The committee met at 1:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): We’re starting our second day this week of the hearings for the Health Committee, and it’s my pleasure to welcome our first speaker this afternoon, which is Dr. Charlotte Waddell.

Welcome, on behalf of the committee.

I’m on the traditional territory of the Squamish, Musqueam and Tsleil-Waututh people, and we have committee members broadcasting from different parts of the province here today.

I’m going to go around and do a little bit of an introduction so everybody knows whoever is on the committee and who you’ll be presenting to.

I’ll start with our Deputy Chair, Shirley Bond.

S. Bond (Deputy Chair): Good afternoon. Thanks for joining us. I’m Shirley Bond. I’m the MLA for Prince George–​Valemount and Deputy Chair.

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

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

T. Halford: Hi. Trevor Halford, MLA for Surrey–White Rock.

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

D. Routley: Good afternoon. Doug Routley from Nanaimo–North Cowichan.

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

S. Chant: Hi there. I’m Susie Chant. I’m the MLA for North Vancouver–Seymour.

N. Sharma (Chair): I’ll pass it back to you, Dr. Waddell. We have your presentation with us, so we can follow along on our own screens. Fifteen minutes for your presentation, and then the rest of the time for questions and answers afterwards. Over to you.

Briefings on
Drug Toxicity and Overdoses

CHARLOTTE WADDELL

C. Waddell: Thank you very much for inviting me to spend some time with you today. I’ll just turn your attention to what would be the first slide or the first page of the handout that you have received.

[1:05 p.m.]

Just to briefly introduce myself, I’m a child and adolescent psychiatrist. I have long worked with street-involved young people, including caring for young people who are dealing with substance use issues along with a lot of other factors that affect their mental health.

I also work as a university professor at Simon Fraser, where I work with a team — many of their names are mentioned on that first slide — at the Children’s Health Policy Centre, where we do public health–children’s mental health research, really trying to inform policy. On behalf of the team, I’m really pleased to be with you today.

Please, before I begin, just join me in celebrating the First Peoples, whose traditional lands we are all privileged to be gathering on today. I’m on the traditional territories of the Songhees and Esquimalt peoples.

I want to just really focus your attention, if I may, on how important it is to start really, really early in the lifespan — in other words, with children — if we are going to tackle the crisis of opioid overdose, toxic drug supply and associated issues. In the 15 minutes, I’d like to cover just a sketch of what problematic substance use looks like in young people, what a robust public health approach could be to really finally get in front of this, and what the main policy implications would be.

What does problematic substance use in young people look like? I’m just going to start with locating substance use problems within the larger rubric of mental health. Positively speaking, mental health involves social and emotional well-being — crucial resources that all young people need to be able to thrive, learn and reach their potential, to be able to cope with adversity. They’re just as important alongside physical, cognitive and spiritual well-being.

But childhood mental disorders are surprisingly common. They start early in life, and they have lifelong repercussions. Substance use disorders are one of those types of disorders.

Slide 6 shows you just how common these disorders can be in very young people. This table presents data from a systematic review that our group published earlier this year. The data come from very, very well-done epidemiological studies of large samples of young people in representative population groups, looking at multiple disorders. The column on the left shows 12 of the most common disorders that young people may experience, and the highlighted row shows substance use disorders — fourth most common among young people aged 12 to 18.

If we look at B.C. estimates, at any given time, about 8,000 children and youth would be affected by these disorders. I’ll just mention that to meet our thresholds to be included in this list, to be included in these numbers, young people had to not only have symptoms but to have severe enough symptoms that they were impaired in their ability to function at school, at home, or in the community. This is a high threshold. These are all kids that would need treatment, by definition.

Slide 7 shows what types of substances are most commonly used by young people. These data come from the McCreary Centre — their adolescent health survey, the latest data we have. It shows that alcohol, cannabis and nicotine are by far the most common, but alcohol, at 44 percent, actually is way ahead of the others; then prescription medications, mushrooms, Ecstasy, cocaine, inhalants; and then finally — fortunately at a very low proportion — amphetamines or things like crystal meth, or opioids such as heroin. That’s just to put things in proportion, looking at the population picture for young people.

Then slide 8 pulls back in some data from those epidemiological surveys, where researchers asked those young people: “If you’ve had a mental health problem, did you get any help for that?” More than 50 percent said no, they did not. That would translate to nearly 5,000 young people in B.C. not getting any services — either prevention or treatment of any type — for substance use disorders.

