The committee met at 9:04 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, I'd like to welcome you to our virtual meeting today. My name is Niki Sharma. I'm the Chair of this committee and the MLA for Vancouver-Hastings. I'm on the traditional territory of the Coast Salish people, the Musqueam, Squamish and Tsleil-Waututh.

I'd like to invite everybody to honour which territory they're on, Zooming in from, today. We have a panel here. I want to make sure you know whom you're speaking to before we get started. I'll just go across my screen, and everybody can introduce themselves.

M. Starchuk: I'm Mike Starchuk, MLA for Surrey-Cloverdale.

[9:05 a.m.]

P. Alexis: Pam Alexis, MLA for Abbotsford Mission, which is in the Fraser Valley.

S. Furstenau: I'm Sonia Furstenau, MLA for Cowichan Valley and the territories of Coast Salish people, the Cowichan Tribes and Malahat Nation.

R. Leonard: Good day. We'll get

Abbotsford-Mission, which is in the Fraser Valley.

S. Furstenau: Hi, Sonia Furstenau, MLA for Cowichan Valley and territories of Coast Salish people, the Cowichan Tribes and Malahat Nation.

R. Leonard: Good day. We'll get over the time changes here. I'm Ronna-Rae Leonard. I am the MLA for Courtenay-Comox, which is on Vancouver Island. I'm in the territory of the K'ómoks First Nation.

S. Chant: Good morning. I'm an MLA, and I'm just going to take a dive here. MLA means Member of the Legislative Assembly for those of us that are on the other side of the line and may or may not be familiar with it. I don't know.

Anyway, good morning. My name is Susie Chant. I'm the MLA from North Vancouver–Seymour.

N. Sharma (Chair): I think you know Artour.

Then we'll go to Doug. Go ahead.

D. Routley: Hello, my name is Doug Routley. I'm from Nanaimo–North Cowichan.

N. Sharma (Chair): Wonderful. We have a couple of people that might be joining us virtually afterwards. I'll pass it over to both of you. You have about 30 minutes to present, and then we'll leave about an hour for questions and answers.

Briefings on
Drug Toxicity and Overdoses

PLANET YOUTH LANARK SOCIETY

D. Somppi: Okay, well maybe I'll just make a couple of introductory remarks. My name is David Somppi. I'm speaking to you from Carleton Place, which is in Lanark County, about 45 minutes west of Parliament Hill — so west of Ottawa, if that helps. I'm speaking to you from the unceded territory of the Algonquin Nation.

It's a pleasure and an honour, actually, to be speaking to you. Your committee is working on what is obviously a very, very important and wicked problem. So we welcome the opportunity to share our learnings with you. I've asked Páll to provide the first 15 minutes of the presentation, which will give you, from the expert, sort of the background and the core of the science and also the practice of what's happening around the world with the Icelandic prevention model.

Then between myself and Dr. Paula Stewart, who is our local medical officer of health, we'll spend some time talking to you about what we're doing in Lanark County, which is the first community in Canada to adopt this model.

So Páll, why don't we just go right straight to you?

P. Rikharðsson: Thank you, David.

I understand I can't share my slides, but you all have my slides in front of you? All right.

I just want to start with a few introductory comments about myself. I'm the chief executive officer of the Planet Youth organization. I've lived most of my life in Denmark. I'm actually Icelandic. I'm speaking to you from Reykjavik in Iceland, in what passes for summer in these parts. I got a PhD from Aarhus. I've been mostly within the corporate consulting sphere. I've been in PricewaterhouseCoopers and the SAS Institute in Denmark, Copenhagen Business School, and now at Planet Youth.

I want to start this by just presenting shortly what results the Icelandic prevention model has generated and then explain a little bit, what it is, and then, finally, tell you a little bit about what the Planet Youth guidance program is, because these two are not necessarily the same things. If you can see on slide 3, that picture is actually from the downtown Reykjavik area 20 years ago, where things were pretty dire when it came to underage drinking and underage substance use. We had a lot of problems with that.

This initiated an experiment, you might call, where we had been doing all the things that other countries had been doing. We had their programs. We had a high legal limit of buying alcohol. We had a ban on alcohol advertisements. We had all the things, but they, at least in our context, were not working. So what we did, we developed over time what is now known around the world as the Icelandic prevention model.

The application of that model is what has generated the results that are in slide 4, from being basically the worst in class, where you asked a random teenager 20 years ago, if you've been drunk for the past 30 days, more than 40 percent of them would have said yes. If you ask the same question today, only about 5 percent of them say yes and so on and so forth. This is for substance use, alcohol, cigarettes as well.

[9:10 a.m.]

The Icelandic prevention model was invented over time. As well, stakeholders, policymakers, petitioners, scientists that participated in

about 5 percent of them would say yes, and so on and so forth. This is for substance use, alcohol — cigarettes as well.

The Icelandic prevention model was invented over time. There were a lot of stakeholders, policy-makers, practitioners, scientists that participated in developing the particular model. But if you lift the hood of the model and look under it — what it is, what it focuses on — then you would see what is on slide 5: this focus on the local community, not to focus on the individual, not the individual kid. You would see a focus on risk and protective factors and doing something about the risk and protective factors — strengthening the protective factors and minimizing the risk factors. I will return to that later.

These factors have been distilled down into these four main factors: the family, peer groups, school and leisure time. These are the factors that impact the lives of young people throughout their adolescence and what the Icelandic prevention model focuses on. I will get back to what that is.

If you look at Planet Youth as an organization, which is slide 6, what we have done…. We have worked with many of the scientists and the practitioners that actually have implemented the Icelandic prevention work in our organization, distilled the tenets of the model into certain guiding principles and an implementation process that we implement and diffuse around the world.

And we, as an organization…. We're not a large organization. We're not an old organization. We were founded in 2020, based on another organization called the Icelandic Center for Social Research and Analysis, which was instrumental in developing the model back in the day. We're 16 people in Iceland, and then we have about four people in other countries that work with implementing the guidance program to, hopefully, achieve the same results in other countries as we have achieved in Iceland.

Now, slide 7 is the first slide of two that tries to encapsulate what the guidance program is all about. We tried to encapsulate the essence of the Icelandic prevention model and the approach to substance use prevention that it entails. The five guiding principles of the guidance program — and the Icelandic prevention model as a whole — is, firstly, that it focus in on social changes. It does not focus on the individual youth. It's not the same as DARE programs telling the kids to not drink or take substances. It doesn't put the responsibility on changing behavior of the individual children but focusing on changing the social environment around the children, leading towards changed behavior over time.

Number 2, this necessitates that we emphasize that community action is what is needed and, in Iceland and in other countries, focus on the school as this natural hub where the kids are — this is their working environment — but also the community around the schools in some form or another. That is where the initiatives that are focused on changing the social environment are implemented.

The third principle is that we empower those communities to take action through data. We call it a data-driven primary prevention approach. We survey the kids, the cohorts of adolescents, about their behavior, about their risk and protective factors, about their relationships with their guardians or parents, about participation in leisure time activities, about time spent with peers, about their school and structure. There's a standardized questionnaire on which we base our data collection. We do this every second year in the communities that we are working with to enable these communities to define actions based on that and address the risk and protective factors. So it's all based on data, all based on evidence — the initiatives that we implement.

The fourth guiding principle is to integrate researchers, policy-makers and practitioners, acknowledging that to change society, to change communities is not the responsibility of just one stakeholder or one group of practitioners. It has to be a coordinated effort between these — we call these coalitions of stakeholders — that focus on this change.

[9:15 a.m.]

The fifth guiding principle is just to acknowledge this takes time. This is not a quick-fix solution. You saw the graph earlier. It was over 20 years. We don't say it will take 20 years to change societies, but our

that focus on this change.

The fifth guiding principle is just to acknowledge this takes time. This is not a quick-fix solution. You saw the graph earlier. It was over 20 years. We don't say that it will take 20 years to change societies, but our projects are usually based on a five-year cycle — just acknowledging that changing the social environment and changing behaviour is a complex issue, and reducing and preventing substance use is a complex, thorny problem that needs solutions that take time to materialize the results.

Slide 8 is where we have tried to encapsulate or distill the steps of the Icelandic prevention model into what we call the Planet Youth guidance program. These are ten steps that are cyclical over time. We do this annually over time.

So the step 1 and 2 are to build this local coalition before you start collecting the data. Build a local coalition. Get the practitioners and policy-makers, the schools and the politicians to work together and have a common understanding of the problem. Ensuring the funding, in step 2, resources available, not just for us — we have a small fee — but also to implement the initiatives that will be defined and decided upon after the data is collected.

Step 3 and 4 are about the data collection. We have a very stringent, standardized process for collecting the data in our communities that we work with. We have a standardized questionnaire. We have a standardized process for collecting it.

We have invested a lot of money in information technology, enabling us to return the reports and results, in six to eight weeks, back to the community. So you survey the kids, and you have the results after six to eight weeks, meaning that we actually have…. We know what the kids are doing right here, right now, in the community. So it's not a…. Our focus is not on writing reports or scientific articles, but it's to return the data to the people that are going to be making the decisions about what to do.

So 5 and 6 are about disseminating the findings into the community. Steps 7 and 8 are about deciding on what to do with the data, what initiatives we are going to implement, focusing on strengthening protective factors and minimizing risk factors. Then steps 9 and 10 are basically about immersing the kids in those initiatives, and then repeating that process annually.

Just to illustrate the annual basis of the project, slide 9 is about this cyclical nature. Year 1 is collecting the data, defining coalition, starting the project, initiating initiatives and strategies that are decided upon. Year 2 is the implementation year with process evaluations. Year 3 is surveying not the same kids but the cohorts that come after the kids that were surveyed the first time, on which the initiatives and the strategies have been implemented. Year 4, implementation again. In the year 5, surveying the cohort, again, that comes after the one that was surveyed in year 3.

Slide 10 is just to give you an example of where we are in the world. We are in 14 different countries, 1,000 or so communities. We are…. There are a lot of different flavours in our projects. We are not implementing the Icelandic prevention model. We are implementing the process on which the Icelandic prevention model is based on. That is the guidance program we're talking about.

The initiatives and the actions that are taken in each community, obviously, are locally adapted. So what works in Iceland doesn't necessarily work in Canada or Mexico or Chile. Those have to be adapted to the local context, and that is what is going on in the different projects in which we are working.

The different stakeholders and the different project organizations are also different. In Chile, in Guanajuato, its state-driven from the highest level. In New Zealand, it's a grassroots organization funded by the touch footy organization of New Zealand. In Scotland, it's an NGO that is driving the project. In Lapland and Tallinn, it's the municipality that is implementing it. So there are a lot of different approaches, but the main process being implemented is the same.

Just to give you an overview of what's happening in Canada. We have signed agreements, in slide 11…. Apart from Lanark County, which David is going to explain and tell you about a bit later, we also are working New Brunswick and Calgary.

[9:20 a.m.]

Now, we signed the agreement with New Brunswick just before COVID struck, which has, obviously, delayed the project, but it's with the government of New Brunswick's Department of Health. They will be collecting…. They have been coalition-building and defining and designing the project now

we also are working in New Brunswick and Calgary.

Now, we signed the agreement with new Brunswick just before COVID struck, which has obviously delayed the project, but it's with the government of New Brunswick Department of Health. They will be collecting…. They have been coalition-building and defining and designing the project, now, after COVID, and will be collecting the data for the first time early next year.

In Calgary, it's United Way of Calgary and Area that is funding the project. Right now they are in a similar phase — building the coalition and structuring the project. They have a lot of stakeholders they are working with, including the University of Calgary. But they will also be collecting the data early next year and initiating the project after that.

The final slide is just to give you…. I think we've published — ICSRA, the Icelandic Centre for Social Research and Analysis, and Planet Youth, our employees — around 150 different scientific articles. But these articles here, the three first ones, encapsulate and show what the Icelandic prevention model is all about and how our approach to guidance programs is based on that. We also have different implementation guides that we have translated into French and Spanish and English, obviously, that kind of tell our partners how to implement the process on which the model is based.

So that was a very short introduction to the model and where we are. I'm very much looking forward to questions.

Over to you, David.

D. Somppi: Thank you.

I see that Dr. Paula Stewart has joined us. Perfect timing, Paula, because we're just going to start our part of the presentation.

You should have also received a slide deck called Planet Youth Lanark County, B.C. Health Committee, August 2, so I ask you to take a look at that. We'll get right into it. Just maybe move to slide 2.

From a bio perspective, I'm a member of the community in Carleton Place in Lanark County. I'm actually an engineer by training, and one of the things that Paula and I have in common is that we both were employed by PwC for a while. I'm still there working part time, a sort of semi-retirement, I guess.

I've lived in this community for 30 years, and during that time, I've been a volunteer in governance of health care. I don't know if you're…. Actually, I'm not exactly sure how the system works in British Columbia, but in Ontario, hospitals are our corporations that are governed by a volunteer board. I chaired that board in the town that I live in, in Carleton Place, a 22-bed hospital. Then after that, I was a member of the board of the Champlain Health Integration Network. That's like a regional health authority. It was the model that existed for about, I don't know, maybe eight or nine years and now has been changed with a different model in Ontario.

I currently serve on the board of the Royal Ottawa Health Care Group, which is one of four specialty mental health and addictions hospitals in Ontario. That's based in Ottawa, and it has a large community program and a research institute associated with it.

Closer to home, about 12 years ago and with strong support from Dr. Stewart and the health unit, I was a founding member of a network of municipal drug strategy committees around Lanark County, and it was that work that brought me to Planet Youth.

Paula, did you want to introduce yourself?

P. Stewart: Hi, everyone. Sorry for the delay. I was otherwise occupied. I'm the medical officer of health at the local public health unit in Lanark, Leeds and Grenville, a big geographic area. Our biggest town is 16,000, 18,000, and then we have a lot of little, small towns — sort of 6,000, 7,000, 8,000. We have a lot of rocks. We have a lot of chickens, and we have a lot of cows and trees and amongst our people. So mostly a rural area where people work together well.

D. Somppi: Thanks, Paula. We'll ask Paula to make a few comments as we go on.

So maybe I'll refer you to slide 3 of the deck that we've put together. That kind of picks up on what Paula was saying.

[9:25 a.m.]

Lanark County is one of a couple of counties that are within the health unit that Paula is responsible for. It's also one of multiple counties that are served by our school boards. The school boards that serve Lanark County serve an area that's, I think, comparable

was saying, Lanark County is one of a couple of counties that are within the health unit that Paula is responsible for. It's also one of multiple counties that are served by our school boards.

The school boards that serve Lanark County serve an area that's, I think, comparable to the geographic extent of Prince Edward Island, so pretty large. We have nine municipalities in Lanark County, four towns, if you will — those are the towns where high school students attend school — and then lots of more rural area.

Having said that, we're undergoing pretty profound growth. The part of Lanark County which is closest to Ottawa…. If you look at that map that we've put there, that edge of the county is expected to double in population over the next 20 years. In fact, Carleton Place, where I live is…. These things get reported in different ways, but we were reportedly the fastest-growing town for the last four years. So close to a large city, but we have this rural character.

One of the questions or one of the things I wasn't sure about when I first started learning about the methodology is whether this methodology, this process — how well it would work in a rural environment. What I've learned is that there are lots of rural environments, lots of rural communities that are starting to use it, and there's some good sharing that's happening there. So it works in cities, but you treat cities as groups of communities, is my understanding. Certainly, I think it's going to work well in our community.

Slide 4 is just about how we got started. Back in 2017, there was a lot of concern locally about opioids. I and maybe a few hundred people attended a community meeting where a pharmacist named Mark Barnes, who operates an opioid replacement therapy–based practice, spoke. He trained everybody in the administration of naloxone. During the Q and A, a local doc and another resident stood up and said: "Hey, what are we going to do about doing something about prevention here? Harm reduction, treatment — all those things are very, very important pillars. But what are we going to do about prevention?"

That started off a series of grassroots meetings. The first one was just a week after the training. We started thinking about and asking ourselves: "Could this Icelandic prevention model work in Lanark County?" Slide 5 talks a little bit more about that. What we didn't realize we were doing is…. We were doing step 1 of the 10-step method that Páll mentioned earlier.

In slide 6, you'll see that we actually formed…. We have sort of formal terms of reference that we established in June of 2018 for this committee that I am the chair of. It's an ad hoc, community-led committee. We currently have no recurring funding. We have no staff. Everybody is a volunteer. That's a constraint which we're trying to deal with right now. We've done fundraising and received some one-time grants to cover existing costs, including signing up for the five-year guidance program that Páll spoke about. We've had very, very strong support from Dr. Stewart and her health unit.

Right now…. There's an organization called Open Doors for Lanark Children and Youth, which is a provincially funded community mental health service provider. They're kind of providing our back-office support. They officially handle our money. They provide strategic leadership and governance oversight in what we're doing.

Paula, did you want to talk about your perspective about what you saw in Planet Youth?

P. Stewart: The most exciting thing, I think, was that it was a whole-of-community response. There's an expression: it takes a village to raise a child, and it takes a community to raise a young person. I think that is so public healthy. For those of you who are in public health, that's exactly how public health works: with a whole-community approach.

The other thing that really drew me to it is that it's science-based, it's research-based, it's evidence-based. The third thing is that it's compassion. It's putting our young people first and saying: "How can we as a community help you?" So it was it was just a no-brainer for us in public health.

I remember being at that community meeting. I was probably the first one that stood up and said: "All right. Count public health in to this." Then others would stand up and do the same thing. So I think that for your local public health and your regional public health, this is a really easy one.

[9:30 a.m.]

D. Somppi: Thanks, Paula.

The reason why I mentioned my experience in health care governance is that what also appealed to me is the idea that we have this recurring measurement, so we have a way of evaluating whether we're making a difference. The things that are working, we'll do more of. The things that aren't working, we'll stop doing, and we'll do

D. Somppi: Thanks, Paula. The reason why I mention my experience in health care governance is that it also appealed to me, the idea that we have these recurring measurements, we have a way of evaluating whether we're making a difference. The things that are working we'll do more of, the things that aren't working we'll stop doing, and we'll do something else. That's not something that is common in my experience, sitting on the health boards of health care organizations. We don't have really effective evaluation methodologies.

I'll refer you to slide 7 just to give you a little bit more of what our status was. We were the first community in Canada to implement Planet Youth. There's a picture of Páll there. This was back in January of 2020. Our plan was to implement our first surveys in March of 2020, but of course, you know that the pandemic happened there, and so we got…. It was a kick in the gut for us, and we didn't get our first surveys done until February of 2022. So, quite frankly, we lost momentum. We had great community engagement leading up to March of 2020, and then things went quiet. People got very focused on what was happening in their lives. So that is a challenge for us right now.

We did do our surveys in February of 2022. I think the next slide, slide 8, talks a little bit about that. Sorry. I'll refer you to slide 9. So we did do our surveys in February of 2022. The reports were delivered to us on time, as Paula suggested. And we have made our reports available, so if you want to see what they look like, the website that I've included in there has them. We typically…. You would look for an 80 percent, 85 percent participation rate. This is not a statistical sample. This is meant to be a population health–based methodology.

We achieved 70 percent of grade 10s who were attending school in Lanark County in February of 2022. We had planned to do the survey over one week. We had three snow days, so no kids were in school or available. And we had…. Of course, if kids had the sniffles, they couldn't go to school. So we ended up with a 70 percent participation rate, and my understanding, from speaking to other folks around North America, anyway, who have been doing surveys over the pandemic, is that that's typical.

You can see some high-level findings from our surveys. The bottom one is a real concern to me. Thirty-three percent of the grade 10 students who answered the survey said they do not feel safe at school. I'm really concerned about that. I'm concerned about use of alcohol, low rates of activities. But not feeling safe at school is a big concern for me.

Slide 10 is a sample of a graphic from one of our reports, and you can see more of those if you look at that website that I mentioned to you earlier.

Slide 11 is where we are at now. What are our next steps from a Planet Youth perspective? We have our reports now, and we are starting to do dissemination. One of the things that we're looking to do is to involve youth directly in this, and so we're organizing some sessions which we hope are going to happen before September, in which we're going to discuss the reports from Planet Youth. As well, we've got an asset-mapping exercise through Open Doors, which I mentioned earlier. Those are going to be first shared in a formal way with youth, and we're hoping to bring the learnings from that and the youth who participate back into the larger process as equal partners in proposing changes in the communities that we live in.

We are in the process of rebuilding community-based coalitions, and our goal is to have one of these coalitions in each of the nine municipalities that constitute Lanark County. We will be supporting them, from our committee's perspective, in reviewing, responding to, and maybe coordinating across the county responses, and we're certainly going to be leveraging the expertise that Páll and his team bring.

Slide 12. I just wanted to give you a sense of what I've observed happening across North America. There are several communities that are starting to implement this model, and it's a very supportive group.

[9:35 a.m.]

I participate in regular calls. There's one call that's called the North American cohort call. Paula, I don't know if you know about this one, but it's organized by folks in Vermont who are pretty experienced with the model. In fact, Páll has an employee who is based in Vermont who is

I participate in regular calls. There's one call that's called the North American cohort call.

Páll, I don't know if you know about this one.

It's organized by folks in Vermont who are pretty experienced with the model. In fact, Páll has an employee, who is based in Vermont, who is supporting us. There are representatives from multiple states who participate in that.

There's also a regular call which is arranged by the southwestern health unit in Ontario. It tends to be mostly Ontario communities who are looking at the model and considering bringing it into their communities.

Páll also spoke about the Canadian initiatives.

Páll, maybe later you can talk a little bit…. My understanding is that Calgary is looking to do something specifically around the Indigenous community in Calgary. I think that may be of interest to these good folks on this call.

There we are. I think we're 19 seconds ahead of our schedule. We're happy to entertain any questions that you may have.

P. Stewart: I wonder if it's worthwhile hearing about what the local public health role is and what the municipal role is to support all of that. That's slide 8. Would that be okay? You want to finish.

D. Somppi: Oh, sorry. Yeah. Go back there, absolutely.

P. Stewart: This is very much, as you're hearing, community-driven, a sense of urgency. It really helps to have some local infrastructure that can help to support the community work. I think that's why…. I was thrilled to hear that B. C. might be thinking about it.

On slide 8, the last two things are really important. There's a provincial initiative, which is the municipal drug strategies. They're supporting municipalities right across the province to be involved in drug strategies. Prevention is one of the key roles. It means that the work that is nested within the Planet Youth model is part of a bigger provincial program, and it provides a network and an opportunity for people to connect.

The other provincial program is…. I'm assuming you have something similar. Every municipality has to have a community well-being and safety plan. The criteria for the plan totally fit with supporting youth, preventing youth substance use, healthy youth, healthy engaged youth in our community and so on.

I was really pleased that you're actually looking at this. I think there's a huge provincial role. Then there's a huge role for the local public health unit or your regional…. You have a little bit of a different model. I think that's…. If you're thinking about something provincially, you need to have a network and infrastructure that will support it provincially and then can support it locally as well.

What we've been doing is sitting on…. I sat on the steering committee initially. I think that validates it. When we would go to the school boards…. David would bring me along. The medical officer of health is saying: "Look, this is important for our community." That's a critical role that local public health can play.

