The committee met at 8 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good morning, everybody. Welcome. As everybody kind of settles down, I think we should try to get started as soon as possible so that we can maximize our time together.

I want to start by acknowledging that we’re all on the traditional territory of the Lək̓ʷəŋin̓əŋ-speaking people, the Songhees and Esquimalt First Nations.

This morning we have two very esteemed guests with us today: Dr. Bonnie Henry, of course, our chief medical officer, provincial health officer, and Dr. Nel Wieman, deputy chief medical officer of the First Nations Health Authority.

I’m just going to go through…. If everybody could just say their name and where they’re from, we’ll just get to it.

P. Alexis: Pam Alexis, MLA for Abbotsford-Mission.

H. Sandhu: Harwinder Sandhu. I’m the MLA for Vernon-Monashee.

D. Routley: Doug Routley, MLA for Nanaimo–North Cowichan.

R. Leonard: I’m not quite officially here yet. I’m Ronna-Rae Leonard, MLA for Courtenay-Comox.

S. Furstenau: Sonia Furstenau, MLA for Cowichan Valley.

D. Davies: Dan Davies, Peace River North.

S. Bond (Deputy Chair): Shirley Bond. I’m the MLA for Prince George–Valemount.

N. Sharma (Chair): Shirley is our Deputy Chair, as well, of the committee.

We’re going to have 20 minutes of presentations each. Then afterwards we’ll have the rest of the time for questions and answers.

Everybody has their materials printed off here. So you should be able to follow along that way.

Briefings on
Drug Toxicity and Overdoses

OFFICE OF THE
PROVINCIAL HEALTH OFFICER,
FIRST NATIONS HEALTH AUTHORITY

B. Henry: Thank you very much. Thank you for having us. It is a great privilege to be here and to be here with my friend and colleague Dr. Wieman.

It was important to me, when we talked about the work of this committee, that we recognize that there are important differences in the experiences of this crisis for First Nation, Métis and Inuit people in this province. One of the things that we did very early on was to ensure that we could understand those differences. It is incredibly important that we have the voices of these First Nations represented here today.

I also want to acknowledge, with gratitude, that we’re on the land where the traditional keepers are the Lək̓ʷəŋin̓əŋ peoples, now the Songhees and Esquimalt First Nations, and the Victoria Métis chartered community.

I want to talk a little bit about where we’ve been. As you know, we declared a public health emergency — with my predecessor, Dr. Perry Kendall — under the Public Health Act, in April of 2016. At that time, it was in response to what we saw as an unprecedented increase in drug toxicity–related harms.

The increasing availability of highly toxic, illegally produced opioid fentanyl analogues, in particular, was resulting in increases in people taking drugs with an unknown potency. That led to an increase in deaths. Also, we had increasing numbers of people who had overdoses that were medically treated. We were trying to find out and understand what was happening. Who was being affected? Who were the populations being affected, and differently? We issued this order to better understand the situation.

There are a couple of things that we did very early on, Dr. Kendall and myself. One of the most important ones was being able to compel the linking and sharing of information and data and databases. We had apparent overdose incidents from emergency departments. That was very energy-intensive. We now have a more automated way of linking with emergency department data. We have all of the incidents of people who have died of a suspected overdose from the B.C. Coroners Service.

[8:05 a.m.]

That information was not available to us, in public health, to be able to link to other important health information, to try and understand who was most effective. We now have a very strong partnership — I know you’ll be talking with the chief coroner very soon as well — where we have linked that information, even the preliminary information, because that allows us at the health authority level to reach out and understand what’s happening.

We also have linked information around corrections services so that we can understand when people are being released from custody. We’ve linked data with the Ministry of Social Development and Poverty Reduction so that we can understand the trajectories and the journeys of people who’ve been in receipt of income and disability assistance.

There has been some very interesting data. Unfortunately, much of that data is delayed, so just last week we were looking at some of the analyses from 2019. Obviously, the picture has changed quite a bit in the last two years.

We have data from paramedic-attended overdose events from emergency, BCEHS, and also — something that is quite unique across this country but very helpful to our understanding — the patterns of use, what we were seeing in terms of sickness and deaths or people overdosing in the community, and the proportion of people who were saved with naloxone, which is really important for us to understand, as well as the differing in people wanting or needing to be taken to hospital.

We did see a change, a dramatic change, where people were being resuscitated by peers, in particular, and not going to hospital. It was another place where we could look at how we do targeted outreach to certain communities through paramedics. That’s something that we’ve been working on.

We also authorized reporting of patient information to BCCDC so that we could follow up with those people who refused transport to hospital, and do outreach. These sound like simple things, but it really was…. We created what we call our overdose cohort, which is the linking of all of the people who’ve been connected to our system — in emergency departments, with BCEHS and, obviously, the coroners’ data around deaths — understanding the person’s history of how they came into the system, where they had contact with our health system, where they had contact with our criminal justice system so that we could understand the patterns that we were seeing.

Because of the emergency, we were able to link an anonymous 20 percent random sample of age-matched people who did not overdose. That’s so important from an epidemiologic point of view because that gives us a sense of how these people are different.

We’re on the next slide here, “Building a knowledge base.” We established the B.C. Centre on Substance Use in 2017. That was another area where we could expand our understanding and engage with people with lived and living experience of problematic substance use to understand both needs and the barriers to care. We learned that everybody has been affected by this.

I know we all have these ideas — we still see it reflected in media — that it’s “those people” in the Downtown Eastside, on the streets in Prince George or in First Nations communities. We are understanding that there is more than one population affected — it affects everyone — certain priority populations warrant our particular specialized attention. People who are marginalized due to poverty, lack of housing and mental illness, we know, are differentially, negatively affected; and people who are of First Nations, Métis and Inuit background living at home or living away from home in our urban centres.

Another area that we have come to understand through the data that we’ve collected is of young to middle-aged men living alone or living with families, where they are not sharing their drug use, often working in the trades. We’ve seen that. We’ve done some work with the construction industry, in particular, to try and address some of the reasons why people are using drugs. I will say that that is an area — I have some data that will show it — where we’ve seen a dramatic increase during this pandemic.

[8:10 a.m.]

We also know that substance use and experimentation are things that happen naturally. All humans possess these desires to test things. We know that young people want to experiment. Right now that, of course, is incredibly and increasingly lethal, and we’ve seen that reflected. Thankfully, it remains a small percentage of the overall, but it is incredibly tragic when young people die from experimenting with drugs. That is particularly because of the toxicity of the drug supply.

Some of the work that my team has done has been looking at what we call life expectancy at birth and the impact of this crisis on our population-level expectancy of life. What we have seen is that….

We just did a recent update. We reported on this in 2019. It’s a draft version still, not yet published, from April of 2022, looking at the end of 2021, the data. Life expectancy at birth has declined by 1.77 years. This is nine times the average annual increases that we’ve seen in life expectancy over the last 20 years. So we have lost that, and it is particularly in men, among males — about 0.55 of a year.

It seems like a small amount, but when you talk about it on a population basis, it’s a huge amount. That is primarily in the last two years. That amount of loss has been from the overdoses and the toxic drug crises.