So we have a large, untreated proportion, a really stark shortfall that I cannot imagine us accepting if we were talking…. If this event today were about childhood cancer, for example, we would not tolerate this, but we’re doing it for mental health problems, including substance use.

[1:10 p.m.]

This is not a new story. These shortfalls have been highlighted for a long time. In the picture on the left, André Picard, Globe and Mail health reporter, was talking about Canada’s ugly mental health secret nearly ten years ago, about the shortfall when people simply can’t get help for their kids early on. The headline on the right, unfortunately, talks about how young we’re seeing the people involved in the overdose crisis — a 12-year-old who died in Victoria recently. So the shortfalls in services are having lethal consequences for some children.

Page 10. What would a robust population health approach look like to actually start to get in front of this problem? Slide 11 shows a figure depicting the components of what we believe we need to be looking at and that we’re not doing at the present moment.

The larger, outer oval depicts looking at all kids in the population and addressing the social determinants of the crisis. The inner oval talks about preventing disorders where we can, with kids who could benefit. And the far smaller oval on the right-hand side: provide treatment to all kids who have disorders. And then the bottom arrow depicts just monitoring our outcomes. How do we know that we’re doing the right things and that we’re doing them right?

Just to quickly address each component of that framework. Social determinants mainly involve committing to addressing avoidable childhood adverse experiences that are known now to contribute to mental health problems, including substance abuse. Family socioeconomic disadvantage or inequities is one of those. Racism is another. There are other examples, but those are two tough ones that we need to address.

How is it that those adversities affect children’s mental health? Longtime exposure to stressful environments affects the child’s biology as well as their emotions, and we see things emerge, like influence on gene expression over time, making kids more vulnerable to certain mental health problems. But the positive news in all this is that these inequities are socially produced, and that means that we can remediate these inequities.

A couple of examples where people have started to do that…. Addressing family socioeconomic inequities. We have grappled with this during the COVID-19 pandemic — things like basic income supports. There are many other ways that various governments have chosen to try to reduce economic inequities that would help children.

Addressing racism, of course, is a collective ethical imperative. Just a positive example here in the Duncan community. Business leaders noticed anti-Indigenous racism, and a number of them responded with putting up signs in their windows, their storefronts, in the local Indigenous language, saying: “Please come in. Welcome. Thank you.”

Slide 15. Back to the table of 12 of the most common mental disorders in children, including substance use disorders, what about prevention and treatment, those other parts of the framework? If you look at the substance use highlighted line again, you’ll see that, indeed, there are effective prevention interventions like there are for most childhood mental disorders, and they’re absolutely effective treatments, like they are for all childhood mental disorders.

Slide 16. What are those effective prevention programs for substance use? Two great examples — exemplary, I would call them, because they have very solid randomized controlled trial evidence. They’re both school-based.

One is called unplugged, and it’s a universal program, meaning all kids get the program — delivered by teachers, tested in Europe, a couple of very vigorous trials, quite young children. It’s grades 6 to 8, actually. The workshops and classrooms and groups go on over three months to over one school year, and it’s essentially 12 one-hour sessions — so pretty brief, pretty feasible, well documented.

The second one is called PreVenture. It’s more targeted, tested in the U.S. and also in the EU — two rigorous trials, kids as young as grades 8 to 10, and over just two weeks. This one was even briefer, showing positive results, and this last one is actually being tested now in B.C. schools.

We have programs that have been shown to work, shown to be very effective before kids ever get into trouble with using substances.

[1:15 p.m.]

An even earlier form of prevention…. I just want to highlight that we can do something about prenatal substance exposure, which, when that happens, sets young people up on a pathway of considerable difficulty.

We’re just completing a randomized controlled trial that we’re leading with McMaster University, and we’re also collaborating on this with the B.C. Ministries of Health, Children and Family Development, and Mental Health and Addictions, alongside with Fraser, Interior, Island and Vancouver Coastal health authorities. So a pan-B.C. approach. First Nations Health Authority has also been involved.

We’ve been testing nurse-family partnership, an intensive support program, going into the homes of first-time young mothers who are experiencing socioeconomic inequities. What we showed in our first findings paper…. That’s illustrated on the right. We significantly reduced prenatal substance exposure. So even before kids are born, prevention can start.