We also collect data, and we're really good at interpreting it. Our nurses helped out in some of the data collection, and our epidemiologist is able to bring the data that we have from the youth speaking to us in March with the other data that we have as well.

Our school public health nurses can actually help the response in schools. The survey is the young people speaking to us. Then the nurses can actually work with them in the schools around what can make a difference to them and, also, with the parents around parenting.

Then we have…. Our public health nurses who work with the municipalities can support the response in municipalities. Leisure activity is incredibly important — and role models. The municipalities can really be involved in that.

I think the reason that it's going as well as it is, is because we have that combination of the science, the research that comes from Iceland. You hear the energy and the passion that's in David's voice. The community and the United Way role and so on and then the local public health as well. It's a combo thing.

I commend you that you're looking at this. It's really important for our young people.

N. Sharma (Chair): Thank you. Just going to switch to questions now. I see my colleagues have hands up.

I'll go to Pam first.

P. Alexis: Thank you so much.

Thank you, for making time for us this morning, to all of you, especially Dr. Ríkharðsson. Am I saying that correctly? Thank you.

[9:40 a.m.]

I have a question for you, Dr. Ríkharðsson. As far as your demographics go…. Can you please break down, economically, your policies on immigration and how that impacts family and activity and all of that? Canada, as you know, is full of many, many people that bring many, many different views to the table.

your policies on immigration and how that impacts family and activity and all of that? Canada as you know, is full of many, many people that bring many, many different views to the table. I just want to know how Iceland fits in with respect to the demographic that you're actually serving. That's my question.

P. Ríkharðsson: It's an interesting question. Actually, I think at the latest count, almost 16 percent of people who live in Iceland are not born in Iceland. That's higher than the U. K. That's higher than Denmark. That's higher than Sweden. They come from, mostly, the Scandinavian countries. There are a lot of Polish people here, originally. There is a Vietnamese population, for some historical reasons. So Iceland is not the homogeneous population that maybe people think. We do see that reflected in the culture, in the use of language, in the administrative systems, in the schools, with how we are teaching, and both culture, religion and languages.

As for prevention, it's the same approach, the same process that is being used in Iceland regardless of the different suburbs and their composition of ethnicity. And this is the same in Chile and Mexico and Australia. Well, we have even more in Australia. I think it's about 30, 35 or even 40 percent that are not born in Australia. So there's a lot more variety there.

The process of building the coalition, gathering the data, reporting it quickly to those that make decisions, make the decisions, implement the initiatives, implement and then measure again to see how the initiatives are working is always the same process regardless of how the population is composed ethnically.

We do see, however, in Australia that there is some Aboriginal element. We do see it in New Zealand. In Abacore, there's a large Maori population. We do see it in Calgary, with the First Nations. It's more the project structure and the voices within the project and how the project is defined and designed that are varied. In Calgary, for example, they have a project governance board, the United Way, in which there is First Nation representation. When I was there in May, that was a big part of how the project was introduced and the voices that were heard on how to progress and design the project. A similar thing in Papakura, in New Zealand — you know, the participation of the different factions in the project.

There's also quite a lot of adaption in the questionnaire to ensure that the questionnaire, the questions that are asked, the vocabulary, the references are adapted to the local population, the local context. And finally, the initiatives that are implemented based on the data of course also have to be adapted to the local context. Although the initiatives focus on the same risk and protective factors, the leisure time, family, school and the peer group, what is being done, obviously, is different, again based on the data.

To give you an example, in Australia, one of the communities in Australia found out that sports — in that particular community, the rugby clubs — were not a protective factor, because the more you played rugby, the more the kids drank.

Interjection.

P. Ríkharðsson: Well, I've lived in Australia, so I could actually say yes, I understand that.

But then they knew six weeks after they asked the kids, put the correlations…. Then they knew and they could implement initiatives focusing on educating parents in the sports clubs about the harmful effects of alcohol. They could implement training courses for the coaches in role modeling and how to behave around the kids so they can address the issue. Hopefully, next time we measure, the correlations will be different.

It's the adaption of what we are doing. What we do with the implementation is always the responsibility of the local partners.

[9:45 a.m.]

S. Chant: In Iceland specifically, have you got any longitudinal data on the kids

N. Sharma (Chair): Okay. Yeah, we have lots of hands up right now. Let's try to let's try to be as brief as we can to get as many people asking questions. I'm sure there's lots in there to learn.

S. Chant: In Iceland specifically, have you got any longitudinal data on the kids that you surveyed 15 years ago — as adults, now — and what their use of recreational substances looks like now?

P. Ríkharðsson: Yes, well, there is some evidence on that. There is also some evidence on how the treatment systems, like tertiary and secondary prevention treatment systems, have changed — how treatment facilities for alcoholism and how the composition of the people in those systems have changed. We have some evidence from the police as well on how changes in crimes — for example, in that particular age group throughout the years — have changed as well.

But to be very honest, our world, in Planet Youth at least, kind of ends at the age of 18, because there are a lot of other factors in the macroenvironment that impact the adult population as well. There's a freer access to alcohol, also, in Iceland. We have web shops, now, that you can access alcohol through. Alcohol ads have been become more liberal throughout the years as well. In Iceland, you have to always state that it is a low-strength beer you were advertising. There is no requirement on how big that lettering has to be in the advertisements as well. We do have a lot of ways to go around that.

But the consumption of alcohol and the treatment of alcoholism and substance use — there is some data on the composition of the treatment and on the prevention activities as well, and also more on the demographics as well — on what people are being treated. We see a lower percentage of kids being admitted to the treatment of facilities. We see higher percentage of middle-aged women, for some reason, being admitted. There are a lot of other factors that are at play.

S. Furstenau: Thanks for the presentation. I want to understand, Dr. Ríkharðsson, the building the local coalitions and the ten steps and repeating. There's an expectation that this is going to carry on. What is the funding model for this? How does that compare to what is happening in Lanark with fundraising — no funding and no staff, as David pointed out? There is the framework of the public health, but is there a secure funding model for the work that's being done in Iceland?

P. Ríkharðsson: In Iceland there is, yes. I think Iceland is a bit of a special case. We've been dealing with it for 20 years. This has just become ingrained in public policy — how to fund this model. This is nothing special. This is just how things are in Iceland.

I think we could maybe learn a bit more about how these things are when you're starting this, for example, in Calgary and in new Brunswick and in others, and in North America as well. We try to qualify, before we start a project around the world, that there is funding, not just funding for us. Our fee is now €27,000 per local unit, which can be a municipality or a county. That is defined in the project context. But, for us, it's maybe more important that it's funding to drive the project over time.

Where that funding comes from varies. It can come from grants, like the North American system, at least in the U.S. In Idaho and in Vermont and in Kentucky, where we are, it's very much based on grants and writing grants in getting that funding. In the South American project, in Chile, it's governmental funding. It's on the national level. In Argentina and in Mexico and Yucatan and Guanajuato, it's state-level as well.

[9:50 a.m.]

The funding has, obviously, to pay our fee but also to pay for what happens afterwards. What initiatives will you implement? And that varies quite a bit from project to project. But, for us, it's important that there is a resource. There is a commitment. There is someone who can actually manage the project. There is a team in place to build the coalition; to drive the project; to contact and engage with the schools; to be the driver of the project, because this isn't something

to project.

But for us, it's important that there is a resource. That there is a commitment. There is someone who can actually manage the project. There is a team in place to build the coalition. To drive the project. To contact and engage with the schools. To be the driver of the project, because this isn't something you do after five o'clock on a Friday afternoon. This is something that has to be integrated, so that's where the funding comes in. That varies.

You have to pay the salaries of the people that are going to be working with this. That's our requirement, but that's also the challenge in many of these systems. So the funding model…. We don't have a funding model, but we engage with partners that have a funding model. That can be governmental. It can be based on grants. It can be based on donations, or it can be based on even private companies' donations as well.

D Somppi: Can I just jump in and respond to that a little bit? Just a little bit more clarity on what's happening in Lanark county. We just decided we were going to do this, and we weren't going to let anybody stop us. So as a community group, we just decided we would do it, very much encouraged by Paula's support, which you saw happening earlier in this call, which is profound.

But what our goal is, is to use the data that we're gathering to help other organizations that are already performing what you might call interventions. To help them raise more money to do what they do, because we can help them with understanding what the need is, and also show help them show that they're making a difference. That's the hypothesis we're working under.

Also, because of the pandemic, everything was slowed down, so we just kind of were in stasis for a couple of years. We are actually, now, aggressively looking to find a way to fund the continued engagement that Páll talked about earlier, because quite frankly, we've been doing this off the side of our desks, and it's hard. It's not the time where we need to move into a bigger model here. So it's not sustainable to not have staff at some point — some level. We need to fix that over the next, I hope, two months.

D. Davies: Thanks, everyone, for the presentation. It's great to hear. We've obviously talked a lot about the opioid deaths that are happening right now in British Columbia — preventing that. But obviously, hearing the prevention piece as well as the recovery piece is very important for all of us.

A couple of my questions have already been answered, and I have a number of questions, but I'll keep it to a couple of kind of technical ones. I know in the Icelandic model, there was a piece around a curfew that was implemented and such, which is really interesting. I remember being on city council here in Fort St. John years ago, and there was discussions around a curfew, and the public pushback on that was incredible.

Specifically, I guess, maybe in Lanark county, I was wondering if that was looked at or has been implemented as something within the county. There's one my quick technical questions. The second one, I guess, is also aimed at the county as well. You said 70 percent response in the survey for grade tens. To get my head around what the survey looked like, was the survey actually done in-classroom, as part of, "Okay, everyone sit down, here's the survey, and do it," or was it a voluntary survey that was given. Maybe even on the Icelandic side, what that survey looked like.

Those are my two technical questions.

D Somppi: I'll answer the questions quickly. The survey was passive consent, so it was an opt-out, not an opt-in. It was administered in the schools. We had the support of nurses who work for Paula that do their work in the schools to help with the administration of it. In Ontario, every school board has a mental health lead. In one of our school boards — we have two schools boards — one of them is actually a nurse, and the other one is a psychologist. They were helping out as well. Administered in class. Passive consent.

From the perspective of the survey, I think we actually have a curfew. I think we actually have a curfew on the books, but it's not enforced. I don't expect we'd be getting there, but I do expect that we would be sharing with parents the correlations between unsupervised time, staying out late at night on the weekends or during the day, and appealing to parents to take responsibility, perhaps as groups.

[9:55 a.m.]

We've heard, in other communities, where parents kind of sign parental contracts with their kids and parents of other kids that say: "If your kids are at my house, they will be supervised, and if my kids are at your house, make sure they're supervised." So there's that "it takes a village to raise a child" comment that Paula made earlier

responsibility.

Perhaps as groups. We've heard in other communities where parents kind of sign parental contracts with their kids and with other parents of other kids that say: "If your kids are at my house, they'll be supervised. And if my kids at your house, make sure they're supervised." It's that "it takes a village to raise a child" comment that Paula made earlier. But I don't see us having the police going around and enforcing.

P. Ríkharðsson: Maybe a comment about that too, David, because the curfew is…. It pops up a lot. What David is actually explaining really well is that it's the unsupervised time — that is, how to minimize that.

In Iceland, curfews worked. I mean, being outside after ten o'clock in January is not very good. It could actually kill you. So that worked in Iceland, but I'm not sure that it works in all contexts. So what David is saying, with engaging with parents and explaining about the dangers of unsupervised time at night and their correlations to behaviour — that works in other contexts. We see other models being implemented in South America, where you can be outside 24-7 without, you know, anything.

It's not the curfew itself. It's what, in Iceland, it was meant to do. That doesn't necessarily translate into other contexts.

D. Routley: Thanks very much for your presentation. I appreciate the questions that have gone towards the sustainability of the program, both longitudinal data and support.

As a former school trustee — and person; in my family, we're all teachers — I always found it frustrating that each cohort of elementary school kids or junior high school kids would go through, and their parents would be brought up to speed on a whole bunch of issues, and then the next cohort would go through, and there was no effort, really, to capture the value of that in terms of support and awareness of public education issues — to continue that.

I'm wondering. The way you have structured this cyclical approach where gathering information, action, reflection on that action, and then rinse and repeat…. You're creating these cohorts of people who are involved as their kids are growing. Then they go through it, past the program.

You had a question — I'm sorry; this is taking too long — related to how they do going forward. Do you have efforts to capture the value of the people involved in order to keep a public awareness on the issue, going forward?

P. Ríkharðsson: Yeah, I can maybe shortly answer, and then maybe David, what you're doing in Lanark County.

The initiatives and strategies that are being implemented in Iceland…. We can see that in others, like Ireland. If you go on to planetyouth.ie, you can see examples of what is being done, not necessarily focused on teenage parents but focusing on kids that are starting in school, focusing on parents that are starting the school journey with their kids, focusing on primary prevention already there.

As Emmett Major in Ireland says, it's much easier to talk to these parents than teenage parents and just keep that on until these kids become teenagers. The long-term perspective doesn't necessarily have to be two or three years to that cohort, but, like the Icelandic prevention model is focused on, it can also start when the kids are starting school.

That being said, we can see in Chile and, to some extent, in Mexico also, that the parents of these kids…. Even though the kids there are taught through into high school and even to universities, some of these parents engage with the project teams still and want to engage and give off their experiences to parents of younger kids that are going through the schools. But this is all based on the community. The community teams interact with the parents, not just the parents that are in school but also the parents of kids that are outside of the school system, have gone through the schools.

D. Somppi: I'd like to draw an analogy to successful prevention initiatives that I have experienced. You can see by the color of my beard, I've been around for a few decades. Drinking and driving, smoking in public, wearing seatbelts — those are three things which changed in my lifetime.

[10:00 a.m.]

Even though it was targeting people who were driving at the time or smoking at the time, that has been pervasive, because it has changed the environment in which my kids and my grandkids are growing up. So I'm cautiously optimistic that we'll have the same sort of impact as we move ahead.

P. Stewart: I'll add a little bit. I think from a public

or smoking, at the time. That has been pervasive, because it's changed the environment in which my kids and my grandkids are growing up. So I'm cautiously optimistic that we'll have the same sort of impact as we move ahead.

P. Stewart: I'll add a little bit. I think, from a public health point, that's the advantage of having public health involved — that we look throughout the age spectrum. The media and the communication and the awareness that you can raise in the community — that we all have a role to play — then carries over into prenatal classes and into the early-years parenting. It's a unifying concept because it's about the community supporting our children and youth.

R. Leonard: Thank you, everyone, for being with us today and sharing your experiences. I wanted to especially say thank you for the example that you gave, Dr. Ríkharðsson, about the rugby team, because I was thinking that most communities have a lot of different activities for kids, whether it's sports or, in my community, they have a youth place with workers. We have boys and girls clubs. There are a lot of different things going on. So I really appreciate that piece of it and just trying to connect all of the dots in terms of how that all fits together with the notion of collecting that data and seeing what's working and what's not in real terms.

But the piece that I'm kind of missing — I was triggered because I was visiting a child care centre that was actually started for teenage moms many decades ago — is conversations about the kids who are trying to come back to be educated. There are a lot of kids who are not part of the K-to-12 system. I'm just wondering if that's part of your experience in your communities and how you have addressed it.

P. Ríkharðsson: Yeah, very good question. The short answer is no. Our focus is mainly on the kids in the communities that are on the way through the school system, to instill primary prevention there.

That being said, when we start in the community, we don't replace or say that the Planet Youth guidance program or the Icelandic prevention model is to replace everything else. All the other programs — the youth clubs, the focus on suicide prevention and underage parenting…. All of these things obviously will continue as well. The elements of these can also be integrated, to some extent, in the Icelandic prevention model. It doesn't necessarily have to be only substance use or alcohol. The other messages can be integrated there as well. But our focus is…. We're pretty much a one-trick pony in that we do focus on substance use and alcohol. That's what we have developed our focus into. That's one thing.

I also want to say that what we noticed also in communities — and David and Paula can maybe attest to that — is that when you collect the data, you get this one version of the truth: "This is how things are right now right here with your kids." It's very difficult to argue with cohort studies, population studies. There are no confidence levels. There are no samples. There are no population sample statistics. This is how the kids are doing.

And what you ask about…. We have a standard set of questions, but there is also a possibility to adapt and include other types of questions about context-specific factors that are important in the community to base some initiatives on that as well. But we do see that stakeholders work differently after a while, after having access to empirical evidence on how the kids are doing and the risk and protective factors and the consumption patterns, also in other domains than just in the ones that we are dealing with.

[10:05 a.m.]

S. Bond (Deputy Chair): Thank you for the presentation. I want to ask a question about…. This is about data shaping policy and direction. In British Columbia, the McCreary Centre does an adolescent youth health survey, and it is extremely comprehensive. The challenge is that it's done every five years. We have one coming up

data shaping policy and direction.

So in British Columbia, we have…. The McCreary Centre does an adolescent youth health survey, and it is extremely comprehensive. The challenge is, it's done every five years. We have one coming up in 2023. It covers a lot of topics, including mental health, substance use and a variety of other things. Not sure if you're familiar with that, but I'm wondering, if that data is already available…. It is used by, I think, all of the school districts, or the majority of them. I know it certainly was when I was a school trustee.

The principles that you speak of, Dr. Ríkharðsson, in terms of the Icelandic model…. If we have a survey already in place — and I would encourage committee members to go take a look at the 2018 one and take a look at how students were feeling in our province in 2018 about mental health and wellness and all of those things — are there principles of the model that can be utilized when we already have data that is comprehensive?

P. Ríkharðsson: Yeah. I think there is no context — no country in which we operate — where there is no collection of data from the kids. You have the aspect surveys. You have the HBSC. You have a lot of different surveys being done. Yes, you probably can. Of course you can.

There are two issues that we often encounter. One is just the surveys that are being implemented aren't necessarily focused on action, so they're not based on rapid return of the reports to the communities and the coalitions that actually have to decide what to do. Most often, in our experience, the surveys are academic. They're based on generating reports, on overviews, on making issues visible to the political and the academic system, and then, maybe, decide on some policy-level initiatives.

So our focus is on, partly, the structure of our questionnaire. These are very specific factors, because the data, the evidence base that we focus on — it's actually divided into two. One is the scientific evidence for what is working in the model. We focus on the risk and protective factors, and we can see that throughout our context…. We just did an evaluation study in Tarragona, showing us, again, that the four risk and protective factors are the ones that are actually…. If you focus on them, then things will change. This is like a universal constant. So that's one, evidence-based.

The second evidence-based is the data collected in the project itself. That's based on a very structured approach. Rapid return of the data to a coalition that is empowered and has the resources to make decisions on what to do. We have found that in the countries that we are, and even though you have surveys — you have collections of data — you often are missing the structure, the focus on the risk and protective factors, and the rapid return of the data to the decision-makers that are actually going to be implementing the model going forward.

But if that can be done, then…. I mean, we don't claim monopoly on this, you know. All that we are doing is accessible in scientific literature. So if there is a system in place which can ensure the focus on the risk and protective factors, integrate the data into a coalition and ensure that something happens on the basis of the data, rapidly after the data is collected, then I don't think you would need Planet Youth's guidance program. You can just do it on your own.

P. Stewart: Perhaps I could add to that, because that was the question that came to public health: don't we have the data already. We have the data at a provincial level, and at a broad, Lanark, Leeds, Grenville — like, that big geographic area — but we didn't have it specific to Carleton Place and to Beckwith and to Lanark Highlands.

When I presented the data just recently to our municipal people, I said: "These are our kids. The people who live in your communities are speaking to you." That makes a huge difference, and Páll is right that it's the risk and protective factors — that what can we do about it, which is so important, that you often don't get on provincial surveys. You start with the provincial surveys, and at that big community meeting, that's what we started with. So you have a sense that this is something we should be looking at, and then it's a survey that's entirely geared to intervention.

S. Bond (Deputy Chair): I just want to make a comment. I appreciate that, and I think that I guess you made my point for me that the data is there.

[10:10 a.m.]

It is very regionalized. We surveyed 38,000 kids across British Columbia in 2018, so the question is, what do you do about that and how do you take action, because one of the things we're concerned about is six people a day are dying

I guess you made my point for me. The data is there. It is very regionalized. We surveyed 38,000 kids across British Columbia in 2018. The question is: what do you do about that? How do you take action?

One of the things we're concerned about is…. Six people a day are dying in British Columbia. If you make one mistake, make a choice, as a 14-year-old, it may be the only choice you make.

The data is very detailed. I appreciate that, whether or not there's a utility in it. Certainly, speed of return is an issue because of the massive data that's collected.

P. Stewart: Yeah. Use that data to get people coming together in a community to say: "Look, we have a problem here. What can we do about it?" It's not that you…. Use that data. Then you think about…. Do you need something else, with the risk and protective factors?

Use that data. That can be your starting place. That can be the drawing place that brings people together.

N. Sharma (Chair): I have a couple of questions that are, I think, interrelated. My first one is….

First, thank you for the presentation. It's really interesting to know how this is unfolding in a very adaptive way, it looks like.

I would say B.C.'s context is a little bit what we talked about, about the…. The task of this committee is to focus on the impacts of the toxic drug supply and what that is really doing to communities. Shirley already mentioned the death toll.

I would love to know if there are any longitudinal or even not so short-term studies that show that this kind of a model connects with youth not using or interacting with the toxic drug supply. I saw in some of the charts things about cannabis and alcohol and smoking. I'm wondering if somebody can make that a little clearer for me and what the success rate on that part of it is.

Then the other question is…. We heard a lot about trauma being…. There's a substance use, and there's a problematic substance use. It seems like the measure of this program is a reduction in substance use overall by all kids, but there's a stream we're seeming to learn about people that have had some kind of trauma in their life or something that leads them to use substances in a way that becomes quickly problematic or substance use disorder.

How does this model interact with that kind of a cohort, and what do the protective factors do for those youth?

P. Ríkharðsson: Maybe the last question first, trauma and substance use. The basic assumption of the model is that kids shouldn't be using substances. Obviously, trauma might happen, and then substance use might result. That is kind of outside the scope of the primary prevention initiatives. The social change and the social focus this model is all about.

It's absolutely correct. The aim of the model is to reduce substance use. As you can see in the figure and the graph, the results in Iceland…. That's what we're trying to achieve in other countries as well but, again, focusing on the kids. We're looking at 12-, 13- and 14-year-olds and trying to change the environment around this age group.

All discussions about the legalization and decriminalization about cannabis, for example…. I don't think anybody's focusing on that age group when it comes to that. It's all about grownups and some choices. That age group is still under-age, and that is what we are trying to focus on.

I think that was the second question. Can you please repeat the first question?

N. Sharma (Chair): I just would love to know the record on how this model does in steering people away from the toxic drug supply that certainly exists in B.C. Some of the measures I saw were cannabis, alcohol and other substances. I just wondered about research connecting it to that.

P. Ríkharðsson: Yeah. Again, the police reports in Iceland show…. Well, the kids that get arrested or detained or become the focus of the juvenile courts for buying illegal substances…. Those statistics show that that is being reduced. As for other age groups and access to illegal substances and the illegal substance market, that is not really within the model as such.