The pandemic has a much smaller percentage of the loss, and more in females than males, but that’s because the pandemic has been…. COVID is affecting older people, so you don’t have those years of life lost. The experience of young people dying from that illicit drug toxicity has been that dramatic on a population basis.

It is not a simple problem. I put up one slide I have here about First Nations being disproportionately harmed. I’m just grateful that Nel is here today and will talk specifically about that story.

It was really important for us early on, when we were able to link data, that we were able to, on behalf of and working with the First Nations Health Authority, link data with a First Nations client file so we could better understand, in a more fulsome way, the impact on First Nations. Also, we’ve been working with Métis Nation B.C. to link data with the Métis cohort. My office has been working with them very closely, and we see a very similar pattern in Métis people in B.C. as well.

What we have seen…. If we go to the next slide, it’s a highly complex problem. This is one of my favourite systems maps. I refer to it a lot and have over the last few years. This was work that we did in 2017, and I’ll refer you to this journey mapping substance use report. I’ve asked my office to send this to you. It’s an exploration we did with people who use drugs, also with care providers, and peer experiences about how they experience their journey, particularly focusing on the interactions with our care system and with the correctional system.

There are some really, I think, poignant and memorable journey maps, we call them. They explain in real words how people are feeling and the barriers and the cracks and how they fall off their trajectory, and how recovery is such a fraught event for people. We need different strategies for different populations, and we need to understand the vulnerabilities.

Also important in this…. We talked with people who provide addictions care — with family physicians, with nurse practitioners, with people in the community. We understand a lot of the issues that they were dealing with: the frustration, the not feeling like they had the tools to be able to talk to people about their drug use. We hear this from families as well — that they don’t know what to do.

[8:15 a.m.]

Providers are concerned about what it’s going to mean to their clinic. How are they going to be able to continue to serve the needs of the other people in their clinic? They don’t have the abilities and the tools that they need. So it is a very complex problem.

I like this systems map that I put it in here because it tells us about how all of these are intertangled. The size of the circles is how many connections they have with the different aspects. There are many, many things that go into this problem, and there’s no one way out of it. There are many, many things that we need to do to get us through this.

We need to address the determinants of health. I’ll talk a little bit more about that when we talk about decriminalization. You need to understand that it is things like stigma that support this ongoing problem.

Increasingly, though, we have seen, through this pandemic, that the drug supply has become more and more toxic. That is partly because of the way we have shut down our borders. We hear from our Public Safety colleagues, and I know you’ll be speaking with them as well, that much of the synthetic opioids — carfentanil and fentanyl, etc. — that were coming into the province were coming in from China in small amounts and then being mixed here with a whole bunch of things.

Drug checking, being able to test what’s in a product, is something that we’ve been really trying to work to make more available. But we’ve seen, since the pandemic, that that ability to bring in drugs from these large, illicit manufacturing places in other countries has been shut down in some ways.

It has become increasingly toxic because when you get a small amount in, they want to make it last as long as possible. People are developing it onshore now, and it is increasingly adulterated and difficult to make. There’s a whole lot of rationale behind why it’s become more and more dangerous.

I just wanted to put in a couple more slides that tell us some of what has happened over the last two years. The paramedic-attended overdose events — what we saw was that up until the pandemic, they were grumbling along. These are the ones that are severe, where a paramedic has to attend whether somebody gets taken to hospital or not. We saw the success of our take-home-naloxone program, the fact that we had naloxone out on the streets.

When this all started, the BCCDC harm reduction program, we were really fighting to get any naloxone out there. It was a drug that Health Canada was requiring to be provided by prescription only. So the fact that we have made a major ability to be able to provide it to people for free across the province has made a really important difference in saving lives.

The other important thing that we learned and that happened was that we developed overdose prevention sites, which were places that people could go and use with somebody who knew what to do if they overdosed. Those save lives. We have had no deaths in any of our overdose prevention sites across the province since they started opening.

We also learned that they are an important source of connection. It’s often said, and I say it a lot, that the opposite of addiction is connection. For many people, it was a place that they could go and feel safe to talk about their drug use. They could get their drugs checked.

It was what I call cookies-and-milk medicine. It was a place where people could get a meal, where they could talk to somebody who treated them like a real person, where they could get their wounds attended to — foot care. Things that made that little bit of a difference in connecting with somebody so that at that time in their life, when they might be ready for it, they knew where to go to get the help they need.

This is what we are learning, particularly about opioids. They create a chronic relapsing brain disorder. Opioids — we have a natural part of our brain where they attach to. When substances are used frequently and regularly, the brain circuits, including these reward systems, adapt over time.

[8:20 a.m.]

The brain comes to think that that substance is essential for our survival, and you no longer get that high from it. When you don’t have it, you feel like you’re…. The lows become really negative and intense, and the cravings start when the substance isn’t there. These pathways are what lead to the excessive wanting, even if you no longer experience pleasure from using that substance.

I think that’s one of the misconceptions that many people have — that people are using this by choice. We’ve learned with opioids that it can happen very, very quickly. If anybody has had fentanyl, it’s a great drug. I certainly had it when I had a colonoscopy not that long ago, and you can see why people feel good on this drug.

Physical dependence on opioids can happen very quickly, and that’s one of the things that we work on. We work on it with surgeons, for example — giving people small amounts of opioids for pain after surgery, because you can get physically dependent on it very quickly. But for some people, it’s that physical and mental dependence that happens. Then it becomes: you need more just to continue to feel normal. That’s where you get into the issues of problematic substance use and addictions. There’s no easy way to get through that.

What we are finding is that these paramedic-attended overdose rates…. When the pandemic started, we separated people from these places of connection. And we know that particularly the young men that were working in the trades…. Many of them were at home, and they were at home alone, and they were using alone.

The toxicity went up, the number of paramedic-attended overdoses went up, and we also saw changes of patterns in the drugs. Particularly, we saw benzodiazepines being mixed in with opioids.

Benzodiazepines are depressants, and they don’t respond to naloxone. Naloxone only works for opioids. So what the paramedics were finding was that they were having more and more intense overdose responses, and people were given naloxone but not waking up. They needed to be taken to hospital because benzodiazepines last a long time in the system. They depress your breathing. They depress your mental alertness for a longer period of time. So we saw that was quite dramatic.

Next slide: “The changing patterns of use.” This comes from a harm reduction client survey. These are the latest findings from 2021 — they were just released — where we asked…. We routinely ask people who use drugs what they’re using and why.

What we’ve seen is — in one way, it’s a good thing — that people prefer smoking substances now. Particularly with people who are using fentanyl, it’s gone up from about 60 percent to 80 percent of people who are now smoking rather than injecting. In some ways, that’s good. In other ways, it makes it challenging, because our overdose prevention sites are not set up, in most of the places, to deal with people who are smoking drugs. The worry is the impact on people around them, especially staff and peers who are working in those overdose prevention sites. So we are working on that, but we’ve not solved that problem yet.

