Question Period Note: Opioid Overdose Crisis

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• Our Government recognizes that the overdose crisis is one of the most serious and unprecedented public health threats in Canada’s history.
• Substance use is a public health issue, not an issue for the criminal justice system.
• The pandemic has highlighted the gaps that exist in our health system and social safety net.
• That is why we are exploring new ways to ensure that Canadians receive the life-saving substance use and health supports that they need, and that the health systems that underpin these important supports are robust.
• The Government of Canada remains committed to working with national partners on a whole-of-society approach to address the opioid overdose crisis.

IF PRESSED ON THE ALBERTA’S OVERDOSE DEATH NUMBERS
• The opioid overdose crisis affects each part of the country differently. While Alberta’s latest data points to recent improvements, it is important to acknowledge that that the number of deaths in Alberta remains above pre-COVID levels.
• Health Canada and the Public Health Agency of Canada is monitoring and analysing data to better assess the longer term trends. At the current time, changes to death and harms are not attributable to one specific factor.
• Scientific research and evidence show that a comprehensive evidence-based approach that includes harm reduction, treatment, prevention, and enforcement is most effective to address the overdose crisis.

IF PRESSED ON CHANGES TO ALBERTA’S MENTAL HEALTH SERVICES PROTECTION REGULATION
• Our Government is taking a wide range of actions, including prevention, treatment and harm reduction, to help people who use drugs get the supports they need.
• We support lower-barrier approaches that can help to save lives due to the significant risks posed by the highly toxic illegal drug supply in Canada, including enhancing access to safer supply.
• We are aware of the policy change in Alberta.
• We are committed to working with provinces, territories, and key stakeholders, to continue sharing the evidence on innovative practices that can save lives.

IF PRESSED ON FEDERAL ACTIONS TO ADDRESS THE OVERDOSE CRISIS
• The overdose crisis is a public health issue and increasing access to evidence-based treatment and life saving services is a key priority of the Government of Canada.
• Through the Substance Use and Addictions Program, we have committed nearly $350 million since 2017 to pilot and build the evidence-base for promising community-based interventions, such as providing medication as alternative to the toxic illegal drug supply.
• We provided $150 million to provinces and territories to improve access to evidence-based treatment services.
• Moving forward, we will continue to work with partners and stakeholders to address barriers to accessing services, the inconsistent quality of services, and limited front-line workforce capacity. These challenges make it more difficult for people in Canada to get the substance use services that they need.

On April 14, 2016, BC first declared a public health emergency due to the rise in opioid-related deaths. Since then, two other PTs have also declared emergencies: Alberta declared a public health crisis in May 2017 and the Yukon declared a substance use health emergency in January 2022.

Most recent national data indicates that 30,843 apparent opioid toxicity deaths occurred between January 2016 and March 2022. Toxicity of supply continues to be a major driver of the crisis with as many as 85% of accidental apparent opioid toxicity deaths in 2022 thus far (January to March) 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 59 years old.
The COVID-19 pandemic is compounding the ongoing overdose crisis, and people who use drugs are experiencing higher risks related to an increasingly toxic illegal drug supply and reduced access to treatment and harm reduction services. Several jurisdictions have observed unprecedented numbers and rates in relation to the wider impacts of the COVID-19 pandemic.
Although these increases have been observed across the country, Western Canada continues to be highly impacted. In 2021, the British Columbia Coroners Service reported 2,267 illegal drug toxicity deaths, a 28% increase from 2020 and a 130% increase over the number of deaths in 2019. There have been 1,468 deaths in the first eight months of 2022 in BC, a decrease of 1 over the same time period in 2021 (1,469 deaths)

Data released by Alberta in November 2022 indicated that in 2021 the province reported 1,824 deaths from all substances, the highest number per year since the province began tracking such deaths in 2016. Of these deaths, 1,614 were related to opioids. The highest opioid-related death count was in Edmonton (620) followed by Calgary (501).

Compared to November 2021 when Alberta peaked at 192 deaths from all illegal substances, there was 51% decrease in drug related deaths in the most recent data available for July 2022 (95 deaths). When looking at quarterly trends of drug related deaths, there has not been a significant variance until the last quarter (Q1 saw a decrease of 13%, Q2 saw a decrease of 26% when compared to the previous quarter). It is too early to say what the actual trends will be moving forward and it would be difficult to ascribe any change in rate as a result of a particular action. HC is working with PHAC to analyse the data and will provide an update in the future.

A dynamic and complex set of factors influence who is most at risk, including but not limited to: gender, age, being part of a racialized or Indigenous community, and having a history of criminalization, discrimination or trauma. So far in 2022 (January to March), males accounted for the majority (76%) of accidental apparent opioid toxicity deaths. Among both males and for females, the majority of accidental apparent opioid toxicity deaths were among individuals aged 20 to 59 years.

Among youth 0-19, between January 2016 and March 2022, the total number of opioid and stimulant-related poisoning hospitalizations among girls was consistently higher compared to their male counterparts. Between 2018 and 2021, girls aged 0-19 years experienced fewer accidental apparent opioid toxicity deaths compared to boys of the same age; however, preliminary data from 2022 (January to March) shows higher numbers of deaths among girls over boys in that age category (11 and 7 deaths, respectively).