[10:15 a.m.]

If you look at the supply…. In Iceland, there is always going to be a supply of illegal substances. We can see that in other countries, particularly in Mexico. The issue is just enormous.

We're trying to focus more on…. There is a war on supply, and there is a war on drugs. There probably always will be, given the legal framework. We try to focus on the demand. We are a war on demand and trying to get

particularly Mexico. The issue is just enormous.

We're trying to focus more on…. There is a war on supply, and there is a war on drugs, and there probably always will be, given the legal framework. We try to focus on the demand. We are a war on demand and trying to get the demand changed, over time, which will then impact the supply, hopefully, when the demand will be reduced, and then the supply will not be an issue. That's kind of the long-term view of the model.

I don't know if that answers your question at all, but….

D. Somppi: I'd like to pitch in. I'm not an expert, by any means, but two things. One of them is that we're certainly not immune in Lanark County to the impacts of the toxic drug supply. We have…. Paula can better than I speak to the deaths we've had due to overdose, of unintended consumption of substances. It's there, for sure, and it's certainly there in Ottawa and schools out there.

Páll, there was…. Alfgeir Kristjansson is a senior scientist that has worked on this model, and when he spoke here a few years ago, he talked about the results of a study that compared the age of first use amongst Nordic countries and showed that the model that is embodied within the Icelandic prevention model had delayed first use by about a year, something like from 13 to 14, or 14 to 15, or something like that.

If you consider brain development, there's a lot of difference between a 13-year-old and a 14-year-old or a 14- and a 15-year-old. If we can achieve that kind of thing, too, the odds are we're going to be making a positive difference from a public health perspective.

N. Sharma (Chair): Thanks for that.

P. Alexis: I just want to go back to the data again. I, too, was a school trustee, and we used the survey system that Shirley referenced. I was always asked the question: was the data reliable? Was it honest? Were the kids in a position where they felt safe filling out that survey? So how did you manage that?

The second question is about COVID. We saw a dramatic increase in mental health issues, substance use, all of that. How did your data reflect a different direction, perhaps, that you captured through COVID? I'm not sure if you shut schools or whatever in Iceland. I would be very curious as to how you addressed the COVID isolation issues that we are certainly seeing the aftermath of, not only amongst kids but in adults as well.

P. Ríkharðsson: Maybe I can start just generally, and then Paul and David can chip in with how they did in Lanark County, which did quite well.

The collection of the data is we have a very stringent procedure for how you collect the data. There is a procedure for where the kids take…. It's electronic questionnaires, mostly. So where they actually answer, there's a procedure for it. When they ask for help, there's a procedure for it. We don't collect any private or personal information at all.

We also have procedures and algorithms for when we actually receive the data in Planet Youth to clean the data. We go through the data to…. If the kids have answered 1, 1, 1, 1, 1, 1, 1 all the way through, then those are filtered out a bit. If a kid reports that they have tried heroin at the age of ten, that is probably not true either, so that gets…. We have different mechanisms to clean the data to ensure that the data is as reliable as possible. We do have….

That being said, then, it gets put into the reports and then reported back to the community. It varies a little bit between the different contexts. Like in some of the Mexican and Chilean, up to about 20 to 25 percent of the kids just are not in school. They just are working or they're just not in schools. So they can't be accessed. That can be a data quality issue.

[10:20 a.m.]

Also, in…. Maybe not so much in Iceland. This relates to your COVID element in the question. It was a bit different from different partners. In Iceland, there were the lockdowns. So we didn't do any surveys in Iceland during the lockdowns, but we did surveys in Mexico, for example, during lockdowns, also in Australia and in Ireland.

Then we had to develop a home survey protocol for how to collect the

partners. In Iceland, there were the lockdowns. We didn't do any surveys in Iceland during the lockdowns, but we did surveys in Mexico, for example, during lockdowns, also in Australia and in Ireland.

Then we had to develop a home survey protocol for how to collect the data while the kids were being home-schooled. That was through the Zoom or Teams. There was a procedure for how you can…. In the school, in the class, they were asked to do this survey. The survey takes about 45, 50 minutes to answer, all in all. There is quite a stringent protocol for how to get the kids to answer. There is a focus on the data quality to ensure that the data is as reliable as possible.

But there are issues that can affect data quality, like kids simply not being in school, being absent on the day. We try to focus a lot on collecting the data in periods during the school year, when there are not a lot of projects or study trips or whatever that can affect the attendance or the minds of the kids. There's a lot of focus on that.

Maybe, David and Paula, you can explain how this is done in Lanark.

P. Stewart: Yeah, so I'll talk a little bit. I'm very concerned about how youth have traversed in the last 2½ years. Mental health concerns are really significant, both anxiety and depression. The lack of the socialization, which is a critical part of brain development within that time period…. It's so important, which is why I was so pleased to be able to do the survey now, and we see some of that. It's like 33 percent of the young women thought their mental health was good or very good. It would've been up around 60 percent before that, from provincial surveys. And even boys saying 50 percent is okay….

The survey now, I think, has shown what our nurses who are in the school and in the community have been telling us. The nurses have been telling us that vaping has just gone through the roof. It's like 20 percent or 30 percent of kids are vaping now. That's a coping mechanism, because it gives the nicotine to the brain to stimulate the brain — not in a good way because nicotine is very dangerous for young people's brains.

I think you're right to be really concerned about young people. Because they lost a lot of those social connections, which keep them more in the mainstream because they feel like they belong and they feel they can cope…. Many kids, I think, have potentially lost that. So now is more than ever the time that you should be having this meeting and focusing on what you can do collectively.

N. Sharma (Chair): Okay, I don't see any other hands up.

I just want to, on behalf of the committee, thank you not only for helping us learn about your experience and the work that you've done in Iceland for a long time and also what you're doing out East. It was very interesting, and I know it required a lot of community connections and building up that kind of social fabric in your community, which is great to see. So thanks so much for your time. We'll let you know if you have any other questions.

To committee members, we are at recess until 10:30.

D. Somppi: Can I make one comment, please? I just want to acknowledge that Paula is charging. She's picking up speed as she approaches retirement in a few weeks. I just wanted to say thank you, Paula, for joining us here today and just for everything you've done as we've been working into this. I very much appreciate it.

P. Stewart: Thank you. Yeah, I would say the same back to you.

N. Sharma (Chair): Congrats on your upcoming retirement. Take care.

The committee recessed from 10:24 a.m. to 10:32 a.m.

The committee recessed from 10:24 a.m. to 10:32 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, I just want to welcome you. We have, as our next speaker, João Goulão, general director for Intervention on Addictive Behaviours and Dependencies in Portugal, and we're just so honoured to have you at what is, I think, 8:30 your time. Thank you for joining us in the evening.

My name is Niki Sharma. I'm Chair of this committee and MLA for Vancouver-Hastings. I'm just going to do a go-around so that you can meet everybody who's on the screen with you before we pass it over to you.

P. Alexis: Good evening. My name is Pam Alexis, and I am the MLA for Abbotsford-Mission.

S. Chant: Good evening. My name is Susie Chant. I'm the MLA for North Vancouver–Seymour

R. Leonard: Hello, I'm Ronna-Rae Leonard. I'm the elected representative, MLA for Courtenay-Comox, which is on Vancouver Island, on the very west coast of Canada.

D. Davies: Hi, there. Thanks for joining us. My name is Dan Davies. I'm the MLA for Peace River. North, up in the northeastern part of British Columbia.

S. Bond: Hello, I'm Shirley Bond. I'm the Deputy Chair. I am the MLA for Prince George–Valemount — basically, the centre of the province of British Columbia.

D. Routley: I'm Doug Routley. I'm from Nanaimo–North Cowichan.

M. Starchuk: Mike Starchuk, MLA for Surrey-Cloverdale.

J. Goulão: Good to meet you all.

N. Sharma (Chair): We have your presentation with us. We have about 30 minutes for your presentation and an hour for questions and answers, and we're really excited to learn from you.

JOÃO GOULÃO

J. Goulão: Thank you, Madam Chair. Thank you for having me and for giving me this opportunity to share with you our own experience. Allow me to congratulate you for the movement that you have just done in the last couple of months. I hope that you are very successful with this experience.

[10:35 a.m.]

It might be better to have you passing my presentation, but as it has a lot of

couple of months, and I hope that you are very successful with this experience. Even if it's better to have you passing my presentation…. But, as it has a lot of animation, it's probably better that I control it. If you don't mind, I will share my screen.

N. Sharma (Chair): I guess that's technically possible, right, Artour? We're good with that. Please do that, yeah. Go ahead.

João Goulão: Okay, here I am. Well, I hope that you can see it. Yeah? See it okay?

N. Sharma (Chair): Yeah, we can see it.

João Goulão: Okay, well, it's a quite long presentation, but I'll move quite fast over some of the slides. But, anyway, I would like to share with you our experience. In the '90s, we lived a very, very difficult situation here in Portugal. I would say that it was a catastrophic situation mostly related to heroin use, with lots of poverty seen over those decades. I will share with you some of the of the problems that we were facing in those days.

It was the main concern of the Portuguese population — drugs and drug addiction. We had around 1 percent of the population with problematic drug use mostly related to heroin. We are roughly stable — 10 million inhabitants. This means 100,000 problematic drug users at the time. 98 of them were heroin users. 48 of those were using intravenously. They contributed 56 percent of HIV notifications at the time, here in Portugal. We had around 30…. Around one overdose death a day. That means 350…. 60 each year….

The response that that we found was to develop — to build — a new strategy, a clear guidance to deal with the problem. From that strategy, a new paradigm started as a result. The decriminalization law lost 30 of 2000. We also organized national coordination for drug problems in the national network of structures for intervention, building an integrated model to deal with it.

The first Portuguese strategy on drugs was built under the government of António Guterres, the current Secretary-General of the United Nations. It was based in two main principles: humanism and pragmatism. It then compares two big sides of the problem, the supply reduction and demand reduction. On demand reduction, we had treatment, harm reduction, prevention and social reintegration. On top of that, because we assumed that we were dealing with a health and social issue rather than a criminal one when talking about drug use and drug users, we decided to propose, also, decriminalization of all drugs — decriminalization of use and possession for personal use.

[10:40 a.m.]

This is the most known aspect of our of our drug policies but, in fact, we face the decriminalization of drug use as one of the components of a comprehensive strategy — a comprehensive direct policy. It's not just a magic bullet that, by itself, would contribute to solve all the problems I just showed to you. We call this the integrated approach, and evaluation is an integral part of this strategy.

We call this the integrated approach. Evaluation is an integral part of the strategy.

We proposed the decriminalization of drug use. It was included in the strategy, but if the strategy was approved, adopted as a complete package by the government, this issue of decriminalization had to be discussed at the Parliament, which happened only one year and something later. The strategy was approved in '99, and the decriminalization law was discussed at the Parliament only in 2000.

We took that period to organize a big number of public discussions, public sessions with the population. What I take from that period was a massive support of the common citizen to the idea of decriminalization. In my view, it comes from the fact that every family had problems with substance abuse. It was not something that was only in the margins. It was attaining medium class, upper classes, political class, everybody. It was the feeling of the common citizen: "Okay. My son is not a criminal. He's someone in need of help, in need of support, in need of treatment. But he is not a criminal by the mere use of substances."

If it happened among the common citizen, at the Parliament, the discussions were much more complicated. Standing on some issues, such as United Nations treaties — were we complying with the United Nations treaties? Would Portugal become paradise for drug users from all over the world? Would we have people coming to Portugal just to use drugs freely? What about the kids? Would they start using drugs very early, in their very early ages? Would they start using drugs with a milk bottle?

Well, it's important to say that we only changed one article of the drugs law, of 93, which still stands. It's a quite inspired in the war on drugs, but there's only one article that deals with personal use and possession for use. This is the only one that we changed. I sent to you the law, the law 30 of 2000. I hope that it may be of some use for you.

According with this law, the consumption, acquisition and possession for own consumption of banned substances or preparations constitute an administrative offense. Possession cannot exceed the quantity previewed for individual use for 10 days, for a 10-day period. Exceeding this quantity, criminal procedures take place. We have a threshold that was calculated on the basis of a 10-day personal use. It's as arbitrary as any limit that we can use. We could have adopted a 15-day or five-day. Even the amounts of drugs that people use during 10 days is quite complicated to calculate.

Even so, I think — and this is an important topic in my view — it's very important to have it clearly established by law because it provides a lot of arbitrarity that police officers can incur if they do not have a clear guidance on how to deal with this possession.

[10:45 a.m.]

We have the example of some countries here in Europe that do not have a clear distinction, a clear strategy

officers can incur if they do not have a clear guidance on how to deal with this possession.

We have the example of some countries here in Europe that do not have a clear distinction, a clear threshold, let's say. In practice, what happens is that some citizen is intercepted by the police, comes to the police station, and if it happens to be a good family, a clean, blue-eyed blond guy, he or she will be probably sent in peace by the police officer. Or you are just the user. But if the opposite happens and someone from a marginalized community, a poor guy, dirty, ugly, Black, whatever, probably he or she will be charged as a trafficker. So in my view, I think it's very important to have that threshold clearly established.

According with our law, the drug addict is considered as a person in need of health and social support. In this situation, intervention provides an opportunity for an early, specific and integrated interface with drug users. So we face it as an indicate, prevention tool. It is aimed and targeted to the drug user's characteristics and individual needs, so it allows us to have contact with people that otherwise are not reachable by health personal.

I will just briefly explain. When we approved this decriminalization law, we created in each district…. We have 18 districts here in Portugal, on the mainland, and we have two autonomous regions, Madeira and the Azores, where we also have those commissions. Those are not drug courts. They are not under the Ministry of Justice. They are administrative bodies under the Ministry of Health.

So in practice, if…. I'll come to this later. On those commissions, we have three members, typically — a president and two other members, jurists, usually a psychologist and a social worker — and they have a multidisciplinary technical support team with psychologists, social service workers, lawyers, administrative staff.

In practice, if someone is intercepted by the police using drugs or in possession of drugs, they are conducted to the police station, where the drug or drugs are apprehended. They are weighed, and if the person has on them more than the amount that is calculated and is established in a table for different substances with different amounts…. If a person has more than that, they are just sent for the criminal system, as before. It's up to the court, to the judge, to all those procedures to define if they are a trafficker or just a user, but he or she may end up in prison after those procedures. But if the person has less than that amount, they are just sent to the commission for the dissuasion of drug addiction. They just receive a piece of paper and must present theirself in the next three days to this commission.

[10:50 a.m.]

The multidisciplinary technical support team elaborates a report with all information — consumption history, family, studies, work, a report on the personal history — and tries to assess if we are dealing with someone

consumption history, family, studies, work, a report on the personal history ––and tries to assess if we are dealing with someone with an addiction problem or just an occasional recreational user. This is the first big attempt to distinguish, to make a rough diagnosis of the situation.

Then, on the basis of that report, there's an interview of the commission, the president and the other members, with the person. And then it's possible…. If we are dealing with someone who is addicted and in need of treatment, they are invited to join a treatment facility. It's not compulsory. They're invited. "Have you ever sought or are searching for help, for treatment?" "Yes, I did, but it's so complicated." "You think so? What about starting tomorrow? If you are interested, I can book you an appointment for tomorrow or the day after tomorrow." A phone call, and the consultation is arranged.

I must say that most of the people in need of treatment for addiction accept going there, going to a treatment facility. But they are free to refuse. In that case, the commission just tells them: "Okay. Please don't come here for the same reason in the next, let's say, six months. Otherwise, if you come, I'll have to apply to you some kind of penalty. Okay?" In the first contact, usually there's no penalty. There's information about the availability of treatment and other resources, but not a penalty, neither an administrative penalty. It's important to say that the presence in this commission does not imply a criminal record. So there's no criminal record for drug users and people in possession of small amounts of substances.

Madam Chair, I don't know if you want to interrupt to ask any questions, even during the presentations. Please….

N. Sharma (Chair): I think we'll save the questions to the end. We have lots of time for discussion afterwards. I'm sure people are taking notes about what they want to ask. Please continue.

J. Goulão: Okay. Thank you.

This is the procedure that I was explaining. A police authority finds a person in a public place in possession of or using drugs. There's a police report. The substance is seized, and the user is brought to the commission. There's a hearing of the user, and the decision…. You may have some motivation work, and the invitation, the offering, the information about the resources that we can mobilize at this commission.

Of course, it only works if we have a network of responses to whom the commission can refer these people –– either an addiction treatment centre, a health centre, welfare services, indicate prevention strictures. And also, the source of those referrals may be prison, schools, police authorities. So there's a need to have an interconnection of all those strictures in order to make it work.

[10:55 a.m.]

If the person says, "Okay, I'm not…" and in the discussion in the interview it seems

to make it work.

If the person says, "Okay, I'm not…." In the discussion, in the interview, it seems evident that there's no big deal with this drug use. There's an occasional recreational user, someone who says: "Okay, I have no problems with drugs. I smoke a joint with my friends on weekends." But even so, the commission and the technical staff try to identify any problems in the person's life that, along with drug use, may lead to more problematic use later on.

For instance, okay, I know I have no problems with drugs. I don't feel that drugs are a problem in my life. But my parents are divorcing, or my father just lost his job, or myself, I am in difficulties with my gender options or whatever. The commission may invite this person and offer support not in a centre for the treatment of drug addiction but in other resources in society where the person may have some support to deal with these problems.

We have a long list of administrative sanctions that may be applied to the people who present to the commission. A monetary fee is only applicable to non-addicted people. But there's a long list, such as periodic presentation to the CDT, to the health centre or treatment centre for addictions. There is the possibility to have community service, forbiddance of attending certain places or meeting certain people, interdiction to travel abroad, apprehension of objects — for example, to fire guns or things like that. It's possible to define sanctions according with the lifestyle of the person, so it's a tailor-made suit that we can use according with life conditions of the person.

From all this, I think it's important to share with you this idea. From 2001 to 2021, we had 154,000 different people coming to those commissions. From those, there are some figures missing in between, but we have a clear diagnosis of 85,000 that was were assessed as non-problematic drug users, and 16,000 were assessed as problematic drug users, people in need of treatment. From those, even if they were assessed as non-problematic drug users, 45,000 were referred to specialized support — social support, health support for other conditions. This means almost 50 percent of them were referred, and accepted being referred, to other kinds of support.

From the 16,000 that were assessed as problematic drug users, 12,000 were referred to treatment centres, and 10,000 actually initiated a treatment after that referral. I'm not saying they were successful, but they accepted to initiate a treatment process.

Well, at the international level…. I think it's also an important concern, because in the beginning, in 2000 and 2001, United Nations bodies were very critical about our decision to decriminalize drug use.

[11:00 a.m.]

But in 2009, for the first time, in the World Drug Report, the UNODC said that Portugal's decriminalization of drug usage

to decriminalize drug use.

But in 2009, for the first time in the World Drug Report, the UNODC said that Portugal's decriminalization of drug usage falls within the convention parameters. Later, in 2016 at the United Nations special session on drugs, we had an introduction by Mr. Werner Sipp, the president of the International Narcotics Control Board, the guardian of the treaties. And he said: "The Portuguese approach is a model of best practices, fully committed to the principles of the drug control conventions, putting health and welfare in the centre." Since then it was completely admitted, and I think there are no worries about the reaction of the United Nations bodies nowadays related to decriminalization of drug use, keeping administrative sanctions to do it, as we did.

Another component of our approach was the building of a coordination structure. We have an interministerial council, shared by the Prime Minister, that encompasses 11 ministries, in fact. Each one of those ministers nominates a personal representative that works in the technical commission directly with the national coordinator. The member of the government that is responsible for drug policies in Portugal is the Minister of Health. Under the Minister of Health, the national coordinator is SICAD DG. In this case, it's myself, in the last years.

The technical commission has several thematic subcommittees on prevention and treatment and so on. We build our strategic documents together — our strategic plans that follow the first strategy and that addresses several areas of intervention. We also have a national council and advisory body, which has representatives of governmental bodies and civil society, academia and so on. So all the documents, all the action plans and all the legislation related to drug issues are evaluated by these bodies.

With this, we have a coordinated, public health–oriented approach based on five pillars. I would say that dissuasion is more or less the anchor for all of this, but we have preventive work, treatment — a quite solid network of treatment centres, state-run and private with agreements with the state; treatment is free, out of costs — reintegration work that starts in the beginning of the process, and harm reduction policies that are very present also in our reality. I will not go through these different areas, but we have different projects and different interventions in the preventive work.

[11:05 a.m.]

N. Sharma (Chair): I'm sorry to interrupt. Your time for the presentation is over, but I would love it if you could — maybe if you have some slides — talk about the present and how it's working right now, and then maybe we'll go to questions. I don't know how many slides you have left, but I didn't want to….

J. Goulão: I still have…. I would like to show, at least, some results of these interventions.

N. Sharma (Chair): Great. Yeah, that'd be

if you could, maybe, if you have some slides, talk about the present and how it's working right now, and then maybe we'll go to questions. I don't know how many slides you have left, but I didn't want to….

J. Castel-Branco Goulão: I still have…. I would like to show at least some results of this intervention. Okay?

N. Sharma (Chair): Yeah, that would be great.

J. Castel-Branco Goulão: Okay. This is the network for treatment, the intervention in the area of harm reduction. The last one to be launched is the drug-checking, which we feel is very important nowadays with the presence of all of those new psychoactive substances.

This is a list of structures, working on our intervention, on reintegration. That's something that starts in the beginning of the process of treatment. From the start, there's an evaluation, and we build an individual integration plan, aiming the subject's autonomy in all the areas, in the areas of housing, finding jobs, joining the families and so on. So we start from the beginning of the treatment process.

Nowadays we are in the process of approving the national plan, the next cycle for a strategy, and 2021 is already gone, but it has not yet been approved by the government, because we had some difficulties with it. The new national plan encompasses not only illicit substances but alcohol and dependencies and the addictive behaviours without the substance, such as gambling and gaming, screen dependence, Internet dependence and so on. We have the first action plan horizon to 2024 and then three-year cycles — '25, '27, '28 and '30.

While our vision is to have healthier communities with lesser problems caused by addictive issues…. They are based in the principles of focusing on the citizen — the principles of humanism, pragmatism and quality and equity. Those are the main concerns for this next cycle. It is centred in the citizen, in the life cycle. So we propose to intervene from the coming child, the newborn, until the elderly.

That is one of the main concerns that we have now. We have an aging population of users, and for the first time, we address, specifically, some of the themes concerning the elderly, and we intend to work in different contexts, from family, school, sports, the workplace piece and all those contexts that we can see on the screen.

This new plan is based on three pillars — empower, care and protect. Around those themes, we develop a set of actions or objectives, and we intend to follow all of this in the next cycle.

[11:10 a.m.]

Just to finish, I would like to show you some results of this intervention. This is the graph of HIV infections among injecting drug users. As you can see, we had, in '97 and '98, a huge number of new infections every year, and then it dropped, and it is

the graph of HIV infections among injecting drug users.