Then I put in the other slide…. It talks about the fewer visits to SCS and OPS. This is one of the triggers that we know has contributed to the increasing number of people, particularly young men, who are using alone. We saw a dramatic decrease in the overdose prevention sites — visits to either our supervised consumption or overdose prevention sites — because of the pandemic. This became apparent to us….

We were looking at: how do we protect people in those most vulnerable settings? But that did have a downside, of course, and by the time we recognized that, it was very challenging to try and overcome that. We’ve now seen these services coming back, but the patterns of use, as I’ve just mentioned, have changed, and the toxicity of the drug supply has changed.

All right. I’m going to go to this “Where are we now?” It really talks, again, in some detail about some of the complexities that we’re seeing.

Prohibition continues to be one of the biggest barriers to service use and connection. We can’t just tell people to stop using drugs. We know that we need to understand what led them to that place, for every single individual.

[8:25 a.m.]

What we see is pain. And as Grand Chief Doug Kelly says to me, it’s not just physical pain. We have a pain problem. It’s emotional pain. It’s psychic pain. Not everybody is able to overcome the pains that they had in their childhood, and we need to understand that. We need to stop saying, “What’s wrong with you?” and change to: “What happened to you? What can we do to help?”

It is those things that we’re hearing from young men about their experiences, their isolation, toxic masculinity. The meaningful decriminalization of people is something that we need to think about. And access to a known, safer supply of medications.

We know that stigma is a very powerful emotion, a very powerful tool, and that we have both systemic, or structural, stigma. We have social stigma around people who use drugs, and we have personal stigma, where people are afraid to talk about it, because of their own shame. Shame is a powerful emotion that keeps people from reaching out and keeps people from telling even their clinicians that they’ve been using drugs.

We need to focus on racism. We’ve seen that as a reason. It’s a huge barrier for access to health care services, and people who use drugs feel it in ways that is even greater than people who are in racialized communities.

We talk about decriminalization of people who use drugs, and we know that our drug laws in Canada, and in B.C., are racist. They were started…. If we think back, in my report, Stopping the Harm, this was a lot of the work that I thought through — that we thought through — when we were writing that. Starting with the Opium Act in 1908, it was really to deal with the “Chinese problem.” And the war on drugs in 1986, where we know Black and Indigenous people were arrested — overrepresented in drug possession arrests and continue to be.

Racial disparities in drug possession arrests stem largely from racially biased policing practices. We know that drug use is the same across racial groups. We know that that experimentation is the same. But we know that Black, First Nations, Métis and Inuit are more likely to be stopped by police, more likely to experience homelessness and poverty and more likely to have to go to the streets to buy and use drugs and increase the chance that they’re going to be interacting with police.

Middle- and upper-class drug users can call on delivery services to obtain their drugs and use in private spaces. That’s what we’re seeing happening with the 30- to-59-year-old age group during the pandemic, where they were able to stay at home. But because of the stigma around using drugs and because of the shame they felt, we hear from families — and I hear from families — that they didn’t know that they had gone back to using or that they had relapsed or they had started using drugs. And when they would normally do it with a group of people or friends, the things that we put in place because of the pandemic meant that they were using alone at home.

Essentially, in many ways, we are criminalizing poverty. We’re criminalizing some of the historic injustices that have happened, and we know that when that happens, there’s more difficulty in finishing your education and finding meaningful employment, in securing housing. I think a lot about some of the people who use drugs who tell me: “You know, when I’m on the street, I’m resilient, and I’m strong, and people respect me. As soon as I go into the system to try and get assistance, when I think I want to get off drugs, I am suddenly shamed. I lose my family. They take my children away.” These are the barriers that people have expressed.

We have a lack of access to services. As we know, there’s not a mental health and substance use system. I often say that in our hierarchy in the medical world, mental health is the stepsister, and substance use and addictions treatment options are a neglected first cousin twice removed.

It is a very challenging situation. We do have some options now, like Suboxone and injectable opioid agonist therapies. And we can’t lose sight that we have made some progress. We know that the progress we’ve made in housing has made a difference. Some of that was stimulated because of the pandemic and the places that we had established.

[8:30 a.m.]

We also know that there are people, inevitably, that will exploit whatever system we have and will prey on the vulnerable. Those are the balances we have to find, and I know that our public safety colleagues see the worst. They see the people who prey on the vulnerable, and it makes it very challenging when we talk about meaningful decriminalization of people who use drugs.

We’ve been talking about how we can do that in a way that is the same across the province. We just recently had the report, as you know, about policing services and the challenges that they’re facing. In no place is it reflected more than how we deal with people with mental health and substance use issues in communities across the province.

Decriminalization of people who use drugs is the next important step. It’s not going to solve all of these problems, but it is a step that we need to take. I know we’ve put in a request to the federal government for a section 56 exemption for the province. I’ve written a letter of support for that provincial approach. It has some very important things in there about not seizing somebody’s drugs when they’ve been stopped, because we know that drives them to get more, and more desperately, and use in a less safe manner.

One of the biggest challenges we’ve had is around an amount. One of the important fundamental pieces around decriminalization is that we need to have a cutoff that doesn’t leave it to a subjective police response, because we know that they’re more likely to encounter people who are racialized. That means that you’re more likely to end up in the correctional system. And it can’t be too low. These are some of the things we’ve learned from places like Mexico, where if you set that amount too low, you end up actually increasing the number of people who end up in your criminal justice system.

We have had a group together with people who use drugs and came up with an amount that we were looking at in B.C. I know there are some challenges with Public Safety about what that amount is. We hear, because of the increased amount of fentanyl and carfentanil and other analogs in the drugs that are in the system right now, that that is a reasonable personal use amount. We also know that there are differences in rural communities, where people will get an amount for themselves and their friends because it’s so challenging to access drugs.

There are many, many different aspects, too, that we need to work through — but we need to work through. We need to do this across the board in this province because we are bearing the brunt of this. Part of it’s because we are looking for it in a way that others aren’t. But we also are seeing that five to six to seven of our colleagues, our friends, our family members, are dying every day in this province.

The other part of it is: how do we meaningfully get access to non-prescribed drugs of a known potency that people can use? We can’t stop people from using drugs right now. We estimate people with substance use disorder — so that’s problematic use of substances and drugs — is about…. There are probably 60,000 people in British Columbia, and they’re not all accessing treatment. Not everybody is at that place where recovery is an option. We’re also learning that everybody’s recovery journey is unique because of where they’ve come from in their background and their life.

We know that some people may not be able to overcome the experience of their lives, of their past lives, and they need our compassion and support as much as ever. That means making sure we’re not putting them into a system that is going to unfairly penalize them and that we’re able to support them in that connection.

We’re not just talking about giving people drugs and letting them be. I know somebody said to me: “You know, it’s not about meeting people where they are and leaving them there.” It’s about, “This is a connection. It’s a place where you can start to build those relationships,” so that when people are ready there is somebody there to help them.

[8:35 a.m.]

I talk about how, in the words of John Donne: “Every man’s death diminishes me, for I am involved in mankind.” We need to recognize that — the vulnerability of being human. It’s our job to put in place those systems. Right now, the two things that we need to focus on are: how do we keep people out of that criminal justice system that differentially negatively impacts every aspect of their lives and find ways to connect and provide them with medications that will keep them alive and support them as we build a system of mental health and substance use care?