What about treatment? That was another component of that public health, population health framework. There is an exemplary psychosocial treatment as well: multidimensional family therapy. This one, actually, has three different randomized control trials. When kids have problems and then need to come into treatment, 11- to 18-year-olds, this approach focuses on the family quite a bit more. It involves parents helping them improve their parenting, their communications. It also helps the youth. Delivered over three to six months. It tends to be delivered by therapists but in the community.

Then slide 19, what of medications to treat youth substance use disorders? Not so much evidence here at all. Most of the evidence is with prevention and psychosocial treatment. So we need more evidence here.

What we do know comes from studies of youth opioid use disorder and a couple of small trials looking at Suboxone, a combination medication, looking at 12 weeks plus counselling, showing some success but with opioids only, not with those other more common substances. Then one trial of the medication called buprenorphine, or BUP, compared to another medication and a further trial just saying that if you give it for a bit longer, it’s more successful. But the bottom line is that the preponderance of evidence supports prevention and psychosocial treatment.

I’ll just paraphrase from Dasgupta’s 2018 paper to kind of wrap this up. The overdose crisis is fundamentally fueled by economic and social upheaval, closely linked to the role of opioids as a refuge from trauma, concentrated disadvantage, isolation and hopelessness. By ignoring the underlying drivers, current interventions can aggravate the trajectory.

Next slide. Briefly, what about secure care? I know that comes up frequently. I’m often asked about that as a policy option. This slide depicts a recent paper that was co-authored by Perry Kendall, the former provincial health officer, really pointing out the potential for much more harm than good. One of the potentials for harm with secure care is that where countries have actually studied it — Sweden and Scotland come to mind — they find that long-term outcomes for the kids in secure care are poorer than kids who didn’t go through that.

Another problem with it is that if you think back to that slide where I talked about fewer than half of kids with mental health problems are getting any services…. If you pull kids into secure care, what do you then send them back out to, if there aren’t the services already in place, which we know there are not? It’s also ethically problematic if we haven’t done our best to prevent the problems in the first place.

I would say the most serious ethical problem with secure care comes from feedback from Indigenous leaders who say: “Never again will you take our children and take them away from us and put them into secure settings, away from community.”

So policy implications of all this. I guess my main message is that we need to be thinking about investing in children — in other words, starting to tackle this problem much, much earlier than the news headlines would often depict, addressing those avoidable adverse childhood experiences and offering those effective prevention programs.

Unplugged and PreVenture could be offered in all B.C. schools, and they’re not right now. That’s a concrete step that we could take to ensure that all young people with substance use problems can access an effective psychosocial treatment like multidimensional family therapy.

[1:20 p.m.]

A final comment pertains to how we organize children’s mental health services, including for substance use. Right now things are fairly fragmented across different ministries, including MCFD and Health, but also across all of the regional health authorities and PHSA. We need to come together. We need to have a much more coordinated approach, because substance use problems are mental health problems. We need to monitor child outcomes, not just the care provided, across all of those places.

Is dramatic change possible? Slide 24. People often ask me: “This is unrealistic. What are you trying to say? We can double the services for kids?” Other high-income countries have done so. Australia is the poster child. They measure children’s mental health in the population quite regularly and quite carefully. They showed that between 1998 and 2014, they were able to double young people’s access to prevention and treatment programs. If they can do it, I’d like to suggest that we could too.

I’ll just close out with basically an economic note. James Heckman is a Nobel laureate in economics who, late in his career, turned to early child development as what he thought was the best investment. Paraphrasing him, investing in disadvantaged young children is a rare public policy initiative that promotes fairness and social justice and, at the same time, promotes productivity. Early interventions have much higher returns than later interventions such as police or jails and, I would add, later interventions, such as some of the rescue efforts that we do far downstream, when we don’t attend to prevention and early treatment for the overdose crisis.

It’s a question of honouring children’s rights. This is the UN convention on the rights of the child. It’s especially a question of honouring Indigenous children’s rights and, once and for all, addressing colonialism and its legacies. I think you’ve heard from other speakers really outlining how there’s a disproportionate impact of the overdose crisis and the toxic drug supply for Indigenous young people.

I’ll just end by thanking some of our funders. A quote from Neil Postman: “Children are the living messages we send to a time we will not see.” Keep the focus on kids.

My last few slides are simply references from the talk. Please just email me if you would like copies of those or any other references to the material that I’ve spoken to today.

N. Sharma (Chair): Thank you, Dr. Waddell. We’ll have our colleagues….

Just put up your yellow hands there if you have any questions.