As you can see, we have a peak in '97-98 — a huge number of new infections every year — and then it dropped. It is, nowadays, the less important contingent of new infections in the Portuguese population. Nowadays, the main concern is related to heterosexual people that think that HIV infections is a solved problem in society. Even homo or bisexuals are less important — less contributors to these new figures nowadays.

As to drug-related deaths, as I said before, we used to have around one overdose death a day. That means 350, 360 a year. In 2020, we had 51 overdose deaths, all over the year. The main substance of new users that join the treatment ambulatory public network are cannabis users, nowadays. Heroin, as you can see, has been dropping slowly. It's vanishing. Cocaine is increasing slowly but steadily in our reality. The new psychoactive substances that we fear would have a boom in the coming years remain at very low levels in our reality.

So, you remember. One percent of the population that were estimated to have problematic drug use — nowadays, we estimate that we may have 33 percent of the population. From the 100,000 problematic users, we estimate that we may have, nowadays, 33,000. From the 98 heroin users, nowadays, we have 16 percent of heroin users. From the 48 percent that use the IV route, nowadays, we have 2 percent of people injecting drugs. The 56 HIV new cases — nowadays, injecting drug users contribute with 3 percent of total numbers of HIV. 350 overdose deaths — nowadays, we have 63.

Since 2001, we noticed small increases on illicit drug use among adults. A reduction in delaying experimentation of illicit drug use among adolescents. A reduction of injecting drug use. A reduction on opioid-related deaths and infectious diseases. A reduced number of drug offenders on the criminal justice system. A reduced stigma of drug users, contributing to increase the possibility to integrate people in the normal society.

An increase in the amounts of drugs seized by the authorities. This is a quite interesting side effect, I would say, because instead of spending all their time and energy with mere users, the police authorities could address their attention to the sharks — to big criminal organizations — so they are much more effective nowadays, then before.

Sorry to take too much of your time, but the last thing is that the visibility of the phenomenon — of the drug-related problems — has dropped.

[11:15 a.m.]

It has dropped in the ranking of social and political priorities, so there's a decrease of interest and of investment in this area, so we are facing some difficulties in maintaining the standards of the responses to this problem.

That's it. Thank you very much.

social and political priorities. There's a decrease of interest and of investment in this area. So we are facing some difficulties in maintaining the standards of the responses to this problem.

That's it. Thank you very much.

N. Sharma (Chair): Great. We'll switch to questions and answers.

R. Leonard: Thank you so much for speaking to us today, all the way across the world from Portugal, and for sharing your experiences. It's very helpful. I had a whole bunch of questions, and most of them have been massaged and answered very nicely, but I do still have one.

That relates to…. You have a bunch of sanctions that, to me, reflect a criminal sanction, like a restriction on people's ability to move or to go across borders and other things like that, yet it is an administrative penalty, not a criminal one. How does that play out, in how and where it changes from being an administrative issue to being one with a criminal element?

J. Goulão: Well, the big difference is the context of where this decision is taken and how it is enforced. In fact, under the criminal system, this is a decision from the court. It's enforced by the police authorities. I am not probably not able to explain — I am not a jurist — but I think it's quite a good question.

For instance, if someone does not use their safety belt when they drive and the police officers stop them, they may apply a fine on site. In some cases, in accordance with our law, they may impose that you attend a training course for drivers, for instance — education for drivers without a court decision.

This is an administrative sanction, with no criminal record. I think it's the best comparison I can find for it. It has not been an issue — the capacity of this administrative body to apply these kinds of sanctions. It happens in other kinds of areas that, without a decision from the court, you may define some…. For instance, one of the sanctions that we have: you have someone that, in the conversation, in the interaction with the commission, you understand that….

Let's imagine someone who is HIV-positive and is missing his consultations at the hospital. One of the decisions that the commission might take is, "Okay, from now on, you must attend your consultations every two months," let's say, "and you must bring evidence, a piece of paper showing that you are attending your consultations." This is one of the most-used sanctions at the commission. This allows us to increase the compliance with the therapeutics that the person may have.

[11:20 a.m.]

We don't really have questions from the citizens about the legitimacy of applying this kind of a sanction, taking it as a sanction, or

we don't have, really, real questions from the citizens about the legitimacy of applying this kind of sanction, taking it as a sanction, or on having people developing some social work, for instance. In fact, I cannot establish clearly the distinction between these types of sanctions, only the context where they are taken.

I'm sorry if I do not explain better. I cannot see you.

N. Sharma (Chair): We've lost your video too, but we can hear you pretty clearly.

S. Chant: Thank you for your presentation and all the work that you have done in this field — a huge commitment to a population that really needed that commitment. Thank you for that.

My question is in relationship to decriminalization. Do you have a problem with toxic drug supply integrating into your drug system, your illicit drug system, or has decriminalization made it so that toxicity did not come to Portugal as much as it has come to other places?

J. Goulão: Thank you for your question. Well, in fact, I would say that the vast majority of our drug problems are still related to the classic substances and, of course, there are a lot of cuts in the substances, in the products that are sold. The response that we tried to install in the last years is to have the availability of drug checking for users, so they can have an idea of the composition of the product that that they are going to use.

For now, we are quite happy with this system. It's quite helpful. As you can see, we have a very low number of overdose deaths. It isn't doesn't mean that we don't have dangerous products circulating.

We are still facing…. The vast majority of the problems are related, still, to heroin. We developed the availability of nasal naloxone. We are training the users, so nasal naloxone is available in the community of users. This, along with drug checking, has allowed us to keep the numbers very low in relation to overdoses.

Of course, there are a lot of unknown products circulating that are very, very difficult to identify. But in comparison with other European countries, these products are not very popular. We are happy with this, but we try to prepare the best that we can. For instance, fentanyl has not been identified on the street here in Portugal, but we try to prepare, because we know that sooner or later, it will come to us as well.

[11:25 a.m.]

P. Alexis: I do have a couple of questions, but I'll start with one. Could you please define treatment? What does that look like, and

to us as well.

P. Alexis: I do have a couple of questions, but I'll start with one. Could you please define "treatment"? What does that look like, and do you do anything differently than other countries do with respect to treatment?

J. Goulão: Honestly, I don't know if it is different from what other people do. We have quite a solid network of ambulatory centres where people can have different modalities not only with the substances that they use but mostly with the personality and the personal conditions that people have.

The driver for the development of this network was, some years ago, the epidemic on every news. We had a lot of discussions, and one of the needs that was identified before the national strategy of '99 was to have a clear option, a clear adoption of the utility of substitution treatment. Even among us professionals, there were different positions about use of methadone or buprenorphine. So we needed to have a clear definition.

In our strategy of '99, it's not said that you should treat heroine users with methadone, but it is said that substitution treatment — it was the term at the time — should be available and used were needed and be sought as a legitimate tool to deal with opioid addiction. So along with opioid substitution treatment, which is available very easily not only in treatment centres but also in low-threshold harm reduction facilities, people can access, very easily, to methadone. That in my view, contributed precisely to the drop in overdose deaths.

Along with this, we have psychological support. You may need an inpatient treatment residential in a therapeutic community, where you learn how to live in society with the others. We can have a clear idea of your limits and the limits of the others.

So we have quite a large availability of therapeutic communities with different models, a broad range of models of intervention. What they have in common is that to work on the field, they need to have a licence. They need to comply with some rules. The first of all is having a multidisciplinary team and the psychiatric responsible. There are a lot of conditions even in terms of the place, the building where it works.

Prior to assuming the regulation by the state, we had real problematic responses, even in terms of human rights, respect. But nowadays we have quite good standards for it. It's very smooth to move from the different kinds of responses in terms of therapeutic communities.

[11:30 a.m.]

For instance, we have…. Some of them are addressing mostly minors, for instance, pregnant women with a little child. Therapeutic communities for addressing, mostly, the elderly, which pose a different kind of

addressing mostly minors, for instance, pregnant women with a little child. Therapeutic communities for addressing, mostly for the elderly, which pose different kinds of concerns, namely in terms of general health, general health care….

In terms of treatment and the outputs of the treatment, our aim is to have…. We are dealing with a chronic relapsing disease. Our aim is to have people living in balance with their disease. We do not assume we want to cure you. We want to have you functional, able to have your role in society, to raise your family, to have your kids, to have your home. When something goes wrong, we are here to support you again. We do not turn out. We do not punish you for relapsing in specific circumstances.

I don't know if you….

N. Sharma (Chair): It's good, yeah.

P. Alexis: Thank you. No, it does. Thank you.

S. Bond (Deputy Chair): Thank you very much for your presentation. There are few things that are talked about more than the Portuguese model when it comes to talking about how we, around the world, have to address these issues in our provinces and our jurisdictions.

One of the things that has been critical to me…. I have listened to you on a number of programs and other ways. If you are going to use the model that you use, isn't one of the absolute critical pieces the accessibility of treatment? If you are going to say to a person, "Are you willing…?" After they have been to their commission for dissuasion, isn't…? A variety of models, which I was appreciative of hearing. But isn't accessibility the critical feature? I think, coupled with the fact that decriminalization in and of itself isn't the answer…. It's a package of things.

Maybe just speak to the need for access to treatment. If you can't get treatment — we have wait-lists and all of those things — how does this model work?

J. Goulão: Thank you for your question.

The answer is exactly that. When I said decriminalization is just a part of it…. It doesn't work if the rest of the intervention is not present.

Usually people think…. Okay. In Portugal, in 2000, '99, they decided to build a model standing on decriminalization, and then they developed a treatment network. It's not the case. It was not like that.

The treatment network was almost ready. It was quite available, quite solid. Decriminalization was the next step to turn everything more coherent, with the idea that we were dealing with a health condition rather than a criminal one. It's critical to have a solid response in the health system addressing those problems.

In our case — I'm happy also to say this — there's a very close connection between the harm reduction responses and the treatment responses. People may access either of those kinds of responses, according to the phase of their lives they are living.

[11:35 a.m.]

We were talking about substitution availability. We have treatment programs using methadone or buprenorphine. There's a lot of conditions to keep following those treatments. For instance, in treatment facilities, people who are using methadone may be submitted to urine samples to understand if they are using other illicit

those treatments.

For instance, in treatment facilities, the people who are using methadone may be submitted to urine samples to understand if they are using other illicit drugs or not. But there are low-threshold programs of methadone, where people can address, even if they are still using other kinds of drugs, and have access to methadone. In accordance with the phase of their lives, they may benefit from one of others, easily accessible, in any case, with no big waiting lists.

Nowadays, after the pandemic, we are facing some difficulties to come back to the same availability of response that we had before, but we are recovering for from that as well. This is critical — to access treatment easily.

M. Starchuk: Thank you, Doctor, and thank you for your presentation. I find I find the comment that fentanyl has not been identified in your system as shocking and curious, as to where you would be waiting for that to come.

My question goes back to drug checking. It's fairly clear that you've got 70 percent of the people that are seeking treatment on opioid substitution therapy therapies. But with regard to the drug checking, is that for the user, or are you taking it down the notch and are you going out to, or trying to locate, those traffickers that are on the street to check the drugs that they're selling to users?

J. Goulão: Thank you for your question. We are trying to use both routes. On one side, we have established some protocols with academia, in the forensics, in order to very rapidly identify, in samples of the apprehended substances, what is really circulating. We also use residual syringes and needles that are used in the needle exchanges to try to identify new substances. But of course, this demands some resources that only academia can provide.

Then we have close…. For injecting facilities, for instance, we have a van with a mobile lab where users can provide a small sample of the product they are going to use in the next minutes, and they have a rough evaluation of the purity and the composition of the product they are going to use.

So we are trying to develop a more demanding and more accurate system in academia and the forensic and a very rough evaluation of the products closer to the point of use.

D. Davies: Thank you very much for joining us. It kind of follows…. Again, very surprised around the fentanyl discussion. I just kind of want to go back to….

You talk about testing. I'm just wondering if there is a correlation, because fentanyl is an issue in the U. K. There are some pockets in Europe where it is an issue, but it's very interesting to hear that in Portugal, it seems to be…. There's almost this anomaly, so there's got to be some correlation with what you're doing that has created this little safer area. It is it a combination of the decriminalizing of a certain amount? Is it the testing? Do you have a safer supply that is also part of part of your program?

I'm just trying to wrap my head around exactly how you've avoided fentanyl, certainly, as a major problem.

[11:40 a.m.]

J. Goulão: I must confess that for me, it is also a surprise. I was expecting to have fentanyl present in our streets. In fact, very recently I had the opportunity to visit several

this is for me it is also a surprise, you know? I was expecting to have fentanyl present in our streets.

In fact, very recently, I had the opportunity to visit several drug-checking facilities, and that's stuff I know that the police has intercepted — how do you call package sent by mail? — by common mail, fentanyl addressing Portuguese people. So I was expecting to see it already on the street, but it was not identified, nor in the drug-checking facilities. If I had the opportunity to ask drug users, those who attend the safe injecting rooms, "have you seen, have you been with people who are using fentanyl; do you know if it circulates in our market?", they say: "No. It's not present."

We do not have a specific strategy addressing this once it's not. What we are preparing is the availability of nixoible, having this this capacity to intervene if needed. But, in fact, I'm sure it will come. In some of the European countries, it has been exploding in the last few years. That's the case in Scotland, for instance, where there's a lot of overdose states related to fentanyl. Well, we're lucky with that. That's closed fingers.

N. Sharma (Chair): I have a question before we go to the next round. I see more hands up.

Thanks so much for your presentation. I was just really curious to understand at what point the harm reduction strategies step in. Is it when somebody is caught with some amount for possession and goes the administrative route? Are there programs on the ground that do it? Then, coupled with that, I'll just say that one of the discussions we've been diving into is the medical profession and the pharmacists and the professional bodies that we would rely on at this stage to give prescribed safe supply or the methadone, administer it, and the kinds of things we hear from drug users saying that the way that that is administered or "the way that I have to receive my methadone makes me drop off, so I don't do it anymore."

I just want to know: what does it look like in Portugal? Is it pharmacists across the country that are administering the methadone? Are there mandated requirements for professional bodies to have to participate? That kind of thing.

J. Goulão: Well, thank you for the question, but I'm not sure that I understood exactly what you are asking.

N. Sharma (Chair): Sure. Let me try again.

J. Goulão: Because I know that there's a discussion about safe supply of different substances, in our practice, safe supply is different from substitution treatment, okay?

Our main concern at the time was heroin use. What we tried was to make safer medicines instead of drugs. In Portuguese, we are happy to have different words for — one thing is a drug, an illicit drug. Another one is medicaments, medical. We keep the idea, and we try to educate the drug users, that one thing is taking a drug without any kind of control on the street. You buy whatever is available.

[11:45 a.m.]

Or you have a substance that is medicine, that is prescribed by a doctor according with your history of drug use, with your weight, with your medical conditions. So you can take this safely without

according with your history of drug use, with your way with your medical conditions. You can take this safely without fearing to have any kind of dangerous episode.

Another kind of thing is thinking about having, for instance, cocaine available — pure product to deliver to cocaine users instead of having them using the street products. Okay? I think this this is one kind of discussion that you are having about making available the products that the person is using but making it safer.

Honestly, I have some doubts about this procedure. I have visited — for instance, in Switzerland — facilities that provide heroin. They do not substitute with methadone or buprenorphine. They provide, to the opiate users, the heroin itself. This is a very, very demanding project, very much invested in terms of social — and else — support. As far as I know, the outputs for those programs are not brilliant. I'm not really enthusiastic about the use of the substance itself. But, yes, about the availability of the treatment that helps people to live and to stop using the substance or substances…. I don't know if….

N. Sharma (Chair): Yeah, thanks for that. But I guess my question was: do doctors and pharmacists and…? Who delivers the kind of treatments that you give to drug users? Is there a problem with participation when it comes to your health care professionals?

João Goulão: No, as I said, we have we have a network of centres that deal with these problems. The assessment, for instance, to methadone prescription is exclusive of those centers. Okay, so everybody who is introduced in substitution treatment with methadone is observed by a doctor, and the doses are established by the doctor. Until the person stabilizes and feels comfortable with the doses, he has very, very successive consultations until it stabilizes. Methadone that is delivered in Portugal is bought by SICAD — by my service. We launch, every year, a public international context for the providers — for pharmacists and for pharmas.

[11:50 a.m.]

I just signed the contract for next year, and it is a German company that has won the contest each year. It varies with the prices that they offer and the conditions that they offer. Once it is it is delivered to Portugal, it goes to the military lab, the laboratory of the armed forces, where it is added to the excipient — to the liquid. Then it is distributed nation-wide under military custody to the centres of treatment.

N. Sharma (Chair): We have ten minutes, and I think I see four hands up for more questions

and then it is distributed nationwide under military custody to the centres of treatment.

N. Sharma (Chair): We have ten minutes, and I see four hands up for more questions. We'll try to get to as many as we can. I know it's late there.

P. Alexis: I'll try to be brief. You mentioned it, but my question is with respect to investment. In 1999, you had 1 percent of the population that had the issues that led to the changes that you were making. I want to ask: was it a significant investment?

Of course, it was very different than past practice. But you're now looking at success, at 0.33 percent who are suffering, and perhaps less appeal or less numbers of people — your constituents or your society — are as engaged or as interested in making these investments any longer. So how are you going to tackle that? Obviously, what you've done has created that lesser percentage of those impacted, but it's going to take maintenance of the program. So how are you planning to convince the masses that that investment is still necessary?

J. Goulão: That is a very good question. One of the classic questions that I usually get is: was there a movement of the budget from the justice side into the health and social side? In fact, no. No. Justice and the prison system, for instance, kept their budget, but as they have a lesser population, their conditions improved a lot. But it's standard there.

The investment on the health side increased very slowly, step by step, but it's very, very modest. In fact, I must say that nowadays the investment, the national budget addressing this area under the Ministry of Health, is 75 million euros a year. This is a very cheap model. In any case, the numbers, the epidemic or narrowing the visibility, everything decreased. But instead — and this was a political decision — of having a downgrade in the services available, we included other pathologies in it.

In 2009, we included, in the mandate of the services, the alcohol problems, and more recently, in 2013, we included a gaming, gambling screen. So we have the same professionals available and busy with new pathologies that were included in our mandate, instead of sending them out or cutting the budget. There's not a big investment nowadays, new investment, but we are still dealing quite adequately with the needs that we have.

R. Leonard: Actually, Pam sort of gave an introduction into this topic that I wanted to talk about too, around investment. You said that treatment was pretty much in hand, in terms of being available, when you introduced decriminalization, but you had a really high percentage of the population who were in trouble with their drug use.

So can you talk about that lead-up to the decriminalization and the access to treatment and the kind of investment that had to be made across the country?

[11:55 a.m.]

J. Goulão: Let me just say that decriminalization and this process of the commissions that I told you about is kind of a supplementary gateway for the treatment system, because people, prior to that, could access the treatment system directly, and nowadays they still can go

this process of the commissions that I told you about is a kind of a supplementary gateway for the treatment system, because prior to that, people could assess directly to the treatment system, and nowadays they still can go spontaneously. They just knock on the door, and they do not need to go through this via the commissions. This is a supplementary gateway, and people are quite confident. Even politically, there's a consensus.

I told you that when we discussed, in 2000, the decriminalization law, there was a bipolarization, with left-wing parties supporting the idea and the right wing opposing or having some concerns. Nowadays there's a broad consensus. Even those who voted against at the time nowadays say: "Okay. It was a good decision." There's a broad consensus, a broad political consensus, nowadays about the drug policies that we have followed in Portugal. Nobody opposes the investment that needs to be made. So we have no big queries about keeping the staff, keeping the facilities. Everybody is, in spite….. Socially, people….

Let me just, to finish…. In '97, in the Eurobarometer — it's a kind of a poll made to citizens on the street — drugs and drug addiction were identified as the main concerns of the Portuguese people. When asked, "What is your main concern about the future of your children?" people would say: "Drugs and drug addiction." Nowadays drug addiction ranks 14th. People talk about unemployment, any kind of difficulties — the war, COVID, whatever. What about drugs? "Oh yes, drugs." It's not the problem that jumps immediately…. I think it is a good….

Of course, we did not solve all the problems of drugs in Portugal — far from it. But we are quite comfortable with the policies that we have developed and the possibility to develop new responses if needed.

N. Sharma (Chair): We have two more questions here. Is it okay if we take you past the time a little bit. I don't want to take up your time in the evening.

J. Goulão: No. It's okay. No problem.

N. Sharma (Chair): It's okay? Okay. We'll take these final two questions, and then we'll go to recess.

S. Chant: When you spoke about the public discussions in 1997, two of the concerns were drugs tourism and the early use of drugs. Has there been any data back to say whether there's been impact in those areas?

J. Goulão: In fact, the drugs tourism did not happen. We did not have people…. We did not start to have people coming to Portugal just to use. We can see, in fact…. The example is Amsterdam. It's known because people go there to…. It did not happen here at all.

On the other way, the early onset of drug usage, on the opposite…. There's a delay in the onset of experimentation, even of cannabis, for instance. We have seen…. In those days, '98 and '99, kids started to use around ten, 11 years old. Nowadays most of them experiment around 15, 16 years old. So it's not brilliant, but it's much better than at the time.

S. Bond (Deputy Chair): Just very quickly, I wanted to reflect on the fact that the government actually created a panel, you said, in 1998, bringing together people — I'm assuming experts on the subject, including yourself — to work together to create the strategy.

[12:00 p.m.]

One of the key things that you have talked about…. I know that when you visited British Columbia you mentioned this as well — the fact that there has to be coordination. There has to be collaboration between agencies. It needs to be led by people who are experts in

to work together to create the strategy.

One of the key things that you have talked about — I know that when you visited British Columbia, you mentioned this as well — is the fact that there has to be coordination, there has to be collaboration between agencies. It needs to be led by people who are experts in the subject.

Can you just speak briefly to the pre-strategy panel that was created, and the need, also….? We've heard a lot of people talking about the lack of coordination. It's very much a stovepipe approach, we've heard in many presentations. So can you just speak to the need for agencies, organizations, governments, communities to work in the way that you reflected in your diagram, but also the pre-panel that was created?

J. Goulão: Well, the panel was an initiative from the government, and the invitations were made to nine people. We were nine from different areas. There was only one person that had no experience related to drug issues, and this was the president. He was a scientist that just came from Stanford, where he was teaching. He had no experience on drug issues, but he had a lot of experience in leading working groups, and he was brilliant. He is now a parliamentarian of the Socialist Party nowadays.

Then we had two judges, two psychologists, three psychiatrists, me as a GP — I'm a family doctor. I can't remember immediately, by heart, but we were we were coming from different backgrounds. It was very important. The president distributed the tasks. I wrote the chapter on treatment and harm reduction. Others developed a team of prevention. The legal proposal came from the judge. It was very interesting.

Nowadays when we meet at the level of the coordination bodies, I have…. As I said, I am the national coordinator on behalf of the Minister of Health, who is the political responsible. Each one of the ministries nominates someone that articulates with the services within the ministry. For instance, I have a representative of the Ministry of Justice that represents not only courts, judges and all the judicial system but also the prison system.