I’ll stop with that and turn it over to Dr. Wieman.

C. Wieman: Bonjour, aanii, good morning. On behalf of the First Nations Health Authority, thank you for the invitation to present to the Select Standing Committee on Health.

My name is Dr. Nel Wieman. I’m a member of Little Grand Rapids First Nation, which is located in Treaty 5 territory and part of the Anishinabe Nation.

I now live, work and play in the traditional, ancestral and continually occupied territory of the Coast Salish peoples, including the unceded homelands of the Musqueam, the Squamish and the Tsleil-Waututh Nations.

I am joining you today from the traditional territory of the Lək̓ʷəŋin̓əŋ peoples — including the Songhees, Esquimalt and W̱SÁNEĆ peoples — whose historical relationships with the land continue to this day.

Just to share with you a little bit of my background before I start, I practised clinically as a psychiatrist for over 20 years, working mainly in acute care and emergency settings, including with people who use substances. I practised on the Six Nations of the Grand River territory in Ontario for over eight years. I worked at CAMH in downtown Toronto. I also spent several years working on an assertive community treatment team in downtown Toronto, working with 100 women with concurrent mental health and substance use issues. About four years ago, I moved to British Columbia, and I now work exclusively in public health as the deputy chief medical officer of First Nations Health Authority.

By now, you are all well aware of the devastating impact of B.C.’s toxic drug public health emergency, which has worsened dramatically during the COVID-19 pandemic. I come before you today to bring to the committee’s attention the reality that B.C. First Nations people face. The impact of toxic drug poisoning on First Nations communities is many times worse. In fact, it is more than five times worse.

The data I am about to share is deeply disturbing, but these are stark facts that the province must face and take more action to address. Indeed, we must work together with the same tenacity and sense of urgency that has guided our public health response to the COVID-19 pandemic. The necessary funding needs to be allocated to address this emergency. Orders and mandates need to be issued to overcome municipal and prescriber obstacles to public health measures, and the message from government must be clear. We are all in this together. We must marshal our political and social will toward combatting this crisis and public health emergency that has been active now for over six years.

Regrettably, the scope of this emergency is most clearly captured by numbers: the numbers of drug poisoning deaths and of events in which people did not die. Of these events, some may have experienced serious and permanent brain injury. But I hope you will keep in mind that each data point or metric is a valued person who a First Nations family and community has lost and for whom grief is ongoing and irreparable. Many families have lost more than one person, and more will leave us this year.

In 2021, the number of First Nations people who died from toxic drug poisonings rose by a shocking almost 26 percent. A total of 334 First Nations people died from toxic drugs last year, up from 266 people in 2020 and 116 people in 2019. Expanding our view to the entirety of the six years since B.C. declared what was formally called the opioid crisis, a public health emergency, the loss of First Nations life is now more than 1,000 family members, extended relatives and friends. Let me repeat as fact: more than 1,000 First Nations people have died in B.C. from toxic drug poisonings in the last six years.

[8:40 a.m.]

This loss of life is immense in both absolute and relative terms. While First Nations people represent 3.3 percent of the provincial population today, in 2021, 15 percent of the toxic drug deaths were among First Nations people. This means that First Nations people died at 5.4 times the rate of other residents of B.C. Compare this to the death rate in 2019, when First Nations deaths were 3.9 times that of other residents, and we see that the disproportionate impact on First Nations is worsening.

We are also disproportionately losing more of our sisters, daughters, wives, aunties, mothers and grandmothers than are other residents of B.C. In 2021, 36 percent of First Nations people who died from toxic drugs were women, as compared to 19 percent of other residents who were women. This translates to First Nations women dying at 9.8 times the rate of other women in B.C. And just to echo what Dr. Henry presented and add to it, there is some evidence showing the increased risk of a toxic drug poisoning for women following child apprehensions.

The root causes for this heightened impact on First Nations people are complex and varied, but they are grounded in colonialism and racism. This includes the effects of intergenerational trauma due to residential schools, the Sixties Scoop, ongoing child apprehensions, systemic racism and discrimination in the health system and other systems, and a lack of access to culturally safe mental health substance use and wellness supports.

The First Nations Health Authority has been working with provincial government, regional health authorities, local health partners and First Nations communities to develop a number of culturally safe mental health and wellness programs and supports. I will briefly highlight some of the key programs and initiatives we have underway, but I want to preface this by saying it is not enough. All of the efforts the province and FNHA are taking are insufficient to stem the tide of harm and death right now. We must do more, and I will return to that point at the close of these remarks.

I just want to point out on the slides that I’ve provided you with that when the public health emergency was first declared, back six years ago, FNHA set up a framework for action. You’ll see it here on this slide. It’s titled: “FNHA’s ongoing initiatives in response to the toxic drug crisis.” Again, I’m echoing what Dr. Henry said in terms of that there is a whole spectrum of interventions that need to be in place.

We have a four-pillar framework. Pillar 1 is to prevent people who overdose from dying. Pillar 2 is keeping people safe when using. Pillar 3 is creating an accessible range of treatment options, and pillar 4 is supporting people on their healing journeys.

FNHA has pioneered the distribution of nasal naloxone spray in B.C. In 2021, we dispensed 34,000 doses of nasal naloxone to individuals through community pharmacies and more than 6,500 nasal naloxone kits to 106 First Nations communities and organizations through bulk ordering. The distribution of nasal naloxone is an additional tool that is more comfortable for many people to use than injectable naloxone, and FNHA encourages the province to consider adding this mode of administration to the provincial formulary and supply.

We are working hard to expand opioid agonist therapy, OAT, to First Nations people with an opioid use disorder. In 2021, FNHA supported 29 rural and remote First Nations communities to improve access to treatment options for opioid use disorder, including OAT. Additionally, registered nurse prescribing has been approved at two First Nations sites, with planning underway at four other locations. We have 17 nurses enrolled in prescribing education, nine of whom have completed their training in preceptorship.

FNHA has expanded the toxic drug response capacity with ten harm reduction educators and ten peer coordinators who are deployed across all five regions in urban hot spots, which are based on health surveillance data, as well as five child and youth care community coordinators who work to build youth connections and networks in First Nations communities.

[8:45 a.m.]

We have a series of harm reduction–related grant programs that we provide to First Nations communities and leaders. In the past year, FNHA delivered 87 harm reduction project grants of up to $50,000 each to First Nations and Indigenous organizations, 25 kick-starter grants of $1,200 to $5,000 to identified harm reduction champions and 77 grants of up to $1,000 to communities to support people who have lost loved ones due to poisoned drugs.

FNHA hosts one- to two-day virtual workshops called Not Just Naloxone, during which participants learn how to use naloxone within a holistic context that also explores the root causes of addiction, racism and prohibition in Canada and B.C., decolonizing substance use and bolstering community and individual resilience. In the past year, 448 people have completed these training sessions.