P. Alexis: Slide 16 shows your prevention measures. I don’t know about them. PreVenture, you said, was less than two weeks administered by the teachers.

Could you tell me a little bit about exactly what that is? You’ve got education, motivational interviewing and cognitive behavioral training. But can you give me a little bit more to go on, please?

C. Waddell: Thank you for your question. Yeah. Basically, in the U.K., there was training provided to teachers and therapists, in some cases, to augment that. Students were screened, taken out of class and then offered, basically, a couple of sessions and then were tracked afterwards.

The sessions involved motivational interviewing, which essentially looks at giving kids tools to say: “Hey, I want to resist substance use” or “I want to reduce it if I’ve already started engaging in it.” Education on the harms and cognitive behavioral training help kids look at what are other ways to cope with what might be luring them or drawing them into using substances.

So that’s the gist of it. Very brief. Two sessions only. That’s one of the appeals of it. It’s likely highly cost-effective and highly feasible to embed within school programs.

M. Starchuk: Thank you, Doctor, for your presentation. I’m sorry if I might have missed it. My office is very noisy right now.

With regards to your slide 24, I’m curious as to what the services are. How are they accessed, and where are they delivered?

[1:25 p.m.]

C. Waddell: Thank you for that question. Slide 24 refers to Australia’s service. One of the big differences compared to our own situation, but where Australia might be parallel to what we could do in the province of British Columbia…. It’s a national health service, as you all likely know, but is it a model for what we might be able to do in a given province, such as our own?

Essentially, they used their baseline data showing that a lot of kids, much like the data I showed you earlier, were not getting prevention or treatment services. They used that data to ramp up government funding and provision of effective mental health services, both prevention and treatment. Then they tested again across the population.

What it looked like was, for example, cognitive behavioral therapy, a very effective prevention program, delivered in schools for making sure that anxiety, depression and things like substance abuse never get started. Then treatment programs were pretty much all community based — so delivered by clinicians, usually in teams.

Again, they put a big emphasis on both effectiveness, making sure that they were good quality interventions, but also efficiencies — so delivering things, for example, in groups or in schools, where possible, to reach more kids.

S. Chant: Thank you for your presentation. When you spoke about unplugged, where has it been trialed? Question one.

The second piece I have is that I’ve heard from other folks that oftentimes, in school environments, they’ll do an assessment of kids. Then they’ll find kids that are in trouble. But within the school environment, they don’t have anybody there that’s really obligated or got the additional training to help them out, and they can’t get them to external resources.

Have you got any ideas on how we could solve that piece of the equation?

C. Waddell: Thank you for those questions. Unplugged was tested in the EU, so big European trials, a very large sample — 7,000 kids across seven countries, another study in one country.

Basically, deliver to all kids in the classroom, which has a one great benefit. You don’t stigmatize anybody by asking them to come to a special session out of the classroom. The teachers deliver one-hour sessions, just 12 of them.

That’s what was tested, and that was what was found to, basically, significantly reduce alcohol and marijuana and to have even greater impact where kids had socioeconomic disadvantage. These were really huge, well-done studies. The one other one in the Czech Republic also found any drug use, not just alcohol and marijuana, was reduced. They followed these kids for a long time. They found positive results two years later. So very effective and efficient, if you think about teachers delivering, and a fairly short training period for teachers. Grades 6 to 8, so you’re reaching kids very, very young.

What I would say is my response about unplugged partially answers your next question too. Imagine if we had unplugged as a universal, school-based B.C. program available across the province. There would need to be some tie-in of child and youth mental health teams — which are spread across the province through MCFD, for example, and through the health authorities — providing training and support. But that could be done initially as part of training the teachers.

Then support could be linked in, but the teachers themselves would be empowered and would know more and be able to do more without a necessarily very onerous demand on them in terms of classroom time. That’s what the authors of these studies also felt was quite sustainable.

I can see no reason why unplugged…. If we were to ramp that up and offer it, it would actually start to address your second question, because teachers would be empowered. There would be more awareness, and the people supporting the teachers would be pulled in. It could be just a fantastic provincewide effort.

T. Halford: Thank you very much for the presentation. Given the fact that we’re, hopefully, coming out of out of the pandemic, we’re going to see a wave, I think, of mental health issues, specifically for our kids — whether it’s them not having access, in the past couple years, to sports, grandparents and other such things.

[1:30 p.m.]