We articulated…. What we decide, what we put on the documents, on the action plans, is discussed within each one of the ministries. So when they assume, when they approve a document that is built by all of us, it has an implicit commitment of all the services that are under this ministry.

When we make the follow-up, the evaluation of what has been done, what has been left behind, what happened…. For instance, one of the big issues that we had as a commitment was to develop work preventive and early identification of problems. We did it in the workplace, and we noticed that no, there's nothing being done there. We need to work, to assume and to produce legislation to the early detection and the way to address, to relate people to the adequate responses.

[12:05 p.m.]

Then we made a push on that. One of these, two years ago, we made…. On the 26th of June, the day of the drug…. The thing was drugs and workplace — big conference, big discussion. Since then, in only one year, we could produce the legislation that we

Two years ago we made the 26th of June the Day Against Drug Abuse. The theme was "Drugs in the workplace." It was a big conference, a big discussion.

Since then, in only one year we could produce the legislation that we were lacking — namely, on how to proceed with testing, and where is it possible or not possible? What kind of privacy should we keep? What should plane pilots be obliged to do or not? — things like that. There was a good launch of a discussion, and nowadays we have arrived to consensus, to the approval by the required bodies in the government, for the legislation.

I don't know for sure if this is the kind of response you were awaiting from my side.

N. Sharma (Chair): Yes. She's nodding her head.

I just want to say, on behalf of the committee, thank you so much for the presentation on your work. You started by congratulating us for stepping into the state of decrim and what that process looks like. I know I learned so much about what it looks like in Portugal and what your successes were.

Of course, our challenge is different here in some ways, but the model is certainly one that shows a lot of compassion and that supports people through a health challenge. Thanks so much for teaching us about that. We wish you a good evening.

J. Goulão: Thank you, Madam Chair. I hope that you can move and deal with the dramatic situation that you are facing there with the opioids. Let me just end by saying that I believe that you also have a kind of a window of opportunity, because this epidemic of opioids is so distributed in all social classes, in all the families, it is probably a good moment to move into a more humane and compassionate policy. Thank you. It was really a pleasure to be joining you. Have a good day.

N. Sharma (Chair): Have a good evening. Thanks a lot.

Committee, we are in recess until one o'clock.

The committee recessed from 12:08 p.m. to 1:01 p.m.

The committee recessed from 12:08 p.m. to 1:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, I just want to welcome our next speakers to our committee today.

We have Shannon Nix, associate and assistant deputy minister, controlled substance and cannabis branch of Health Canada; Jennifer Pennock, director of the substance-related harms division, the Public Health Agency of Canada; Christina Simpson, acting executive director of the opioid response team of Health Canada; and Carol Anne Chenard, acting director general of the Controlled Substances Directorate, Health Canada. I think I got everybody there — long titles.

Welcome. My name is Niki Sharma. I'm the Chair of the Health Committee and the MLA for Vancouver-Hastings. Thanks for joining us today. I'm just going to do a quick go-around so everybody can introduce themselves. I'll start with the Deputy Chair.

S. Bond (Deputy Chair): Good afternoon. Thank you for joining us. I'm Shirley Bond. I'm the MLA for Prince George–Valemount, and I am the Deputy Chair.

S. Chant: My name is Suzie Chant. I'm the MLA for North Vancouver–Seymour.

M. Starchuk: Good afternoon. Mike Starchuk, MLA, Surrey-Cloverdale.

P. Alexis: Hi there. Pam Alexis, MLA, Abbotsford-Mission.

D. Routley: Hello. Doug Routley, Nanaimo–North Cowichan.

R. Leonard: Good afternoon. I'm Ronna-Rae Leonard, MLA for Courtenay-Comox.

D. Davies: Hi. Good afternoon. Dan Davies. I'm the MLA for Peace River North.

N. Sharma (Chair): I'll just pass it over to you. Before I do, I'll let you know you have about 30 minutes to present, and we have all the information that you've sent in, in front of us. After that, we'll leave the time for questions and answers. Over to you.

HEALTH CANADA

S. Nix: Thank you. It's a pleasure to meet all of you, and I really appreciate the opportunity to appear before the Select Standing Committee on Health. I would like to begin by acknowledging that I'm joining you today from the unceded traditional territory of the Anishinaabe Algonquin Nation. You've introduced all of my colleagues, which is great. So I'll just dive in.

The federal government and I think, indeed, governments across Canada are deeply concerned about the devastating impact of the overdose crisis on communities across the country. Today I'm here representing Health Canada, but federally, there are more than 15 departments that are directly or indirectly involved in the response to the overdose crisis.

Far too many lives have been lost to drug overdoses, and this crisis is, first and foremost, a public health issue. The approach that we've taken in our response is premised on that understanding.

I understand that you've heard from many witnesses who have talked about the crisis in B.C., but I also think it's useful to situate B.C.'s experience within the broader national picture. I'd like to then provide you with an overview of federal actions and interventions that we know are making a difference in terms of saving lives, and then, finally, I'd also like to speak to you about some of the innovative approaches that we're exploring.

[1:05 p.m.]

As you all know, we've been dealing with a mounting overdose death crisis, notably for the last six years, since B.C.'s declaration of a public health emergency in 2016. Tragically, since 2016, 29,052 Canadians have lost their lives to drug toxicity. In 2021, we saw a rate of approximately 21 deaths per day and the highest annual death count on record. B.C. has been

declaration of a public health emergency in 2016. Tragically, since 2016, 29,052 Canadians have lost their lives to drug toxicity. In 2021, we saw a rate of approximately 21 deaths per day and the highest annual death count on record.

B.C. has been particularly affected, accounting for approximately 30 percent of all drug toxicity deaths in Canada. Your province's declaration of a public health emergency in April 2016 brought attention to the issue and acted as a catalyst for the response across the country. Having said that, obviously in recent years, particularly through the pandemic, we've seen significant increases in drug toxicity deaths across multiple other jurisdictions, making the crisis truly national.

Moving to slide 4. The modelling, sadly, suggests that the trend of high rates of overdose deaths may continue. I'll draw your attention to the purple line. We know that public health interventions work. However, the state of toxicity of the illegal drug market in Canada continues to worsen.

As this committee is well aware, the drug crisis has been driven by an increasingly toxic illegal drug supply, with fentanyl dominating the market. The illegal supply of drugs is increasingly tainted with even stronger opioids like carfentanil, isotonitazene and etonitazene. We're also seeing more contamination with multiple substances, such as stimulants and benzodiazepines mixed with opioids. While this not only increases the risk of overdose for people who consume these substances, this also impacts the effectiveness of life-saving interventions, like naloxone, that we've come to rely on.

Moving to slide 5. But the deaths alone don't tell the full picture of the impact of the crisis on the health care system. The number of drug poisoning hospitalizations and emergency medical services responses to suspected drug-related overdoses have also increased significantly over the years, putting weight on an already overburdened health care system.

Slide 6. As you've heard from previous witnesses, while anyone who uses drugs is at risk of an overdose, given the toxicity of the illegal supply, there are factors that influence who is most at risk. Some populations — such as young and middle-aged men, Indigenous populations, people experiencing homelessness and people living with chronic pain — have been disproportionately impacted by the overdose crisis, reflecting the need for targeted interventions. It's important to understand these factors, as it helps tailor our responses.

Slide 7. The compounding impacts and effects of stigma further impact people who use drugs. I know this committee is well aware of the harms of stigma, and the province of B.C., in particular, demonstrates considerable leadership in its efforts to reduce substance use stigma. I want to acknowledge those efforts, but it is important to reinforce the impact of stigma.

Stigma is a barrier for all people who use drugs. It can deter them from seeking treatment and harm reduction services, and it can lead them to using alone. Stigma can also drive policies that prevent people from seeking help and accessing support.

I'll transition through slide 8 to slide 9 and talk a bit about the federal response. Last October, the Prime Minister named the Hon. Carolyn Bennett as the first federal Minister of Mental Health and Addictions. This reflects the seriousness with which the government of Canada is approaching the issue.

As I've noted previously, our approach is based on an understanding that substance use is, first and foremost, a health issue. In this regard, pursuant to Minister Bennett's mandate letter commitment, Health Canada continues to advance a suite of key initiatives aimed at providing national leadership on the overdose crisis while working with our federal-provincial-territorial partners to provide support to those who need it. Across those commitments, we also continue to examine the full range of options and evidence to reduce overdoses and save lives.

Slide 10. Federal actions to date have been guided by the federal drug strategy, also known as the Canadian drugs and substances strategy, or the CDSS for short. The CDSS takes a public health–focused approach. It lays out a framework for evidence-based actions to reduce the harms associated with substance use in Canada. It includes four key pillars — prevention, treatment, harm reduction and enforcement — and is supported by a strong evidence base.

Slide 11. Provinces and territories have a range of tools and authorities to address the ongoing overdose crisis in their respective jurisdictions. For example, provinces and territories fund and deliver the majority of direct social and health interventions that support people who use drugs. However, altering the course of the overdose crisis will be challenging, and there's no single organization or government that can solve the crisis alone.

[1:10 p.m.]

There are several levers that the federal government has used and will continue to use to complement the efforts of the provincial government and the First Nations Health Authority in B.C. We have established federal-provincial-territorial governance tables, including the committee on substance

there's no single organization or government that can solve the crisis alone.

There are several levers that the federal government has used and will continue to use to complement the efforts of the provincial government and the First Nations Health Authority in B.C. We have established federal-provincial-territorial governance tables, including the committee on substance use, to facilitate ongoing collaboration and consultation with and among our provincial and territorial partners. The province of B.C. is our co chair on this committee, and I would really like to acknowledge their great collaboration and leadership at that table.

In addition, engagement with civil society organizations, direct care service providers, academics, people with lived and living experience and other key stakeholders continues to inform federal actions. Of note, over the last several months, Minister Bennett has undertaken a number of engagement events across the country, including in B.C., to hear from and engage with experts, including people with lived and living experience.

Since 2017, the government of Canada has invested significant commitments of over $800 million across a wide range of measures to respond to the overdose crisis. The priority is to save lives. This is why, as you can see from the slide, the vast majority of our investments have been directed towards funding treatment and harm reduction interventions, mostly through bilateral transfers with the provinces and territories, and then also with grants and contributions for community-led actions.

Moving to slide 13, the province of British Columbia has benefited from this investment with close to $34 million in direct transfers to support treatment services through the emergency treatment fund. This investment was also cost-matched by the province. We have also allocated $66 million in contributions funding to support community-led initiatives through the substance use and addictions program.

Additional grants and contributions funding has also been provided by the Public Health Agency. For instance, the pathways to care program supports initiatives aimed at catalyzing system-level change to reduce the barriers to care for people who use drugs. In particular, this program has been a key initiative in reducing barriers posed by stigma.

I should note that these are just examples that reflect investments that are directly related to the overdose crisis.

Moving through slide 14 to slide 15, focusing on key federal actions. Since 2017, over $43 million has been spent on awareness, prevention and stigma-reduction activities in direct response to the crisis. A large amount of the money has been spent on various targeted campaigns to raise awareness of opioids and the Good Samaritan Drug Overdose Act and to reduce the stigma surrounding substance use.

More recently we have launched a new targeted campaign that will be rolling out over the next few months to help promote help-seeking behaviour amongst men who are working in the trades and to facilitate linkages to resources and supports for this group, which has been particularly affected by the crisis.

We are working with our partners to provide stigma awareness training so that people better understand substance use issues and the impacts of stigma on people who use drugs. Working with people with lived and living experience, we're also making efforts to change the language used to talk about substance use in Canada. For instance, we have developed a lexicon of non-stigmatizing language that promotes person-first language and respectful conversations about substance use. In addition, the chief public health officer is working in partnership with health professionals across the country to address stigma within the health system, and a resource has been developed specific to the health care community.

Recognizing the significant intersections between unmanaged pain and the opioid overdose crisis, we established, in 2019, a Canadian Pain Task Force to gather evidence and conduct national consultations to better understand the best practices and areas for improvement to better prevent and manage chronic pain. In May 2021, the task force published its final report, which included over 150 recommendations for priority actions to help improve the health outcomes of people living with pain. Health Canada continues to work with federal partners and pain stakeholders to support priority actions identified by the task force in its final report.

As I mentioned earlier, Budget 2018 allocated $150 million in emergency treatment funding to provinces and territories, obviously for the provision of treatment services and for substance use disorders, with investments being cost-matched by provincial and territorial governments. This represented a total investment of over $300 million to enhance the treatment services from coast to coast to coast.

[1:15 p.m.]

This collaborative initiative supported many individuals accessing services across British Columbia. Notably, this investment expanded access to opioid agonist therapies and

of over $300 million to enhance the treatment services from coast to coast to coast.

This collaborative initiative supported many individuals accessing services across British Columbia. Notably, this investment expanded access to opioid agonist therapies, and increased the capacity and accessibility of injectable opioid agonist treatment. It supported the establishment of 25 residential treatment beds in the province, in addition to building health system capacity and expanded telehealth for substance use services. It expanded treatment capacity across all Foundry sites in the province to improve access to mental health, substance use and primary care services for youth in B.C., and it support the establishment of new rapid access addiction medicine, or RAM clinics.

We're also leveraging the substance use and addiction program to support innovative models of delivery of treatment services, but funding isn't the only tool that Health Canada has leveraged to facilitate access to treatment. We've used our legislative and regulatory authorities to remove the barriers to providing people with pharmaceutical grade alternatives to the toxic illegal drug supply, authorized new medications that can be used to treat substance use disorders, such as authorization to diacetylmorphine, and authorized eligible health care practitioners to administer supervised injectable opioid agonist therapies outside of a hospital setting. We've also provided guidance and leadership on prescribing, dispensing and the delivery of opioids and other narcotics, and the treatment guideline for opioid use disorder.

The Government of Canada is committed to actions that prevent overdoses and save lives, given the risks posed by the highly toxic illegal drug supply. Expanding access to safer supply is a key component of this. The federal government has taken a number of steps to help support the expansion of safer supply in the country through SUAP, or the substance use and addictions program, Health Canada has committed nearly $73.5 million over five years to support 25 pilot projects on safer supply services.

These include eight safer supply projects in B.C. — five in Vancouver, two in Victoria, and one in Nanaimo. We've also been addressing the federal regulatory barriers to help improve access to medications used in the treatment of safer supply. For example, we've approved new indications and medications for the treatment of severe opioid use disorder. We've facilitated prescribing of some medications used in treatment and safer supply through regulatory amendments and exemptions. We have encouraged better care for people who use drugs with a full spectrum of options, including the prescription of medications. For example, through an open letter from our previous Minister of Health to our provincial and territorial counterparts and the regulatory colleges.

Safer supply is an emerging practice, and research into its implementation and outcomes is critically important. To help grow the knowledge base, the Government of Canada provided funding for safer supply pilot projects through the substance use and addiction program, and is supporting two assessment and evaluation programs related to SUAP-funded pilot projects. We've also established an expert advisory group of external experts to provide advice on the scaling-up of safer supply services across the country. Recognizing that the delivery of health services is primarily a provincial and territorial responsibility, the information gleaned from these activities is intended to advance the scale-up of effective models at the provincial, regional and municipal level.

Supervised consumption sites are another critical component of the Government of Canada's strategy to address the overdose crisis. As you may know already, in order to legally operate a supervised consumption site in Canada, an exemption under the Controlled Drugs and Substances Act is needed so that people within the site are not at risk of being charged with possession of controlled substances.

In 2017, the Government of Canada made legislative changes to the Controlled Drugs and Substances Act to streamline and simplify the application process for supervised consumption sites under subsection 56(1), and we took efforts to work with communities to help them through this process. Since then, the number of supervised consumption sites in Canada has grown from two in 2017 — Insite and the Dr. Peter Centre, both in B.C. — to 39 across the country.

[1:20 p.m.]

These range considerably in size and scope, and many have provisions in their exemptions to allow for drug checking and peer assistance and splitting and sharing of drugs. We do gather information from most of these sites, and through this, we know that between June 2017 and

39 across the country. These range considerably in size and scope, and many have provisions in their exemptions to allow for drug checking and peer assistance and splitting and sharing of drugs.

We do gather some information from most of these sites. Through this, we know that between June 2017 and June 2022, they received close to 3.6 million visits, reversed some 40,000 overdoses without a single death and provided almost 185,000 referrals to health and social services.

We've also issued exemptions to allow for urgent public health need sites or overdose prevention sites, which are sites that can be set up quickly and may not necessarily offer the full suite of services that you might find in the supervised consumption site. During COVID, we actually issued a class exemption to all provinces and territories so that they could establish new urgent public health need sites without having to apply to Health Canada directly. In the face of the overdose crisis, this class exemption has since been further extended to September 2025.

Slide 21. Whilst take-home naloxone kits are also available at pharmacies and local health authorities across the country for anyone who is at risk of overdose or is likely to encounter one, Health Canada also recently provided $20 million in funding under SUAP to increase overdose awareness and improve access to distribution of naloxone. Funded projects are being implemented across the country in communities where these kinds of initiatives are most needed based on gaps and barriers. In addition, Indigenous Services Canada has helped to support naloxone distribution training and use in First Nations and Inuit communities.

Slide 22. We're supporting other promising harm reduction interventions such as virtual consumption sites that, in particular, provided invaluable support to people who used drugs during the pandemic and were unable to access in-person supervised consumption sites or overdose prevention sites. Then, drug checking services are another promising intervention that we're exploring through a number of different SUAP-funded projects.

Slide 23. As I mentioned previously, the federal government considers substance use, first and foremost, a health issue. To that end, we've taken steps to help divert people from the criminal justice system and, instead, towards the help that they need. The Good Samaritan Drug Overdose Act of 2017 allows for people to call for assistance during an overdose without fear of arrest. The Public Prosecution Service of Canada has issued guidance to consider alternatives to prosecution for personal possession offenses. Bill C-5, which is currently before the Senate, proposes legislative amendments that would encourage the use of diversion measures for personal possession offences.

We're also supporting 14 drug-treatment courts across Canada, including one in Vancouver. The province of B.C. has reported that this program reduces drug-related recidivism by 50 percent over a two-year period and that by March 31, 2021, almost 300 people had graduated.

Moving to slide 24. As one part of the federal government's comprehensive approach to the overdose crisis, on May 31 of this year, at the request of British Columbia's Minister of Mental Health and Addictions, our minister granted a temporary exemption under section 56.1 of the CDSA. The exemption will be in effect for three years beginning January 31, 2023, and covers only personal possession, only possession for personal use by adults 18 and over of up to 2.5 grams of opioids, cocaine, methamphetamine, MDMA or a combination of these. Once in effect, adults found in possession will not be arrested, charged with possession or have their drugs seized. Instead, they'll be provided with information on available services or, if requested, support connecting to those services.

Unless otherwise authorized, all activities other than personal possession with the substances listed within the exemption remain illegal at any amount, even if conducted with amounts under the 2.5-gram threshold.

Youth aged 12 to 17 are still subject to the provisions of the Youth Criminal Justice Act. To support the successful implementation of the exemption, B.C. has committed to actions in six key areas. This includes improving access to health services, providing law enforcement training and guidance, undertaking meaningful engagement with Indigenous peoples, continued consultations with key partners, including people who use drugs, law enforcement and racialized communities, leading effective public awareness and communications activities, and conducting comprehensive monitoring and evaluation.

[1:25 p.m.]

Health Canada and B.C. will be rigorously

people's continued consultations with key partners — including people who use drugs, law enforcement and racialized communities; leading effective public awareness and communications activities; and conducting comprehensive monitoring and evaluation.

Health Canada and B.C. will be rigorously monitoring the exemption to measure progress toward the objectives and to guard against unintended consequences, and there will be a third-party evaluation to garner evidence and data on the impacts and the outcomes of the exemption. This information will obviously help inform both Canada's and B.C.'s ongoing comprehensive approach to addressing substance use harms.

Moving to slide 25, the government of Canada conducts regular surveillance activities that give us information, broadly, on the use, prevalence and impact of substance use in Canada with our Canadian alcohol and drug use survey on the general population and the Canadian student tobacco, alcohol and drugs survey on youth. These long-standing tools give us important information on the prevalence and trends, to support our policy work and to target actions.

More recently with the overdose crisis, we are working with provinces and territories to gather and publish quarterly statistics on opioid- and stimulant-related harms. This gives an overview of hospitalizations, deaths and emergency medical services related to the overdose crisis since 2016, and these statistics are included in our national quarterly updates on opioid- and stimulant-related harms in Canada, which are posted on our website.

Moving to slide 26, we're also collecting and testing municipal wastewater samples to examine the use of 14 drugs such as opioids, fentanyl, cocaine and cannabis in five major cities — Halifax, Montreal, Toronto, Edmonton and Vancouver — over time, through the Canadian wastewater survey. This will help us identify drug consumption patterns across the country.

Other surveys that provide us with relevant and timely information include the new psychoactive substances survey, to support the identification of new drugs appearing sometimes rapidly in Canada, and the people with lived and living experience survey, a new site-based survey that examines the prevalence of alcohol and drug use among at-risk populations — specifically, street-involved youth between the ages of 14 and 25 who use drugs. Of course, there still are gaps in our data and evidence, which we continue to seek to address, including through new content in our surveys and new, timely, shorter surveys.

Slide 27. The driving factors of the crisis are complex and multifaceted, including interrelated social and health-related inequities. The government of Canada recognizes that the social determinants of health — such as poverty, discrimination and trauma — can place people at an increased risk of substance use–related harms and that approaches to reduce those harms, caused by the toxic drug supply, require sustained efforts and supports from diverse systems.

That's why the federal government has also provided significant funding to support the delivery of integrated services and supports across the country. This includes, for example, an investment of $5 billion, announced in Budget 2017, to improve access to mental health and substance use services across the country and more than $2 billion towards various initiatives to address the urgent housing needs of vulnerable populations and prevent and reduce homelessness.

Slide 28. The government of Canada has also made meaningful investments in the mental health and wellness services to support the needs of First Nations, Inuit and Métis people. The federal government has invested nearly $900 million to address the challenges posed by the COVID-19 pandemic, including funding for people experiencing challenges with substance use in mental health; increasing access to virtual services and digital tools like Wellness Together — which is a free online portal where Canadians can access mental health and substance use information and supports; and mental health and trauma support for populations that have been most affected by COVID-19.

Finally, moving to slide 29, this only provides an overview of some of the actions that the federal government has taken to date to address the overdose crisis. We remain committed to working with a wide range of partners to address the crisis on an urgent basis, including by continuing to support innovative, evidence-informed policies and actions, such as safer supply services and innovative treatment services. We recognize that collective efforts are needed to determine the best ways to further support people who use substances, to advance solutions to save lives and to help reverse this national public health crisis.

[1:30 p.m.]

I look forward to answering any questions you may have, as well as to reviewing the final findings of the committee's study on the overdose crisis, once it's completed later this fall. I'll stop there and say thank you.

N. Sharma (Chair): Okay. Thank you, Shannon. We'll go to questions.

S. Bond (Deputy Chair): Thank you very much. I

I look forward to answering any questions you may have as well as to reviewing the final findings of the committee's study on the overdose crisis once it's completed later this fall. I'll stop there and say thank you.

