians as well as their families and caregivers.

• Our Government recognizes the challenges that Canadians living with pain are facing accessing the health services they need to manage their pain.

• Since 2013, we have invested close to $100 million in pain-related research through the Canadian Institutes of Health Research. This includes $12.5 million for the national Chronic Pain Research Network from 2016 to 2021.

• In addition to these investments, we established the Canadian Pain Task Force to help us better understand and address the needs of people living with pain. We look forward to their June 2020 report which will outline best practices and elements of an improved approach to pain.

• We will continue to take steps to improve health outcomes for Canadians living with pain.

IF PRESSED - DECRIMINALIZATION

• The Government of Canada is not considering the decriminalization or legalization of illegal drugs. We are committed to addressing the opioid crisis, and problematic substance use, from a public health perspective.

IF PRESSED ON ADDRESSING STIGMA

• Data suggests that the majority of opioid overdose deaths are occurring when people are alone, often in private residences. A big contributor to this social isolation is the stigma associated with problematic substance use.

• Stigma prevents people who use drugs from receiving supportive health and social services that can help improve wellbeing. This is why stigma has been a big priority for this government.

• Through our national anti-stigma campaign, and outreach with health care professionals and youth, we hope to create a society where people who use drugs can access services without fear of discrimination and prejudice.

On September 25, 2019, jointly with the provinces and territories, the Government of Canada released updated data indicating that 12,813 Canadians lost their lives between January 2016 and March 2019 to apparent opioid-related overdoses. Life expectancy in Canada has stopped increasing, a first in over four decades; this is largely attributable to the opioid crisis.

This most recent national data indicated that, from January to March 2019, 82% of accidental apparent opioid-related deaths involved fentanyl or fentanyl analogues, compared to 54% in 2016. The presence of fentanyl and its analogues in the illegal drug supply is therefore the main driver of recent overdose deaths.

Fentanyl is now so pervasive in the illegal drug market that a large number of Canadians who use drugs are at risk of a potentially fatal overdose. While Canadians of all walks of life are affected, there are striking patterns, with 85% of deaths occurring in BC, Alberta, and Ontario, mostly among young-middle aged men.

FEDERAL ACTIONS TO ADDRESS THE OPIOID CRISIS
The federal government has taken significant actions and made investments of nearly $600M since 2017 to address the opioid overdose crisis and problematic substance use more generally. Action has been taken across the four pillars of the Canadian Drugs and Substances Strategy: Prevention, Harm Reduction, Treatment and Enforcement, underpinned by Data and Evidence. Actions to date include:
• Improved access to treatment and harm reduction, including: $150M Emergency Treatment Fund, reduced regulatory barriers to treatment, more than 40 new supervised consumption sites, and wider availability of naloxone;
• Strengthened law enforcement, including: more than 42kg of fentanyl seized, 6 new detector dog service teams, and more than $37M investment in education and enforcement efforts;
• Developed educational products and tools for the public and health care providers, including: opioid awareness campaign video that has been viewed more than 2.5M times, mandatory opioid warning stickers and patient handouts, new opioid prescribing guidelines, and new restrictions on opioid marketing; and,
• Conducted research and surveillance to build the evidence base, include 15 research grants provided to CIHR, 8 public national reports on opioid-related harms and deaths, 11 Public Health Officers provided to PTs for surveillance efforts, and a new drug checking technology challenge.

Most recently, Budget 2019 and additional funding commitments announced investments of $106.7M over five years with $1M ongoing to: scale up key lifesaving measures ($39.0M), circumvent the toxic illegal drug supply ($35.0M + $1M ongoing), and identify and address emerging drug threats, including methamphetamine ($32.7M).

CHRONIC PAIN AND THE OPIOID CRISIS

Chronic pain impacts one in five Canadians. People with chronic pain comprise a significant proportion of people who use drugs (estimates range from 31% to 60%) and those dying of illicit drug/opioid overdose deaths in Canada (19% to 44% dependent on jurisdiction). Unmanaged pain complicates treatment of substance use disorders and vice versa placing Canadians with these concurrent illnesses at risk of negative health outcomes. There is growing consensus of the need to improve health system capacity to address pain and the complexities of concurrent pain, mental health and substance use disorders, particularly in jurisdictions hardest hit by the overdose crisis.

The Government of Canada has heard from stakeholders about the importance of greater national coordination and leadership on pain, and the desire for more robust Government actions to support and improve the quality of life of people who live with chronic pain. To help address these concerns, Health Canada established the Canadian Pain Task Force (3 year mandate) to provide advice regarding best practices and an improved approach to prevent and manage pain in Canada. The Task Force’s first report was published in July 2019. It highlighted weaknesses in our health system to effectively manage pain. It also highlighted innovative clinical models, proven educational approaches, novel support programs, and world-renowned research that exist in pockets across the country. The Task Force’s next report is due in June 2020.

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