We also hold harm reduction community visits, in-person community engagement and education sessions that primarily focus on naloxone training but also include various other types of harm reduction education. Over the last year, 369 people participated in these sessions.

Lastly, FNHA has hosted both the Courageous Conversations webinar series and the Megaphone’s Speakers Bureau, which, over the course of 2021, have involved 12 webinars with 700 participants engaging in difficult conversations about substance use as a way to reduce the associated stigmas.

Building on these and other existing programs, in the year ahead, FNHA will expand our response in several ways, including opening Indigenous-focused overdose prevention sites — both bricks-and-mortar fixed locations and episodic sites — guided by FNHA’s new Raven’s Eye Sage Sites service delivery framework.

Again, to follow up on what Dr. Henry remarked about the changing patterns of use, one of the overdose prevention sites that was just launched on Cheam First Nation offers both indoor space, where people can be supervised when using, and an outdoor space where people can use according to their preference, if they prefer to smoke or inhale.

We’re launching an Indigenous harm reduction web portal that was created in partnership with Indigenous people with lived and living experience to provide resources, networking and supports; creating a new virtual space where people who have lost loved ones can share their stories and hardships and begin to heal, called the Sharing from the Heart Circle; and working with the province to support the decriminalization of people who use illicit drugs, with a focus on those substances that are contaminated and killing people, including fentanyl.

As part of this work, FNHA is closely collaborating with the Ministry of Mental Health and Addictions to host a series of regional town hall meetings in June of this year to better understand First Nations views and priorities and to inform implementation of decriminalization within First Nations communities. On this file, I would note that FNHA had already viewed the province’s proposed exemption threshold — 4.5 cumulative grams of substances — as set too low and believes that the federal government’s position of 2.5 grams is problematic and insufficient to reduce the harms and stigma of drug prohibition, especially for First Nations people living in rural, remote and isolated communities.

Supporting and advancing provincial efforts to make safer supply much more widely available, key measures FNHA hopes the province will adopt are a non-prescriber model for accessing safer supply, such as compassion clubs or co-ops, and the inclusion of diacetylmorphine in the range of available options for people who use drugs. More broadly, as we move forward in order to reduce the impacts of toxic drugs, we must change our understanding of the root causes of substance use and addictions, and work together to address the stigma surrounding people who use drugs.

I have shared some of what FNHA is doing and what we are planning to do to address the crisis and reduce toxic drug poisoning events and deaths. With the support of government, we must continue to make investments that expand Indigenous-specific, culturally safe harm reduction treatment and recovery services in First Nations communities and for those living away from home in urban areas.

We must also acknowledge the harms perpetuated by ongoing colonial policies and systems that lead to Indigenous-specific racism in the health system. Policy changes and concrete actions within these systems are imperative for the overall health and well-being of First Nations people in B.C.

The toxic drug poisoning crisis has been a public health emergency for over six years. In the face of these immeasurable losses, we need to build hope. We need to build hope that we can turn things around and prevent more deaths, that we can end this public health emergency.

[8:50 a.m.]

How do we do that? We build hope by thinking about how we think about, how we talk about and how we treat people who use substances. Then we take action, including having those difficult and courageous conversations with the people around us, with the people we care about, with those who are using substances. We build hope by redoubling our efforts, by deepening our investment in the response to this crisis, by removing barriers to the harm reduction measures that we know save lives, by dismantling the stigma and shame that surrounds people who use substances.

We build hope by recognizing that, just as with the COVID-19 pandemic, our only way out of this drug crisis is together. We are all in this together. Thank you. Miigwech.

N. Sharma (Chair): I want to, on behalf of the committee, start by just thanking you both, Dr. Wieman and Dr. Henry, not only for your presentation today but for your leadership in the face of so much pain and loss and really working hard to find solutions.

We will go to questions now.

P. Alexis: I’ve got a couple of questions. The first one is regarding the Portugal model that’s mentioned in Stopping the Harm. We haven’t seen it emerge again for some time, but maybe I’m in the wrong circle so I’m not hearing it as much as I did pre-COVID. Can you give me where we are right now with emulating some of those techniques that were so successful in Portugal? That’s my first question.

B. Henry: We obviously have been looking at the models around the world, and spent a lot of time following up on them. I still keep in contact with some of the leaders of the program in Portugal. They are, through this pandemic, also experiencing challenges, as all of us are, where the anxiety and separation and loss of connection has led to increased drug use in communities around the world.

It is still the basis…. If we look at the decriminalization request that we put in, the section 56 exemption request, some of the really important principles that came out of the Portugal model, like having an objective measure. What we’re fussing about is not what that is or having it or not, it’s where it is — the amount that is deemed to be personal possession — because that takes that subjectivity away. That’s really important.

Having alternative pathways but not forcing people into treatment, I think, is a really important thing too, because you can’t force somebody to take that on when they’re not ready. It just means patience. That’s a very difficult thing for us to grasp. I know, in my ongoing discussions with my colleagues in public safety, that’s a challenging one. Not seizing drugs, not having a…. They want to take them somewhere and make people enter into a program or treatment or something. That’s not going to work, and in many cases, that will push people away.

All of those principles have been what we’ve tried to put into the model that we’re building here.

P. Alexis: Okay. Thank you so much.

Regarding complex care, the parents that come to me often have a child who is an adult now with more than one need. So there are other mental health issues; there are addiction issues. Treatment is just addiction or just that particular mental health issue, and we don’t bundle the services, necessarily. I know we’ve begun to offer complex care beds with more support. But can you talk about that part, because that seems to be fairly prevalent, where we have more than one issue?

B. Henry: I think, again, our public safety colleagues will recognize that as well. Having a place or somebody who can deal with those holistic impacts that particularly children have…. It is more complex for children, as we know.

[8:55 a.m.]

There are times where even delaying experimentation helps a lot, but there are many challenges. I personally believe — and I’m speaking as the provincial health officer, not as my role in government but as an independent voice — that the fact that we have mental health and substance use services for children and youth under MCFD and not health has meant that it’s very challenging. When I did our child health indicators report, we just don’t collect information. What the services are that are being accessed? How are they being accessed? Are they effective? How do we get those holistic services for children and youth? Then there’s a huge gap when children and young people age out of MCFD.

I also hear from people who use drugs, who have issues, that they are reticent to get help for their issues because the same organization that takes their children away is the organization they have to go to, to get help. I believe — and I’ve expressed this many times — that we need to move children-and-youth mental health and substance use back into Health, so that we can understand it and build those more longitudinal supports for people, so that there’s not that massive gap when they go from one system to another.

We have started. There are a number of initiatives. I know that the Ministry of Mental Health and Addictions and the Ministry of Health will be describing some of them. But having youth coordinators that look at all of those aspects…. That’s an initiative that was started that, I believe, is really important and will be a helpful one. But these are all complex issues.

We’ve come to understand that for that portion of the population — and I think there are many different people that are affected by the toxic drug emergency — it is hugely interrelated with adverse childhood events, with previous trauma and with intergenerational trauma. That is an overlay. You can’t treat one without the other.

Did you want to add…?