N. Sharma (Chair): Okay. Thank you, Shannon. We'll go to questions.

I see Shirley.

S. Bond (Deputy Chair): Thank you very much. I appreciate the work that you do at the federal level and your presentation this afternoon. I have several questions, but as is our practice, I will ask my first ones and then wait for the next opportunity.

Mine are related to the mandate of the new ministry that was created. I have two specific items I'm hoping you can update me on, because as a committee, we have certainly heard about concerns related to standards in the treatment programs. The mandate letter calls for the creation of standards for substance use treatment programs. Is the intention that that would be a national standard that would be applied across jurisdictions? What is the timeline you think that may occur on?

The second piece related to the mandate letter is related to the creation of a new funding transfer. As I understand it, it is called the Canada mental health transfer — as you can imagine and have referenced in your presentation, inextricably linked, often, with substance use. The goal of that is to expand the delivery of and free access to mental health services. Can you indicate whether or not that transfer will be in addition to the Canada health transfer that currently exists? Will it be additional funding and a transfer that is additional to the one that exists today?

S. Nix: Thank you very much for your question. Starting with the standards work, Budget '20-21 provided $45 million in funding over the next two years to help develop national mental health and substance use service standards in order to address the needs of Canadians, with an emphasis on mental well-being of those most affected by the pandemic. The government of Canada is working with the Standards Council of Canada and provinces and territories to develop national standards so that Canadians can be assured of a standard level of care no matter where they live.

The standards will be available for voluntary implementation by stakeholders and health organizations with responsibility for mental health and substance use service delivery. The Standards Council of Canada will also lead the development of guidance and related resources to support the uptake and implementation of the standards.

Tangible and significant progress has been made over the last decade in developing and advancing the use of best practices in mental health and substance use services and supports, supported by significant federal and provincial and territorial investment. However, many gaps remain to be addressed. Access barriers, inconsistent quality of services and limited front-line workforce capacity are among the factors that make it difficult for people in Canada to get mental health and substance use services that they need. The important work of the Standards Council of Canada will provide a foundation to close this gap, a national approach that will provide a common framework for service delivery.

I should note that there are two standards on substance use under development. The objective of the standard on the substance use treatment centres is to improve access by promoting an integrated and coordinated treatment system. The standard will aim to address the patchwork of existing guidelines in accreditation of treatment centres across Canada, which has led to a fragmented system that has increased the barriers to care.

Then there's the objective of the standard on the substance use workforce. It's to increase the capacity among medical personnel and allied health professionals to provide evidence-based care, including stepped care approaches, via proper accreditation, such as personal certification and training. While clinical guidance exists for these approaches, individual personnel may need to acquire the knowledge, skills and procedures to apply them in their practice. Ensuring a standard level of care for those seeking treatment is just one of the pieces in a multi-pronged approach that's needed to address the overdose crisis.

[1:35 p.m.]

You specifically asked about whether or not this would be a national approach. Yes, it will be. But I would say that participation in the standards development process as well as implementation is voluntary. While the government of British Columbia isn't currently participating in the government advisory table that the Standards Council of Canada has established, the Standards Council is continuing to provide updates, and provinces and territories are welcome to join at any time through this process.

With regard to your question about the Canadian mental health transfer

of British Columbia isn't currently participating in the government advisory table that the Standards Council of Canada has established. The Standards Council is continuing to provide updates, and provinces and territories are welcome to join at any time through this process.

With regard to your question about the Canadian mental health transfer, I would say the government is committed to supporting the mental health needs of Canadians. This commitment is obviously reflected in a suite of existing pandemic responses, as well as new initiatives. The government has mandated the first federal Minister of Mental Health and Addictions with ensuring that mental health is treated as a full and equal part of the universal health care system. A key way to achieve this objective would be through the establishment of a Canadian mental health transfer.

Then the government remains committed to engaging with provinces and territories on the development of the new Canadian mental health transfer to help expand the delivery of high-quality, accessible mental health and substance use services, including for prevention and treatment. And the minister is committed to a robust dialogue with provincial and territorial colleagues, stakeholders and experts from the bottom up to inform how best to advance the transfer. Maybe I'll just stop there.

P. Alexis: I just have a question regarding drug-checking. I think that's on slide 22. There was a competition of sorts that was launched in 2018 with respect to drug-checking machines, I guess you could call them. We did hear from quite a few different health authorities with respect to these machines that are quite cumbersome, not portable, difficult. It seems that that's something we could do quickly that would certainly help.

So can you tell me where this competition of sorts is? And have you accepted some machines that will work for people that are portable? We heard really specific concerns about these particular machines. The floor is yours.

S. Nix: Thank you for that question. I would say, obviously, drug-checking is an important harm reduction tool that allows people to find out the content and purity of the substances before they actually consume them. And so it empowers them to make safer choices, to avoid dangerous substances, to use smaller amounts and to avoid maybe dangerous combinations.

As you noted, we had a drug-checking technology challenge which we launched in October of 2018 with the aim of incenting and advancing technology in the area of drug-checking and as a way to help contribute to addressing the overdose crisis.

We used Impact Canada, which is an organization within our Privy Council Office, and they set up a prize challenge model for us. And so approximately $1.7 million worth of prizes were awarded over three stages to nine different organizations. Then in the end, there were three finalists — Scatr, SpectraPlasmonics and DoseCheck technologies — with differing technologies and business models, and they vied for a final $1 million grand prize, which was awarded in the spring of 2021 to Scatr.

The selection of the semifinalists and finalists, and eventually the winner, was done by a mostly external judging panel comprised of people with lived and living experience, individuals in academia and science, community service providers in the area of harm reduction and individuals from business and innovation sectors.

The three finalists in the drug-checking technology challenge offered different prototypes and applications that interested the judging panel in terms of improvements on what was currently available, in a number of different ways — a bit more portability…. But I think, as you heard from my provincial colleagues, drug-checking runs the gamut from the individual test strips to the big spectrometer machines that require a certain level of expertise in order to be able to understand the results of the technology.

For right now, the size of the machine also has somewhat of an impact on its ability to detect different substances. Some of the smaller machines are not going to be able to detect carfentanil, for example, because carfentanil is often in the drug at such small quantities that it lacks the sensitivity to be able to pick it up.

[1:40 p.m.]

I would say that the one element that the panel appreciated about Scatr's technology was that it didn't require the destruction of the sample that was used for resting. Obviously, a deterrent for people testing

the sensitivity to be able to pick it up.

I would say that the one element that the panel appreciated about scatters technology was that it didn't require the destruction of the sample that was used for testing. Obviously, a deterrent for people testing their drugs is that they don't want to give up a chunk of it to find out what's in it. The technology that scatter was able to showcase was definitely of interest, particularly to people who use drugs.

I would say none of the three technologies that were finalists in the challenge are fully on the market yet. All three groups are continuing to refine their products, and I would say that all three are part of applications that are also currently being considered by our substance use and addictions program.

It's obviously been a year since the end of the drug checking technology challenge. We didn't have a requirement for the finalists or the winner to provide updates to Health Canada, but they've remained committed to working with us to continue to reform their respective devices and give us regular updates on how that's going.

D. Davies: Thanks for the information and presentation. Understanding, of course…. Even the title of your PowerPoint is: "The federal government's response to the overdose crisis." I was just kind of…. It tweaked me a little bit when one part of your slide there was around the prevention and such.

I am just wondering what the federal government is doing on the prevention side. This morning we had a presentation from Planet Youth and the Icelandic program, which was very enlightening, some impressive stuff. I'm just wondering what the federal government is doing, if you could maybe enlighten us, in regards to some of the supports that the province could look at getting from the federal government regarding prevention, some of the research that is being done and, possibly, some of the funding.

S. Nix: Sure, great. Thanks for the question. Maybe I'll start, and I'll see, after I've said a few things, if Christina, who's a bit more of an expert in this area, might want to jump in and add.

We've invested approximately $22.8 million since about 2016 in public education — that tends to be where our focus is — on the risks of opioids, overdose awareness, harm reduction and stigma awareness and reduction. In 2018, we launched the Know More Opioids high school tour that engaged teens between the ages of 13 and 18, via moderated virtual classroom visits across Canada, on the risks of opioids and substance use, and then on the ways to reduce harms, along with the importance of stigma reduction, to support those around them.

We've also pursued a national public education advertising campaign and a digital media advertising campaign to help end stigma around people who use who use drugs and inform Canadians about the Good Samaritan law.

We will also launch a campaign in the fall of this year aimed at men working in the trades, who are disproportionately affected by the opioid overdose crisis, to promote help-seeking and link them to resources and supports and, hopefully, to help reduce the stigma associated with addiction and help-seeking behaviours.

Then we've also introduced new restrictions on opioid marketing to help reduce the opioid overprescribing and launched the stigma awareness training for law enforcement to better understand the substance use issues and the impacts of stigma on people who use drugs. That's a bit of a sense of what we've done on prevention.

I would say that on stigma, in particular, we engage quite extensively with people with lived and living experience of substance use, which we think is key to reducing stigma and barriers. We have a people with lived and living experience council that informs our government policies and programs, helps other government departments and is available to provinces and territories, as well as internationally, to promote and support stigma reduction efforts.

Maybe I'll pause there and see if there's anything that Christina wants to add to all of that.

C. Simpson: Sure. Thanks, Shannon.

[1:45 p.m.]

I think Shannon covered it, actually, quite well. The one thing I might mention is that since 2017, every two years, Health Canada conducts public opinion research follow-up surveys and qualitative research on opioid awareness, knowledge and behaviours. We use this data and evidence to help inform our public education campaign.

quite well. The one thing I might mention is that since 2017, every two years Health Canada conducts public opinion research, follow-up surveys and qualitative research on opioid awareness, knowledge and behaviours. And so we use this data and evidence to help inform our public education campaigns. The data is used in performance indicators in some cases, but we look at it a lot to see how the attitudes around stigmatizing behaviors have changed across Canada, across the public.

N. Sharma (Chair): Go ahead, Mike.

M. Starchuk: Thank you for the presentation. I'm just looking at slide 18, where we're talking about harm reduction and safer supply and the 25 pilot projects, eight of which are in the province of British Columbia. I'm just curious as to what the length of time that's going to be around the pilot project before you come up with some data that says that this is working or this isn't working, for instance.

S. Nix: That's a good question. As you note, we've invested $73.5 million in funding through SUAP for 25 safer supply projects. It includes supporting a range of service delivery projects, research and knowledge transfer and exchange projects, as well as the National Safer Supply Community of Practice.

I would say it's time-limited funding, but it can serve as the basis for developing evidence and helping to establish best practices and the scaling up of successful models. The funding is not really intended to replace funding normally provided by provincial and territorial health care systems and help for health care services. Applicants for federal funding are required to successfully demonstrate a transition period for the period of time following the time-limited funding. And I would say in general…. I mean, the projects vary in terms of length, but on the whole, I would say probably not more than five years in duration.

N. Sharma (Chair): Ronna Rae, go ahead.

R. Leonard: Thanks for your presentation. I congratulate you on being down to the second in your 30 minutes and very clear as you went. So thank you for that.

I just wanted to comment on…. Earlier today, we heard from Portugal about the public support for decriminalization and how overwhelming it was when they stepped into it. And I just heard that every two years, there's a survey happening to inform public education, and it refers to attitudes as well. I'm curious about just what the trends are for that, especially as we've gone through COVID.

But that was actually just in response to what you just said. My bigger question is that we have heard a lot about the urgency and the need for quick action. I recognize the value of pilots, and but we've also faced some criticism around "This is not enough. Things aren't moving fast enough." Pilots usually are a precursor to expanded programs, and I guess I'm looking for some kind of reassurance that we will be moving and give credence to that sense of urgency because of the growing number of deaths. Thank you.

S. Nix: Well, I think, going to your first question…. I don't know, Christina, if you've seen data trends around public acceptance or what have you with respect to decriminalization. Anything that I've seen of late has indicated that somewhere in the neighborhood of 60-odd percent of Canadians are generally in favor. But we could certainly do a little bit of digging, because Christina is shaking her head at me, so I know that she doesn't have any better data than that.

[1:50 p.m.]

I would say, on the question of safer supply, I guess, as I said in my previous answer, this is time-limited funding. The intention of SUAP, the substance use and addiction program, really is to test promising and innovative new approaches and…. I hate to say "pilot them," because I don't want us to be a country of pilot projects, but to test those in order that we can build the evidence base so that they can be funded normally through the health care system and through

and I hate to say pilot them, because I don't want us to be a country of pilot projects. But to test those, in order that we can build the evidence base so that they can be funded normally through the health care system and through the health care services…. I mean, I think that unfortunately, in terms of our ability to support safer supply projects, that's kind of our limitation there.

N. Sharma (Chair): Okay, I have a question. The slide that you had at, I think, page four that talks about the health interventions with the same portion of fentanyl and that the modeling suggests the death rate would worsen, I find this graph really devastating to look at — just the modeling that shows have steeply that line goes up. I want to understand what you mean by health interventions here. Do you mean the existing health interventions?

I guess my real question is: what are we not moving fast enough on, or what are we not doing well enough to make that number go so high? Is it that the Controlled Substance Act is not getting the right substance to people, so they're not taking the fentanyl? I juts find that…. First, an explanation of: what do you mean by health interventions, when it says that you're basing it on the level of deaths or the wording there? Then, what do you think we're missing, and how do you stop that from going that high?

S. Nix: Before I turn it over to Jennifer, who is really the expert in this area, I would just say that it's a it's a graph that's startling to me as well. I think it's this constant race between testing what we think might be innovative and effective solutions against an increasingly erratic substance use landscape. Trying to keep pace with that is proving challenging. But I will turn it over to Jennifer to explain what the different assumptions are between or among the different trajectories of the overdose deaths.

J. Pennock: Thanks so much, Shannon, and I really do love it when people ask us questions about our model, for two reasons. It really is true that the numbers are really quite devastating. I can tell you that when our modelers are working on this, they always lament on just how grim the numbers are looking.

Without getting too technical, what I want to say about the model is that the model is a dynamic state model. We're all humans who live in an environment and, very much like the COVID modeling that everybody, I'd like to think, got familiar with during the pandemic, the model itself really is dynamic in that it really represents an ever-changing scenario that we find ourselves in.

[1:55 p.m.]

In the attempt to look at a worst-case scenario and a best-case scenario, it's really important to emphasize that that these are assumptions that are made. The main assumptions that we make, which are evidence-based — so we base this on what our surveillance data and the literature tell us — are around, first of all, what might happen to the illegal drug supply. I mean, I think one of the things that we all anecdotally know is just how toxic the drug supply is. The second main assumption is around the proportion of opioid-related deaths that are prevented through health interventions. The health interventions that you see there are things like harm reduction, naloxone use and supervised consumption sites and their ability to really prevent opioid-related deaths during the COVID-19 period.

What is most challenging about this model is that when we are looking at the health interventions, it is very difficult

prevent opioid-related deaths during the COVID-19 period.

What is most challenging about this model is that when we are looking at the health interventions, it is very difficult for us to sort of disentangle the individual health interventions, so we actually put it together into a measure that enables us to make an estimation of just the proportion that could be prevented by health interventions. A big part of this we get from the literature and through other evidence-based means. For example, if there's a harm reduction program that has gone through a formal evaluation, we can put that information in it.

It's just really important, too, to mention to everyone — my modeling team always likes to remind me — that it's not a crystal ball. We can't always attribute causality to our public health interventions, so it's really important to sort of think about it from a very dynamic model. Really, what this tells us is what it might look like, going forward.

I hope that that answers your question or provides you with a little bit more background to that model.

N. Sharma (Chair): Thanks. Any other questions, colleagues?

S. Bond: Maybe just a follow-up to the last one, then I have a question about a different issue.

You talked about there being a table where standards were being delivered — I think that was what you were talking about — or the mental health transfer. I think you said B.C. was not at the table. Can you just clarify for me which table they're not at and the fact that you said that they could join at some time in the future?

I'm interested in the work that's been done, because we've been talking a lot about…. Obviously, opioid-related deaths are tragic and terrible, and our mandate relates to that. But there is also — one of your slides articulates that — the impact on the health care system. Your slide talks about how, in fact, stimulant-related poisoning creates additional hospitalizations.

One of the other numbers that was staggering is the fact that emergency medical services responses to suspected opioid-related overdoses represent…. The increase was 92 percent in terms of a similar time frame in 2019. What that tells us is that not only are people dying but that our health care system is facing unbelievable, unprecedented pressures related to hospitalizations, ambulance, all of those things.

Where in the plan that the federal government is working on — the funding, the programs, all those kinds of things — does that feature? How is that factored in? Because isn't just…. Obviously, we want to stop people from dying, but we have permanent brain injury, for example, and that is a huge problem because of trying to find proper care on an ongoing basis. Can you just speak to the bigger issues that are related to the opioid crisis in our country?

S. Nix: Sure, thank you. I think, going back to your first question with respect to the table, that my response was specific reference to the standards work. The Standards Council of Canada has set up a number of advisory tables, one of which being a government advisory table. At the moment, the province of British Columbia has decided not to participate. As I noted earlier, they do get regular — or will get regular — updates from the Standards Council of Canada through the Council of Deputy Ministers and other fora.

[2:00 p.m.]

With respect to your comments about the impact on the health system, yeah, that slide continues to be staggering to me, as well. Obviously, the pandemic has had an incredibly significant impact on our health care system

your comments about the impact on the health system.

I mean, yeah, that slide continues to be staggering to me as well.

Obviously, the pandemic has had an incredibly significant impact on our health care system, as have the associated mental health and substance use impacts. I would say that in terms of how the health system responds to that and how we go about managing that…. I think that is something to be discussed between the federal government and the provinces at upcoming discussions around the Canadian health transfer. Obviously, it will also come about as the minister continues her engagement around the Canadian mental health transfer as well.

S. Bond (Deputy Chair): My last question…. I see no one else's hand is up.

It was interesting to note that in your slide about who is most at risk, the box that talks about people who work in physically demanding jobs…. That is obviously construction and other jobs. Is there work being done nationally with trade organizations, all of those kinds of things? We've had some presentations here in British Columbia reacting to our committee's work, but it seems to be a very substantive problem, when you look at the age bracket and the gender of people who are dying and often using alone.

Is there a specifically targeted emphasis on bringing trade organizations together across the country? We see groups here trying to do their thing, and we've got one group doing this and that. Is there a sense that there is momentum behind a national approach to looking at the issue of physically demanding work?

S. Nix: Yeah, that's a great question. I would say…. Last year, the previous Minister of Labour, Minister Tassi, and the previous Minister of Health, Minister Hajdu, had a couple of round tables with organizations, trade organizations, unions, people who work in physically demanding jobs as well as pain organizations to talk about what needs to be done in this area.

Coming out of that, we did some work with the Canadian Centre on Substance Use and Addiction to develop a toolkit that's available on the CCSA's website that provides resources to people working in those industries to encourage help-seeking behaviour, to try and reduce stigma, etc.

Then I would also say that it's also very much top of mind for our current minister, and her intention in the coming months with her Minister of Labour colleague, Minister O'Regan, is to focus in — again, in a couple of round tables — on people working in the natural resource industries, recognizing that those two tend to be physically demanding areas. Our supports and resources are needed there.

Maybe I'll just see if Christina has anything to add that I might have overlooked in that response.

C. Simpson: The only thing I might add is that we recently…. As part of the men in trades public education campaign, we recently launched a website that provides resources for them, and it's actually available now, and it's live. There is information about finding help with substance use and knowing the risk of opioids and a little bit about chronic pain and substance use. That's part of our broader approach to addressing substance use and the men and trades that I think is worth noting.

D. Routley: Thank you very much for your presentation. The $800 million, the total spend that you indicated…. How many years are covered, or how many years is that accounting for? If you could give me that answer first.

S. Nix: Sure. I believe that is over the last five or six years. I'm just double-checking here. Yeah, since 2017.

[2:05 p.m.]

D. Routley: While nobody wants to speak poorly of funding received, it's still, over a very long period of time, a very small per-capita investment when you consider all Canadians, all provinces and territories. It's important that all of this long list of spends and pilot

speak poorly of funding received.

It's still over a very long period of time and very small per capita investment, when you consider all Canadians — all provinces and territories. It's important that all this long list of spends and pilot projects that you mentioned are supported. What we're finding here, delivering health care in our provincial budget, is a need for a higher level support, particularly around providing professional supports like treatment. That is really the big ticket item. Not only is it difficult to deliver in terms of the cost per person who requires treatment — which is really, I think, what I would most like to see the federal government contribute to — but it's also the shortage of professionals who can deliver those services.

What efforts are being made by the federal government to support the training and recruitment of people to work in the field, and what kind of supports are being given in direct support of access to treatment beds.

S Nix: Okay, well, maybe I'll start with kind of the health human resources component of your question. I would say that obviously, we continue to work with provincial and territorial governments and stakeholders to support the improvement of Canada's health care system, including solutions to address the health human resource crisis that the sector is currently facing, probably largely laid bare as a result of the pandemic.

Canadians deserve access to accessible, high-quality health care, and continued collaboration with provinces and territories who have the responsibility for matters related to the administration and delivery of health services, including health work force planning and management. It's going to be indispensable to address the pressing health work force challenges.

Action has been taken to address some of the key concerns voiced by the health care providers. A safe working environment is critical to support the retention of health care workers, which is why the government has made amendments to the Criminal Code under Bill C-3, in order to ensure health care workers are safe from threats, violence and harassment.

To support health care workers' financial needs and address the supply and retention issues in rural and remote communities, this past budget announced $26.2 million in funding to increase the forgivable amount of student loans for both doctors and nurses who practice in rural and remote communities. This means up to $30,000 for loan forgiveness for nurses and up to $60,000 in loan forgiveness for doctors working in under-served rural and remote areas.

I would also say frontline workers are suffering, and there's a need for them to feel supported. Therefore, to support the mental health and wellbeing of our health work force, this past budget proposed to provide an additional $140 million over two years for the wellness together portal, which offers free confidential mental health and substance use tools and services to frontline health care workers, as well as providing access to service for regular Canadians.

Additionally, this past budget proposed investments of $115 million over five years, with $30 million ongoing to expand the foreign credential recognition program, and to help up to — I think it's 11,000 internationally-trained health care professionals per year get their credentials recognized and find work in their field.

Then lastly, I would note that the Government of Canada is also hiring a chief nursing officer, which will bring nursing issues to the forefront federally, and support work with the provinces and territories and stakeholders, as well as regulatory bodies.

With respect to your question on treatment, I think in my presentation I noted the investment of $150 million over five years in the emergency treatment fund, of which British Columbia received somewhere in the mid-30 millions. That is intended to support all manner of evidence-based treatment that the province wishes to invest in.

[2:10 p.m.]