Right now there’s a backlog, in terms of that support. I think one of the study’s referenced about 800,000 kids across Canada that would be estimated to be suffering, and then there’s support for maybe half of that. Just in terms of how we adequately try and clear that backlog and also, too, on the financial restraints….

I know that during the pandemic, there was a complete drop in calls that were going to child protective services and things like that, but that doesn’t mean that those issues weren’t prevalent in the home, whether it was financial issues at home and things like that that were changing the family dynamics.

So just your comments on that. One is around access, and the second is around economic hardship to obtain that access.

C. Waddell: I really appreciate those comments and questions. Thank you for that.

The slide that I showed you depicting the shortfalls — that is pre-COVID, the data that we gathered just before the pandemic really, really hit hard. You’re absolutely right that with the pandemic and the associated public health responses, even though B.C. was relatively quick to get kids back in school, and things are more open now, we’re still likely yet to see the full aftermath of that in terms of children’s mental health writ large, not just substance use problems, as I think you’re alluding to.

There is an argument, I think, based on your question, for saying that we need to be ready to really gear up services. We need to increase the number of things that we’re providing. We need to gear up MCFD’s child and youth mental health services provincewide. We need to make sure the health authorities are mobilizing to do the more secondary and tertiary forms of care that I believe they’re all providing. More resources would help them hire more people.

At the same time, we need to ask them, I would suggest, to be more efficient. Efficiency would mean coordinating across the MCFD child and youth mental health community-based services, across the health authorities, linking kids more closely in with the secondary and tertiary services — for example, the specialized teams and the hospital care that the health authorities provide — of course, linking closely with First Nations Health Authority and their efforts to support those.

And asking people to take lessons from…. You know, a lot of people learned during the pandemic that mental health care can be provided to kids virtually, the way that we’re talking today. I have done this myself in my own child and adolescent psychiatric practice. Kids respond quite well. They can work the Zoom. They can work the other platforms. They’re quite comfortable, once they know you a little bit, to really…. You can reach a lot more kids if you’re willing and able to do that.

Also, seeing kids in groups, which we’re able to do now, and seeing kids and offering these kinds of programs in schools…. Now would be a great time to ramp that up, because kids are going to be going back to school. It would be great to have a set of investments that went across early prevention and early psychosocial treatment — a ramping up of asking the existing child and youth mental health service providers to be prepared to take these on and to, perhaps, take the lead.

N. Sharma (Chair): I have a question. Some of the facts that you provided were new to me, and they were very interesting in terms of the deep analysis of the gaps between accessing services and the need and the approach. I think that what I’m learning from you is that there are prevention and treatment options for kids, so investing in wellness. We heard that Foundries are expanding, so investing in youth services.

Also, I just wonder if you’re tracking how much stigma plays a role in accessing services or not. One thing we’re learning a lot about is that people sometimes don’t talk about their substance use, or they don’t reach out and ask for help, so there’s an inability to get at them.

The first question is: how do you measure for that stigma that prevents access to care? And then do the programs that you talked about that are being offered in school kind of universally…? Is that a way to get at that idea of…? Maybe just…. That was what I was wondering about.

C. Waddell: Yes, thank you for that.

I’m going to link back to something you said, Trevor, just about inequity in access. I think it was one of the things that you were getting at.

[1:35 p.m.]

One of the access issues…. If people have robust socioeconomic resources, parents and families can find ways to get help for their children. But I think, with the COVID-19 pandemic, which has disproportionately affected certain families far more than others, we have kids that are in the homes, the parents have been highly stressed, including economically, and there’s been no way to access anything extra.

So that addressing of social determinants still is incredibly important so that more families can have an equitable chance at creating the economic conditions for themselves and their children to thrive. And that will, in turn, start to really help by alleviating family stress, for example, so parents can cope better and be more present.

I think that plays into your question about stigma as well, just insofar as there still is, I think, unfortunately, a great deal of stigma about having any mental health problem, whether you’re a child or an adult. And unfortunately, I think substance use disorders have more stigma than any others, and that should not be the case. They should be regarded as a form of mental health problem like any other. And the focus should stay on wellness where possible, as you’re saying, Niki.

To respond to the last part of your comment, when you have a universal program like Unplugged, as an example…. It’s not offered right now in B.C. schools. No, we’re not offering it, but we could be. And it’s offered to all kids, so there’s zero stigma. That’s one of the beauties of it.