C. Wieman: Thanks, yeah. I would just add as an example of more holistic approaches to people with complex problems that, for example, when the COVID-19 pandemic started, FNHA stood up two virtual services: the virtual doctor of the day, which provides primary care, and the virtual psychiatry and substance use program. The uptake of those services by First Nations people was incredible.

Actually, we’ve been kind of a victim of our own success in that we never wanted to have a long waiting list, which we know is a deterrent for people to access services, and now we’re at capacity. Our waiting list, I think, is two to three months.

This is specialized virtual services, where people could see a psychiatrist, for example, for mental health issues but also see the addiction medicine specialist with that program and actually go back and forth between the virtual doctor of the day, providing more comprehensive care.

I will say the other thing I’ve noticed since I’ve been in British Columbia. I sit on the UBC department of psychiatry executive committee. Without getting too far afield, because I know psychiatrists are only one part of the answer, we have an aging psychiatrist population. We have a very dire shortage of psychiatrists. It’s the way in which people are trained. Psychiatry and addiction medicine are now almost two different specialties. Addiction medicine training is not really a core component of psychiatry training. You have to pursue electives in addiction medicine or do additional training at the B.C. Centre on Substance Use.

I don’t want to disparage my older colleagues. But when I was trained, you didn’t see somebody clinically if they were actively using substances. That’s changed to some extent. But we really have to provide that education in the postgraduate setting after medical school and have it be seen here in this province as something that…. Every family doctor — almost every doctor, probably — and other associated health professional needs training in addiction medicine.

[9:00 a.m.]

B. Henry: Absolutely. This is part of how we address it early on when people are experimenting. I’ve had experience personally with people experimenting and family doctors not knowing what to do, not knowing just even the basics of how to get into: “Why are you using now? What are the things that we can do that can help you understand what you’re doing?” Some of those really basic things.

The B.C. Centre on Substance Use is working on a higher level and has been doing a good job, but we need to get it into basic…. So people and parents and kids have a place to go to start this proactively, that we can have that conversation. Having that conversation is fraught, because right now it’s laced with stigma and criminalization and “This is wrong,” and “Just say no.”

Not to disparage our colleagues, but there’s still a basic understanding that abstinence is the only way to treat things, and that’s based on alcohol. Abstinence is an important treatment modality for people who have addictions to alcohol, but it does not work for opioid addiction, because it is a chronic, relapsing brain disease. We know that abstinence, especially in the same ways that we did it with alcohol, just doesn’t work for people who have a dependency on opioids.

S. Furstenau: Thank you to both of you for the presentations. There’s a lot in there that I found really valuable. I have a question for each of you.

Dr. Henry, your 2019 report really laid out what the province can do for decriminalization. The term you used this morning was “meaningful decriminalization,” which I think is really important for us to focus on — that it can’t just be for show. The question I have for you is…. You’ve made it very clear in the report: amend provincial policing policy, amend provincial policing regulation. What do you see as the barriers at the provincial level to implementing these recommendations from your 2019 report?

B. Henry: Thank you for that, but I will say that this report was written in the context where the federal government was not willing to engage in discussions about a provincial exemption from section 56 of the Controlled Drugs and Substances Act.

These were options that I believed we could have taken, provincially, to accomplish the same aim. Now I think we need to focus on the federal government giving us the section 56 exemption, because that overtakes these. These were the options in the absence of that. So my focus now is on getting the federal government to give us what we need so that we can start to implement it in a way — across the province. I think that’s really important.

I know the city of Vancouver has put in their own request, and a lot of the basic principles are the same. We built on a lot of the work that they did, but it does not go far enough, in my mind, and the provincial request is better. It’s not perfect.

I know, on the public safety side, that they feel the limit is too high and that people are going to take advantage of that. And, yeah, we know that there are some people out there who are going to exploit whatever limit we put. But we also know that most people are going to benefit from it, and we have to focus on that.

I really believe that we need to have this as a provincial-level, level playing field so that there’s not a difference in different police services across the province. Right now, that’s what we’re seeing. Some places are doing a really good job; other places, they’re not.

S. Furstenau: Just a follow-up to that. I guess my take on that would be: wouldn’t it be at least beneficial — as both of you have outlined, that the emergency is so significant — to have the province operate in a bridging manner between now and when the federal government grants this permission?

I do want to ask, Dr. Wieman, if you could…. When you spoke about non-prescriber models of safe supply and compassion clubs and co-ops, could you describe for the committee what that would look like and how you see that being implemented?

[9:05 a.m.]

C. Wieman: Thanks for the question. I think one of the core reasons why we’re suggesting that there not just be what we call prescribed safer supply but non-prescriber models is because, overarching, we’re really dealing with three public health emergencies right now in this country. That’s the COVID-19 pandemic, the toxic drug crisis and anti-Indigenous racism, which was well documented in the In Plain Sight report.

Prescriber models rely on somebody having access to a prescriber, and that’s one of the major barriers right now for First Nations, Métis and Inuit people in this province and across the country. So we’re very much in support of that type of model, although we recognize…. Access to service, as well. It relates to racism. So it’s not even just having a prescriber available to that person. It’s whether that person will choose to access a prescriber, given past experience that they’ve had with other health care professionals in the past.

For example, when we were talking about our framework for supervised overdose prevention sites, part of that could be paired with what we call a compassion club or a co-op where people could access a safer supply that would not necessarily come from a prescriber of an illicit substance. But mainly, it’s because of the…. The major reasoning behind this is because of the data that I shared at the beginning of my presentation. We really are so disproportionately affected in this toxic drug crisis that we feel we have to do everything that we can — offer as many options and alternatives as we can to try to save lives according to that framework that I described.

B. Henry: Could I…? Would it be okay just to…? I’m glad you brought that up. This is one of the things that we did do during the pandemic when we recognized the disproportional impact the pandemic was having at separating people from safe things. I issued an order that allowed for other prescribers to be able to provide. So that was a start. We have nurse practitioners, psychiatric nurses and other nurses who are able to prescribe.

It has been a challenge to get the colleges on board. There’s a lot of concern about use and prescribing of opioids, so they have been focusing mostly on opioid agonist therapy — Suboxone. But I am working with them to push them to have what I call a protocolized model. So somebody can come in to an overdose prevention site, they can talk to the peer or the people who are working there and be able to access a supply of drugs that would keep them from using the street supply in a way that is safe for them. These are things that we need to work on, for sure.

H. Sandhu: Thank you so much, Dr. Henry and Dr. Wieman. Really appreciate all the work you do and for these presentations.

My question and comment is regarding overdose prevention sites. We have one in Vernon too. As Dr. Henry mentioned, there are no lives lost. Not only that, to MLA Alexis’s question, when Minister Malcolmson and I recently toured that site, those teams also provide people with other…. They will assess — mostly, they’re health care providers and nurses — the other physical…. If they see something, an underlying cause, they do connect them with services. They’re doing an exceptional job.

Besides the ongoing systems that we’re developing or trying to develop, like complex care housing and mental health substance use teams — which we have and much appreciate in the health care sector — what are your thoughts about equipping the existing overdose prevention sites and the people who work there with more resources so they can provide these wraparound services? Is there a conversation? Do we know any other jurisdiction in Canada that may have similar sites and if they have a different approach which might be more or less successful or something we try to kind of explore?