N. Sharma (Chair): I have maybe one final one, then we'll go to break. One thing we were learning about from the Portugal model was that having a national approach to

N. Sharma (Chair): I have maybe one final one. Then we'll go to a break.

One thing we were learning about from the Portugal model was that having a national approach to this issue really helped in terms of bringing it more to a health care response from a criminal response. We in B.C. are embarking on this decriminalization, as you mentioned. A lot of the things that come with just the harm reduction, the safe injection sites…. A lot of the things are about the federal government either giving an exemption or working with us to make that happen or else it doesn't.

We were learning, also, that different parts of B.C. need more harm reduction sites. There needs to be different access to the health care responses that you have in that graph, which bring the number of deaths down.

What are the things or the tables that are working through the issues, which we hear throughout this Health Committee, that are sticking points in that process — how fast you can get a controlled substance exemption for a site, how quickly you can get the right substance to a doctor that gets that person away from that harmful substance or is another form of medication that matches the drug supply? How quickly we can move to get all of that into people's hands, who are saving lives, seems to be a big one of the barriers.

I just want a comment on that. Maybe that will be the last question.

S. Nix: Okay. Happy to try and maybe turn to Carol Anne to see if she has anything that she might want to add.

We have numerous…. Well, maybe I'll just start with B.C. specifically. With the province of British Columbia…. Obviously, with the granting of this exemption, we are going to be working really closely with provincial colleagues to monitor what happens on the ground so that we can quickly pivot if we start to see unintended consequences either on the public health or the public safety side of things.

We also are working…. Because British Columbia is at the forefront of safer supply, we're working really closely with the province to better understand, collectively, the barriers that exist in the current prescriber model, to really build up the evidence to support the innovation that's out there and to understand the supply and understand what drugs people are seeking for their safer supply — and then, also, just getting out there and sharing that evidence and uptake of effective models.

I would say, beyond just working bilaterally with British Columbia…. You've got the Council of Deputy Ministers, which meets fairly regularly, to, obviously, make decisions but also to exchange information and best practices. There's the committee on substance use that I chair with my B.C. colleague, which is very much designed to share emerging evidence and best practices across all jurisdictions in the country. Then there is another table, which has just recently started up, that is focused on the intersections of mental health and substance use. That's done at the ADM level, as well, in order to be able to ensure that we're exchanging information and keeping each other abreast of things that are working and, equally, things that are not.

Maybe I'll stop and see if Carol Anne has anything that she wants to add there.

C. Chenard: Yeah. Thank you.

From your question about getting the supply where it needs to be, to where people need it in the community…. I think we've done a couple of things over the last few years.

In February, the federal government approved a Canadian pharmaceutical grade heroin. I know B.C. had been working very closely with the manufacturer to secure a supply previously. We didn't have a made-in-Canada supply. We were having to bring it in either through the special access program — that meant longer delays in bringing things in internationally; obviously, there are import delays and things like that — or through the urgent public health need regulations previously.

In addition, we proactively granted exemptions, a national exemption, which allow for anybody's prescription product to get into community health centres, supervised consumption sites, urgent public health needs sites so that the physicians or nurses could meet people where they were and make sure that they could have access to some of the products that you're speaking about.

[2:15 p.m.]

We also issued exemptions for nurses in B.C. to be able to provide Suboxone. Then subsequently, B.C. made a public health order that made that permanent.

to meet people where they were and make sure that they could have access to some of the products that you're speaking about.

We also issued exemptions for nurses to be able to, in B.C., provide Suboxone, and then subsequently, B.C. made a public health order that made that permanent. So we have done a few things to try and get that supply, like you said, out of the hospitals.

In 2018, methadone and diacetylmorphine, our pharmaceutical-grade heroin…. We made a regulatory change to make it like any other medication, so it didn't need to be provided only in a hospital setting. For methadone, it didn't require a cumbersome kind of exemption every time a practitioner wanted to prescribe. We did try to remove some of those barriers.

But like Shannon said, we're trying to understand what additional barriers there are and how we can address those barriers in a manner that's quick, not taking too long, so that we can try and stem the crisis.

N. Sharma (Chair): Okay. On behalf of the committee, I just want to thank you for your presentation and the work that you're doing. Clearly, the path forward is going to involve us being in partnership to get those numbers down. Thanks for coming here today.

For the committee members, we'll be in recess till 2:30.

S. Nix: Great. Thank you all for your time.

The committee recessed from 2:16 p.m. to 2:33 p.m.

The committee recessed from 2:16 p.m. to 2:33 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I want to welcome you on behalf of the committee. My name's Niki Sharma. I'm the Chair of this Health Committee. We just got back from recess after a day of hearings, and you are very welcome as our final one for today.

I'm just going to, for the record, say who is with us today. We have Kukpi7 Judy Wilson, Cheryl Casimer, Chief Harvey McLeod and Landon Wagner.

Thank you so much for coming. I'll do a quick round of introductions so you know everybody's name that you see before you. They get a chance to say hi to you, and then we will get started.

I will go to the Deputy Chair first. Go ahead, Shirley.

S. Bond (Deputy Chair): Good afternoon. Thank you for joining us. I'm Shirley Bond. I am the MLA for Prince George–Valemount and the Deputy Chair.

P. Alexis: Good afternoon. My name's Pam Alexis. I'm the MLA for Abbotsford-Mission.

S. Chant: Good afternoon. My name is Susie Chant. I'm the MLA for North Vancouver–Seymour.

S. Furstenau: Hi. Good to see you. Sonia Furstenau, MLA for Cowichan Valley.

M. Starchuk: Mike Starchuk, MLA for Surrey-Cloverdale. Good afternoon.

D. Davies: Dan Davies, the MLA for Peace River North.

N. Sharma (Chair): I think Doug had to step away for a second.

I'm coming to you from the traditional territory of the Squamish, Tsleil-Waututh and Musqueam people.

I see Ronna-Rae.

[2:35 p.m.]

R. Leonard: I'm Ronna-Rae Leonard. I'm the MLA for Courtenay-Comox.

I'm here in the traditional lands of the K'ómoks First Nation.

N. Sharma (Chair): We're all Zooming in from different

and Musqueam people.

R. Leonard: I'm Ronna-Rae Leonard. I'm MLA for Courtenay-Comox. I'm here in the traditional lands of the K'ómoks First Nation.

N. Sharma (Chair): We're all Zooming in from different parts of the province.

I will pass it over to you. I think there's 30 minutes for your presentation, and then we will have the rest of the time for discussion. We look forward to learning from you.

FIRST NATIONS LEADERSHIP COUNCIL

C. Casimer: So I will be starting. [Ktunaxa was spoken.] Cheryl Casimer, with the political executive with the First Nations Summit. I'm thanking the committee for hearing us today on this important topic.

As members of this committee well know, the drug toxicity and accidental poisoning crisis gained national attention in 2016 and has only continued to worsen since. First Nations continue to be disproportionately affected by this increasing public health emergency.

For First Nations peoples and communities, substance use is deeply linked to the legacy and ongoing impacts of colonialism. We continue to process intergenerational trauma that has its roots in displacement from and theft of our lands, the attempted elimination of our children and our peoples through the residential school and child welfare systems, and state control over our decisions and our bodies through institutional mechanisms like the Indian Act.

The intergenerational trauma is still very present today. The truths about the detrimental impacts of colonialism are finally being exposed and better understood, as seen in the continuing recovery of the lost children from the sites of former Indian residential schools. This trauma is triggered daily by the racism and discrimination our peoples face across society. This includes structural barriers to accessing physical and mental health care, housing, economic opportunities and even many basic life necessities. The In Plain Sight report also highlighted the interpersonal racism present in the health care and education systems.

Addressing this ongoing emergency and the poisoning of our people requires us to address the colonial legacy of our institutions and the tragedy of our losses. We call upon this committee to centre the needs of First Nations in the critical work to address B.C.'s overdose and drug poisoning crisis.

Some of you are familiar with the leadership council. We're a collaboration of political organizations between the BCAFN, B.C. Assembly of First Nations; the First Nations Summit, FNS; and the Union of B.C. Indian Chiefs, the UBCIC. It's comprised of the political executive members of each of those organizations, and we're mandated by the chiefs in British Columbia.

We have advocated for immediate and long-term action on the public health emergency. UBCIC recognized the overdose crisis as a state of emergency in early 2019 and, alongside the BCAFN, called on the government to launch a public inquiry into the influence of organized crime syndicates in fuelling this crisis. With the onset of the pandemic, UBCIC called for an intersectional approach recognizing the interplay between housing insecurity, safety, and toxic drug supply crisis. Likewise, the First Nations Summit called on governments of all levels to take concrete action to address this emergency. We stand united in our collective call for bold action and tailored approaches that recognize the rights and unique needs of First Nations.

I'm not going to spend a lot of our time today reiterating the numbers that we are all too familiar with, but I will briefly mention a few statistics. The severity of this crisis is unprecedented, and these are human lives. In the 1990s, an overdose crisis in B.C. instigated bold action and innovation. There were approximately 300 fatalities a year. In 2021 alone, 2,262 people fatally overdosed in this province.

[2:40 p.m.]

As with so many crises, First Nations people and communities are overrepresented and disproportionately harmed. Since the start of this crisis in 2016 to January 2020, 1,236 First Nations people have died of drug poisonings. In 2019, First Nations people died at 3.8 times the rate of other B.C. residents, and for First Nations women, the rate of fatal overdose was 9.9 times the rate of other B.C. women. And this crisis continues to worsen year after year, with 334 First Nations people fatally overdosing in 2021, more than any other year, at 5.4 times the rate of other B.C. residents.

The impact of these deaths reverberates through our communities, fracturing families and adding layers of trauma. The devastation of this crisis extends far beyond deaths. Non-fatal overdoses can result in

more than any other year, at 5.4 times the rate of other B.C. residents. The impact of these deaths reverberates through our communities, fracturing families and adding layers of trauma.

The devastation of this crisis extends far beyond deaths. Non-fatal overdoses can result in life changing physical and mental conditions including brain damage and kidney problems, while unaddressed struggles with substance use undermine an individual's well-being on every level. Further complicating the crisis is the growing toxicity and unpredictability of the illegal drug market. The action of government must match the immensity of this crisis.

I will now pass the mike to Chief Harvey McLeod to share some of our recommendations on this topic. Thank you.

H. McLeod: Good morning. [Nsyilxcɘn was spoken.] Yes, I'm Harvey McLeod. I'm the home chief for Upper Nicola and a member of the Okanagan Nation, and I am also a board director for the B.C. Assembly of First Nations. It's good to be here with you this afternoon.

As mentioned by Cheryl, we'll be sharing with you some of the recommendations that we've come up with as a leadership group. No single action will address this crisis. It is reinforced by concurrent interwoven issues and will take holistic, consistent and systemic action for institutional and societal change to occur. We have developed both overarching and specific recommendations.

I will begin with the highest priority recommendations: saving the lives of those most at risk of poisoning and death. While many efforts have been made to scale up harm reduction supports, this is simply not enough to save the lives of our people.

Recommendation 1. A key flaw in the system is the lack of immediate access to detox treatment and recovery for those that are ready for this help. We recommend scaling up to provide immediate access to an increased number of culturally appropriate and safe detox treatment and recovery services. This should be set up first in the downtown Vancouver area, to serve those from the Downtown Eastside, and then be expanded and networked across the province. We recommend that these services include access to cultural healing and support services and be developed in consultation and cooperation with Indigenous peoples.

Another major flaw in the current system is a lack of easy access to a safe drug supply. This crisis is occurring in large part because of the poisoned drug supply and the illegal drug market. Lives can be saved daily, providing a safe alternative. Since 2020, safe supply services have grown from a few individual practitioners to a larger scale project. Millions of dollars of funding have been provided by B.C. and the federal governments. However, access is still limited and even more so for First Nations people living outside of urban centers.

Medical practitioners and drug policy experts continuously express that the current medicinal sized model of safe supply simply cannot meet demand, while tens of thousands of people in B.C., if not more, are at risk of the poisoned drug supply.

We recommend increasing access to safe supply. This must include expanding beyond the medical model to facilitate access for those facing barriers and discrimination within the health care system, as well as those excluded from the medical model due to limited capacity, inflexible eligibility requirements and immense persistent barriers to access.

Another pressing concern is the lack of access outside of urban centers to substance use services and supports. All of our communities have been impacted by this crisis, and although the total number of accidental death and poisoning are the highest among the people residing in the Downtown Eastside, death rates are also high in the North, where services are often inaccessible.

[2:45 p.m.]

We recommend increasing access to substance use care throughout the province. This should include the creation of a centralized coordination service that provides province-wide information on virtual and in-person care and

are often inaccessible.

We recommend increasing access to substance use care throughout the province. This should include the creation of a centralized coordination service that provides provincewide information on virtual and in-person care and supports access, including access to transportation.

We also recommend promoting capacity building within First Nations to provide a wide range of substance use supports and services within their communities. This includes supporting mentorship and knowledge exchanges and providing direct, flexible funding to develop programs, including prevention, aftercare, harm reduction, treatment and recovery.

The final major flaw in our system we want to draw your attention to is the continued oppression and marginalization of people who use drugs. This diverts resources away from saving lives and, instead, further marginalizes and harms those we want to save. The First Nations Leadership Council welcomes the recent decriminalization announcement as a positive step in ending the war on drugs, a war which has always been waged against marginalized people and communities.

Decriminalization needs to go further. We recommend increasing the decriminalized thresholds of illegal drugs to meet the needs of all people who use drugs, especially First Nations people living in remote communities, who do not have regular access to a safe supplier.

We recommend closely monitoring for and rapidly addressing any increased criminalization and other unintended impacts, especially increased charges and convictions of First Nations people for possession for the purpose of trafficking.

We recommend Indigenous-specific decriminalization education for law enforcement and justice officials, including guidance for situations where First Nations people are found in possession of illegal drugs in low quantities that exceed the current threshold.

These are some of our recommendations to save lives and support the dignity of First Nations at risk from the toxic drug supply. We also need to think more holistically about the systems and structures surrounding substance use, mental health and wellness. I will now turn it over to Kúkwpi7 Judy to talk more about these issues.

In closing, this elected committee knows that today we have family down in Vancouver preparing to bring one of our young ladies home from the GRIT. It's the topic that we're talking about today. way̓ limləmt. Thank you.

J. Wilson: kukwstsétsemc, Kúkwpi7 Harvey, and kukwstsétsemc to Cheryl. We're talking about a serious subject today that's near and dear to our hearts and affecting many of our people and our nations across B.C. My nephew also passed away last fall due to an overdose, and my cousin, that Harvey is talking about, is very sad as well — a young person again. So we have a lot of issues to share today.

I'll be talking about transforming the system and our relationships. Our Grand Chief couldn't make it today, so our hearts go out to Grand Chief Stewart Phillip, as well, with his health.

The toxic drug supply crisis has exposed the weaknesses in our substance use system of care in B.C. The need for the system of care to be culturally safe for Indigenous peoples and to provide access to culturally specific services has become increasingly apparent. While we need to take immediate action to save lives, we must also focus on building a resilient system that reflects our commitment to Indigenous human rights in this province, as described in the Declaration on the Rights of Indigenous Peoples Act and the UN declaration on the rights of indigenous people.

Indigenous human rights to health, as described in the UN declaration, are: Indigenous people have access to services without discrimination; Indigenous peoples have access to cultural services; Indigenous peoples exercise self-determination; Indigenous peoples are supported to attain the highest standard of physical and mental health.

[2:50 p.m.]

We have developed a set of recommendations support to support these human rights and additional recommendations related to the right to access to services without discrimination.

The In Plain Sight report, released in November 2020, illuminated the lack of safety in the health care system for Indigenous peoples. The report specifically looked at the intersection of racism

additional recommendations related to the right to access services without discrimination. The In Plain Sight report, released in November 2020, illuminated the lack of safety in the health care system for Indigenous peoples. The report specifically looked at the intersection of racism and this public health emergency, and made recommendations –– recommendations which are still lagging.

Our chiefs have called upon the province to implement this report without delay and report back to them on the progress in order to establish accountability. This work is taking far too long and has become far too bureaucratic.

Number 5.1. We recommend a refocused effort to implement the In Plain Sight report, particularly on recommendations 17 and 20, related to mental health and substance use services and mandatory training for health care workers.

Recommendation 6, related to the right to access cultural services. We must scale up Indigenous-specific services, spanning the entire spectrum of substance use care, and ensure that these are integrated and networked into the provincial services for a seamless system of care. Research shows the effectiveness of culturally situated treatment for substance use, integrating community and perspectives of culture connection and the land as sources of healing. There has been funding provided for Indigenous-specific services, but the rollout of this funding is taking years to materialize. This is a crisis.

Recommendation 6.1. We recommend the immediate provision of funding for First Nations substance use services and support. Number 6.2. To be effective, we recommend that these Indigenous services and supports are networked with and within provincial treatment services to create a cohesive continuum of substance use care, one which is culturally safe and well-coordinated. This must be approached from a systems level to ensure that no one is left behind and that all our people and communities have access.

Recommendation 7: to advance and respect the Indigenous right to self-determination. This work must be carried out in full consultation and cooperation with Indigenous peoples. Although we appreciate the opportunity to speak to you today, we cannot speak on behalf of our nations. Of course, the Crown must engage directly with the title and rights holders.

Number 7.1 recommendation. In support of self-determination, we recommend that the province engage directly with all First Nations in B.C. to offer direct funding for substance use services and supports that have low requirements to access and broad eligibility to provide flexible support and empower them to rapidly implement community-based initiatives. Such funding should not impact any current funding the province has provided to the First Nations Health Authority, which must be upheld.

Taken together, these efforts to uphold Indigenous human rights will support our right to substantive equality and physical and mental health. Although it falls outside the scope of this committee, achieving substantive equality will also require efforts in other sectors. This crisis of accidental poisonings is a reflection of failures in the education, economic, housing and other systems. Substance use cannot be siloed and is an intersectional issue that requires action across government.

We thank you for the invitation to attend today to speak on this critically important issue. We now welcome any questions that the committee may have. kukwstsétsemc.

N. Sharma (Chair): Thank you. With the questions, I just want to start by saying we're really sorry to hear about the personal losses that you've shared today. I'm sure it's a very painful time right now for those family members –– and also to wish Grand Chief Stewart well.

Go ahead, Susie.

S. Chant: Thank you for your presentation. I'm wondering if it's possible to get a written outline of all your recommendations because you've had many. I know they're all tied in together, but if it's possible, it would be great to just get an outline of those recommendations as well, because I'm not so good at writing everything down and getting it all right the first time around.

[2:55 p.m.]

K. Wilson: We're preparing a written submission, so if you didn't take notes…. I think the purpose today is to hear the oral presentation, and it will be followed up by a written submission. Thank you, Lydia, for….

A Voice: Oh, we lost you.

getting it all right the first time around.

K. Wilson: We're preparing a written submission. So if you didn't take notes…. I think the purpose today is to hear the oral presentation, and it will be followed up by a written submission.

Thank you, Lydia, for….

A Voice: Oh, we lost you.

K. Wilson: I just wanted to say we are following up with a written submission, and I just thanked Chief Lydia for letting us know she's on the call too.

S. Chant: Thank you so much. I appreciate that.

N. Sharma (Chair): Welcome, Chief Lydia.

M. Starchuk: Thank you for your presentation. I'm looking down at my notes, and I'd like if maybe you could expand on the centralized care and then, specifically, the access to transportation, please.

K. Wilson: I think the issue is that they're not coordinated — I think that was what was outlined — and they can't be siloed. Those are the two points I picked up on there. I don't know if Cheryl or Chief Harvey want to expand a bit more, but that's what we're seeing. It's fragmented and siloed and needs to be coordinated, and the resources need to go to the First Nations, I'm seeing. Thank you.

N. Sharma (Chair): Okay, I'll jump in here. I have a couple of questions. My first one is: are you working with the First Nations Health Authority closely? I was curious about that. We've heard about some of the programming. And the things that you're recommending to us is that…. It sounds like it would be run by First Nations — what's needed and what helps people when it comes to treatment and recovery. I just was curious about input into those programs under the First Nations Health Authority.

K. Wilson: I think the issue is just not becoming too bureaucratic and that the resources go to the community. I'm on the Secwépemc Health Caucus, for example. I'm not the chair or anything like that. I think Chief Helen is the chair for that. But we meet regularly, and we just always work hard for it not to become so bureaucratic, but it is, and we're always constantly fighting, as many of the other regions, for funding for our communities. So I think in that sense, we are, in the regions. But also, the leadership council does have an MOU, I believe. Maybe Cheryl could speak a bit more to it.

My mind is a little fuzzy today with First Nations Health Authority. We were meeting with them regularly, with First Nations Leadership Council, and perhaps another meeting is overdue. We were supposed to meet on a regular basis, and we did meet with their board the last time. Yeah, thank you. I don't know if that answers your question, though.

C. Casimer: If I can just add. The protocol that Kukpi7 Wilson is referring to is currently under review. It had been in place for a number of years, and we recognized that the landscape around us, politically and legally, has been changing quite drastically, hence the necessity for us to revisit it and make some changes.

We've not been able to come back together yet and have it finalized, but that doesn't stop us from continuing to maintain a level of communication between the work that we do and the work that the health council does. We're cognizant of the fact that we don't want to be repetitive, and we don't want competing interests in this area, particularly in health, because the people that we serve politically and the people they serve with services and programs are the same people. We just need to make sure that what we're providing is the best quality service that we can have. So that's typically where we are with the health council.

We do also work with them on other issues. There are representatives of the leadership council and the health council on the In Plain Sight advisory or task team. So we work very closely there, and of course, the issue of providing quality care and health services to our people is the priority, and trying to address the racism in the health sector. We have a good communication link at that level as well.

S. Bond (Deputy Chair): Thank you very much for being with us today and for your recommendations. We'll certainly look forward to your written presentation.

I'm wondering…. I'm not even sure how to ask the question, because I think the numbers, particularly for First Nations women….

[3:00 p.m.]

Cheryl, I think you outlined them at the beginning in terms of how much more likely First Nations women are to be impacted than non–First Nations people, but women in particular. In Plain Sight, there was also the general discussion

Cheryl, I think you outlined them at the beginning, in terms of how much more likely First Nations women are to be impacted than non–First Nations people but women in particular. In In Plain Sight, the general discussion was about how First Nations women, generally and in health care, have poorer outcomes and relationships with the health care system.

So what steps need to be taken particularly? I know that Kúkwpi7 Wilson spoke about getting moving on those recommendations, but the numbers are staggeringly different for First Nations women. Can you speak to that, Cheryl? Every time we hear that statistic, it's very difficult for us to begin to think about what we need to do differently.

C. Casimer: That's a huge, huge question, and I wish that we did have the answers so that we wouldn't find ourselves in the situation that we do.

I think it's because women are just more marginalized than others within our communities and within society as a whole. We saw during the pandemic, when everything was fully locked down, the increase in domestic violence that was taking place in our homes, and when women fled, especially during the pandemic, there really wasn't anywhere to go.

So we often find women staying in those horrible situations because of that or finding themselves becoming homeless and on the street. When you become homeless, there are just so many issues that impact you, right? You don't have an address. You can't access social assistance, child care. There are just so many things that impact women more so than men. If I am so bold as to say that, unfortunately, in some of our communities, it's a system of patriarchy, and sometimes women just don't really have that level of importance that is necessary for them to be able to thrive in their communities.