Data points to people commonly dying of overdoses alone and mostly indoors. In Ontario, from March to December of 2020, 73% of fatal overdoses occurred where no one was present to intervene. In BC, in 2021, 83% of fatal overdoses occurred indoors, more specifically, 56% occurred in private residences.

Tragically, overdose deaths among First Nations people have also surged. First Nations people in BC died of an overdose at 5.4 times the rate of other BC residents in 2021. In Alberta, First Nations people died of an accidental opioid overdose at seven times the rate of other residents between January and June of 2020. In Saskatchewan, almost three times as many First Nations females died from accidental deaths involving opioids than Caucasian females did in 2021.

The impact of the crisis is not measured in deaths alone and, in particular, the healthcare system has also been impacted by marked increases in opioid-related poisoning hospitalizations and calls for emergency medical services (EMS) since the start of the pandemic. Compared to the two-year period before the pandemic (April 2018 – March 2020, 9,470 hospitalizations) there was a 24 percent increase in opioid-related poisoning hospitalizations during the first two years of the pandemic (April 2020 – March 2022, 11,760 hospitalizations).

COLLECTION OF NATIONAL OPIOID- AND STIMULANT-RELATED DATA
The Public Health Agency of Canada publishes quarterly data on opioid- and stimulant-related harms on behalf of the Special Advisory Committee (SAC) on the Epidemic of Opioid Overdoses. Data on opioid- and stimulant-related deaths is provided by Chief Coroners and Chief Medical Examiners. The time required to complete an investigation into the cause of death for someone suspected of an overdose can range from approximately three to 24 months.

PHAC also conducts modelling to understand potential trajectories of opioid-related deaths as the crisis evolves.

FEDERAL ACTIONS TO ADDRESS THE OVERDOSE CRISIS
To reflect the Government of Canada’s comprehensive approach to addressing the overdose crisis, targeted funding of $815M have been allocated across federal departments and agencies (including Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, Public Safety Canada, the Canada Border Services Agency, and Statistics Canada) to address key, interrelated priorities:
• Over $656M allocated or committed to increase access to evidence-based treatment and life-saving services, such as harm reduction;
• Over $43M allocated for awareness, prevention, and stigma reduction activities;
• Over $74M allocated for data, research, and surveillance initiatives;
• Over $42M allocated for collective law enforcement efforts to enhance safety and security.

To effectively deliver on the federal response to the overdose crisis, federal departments and agencies require salary and operational costs for staff, and other necessary resources. These are standard costs associated with delivering policies and programs in the federal government, and are thoroughly reviewed on an ongoing basis. For example, operational costs have been allocated to support, but are not limited to:
• Health Canada’s Drug Analysis Service (DAS), in which employees provide scientific and technical services to help Canadian law enforcement agencies in their activities involving illegal drugs, including helping police forces safely dismantle illegal drug laboratories;
• Border control agents disrupt the flow of illegal substance into Canada; and
• The Substance Use and Addictions Program (SUAP) analysts that receive and review applications to ensure funding is disbursed to communities for quality projects in a timely manner.

Of the $656M for increased access to evidence-based treatment and life-saving services, such as harm reduction, $157M is allocated for operational costs since 2017. Of the $43M for awareness, prevention, and stigma reduction activities, $18M is allocated for operational costs since 2017.

The Minister of Health established an Expert Task Force on Substance Use in March 2021 that provided expert advice on Canada’s federal drug policy, including examining potential alternatives to criminal penalties for personal drug possession. The Task Force provided its final advice on alternatives to criminal penalties in May 2021, and on federal drug policy in June 2021. Both reports of the Task Force have been made publicly available and can be found online at https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-task-force-substance-use/reports.html.

LITIGATION AGAINST OPIOID MANUFACTURERS CANADA
On October 17, 2022, the Province of British Columbia announced that it would be introducing amendments to its Opioid Damages and Health Care Costs Recovery Act that would allow the federal government to join a B.C.-led class-action lawsuit against opioid manufacturers and permit the expansion of the number of defendants.

Amendments to the B.C. legislation will enable the governments of British Columbia and Canada to pursue recovery from opioid manufacturers, wholesalers and other potential defendants in a class-action lawsuit that is in progress. The amendments will strengthen the act by ensuring directors and officers of corporate defendants may also be held accountable.

In 2018, B.C. commenced a class-action lawsuit against over 40 manufacturers and distributors of opioids on behalf of provincial and territorial governments in Canada and enacted the Opioid Damages and Health Care Costs Recovery Act to support the class action. The aim of the class action and legislation is for governments to recover costs for health care provided to patients that resulted from wrongful conduct of opioid manufacturers, distributors and their consultants. The class action is expected to be certified in 2023.

On June 29, 2022, Purdue Pharma Canada agreed to a proposed $150 million settlement with provinces and territories for the recovery of health care costs related to the sale and marketing of opioids.

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