C. Wieman: Overdose prevention sites really started organically, as you may recall. We did some tricks of ministerial directions and public health orders to be able to make them legal entities in the province. It really has been a really important place for people to connect.

[9:10 a.m.]

It’s also given meaningful work for many peers, who are people with lived and living experience of drug use. That has made a big difference.

I think we are ahead of the rest of the country. I don’t know of any other place in the world that has very similar types of models. The only other overdose prevention site that I’m familiar with for First Nations similar to what they just announced in Cheam First Nation here in B.C. is located on the Blood reserve in Alberta. And it’s actually an Indigenous physician colleague of mine, Dr. Esther Tailfeathers, who’s amazing.

Again, because there’s so much stigma, because there’s so much shame, because there’s so much reluctance to access the western medical system, being able to even come to a place and have someone — this sounds so obvious — treat you like a human being, give you a sandwich to eat, sit down and talk to you for a few minutes…. When I did my medical training…. Actually, when I started working on the Six Nations reserve, we offered those kinds of services at our mental health clinic.

We had established this mental health clinic during my residency, and I was so happy with what we were doing. I went back to my department of psychiatry at McMaster, and I presented what we were doing. I had psychiatrists, my colleagues, come up to me afterwards and say: “That’s really great what you’re doing, but really, your training has been wasted. You should have been a social worker.” That’s sort of the prevailing attitude, right?

These overdose prevention sites are really not just witnessing and preventing people from dying. They are sources of emotional support, the connection that Dr. Henry talked about. There’s so much more that goes on there.

The two sites that FNHA is involved with in the Downtown Eastside for women — the one at the WISH Drop-in Centre and Atira…. People can come and sit for a while. They can do a load of laundry if they need to do it. They can access some food if they need it. These are basic necessities that all of us, most of us here, take for granted. But for someone living in that circumstance, having a warm welcome and actually having someone treat you with humanity instead of racism and discrimination makes a world of difference. And it gets people coming back, not just to use, necessarily, but if they have a situation that they need help with.

I can’t stress more strongly how important the ability to develop trust is, not just for First Nations people but for people with mental illness and people with substance use issues.

B. Henry: I will say one other thing, just because it bears saying.

As Dr. Wieman says, we have three real crises. There’s a group of people…. I’ve talked about this a little bit — that 78 percent of our deaths are in men. The differential impact on First Nations women is the other 22 percent. But 74 percent of the deaths in the last two years have been in men between the ages of 30 and 59.

These are not men, for the most part, who are going to overdose prevention sites. These are the people who are working, who are living at home. They’re in their home, where they’re living with friends and family, and they’re using alone. We need to be able to address them as well, and part of that is, again, trust to have that conversation, to get over that shame and the stigma.

Decriminalization of people who use drugs does two things. It keeps the people who are in poverty out of that rotating cycle of the criminal justice system, and it allows those people who are using at home to have meaningful conversations with people about their drug use.

H. Sandhu: Just a quick follow-up comment.

Dr. Wieman, you mentioned about the stigma and the people reluctant to go to these sites. We also had some criticism when first the site came, but now everybody is appreciative. What I liked is having peer support workers welcoming and the place being so welcoming.

[9:15 a.m.]

When you talked to people who use, they said: “Just somebody making you feel like you’re a human and a place where you can go.” Then, from there on, whether it’s physical or some other ailments or counselling, them connecting. I thought this was really very encouraging to see and to hear the importance, and I think now communities realize that. Dr Henry mentioned that it’s not one-size-fits-all. We have to look at multiple aspects of how we do it, and it is complex work.

I really appreciate this presentation and the work that’s going on, on an ongoing basis, and being very open and thorough with us and really enlightening us with what’s being done and what more we can do. I really appreciate it.

S. Chant: Thank you for the presentation. It’s greatly appreciated.

If you could wave a magic wand, what would be the recommended personal amount that the federal government and the provincial government would agree upon, and would it differ, depending on location? As we’ve said, the rural and urban accessibility and such is different.

To add to that, if we had a compassion club model available, would there be some differences if you were already involved with a compassion club — if your amount could change once you had a relationship or something like that? What would your response be?

C. Wieman: I guess I’ll go first. I can feel Dr. Henry’s eyes on the side of my head.

I think right now it’s important for me to remember and to let you know that I am here serving as a representative of First Nations Health Authority. Even at First Nations Health Authority, we don’t represent ourselves and our own views. We work on behalf of B.C. First Nations. So it’s very difficult for me to say a specific amount other than what I said in my talk, which is the cumulative 4.5 grams.

One of the things…. We’re very early. Even though the submission…. Myself and some policy analysts from FNHA sit on that core planning table that has worked on the submission for Health Canada. It’s that we’re still at early stages with socializing the notion of decriminalization with B.C. First Nations communities.

For example, we just had…. Part of the way that we conduct ourselves is that the data that I shared with you today around 2021…. We release that first to B.C. First Nations Chiefs and leaders before releasing it publicly. This is, sort of, their data. Same with decriminalization. We haven’t yet had that opportunity to speak in depth with B.C. Chiefs and leaders about their views on decriminalization, other than the town hall in which we talked about the 2021 deaths and events.

We know that one of the things we really need to do is to ensure that people really understand the difference between legalization and criminalization. Even though we said “decriminalization” five or six times in that presentation, the first question was: “Well, now that drugs are going to be legalized….” You know, you have to get people used to that idea. I think we worked on the legalization of cannabis for about a year before it actually happened.

We’re still in those early days, and as I mentioned, we’re planning those five regional town halls in partnership with the Ministry of Mental Health and Addictions. I think then we’ll hear more information about what people think about the amount.

The most recent news I have on that front is that last week I sent an email around to our partners at MMHA saying that when we have these town halls, we actually need to show people what the different amounts actually look like. Those of us who aren’t active drug users…. To be completely honest, I don’t really have an idea of what that amount actually is, and if you combine different substances together, I still don’t, really. It’s kind of strange for me to be saying this is the amount it should be, and I don’t have this visual understanding.

I did try to get onto a website from my work computer, and I had to give all kinds of information, but I did actually, finally, get some information on what a gram of cannabis would yield in terms of use. For example, when I said there are, perhaps, some geographic differences, having access to substances is really an issue in rural but especially remote and isolated communities, where it’s not like in an urban centre where you could just walk to wherever to obtain a supply for personal use. That’s not feasible for people to do on a daily basis or maybe even a weekly basis.

[9:20 a.m.]

I’m not really sure. I’m really looking forward to hearing what people have to say in the town halls. That’s kind of why I’m hedging and not giving you an actual amount. I think it’s still…. We need to hear from people in the communities and the users and peers and people with lived and living experience about what they think would work for them.

Of course, there is always some measure of compromise, right? I think the one thing that we have to be kind of proud of, in a way, is that B.C. is really at the forefront of this compared to the rest of the country.