I think what's going to be really important is working with women's groups, working with those women directly to find out exactly what their needs are and how those needs are going to be met. I think the only way to really come up with answers on situations such as this is to go directly to the source, and that would be the women that are impacted.

I know that we need to do some work within our communities, and we continue to lobby and advocate for that level of change to take place so that we can ensure that there are safe spaces for our women and our children. There's work that is taking place on the side as well.

When we're talking about health, we know that housing plays a huge factor in that. We know that the child welfare system is also something that has impacted our communities negatively. So as a leadership council, along with the title and rights holders, we're working on nations — wanting them to be better poised to fully exercise their jurisdiction and authority around child welfare. We've done some work on the health front, as you know because of the health authority that's been established, but we know that there's still so much more to do.

I think that we need the provincial and federal governments to, number one, just recognize the authority and the jurisdiction of First Nations, to recognize our inherent right to be the ones to make decisions for ourselves and the ones to be able to put into place the programming and servicing that best meets our needs. All too often when those things become dictated and we're trying to fit a round peg into a square hole, it doesn't work. All we continue to see is failure.

So those are my initial comments on that, and I'm sure Kúkwpi7 Wilson probably has something that she'd like to add.

J. Wilson: Yeah. Thank you, Cheryl and Harvey.

I think these are really key questions, because it is systemic. It roots back to the doctrine of discovery. That's why we're all on the pope's case this last week. That's the changes that need to happen, from its colonial roots, and where we find our people now with the oppression and the genocide that you're actually seeing in the statistics. Those changes need to happen — the implementation of the In Plain Sight report.

[3:05 p.m.]

We know Education is also working on its reports, and we've seen the reports from our Indigenous people that are incarcerated, over 50 percent — the men, the women and the youth even. It's almost like if our people aren't ending up statistics on the streets from overdose, they're ending up in the penitentiaries and in the justice system. As Indigenous women, we're more likely and more vulnerable

over 50 percent — the men, the women and the youth even. It's almost like if our people aren't ending up statistics on the streets from overdose, they're ending up in the penitentiaries and then the justice system. As Indigenous women, we're more likely and more vulnerable to all of this — and also having our children removed. So this work is very critical that the B.C. standing committee is doing.

I think our recommendations are as clear as we can make it. The written submission will be valuable in what the B.C. standing committee will be looking at. Certainly, if there's more clarification that we need from those recommendations, our technical staff would be able to help work through that process. We really need the B.C. standing committee to really understand it, because your recommendations that you're putting forward mean the lives of a lot of our people that are on the street but also in our communities…. As we were saying, during COVID, it increased along with the overdoses.

I know our three bands in our community were really hit hard, almost as much as Kamloops. But our three communities — Adams Lake, Neskonlith and Little Shuswap — didn't make the list of the priorities in the province. So we had to do a three-band declaration on the opioid and overdose crisis. That'll be being sent to the ministry, to the province, soon. We just signed it a few weeks ago. Then we would be seeking a meeting with the province and other places. But I don't know what we had to resort to, because a lot of our young people were dying, and my nephew was one of them.

The youth continue to be hit hard on this, and it's overflowing. We had a lot of COVID deaths, but we had a lot of overdose deaths too. So I think it's really important — what Cheryl outlined in the beginning of her comments and then what she explained further today — because we lost about five, six Elders from our community due to COVID, and we lost just as many young people. At this rate, it's really sad, and it's impacting a lot of families.

I think those recommendations…. If the standing committee can support those and put those forward in their entirety, it would be very critical to addressing the continued increase and displacement of our people through the health care system and all of the systemic issues that we're having, because we have to start somewhere.

Anyway, that's just what I wanted to add into this issue, and I'm hoping that the B.C. standing committee on this can really make strong recommendations to the province on this critical issue.

N. Sharma (Chair): I see you both, Chief Harvey and Cheryl, have your hands up. So why don't you go if this is to that question. Go ahead, Chief Harvey, if you want to go.

H. McLeod: Again, I'm so thankful for this committee giving us time to share verbally some of the thoughts that were put together on how we can address this huge crisis that is impacting our families and our community.

When the question came around centralized services, in a kind of…. Its related to one of the last comments that I made around a review of our systems and structures. I could get lost in the system looking for help. I go to my health director, who will go to Okanagan Nation Health, will go to Interior Health. Then, by that time, I'm lost and so are the individuals looking for help.

When they need help, they need it right now. The processes that we have in place right now don't allow for that to happen. The bureaucracy insists on taking over the system, and yeah, we've got to be accountable for the requests and the needs that we're asking for, but at the same time, time isn't on our side. When they need help, they need help right now. That goes back to the original recommendation, and that was immediate access to services

[3:10 p.m.]

I've had to deal with and work with some of my community and family in trying to get them into a treatment centre. The process was long. They could have gone today. They made the decision to go today, but now it's going to be about three months down the road before they're going to be actually recommended or given the paperwork, but they're ready to access some help.

It is long.

treatment centre, and their process was long. They could've went today. They made the decision to go today, but there's going to be about three months down the road before they were going to be actually recommended or given the paperwork, but they're ready to access some help.

So it is long. It is complicated, and I'm glad that we're going to have a look at this and, at the same time, looking at some of the immediate recommendations that we're making and finding a way on how we can generate that, because it isn't one specific thing that's going to help us overcome and challenge the system on what's happening with our people.

It also goes into us having a look at the justice system and us having some say in how that happens and, of course, having another look at the laws that are in place when it comes to access to drugs. I'm hoping we didn't…. I hoped that we never had to do that, but it is there now, and we have to address it.

One of the questions that came up was travel. It's always an issue in our community when we're looking for health care for our people. They're not going to get it here. They're going to have to go elsewhere in the province or even out of province to get the supports that they need. It is a big barrier — a big barrier for me as the Chief for this community to support the citizens of Upper Nicola when they want treatment and it's an enlightenment that it is a challenge any time we're looking at finding supports for people.

With that, way̓ limləmt. Thank you.

N. Sharma (Chair): Thank you.

Go ahead, Cheryl.

C. Casimer: I'll try to be quick. Just a follow-up to the question that was raised earlier, I think it's really important to say that the systems that currently exist are colonial, racist and destructive, and, for far too long, First Nations women are seen as disposable in this country. Until we change that mindset, First Nations women are still going to be the highest dismal statistic — whether it's murdered and missing Indigenous women, whether it's the child welfare system, whether it's in the health system. We need to make some substantive changes to that.

We don't have enough detox or treatment centres in this province for women or for youth. I myself had to deal with that on a personal level when my daughter became addicted to opioids. I mean…. I'm going to say it. I blame the doctor that was working with her. I blame him for misdiagnosing her and having her on opioids for such an extended period of time. Then when they found out she was misdiagnosed, they just cut her off, right at the nose.

What was she too do then? She ended up going to the streets, and, unfortunately, she still is. There are times when she's come to me and said that she's ready to go to treatment. As Chief Harvey McLeod has indicated, those systems are not available. The process does not allow for that to happen at that speed.

So we need to overhaul a lot of these systems that we're talking about, and we need to do that in partnership with First Nations in this province. Minister Fraser used to always say that we need to smash the status quo. I think we need to do that when it comes to the health care system in this province. First Nations are working at a federal level on a First Nations health legislation. I think that may be something that we should be considering here in the province as well.

Those are my comments on that for now. Thank you.

R. Leonard: Thank you very much for your response. I'm a little bit nervous even just raising my hand, because I have to admit that I don't understand your bureaucracies. You have three different organizations and the roles that you play. It's challenging for me to get a grasp on that. You obviously have come together to make three very solid recommendations, and I appreciate that very much. I think we all do.

I guess the one question that I have is we've seen that there's quite a distinction between the Downtown Eastside and the challenges that are faced there and the rest of the province. You've made a very specific recommendation to start with the Downtown Eastside and then expand out, in your first recommendation.

[3:15 p.m.]

I think what I recognize is that what has happened is that with the lack of services out in rural communities, the travel tends to happen to go to the Downtown Eastside. It gets centralized in that the problem gets centralized but not necessarily the solution.

I just was hoping I could get a

out in rural communities that the travel tends to happen to go to the Downtown Eastside, so it gets centralized in that. The problem gets centralized, but not necessarily the solutions.

But I just was hoping I could get a reflection from you on that state of affairs between the Downtown Eastside comparing to what's going on for people in your community who are having substance use challenges in a more rural setting, to give it a little bit of fleshing out of the distinctions and how moving first with the Downtown Eastside will be helpful to building out. I hope I'm making sense.

K. Wilson: It's Chief Wilson. A lot of our people gravitate down to the Downtown Eastside, as Chief Harvey was saying. My cousin that they have to bring home now…. A lot of our relatives gravitate here, and I think what I'm seeing is that there are resources that both the feds and the province committed. But how do we see them in our communities? In our communities, we need to deal with it before they start gravitating down to the Downtown Eastside.

I think, right now, we have a great population here on the Downtown Eastside. I'm actually sitting in my office, which is 312 Main Street, right now. We're right in the Downtown Eastside. It's very visual, and we see it every day. I think there's got to be a strategy somewhere to start.

I know with the previous minister, Judy Darcy, for Mental Health and Addictions, we did do a walkabout on the Downtown Eastside. We spent part of the time over Oppenheimer Park, and then we walked to the Culture Saves Lives office and did a ceremony, and then we went to the safe injection sites. I think some of the First Nations Health Authority offices were just being set up at that time. The new minister did agree to do another walkabout here in the Downtown Eastside. It would be nice to know if the leadership council were involved in that one, because it was just the union on the one with minister Darcy. But I know the new minister also agreed now.

I think the strategy, with the technicians saying that maybe the resources are a little more concentrated here right now but we need to start the strategy there and share with our proper titleholders…. But, at the same time, the recommendations are still saying that the resources go to the proper titleholders. That's what I've seen in what I was reading and what we were sharing with you. It's actually a multiple-pronged strategy. It's not just a singular strategy, and it needed to be multilayered and coordinated. That's what I was getting out of what we were explaining to you in our recommendations.

I think, if the recommendations need to be clear, that maybe our technicians could look at it. But I thought it was fairly clear on what we were saying in the recommendations: that it needs to be better coordinated, better resourced and that there would be a multi-pronged type of approach. We still need our nations resourced, as Chief Harvey's section pointed out, and then in my section, I was just kind of tying it all together about the additional work and the In Plain Sight report. Anyway, that's what I was getting out of it, not that it was just a one-off. Thank you.

C. Casimer: I could just add to that too. First of all, I think, just to provide a bit of clarity around the mandate of the leadership council and how we come together, we've been together, now, 17 years, 18 years. But prior to that we were also working in silos with our own separate mandates and, at times, duplicating and fighting for the same resources.

[3:20 p.m.]

Grand Chief Stewart Phillip and a few of the other executives that have been doing this longer than me decided that they needed to come together and have a conversation and say: "Look, this is not helping anybody. It's not helping us. It's not helping our people. We need to find somewhere in the middle where can come together and start working with each other." That's when the establishment, or the creation, of the First Nations Leadership Council came to be.

In the province,

decided they needed to come together and have a conversation and say: "Look, this is not helping anybody. It's not helping us. It's not helping our people. We need to find somewhere in the middle where we can come together and start working with each other."

That's when the establishment or the creation of the First Nations Leadership Council came to be. So in the province, there's only three political First Nation organizations. It's the BCAFN, the First Nations Summit and the Union of B.C. Indian Chiefs. Rather than fighting with each other, it made more sense for us to come together, so that's why we created this entity. That doesn't say that we still don't work on our own respective mandates, because we do. We continue to do that work. We're mandated by our own chiefs and assemblies too for the issues that they've directed us to do.

For example, with the First Nations Summit, our mandate is to support the work of those First Nations that are negotiating agreements with Canada and British Columbia. So that's our mandate, and every organization has their own. But when it comes to the collective issues, such as this important topic — this important issue — that's when we come together and join forces to make sure that we can do everything we can to address it.

I just also wanted to speak a little bit about the recommendation that was put forward about focussing on what's happening in the Downtown Eastside. I think the question was: "Why do people gravitate to the Downtown Eastside?" I think a lot of it has to do with a lack of housing within our respective communities.

For example, in my community, the house that I'm in was built over 20 years ago, and that was the last time we did any kind of a build within my community. Having said that though, our population has since doubled, but yet there's no housing for those people that are coming up behind me. So a lot of people are either living in Cranbrook or wherever they can find a place to live. In some instances — leads to homelessness, which is quite tragic.

But I think what we see in the Downtown Eastside is more visible than what you would see in other areas, whether it's urban or whether it's rural. I know that the number of overdose, for example, in Prince George, is quite higher. When you think about it in comparison to overdoses in Downtown Eastside…. I mean, you've got a larger Indigenous population there, and that is something that they're constantly trying to address and trying to figure out how to come up with solutions for that. Even in my small city of Cranbrook, homelessness and overdose is quite huge as well, and I think it really is just relevant to where you're at and how visible things are.

I think that what's going to be key and critical is just making sure that you're working in full partnership with the First Nations — the title and rights holders — making sure that you're drawing down the experts within those communities that are the ones that are on the front lines, and making sure that whatever kind of solutions that we're going to be putting into place based on recommendations that are being put forward is going to meet those needs, because I said earlier: a one-size-fits-all solution doesn't exist.

Thank you.

S. Chant: We have had a couple of presentations from various folks that are doing some really good work in a variety of ways, but it's very piecemeal. Is there anywhere that you're seeing things are going well that could perhaps act as a preliminary model to build around or build on or to move around the province that supports the various needs of Indigenous women specifically, and Indigenous groups more broadly?

J. Wilson: I think we just have some alcohol and treatment centres, but they're located in specific sites and there's long wait lists to get into them. I think it was Chief Harvey who mentioned about the detox centres issues. So we have some places doing some amazing work, but long wait lists, and they're just specific sites, so the individuals have to go there and they have to wait to get on the list and wait to get funding. So, a lot of red tape and barriers for them to get in there. Definitely, we need more healing centres, more treatment centres, more detox centres, more youth centres and those cultural safe spaces they're talking about.

[3:25 p.m.]

I know Round Lake Grand Chief sits on the board there, for example, so that’s why I'm sharing it. In the Okanagan Nation just neighbouring to us, there may be other centres that are doing great

centres and those cultural safe spaces they're talking about. I know at Round Lake, the Grand Chief sits on the board there, for example. So that's why I'm sharing it. It's in the Okanagan Nation, just neighbouring to us.

There may be other centres that are doing great work, but they're probably suffering from similar things — funding, wait-lists. They can only take so many people at a time. That's why…. I think a lot of the nations need to have programs within their nations. The Downtown Eastside…. Probably the women's centre has done a lot of work. I don't know if there's any listing of all these places.

What we're saying today is more coordination, more resources, better ways to help support the existing work. More is needed in regards to how we address that.

I don't know if that answers your question.

N. Sharma (Chair): Cheryl and Chief Harvey, I see your hands up too. Do you want to jump in there?

Go ahead, Cheryl.

C. Casimer: Thank you.

I'm not trying to toot our own horn, but here in Ktunaxa territory, we do have a few things that are happening. We have a place called Street Angel which has been in operation for a number of years now. That was established to provide wraparound supports to the homeless population here in Cranbrook. We found that there's a lot of…. We have a huge transient population that comes here because we're the largest municipality within the East and West Kootenays. We worked in partnership, actually, with the city to put into place Street Angel.

Shortly after Street Angel was established, we bought a piece of property, and we call it Scotty's House. Scotty's House is a place where you can go when you've just got out of treatment or you're waiting to go into treatment. If you're going into treatment, you get that level of service. If you've come out of treatment, then you're going to get a different level of service. They help you get back on your feet, help you look for employment, if that's where you're at, that kind of thing. So we have Scotty's House.

We've just recently been approved, along with, I believe, Carrier-Sekani Family Services — I believe there was another organization — for a youth Foundry within our area. That's also something that is in the works. We're really happy to have been selected to do that so that we can provide culturally relevant and safe services to our young people.

Also, just recently, the establishment of a few detox beds, in addition to what currently already existed, through the advocacy of Ktunaxa Nation health and Ktunaxa-Kinbasket Child and Family Services to seek additional detox beds here.

We also entered into protocol agreements with the hospital to address that whole issue of making sure that our people receive the appropriate level of care — it doesn't always happen yet, it's not perfect, but we're getting there — and a number of other MOUs with different service providers here within the East Kootenay region.

Those are some examples of some things that are happening. As Kukpi7 Wilson had indicated as well as Chief McLeod in his portion of the presentation, it speaks loudly to the necessity for additional resourcing to support the development of capacity, as well, within our respective communities.

N. Sharma (Chair): Thank you.

Chief Harvey, go ahead.

H. McLeod: When it comes to accessing supports and services for people who are looking for help….

I've been working with Chief Darrell Bob, from Xaxli'p. He's been coordinating and developing some really rough, crude structures to house or to take in, to house and to support youth that are lost, bringing them back to things like the sweat lodge, prayer, fasting, language, culture, a number of different little sessions that allow an individual to hear and understand a little bit about who they are. When they come out, they may have a little better or more success if they go into a regular support system.

[3:30 p.m.]

He's been confiding and been looking for the supports to run these camps. It doesn't really meet the criteria of anything — FNHA, Interior Health and other health supports that are available out there — other than whatever we, as a community, can

and he's been confiding and been looking for the supports to run these camps. It doesn't really meet the criteria of anything — FNHA, Interior Health and other health supports that are available out there — other than whatever we, as community, can offer him to continue running his supports. I see that as a model that we should have a look at and say: "How can we develop more of this, where you're getting your sessions or your training and awareness out there on the land?" I see some good coming out of that.

Also, when it comes to taking care of our children and our women in this community looking for a safe house, where can one go? Where can a mom and her children go to be safe from things that are happening in their home — and they get taken care of? Right now that is done by some of our families, but a lot of the time now they have to move out of community, out of area to find that place. What it's done is it's getting us to talk more about what's happening in our community with our children and with our women. How can we better protect them?

How can we have more understanding of what's going on in community? As a community and as people, there are so many traumas surfacing now and have been surfacing over the last 100 years that we're now starting to look at ourselves and say: "This is something that I understand, that I want to do, that I can do to make a difference to help our children and our women and our families." And getting the resources to do that again, just for a safe house or a few safe houses in our communities, is a lot of work. We just don't have the resources ourselves to build these structures or to renovate the homes that we could use and identify as a safe place for our children and our women, but we have to continue doing that.

My last comment is around the Downtown Eastside. It's the most visible. We all know where it is and who's down there. I take walks down there on occasion just to see if I can find any of our citizens down there and have a chat with them, ask them if I can help or we can help. Do they want to come home? They are happy to see me, but they're not willing to come home. They don't want my support, and they're happy with where they're at, even though their life is hell down there, probably. But they just don't want to come home, and again, that's trauma at its max — not feeling safe anywhere than with others that are in the same boat as they are, feeling the camaraderie of the individuals that are in the same boat as them.

So what happens down there is visible, but it's also here in community — not as visible as Downtown Eastside, but I see it. The health director sees it. The social worker sees it. And now, as community, we're starting to see it, and we're talking more about. Yeah, let's go to where the most need is right now — the most visible — and, at the same time, continue to pull it out and bring it here into communities so that we can benefit.

Just talking about what we're talking about here today and further discussion that's going to happen between ourselves and the province and the feds is a really good indicator of our people wanting better, wanting to feel safe, because right now there are a lot of our people that say: "There are not too many places that I feel safe in this country, even in my own community."

I was one of them, and I am one of them yet, because of my own traumas that I faced and had to overcome. I look at my life over these last 25 years, thinking about the decisions that I was going to make then — and, actually, a decision that I did make, and that was going to Fairview College versus going to Vancouver. How different my life would have been just on that one decision alone.

[3:35 p.m.]

So knowing what we're talking about is going to reach out into community and we, as community, will be talking more about our own traumas and our own social well-being and finding that safe place that we can talk and ask for help…. That's what this is: asking for help. It takes a lot of courage for an individual to ask for help. When they ask for help

social well-being and finding that safe place where we can talk and ask for help.

And that's what this is: asking for help. It takes a lot of courage for an individual to ask for help, and when they ask for help, I want to be there saying: "Here's the road. Here's cash. Let's go."

P. Alexis: First of all, I just want to say thank you for your sharing, because it's extremely important for us to hear from you, and it's extremely impactful. Thank you so much.

I have a question with respect to the relationship between the First Nations Health Authority and you as a group. Are your voices being heard with respect to the First Nations Health Authority, and is there anything that you can recommend, if that's not the case, to us, to help implement?

J. Wilson: I thought Cheryl answered this. We do have an MOU. The ten-year relationship is being reviewed, and also the way the structure is. It's the regions. The First Nations Health Authority has regions, but what happens is that it's locked into their structure.

Say, as a chief, I had an issue. It might go to Secwepemc Health Caucus. That might go to the Interior health caucus, and it might make its way as a recommendation. So there's bureaucracy, is what I'm saying. I said that at the very outset as well, in some of the responses.

So there are processes and systems that the First Nations Health Authority is beholden to. As the Chief of a right holder in our community, that's the process I'm explaining through our Secwepemc Health Caucus, to the Interior health caucus, to the board which runs the First Nations Health Authority. Okay?

Then, as our organizations, we have specific mandates from our proper title holders that give us resolutions. So we have resolutions on these specific issues, and then we're raising them through our organizations.

The Leadership Council also has an MOU with the First Nations Health Authority, and we're supposed to be meeting more regularly, but we haven't met in a while. That ten-year review of the First Nations Health Authority on their health determinants is happening, and there's a Chief's committee to do that.

I don't know, Cheryl, if you want to try to explain it a bit more. I thought you did explain it pretty comprehensively, but maybe you can fill in more.

P. Alexis: I appreciate the further explanation. I think it was because an acronym was used that I wasn't used to hearing, and so I didn't register the two. That's probably what happened with me.

N. Sharma (Chair): Okay, I don't see any other of my colleagues' hands up for questions. On behalf of the committee, I just want to thank you so much for sharing what you did and all the expertise and experience and passion that you bring to the jobs that you have. We learned a lot today. I appreciate your time.

Everything you said is on Hansard, so even if we don't have it, it's going to be in writing anyway. All the recommendations will be there if all the committee members want to look at what was said today.

Thank you very much, and we look forward to reviewing everything afterwards.

C. Casimer: Well, thank you for the opportunity to present on behalf of the Leadership Council. The fact that you said what we've said is on Hansard kind of worries me. I don't know if you can even hear what I had to say with my dog losing his mind in the background. I hope it doesn't interfere much with the message I was trying to relay.

N. Sharma (Chair): No, you were very clear. I actually didn't even know you had a dog in the back.

Well, take care, everybody.

Committee members, we need a motion to adjourn. We have Ronna-Rae. Then a seconder. I saw Sonia next.

All right, we will see you tomorrow afternoon.

Motion approved.

The committee adjourned at 3:59 p.m.