B. Henry: I can say that the number is something that we’ve spent a lot of time on. We have a group that includes people who use drugs. It includes advocacy groups. It includes public safety. We landed on a cumulative because it’s simple. It’s objective. It can be the same across the province. It takes that subjectivity away from the individual person on the ground who’s dealing with somebody — a public safety officer, a police officer.

We landed on 4.5, and that is the approximate amount of different substances that people would use on a week-to-ten-day basis. Yeah, I had to get a better understanding of how much of each it was. I can tell you that all of our public safety colleagues thought it was far too high, and all of our people who use drugs, our advocacy groups, thought it was way too low.

We have right now, especially in the last two to three years, a group of people who are addicted to very potent opioids. The amount that they need to keep that brain from reacting and being so negative…. Opioid withdrawal is hard. It’s physically hard. It makes people feel awful. I think we felt it was a good compromise and a place to start — at a bar that is not too low.

I am very concerned that the federal government wants to bring it down to 2.5. I know that’s because they’ve had consultations with public safety leaders across the country. The city of Vancouver application was even less, which concerns me a lot. I believe we need to start somewhere. We need to start at high enough, and then we need to go from there and adjust it.

S. Bond (Deputy Chair): Thank you very much for the presentations. We appreciate them.

Lots of questions but, perhaps, starting with something even more basic. That is that as we deal with what is a crisis in British Columbia, there is a spectrum of need. I have not heard the word “prevention” today. We are dealing with a crisis because people are dying. How do we actually start having a conversation, especially when questions are raised about experimentation? How do we convey the message?

I understand the need to deal with stigma and be concerned about shame for people who are on this journey. How do we prevent people or at least begin to have a conversation about what the pathway at the beginning looks like? I see it as a spectrum from prevention and education to dealing with issues now and also dealing with treatment and recovery. So I hope that in the course of our conversation over the months ahead, that prevention and education are part of the discussion we have.

Niki, if it’s all right, I’ll just include my other comments. I have lots of questions.

It’s also really interesting to look at some of the groups that are targeted. When you think about tradespeople, particularly, First Nations women…. How do we have a systematic approach to reaching out to those particular groups?

I guess, from my perspective, I have lots of basic questions like…. There’s reference to if you have a family member that’s using, you should consider having a naloxone kit. Are naloxone kits free and distributed widely across British Columbia? Those are the kinds of questions that most British Columbians probably don’t have answers to. I’ll leave it at that.

[9:25 a.m.]

I do want to just reflect on one statement that was made in the policy information provided by Dr. Wieman.

I really appreciated your comments.

One of the things that, I think, sadly, we need to pay more attention to…. One of the bullets — sorry, there’s no page number here. You also reflect on “expanding supports for people experiencing grief and loss from the passing of loved ones.” That, too, is part of this journey, because the people who lose their lives are not the only victims of this circumstance. So I’d be very interested to see if it’s the First Nations Health Authority that focuses on that alone, or does the rest of the system also look at the grief and loss and shame and agony that people feel often?

Mainly, a full spectrum of discussion, including prevention, education and the targeted strategies. Particularly when I look at the numbers in northern B.C., the number of First Nations people that are dying is nearing 50 percent. So I assume there is a very targeted strategy to dealing with rural situations as well.

I’ll leave it at that, Niki. I’m hopeful that we may, at some point in the future, have additional opportunities to pursue some of those topics.

B. Henry: Prevention is clearly an important and incredible piece of it, but it’s not either-or. We have to deal with what we’re faced with right now, because prevention is about…. We know now. We know that the social determinants of health make a difference, that adverse early childhood events make a difference.

Prevention is about addressing the social determinants, including poverty, especially childhood poverty. That is one of the biggest determinants of people going on to experiment and develop issues with drug use — social isolation, unemployment, poor housing conditions. So we need to invest in supporting healthy pregnancy and early childhood development, encouraging social and emotional development. We’ve been working with “how do we…?” We’ve been talking about this.

The other thing is that it’s not COVID or this. It’s COVID and this. We need to look at how we foster resiliency and mindfulness and positive school experiences, because we know that if you have those connections and supportive relationships with peers and a trusted adult, you’re more likely to be able to withstand those temptations as a teenager.

Those are things from our child health indicators report, some of the connections that we found, so needing to build in those positive experiences in communities and schools. That’s all about prevention of mental health and substance use issues. We need that more than ever.

We’ve also spent quite a bit of time on helping…. There’s a very good booklet done by parents that we’ve worked with around how to deal with the grief of losing somebody — particularly, losing somebody from drug use. There’s also the Foundry, the childhood Foundries. This is also a really helpful guide for parents: Parents Like Us: The Unofficial Survival Guide to Parenting a Young Person with a Substance Use Disorder. Lots of really good information in there.

There are lots of things that we need to do. I just don’t have the time to talk about all of them today, so I hope you will talk about what it is that we can do that will help prevent people from getting into this.

We can’t stop people from using drugs. I think that’s the other thing that is very apparent. People use psychoactive substances for many different reasons. Some of them are beneficial; some of them are creative and non-harmful. But then some people merge into more harmful use of drugs. Through millennia, we have seen that people will take psychoactive substances for a variety of different reasons.

I believe — and my colleagues and the medical officers of health in this province have written a report on this — that yes, we should go to legalization of these substances. It is the illegal drug market that is fuelling the toxicity and the criminal elements that feed off that as well. But we’re not…. As a society, I don’t believe we’re at that place yet.

[9:30 a.m.]

We’ve seen it happen with cannabis. The sky didn’t fall. We’re getting through that.

I think the important thing we can do now…. To MLA Furstenau’s point, I believe it’s going to happen relatively quickly, if we can continue to put pressure on the federal government to get decriminalization within weeks or months. It’s already been too long. But that is the next important step. Then we need to be able to have these conversations and to talk about it in a way that is not othering and shaming.

N. Sharma (Chair): Okay, we’re just at time here. I know that some people needed to go at 9:30. It’s just the beginning of our journey. We’ll definitely have more opportunities to discuss.

Did you want to stay and ask your question, Dan?

D. Davies: Just really quickly. Thanks, Chair.

Thank you, both, for your presentations. It really built on what Shirley was just saying around the education — the whole spectrum. We get the importance. We are in an opioid crisis that we need to deal with.

As a former educator teaching in the public school system for many years, the education component, to me, is extremely important to make sure that we continue to capture that, because we want to prevent as much as we can. I was a big proponent of the DARE program when it was in the schools recently — of course, much different than what the American DARE system is. We had one that’s quite catered. So I think that that is something that we need to continue to look at.

These discussions need to happen. We have them at home, with families. But not all families have that at home. The public education system, I think, is a place where we can have those safe conversations. So I just wanted to put that comment in there.

N. Sharma (Chair): Thank you for that comment.

Again, on behalf of the committee, I just want to thank you both for your very thoughtful presentations and really setting us off on the right foot in terms of being the first people to come forward before this committee. We look forward to seeing from you and hearing from you again.

Thanks, everybody. I need a motion to adjourn.

Dan. Then seconded by Pam.

Motion approved.

The committee adjourned at 9:32 a.m.