There are other examples of mental health programming for kids that take the same approach. There are anxiety prevention programs, for example, that can be offered in schools. The teacher does it, maybe just ten minutes a day, as part of a wellness curriculum that prevents anxiety and also prevents depression — offered to all kids. That’s the trick for really avoiding stigma.

And at the same time, what you do is educate young people, including very young ones, even in the primary grades, that mental health is part of life; social and emotional wellness are alongside physical wellness, and young people become more literate about that. So reducing stigma, but you’ve got some side benefits too.

That’s partly why I would suggest something like Unplugged. It’s a really promising approach. We’re not doing it now, but we could be.

P. Alexis: Trevor may have alluded to it, but I just wanted to go back to the chart with the breakdown of the various issues that children face. Now, when this data was gathered, was this based on those that had sought treatment, or was this based on a self-evaluation that the children did themselves? Can you just give me a little bit of background on how this data was gathered? How did it come to be?

C. Waddell: Thank you for that. I think you’re talking about slide 6 of 33. Basically, to pull this table together, we combed the literature, looking for people that did what we call epidemiological studies in large samples, like several thousand children, where they had a mechanism to do representative sampling.

We found 14 studies. One of them was conducted in Ontario. To answer your question, it was typical; the way it was done in that Ontario study was that they used Stats Canada, so partnering with Statistics Canada staff.

Stats Canada has access, as you all likely know, to really fantastic population databases and can pull in what would be a representative sample. How do we ensure we get urban, rural? How do we ensure we get different ethnicities, wealthy, low-income — really to get a good sample? And then they telephoned the families and, by telephone, in this one case, talked with parents of younger children and, for older children, talked with the youth themselves. So it was a telephone interview in that example.

Some of the other studies used in-person interviews, talking with young people or talking with parents if it was really young children. So they’re carefully done in the sense of making sure that they’re representing the whole population and not just looking at those kids who found a way to get service.

[1:40 p.m.]

This is really crucial, knowing that most kids don’t get any services. These were kids that were just in the population, a random sample of given cities or countries or provinces, and asking those kids, “How are your symptoms? How are you coping? What’s your life like?” and asking them if they were getting services. Less than half were getting any services.

So it’s not the same as administrative data where we would look at, for example, how many young people came into the child and youth mental health service that is run by MCFD, or maybe run by one of the health authorities. It’s so important. This is the only data that can get at what’s happening to kids that aren’t able to access service. This tells us how they’re doing, what they’re struggling with.

I’ll just mention, because this was pre-COVID, there is another study underway to take a look at what happened to children just before COVID, and then what happened in a couple of years after, regarding mental health. This will be a follow-up to a 2019 Statistics Canada survey of 45,000 young people across the country — including British Columbia, of course. There will be a follow-up study. It’s starting quite soon, going back to all of those young people and asking them what changed.

What was different? Maybe something improved. Maybe something got worse. We expect things may have gotten worse during and after COVID. So there’s going to be fresh COVID-related data to come, back to the points and the questions about how the pandemic may have affected all this.

P. Alexis: Can I just ask a follow-up for clarity? Do you mind?

We’re talking about, in this particular slide, children in British Columbia, are we not, or are we talking about Canada-wide? So just wanted clarity for sure on that.

C. Waddell: So Pam, what we’re talking about is actually global and B.C. estimates. We looked for really well-done surveys. We found one in Canada, 13 in other high-income countries, but nothing covering British Columbia — only that one. B.C. has never done this kind of survey, so the best Canadian data came from Ontario. But we pooled that with data from other high-income countries, and then we used B.C. population estimates to give you the figures that you have in slide 6, estimating how many kids in B. C. would be affected at any given time.

I wish we had B.C. data. We don’t. We will get B.C. data soon in that post-COVID survey that’s coming. That will be next year. I wish that B.C. did collect better data, but this was the best data there was, looking globally at high-income countries.

P. Alexis: Thank you for clarifying.

D. Davies: Very interesting presentation. I don’t disagree with you at all on lots, but I’m from a smaller community. I live in Fort St. John. Communities like Fort Nelson up in the far north…. We have these communities — these smaller, more rural, remote communities — across the province that just don’t have the access to the needs that our children have.

I really do worry a lot. Trevor touched on it. Post-COVID what we’re already starting to see…. I’ve reached out to a few organizations here, and they’ve already started to see the increase of children that are seeking more psychological supports and mental health supports, but we can’t get them. In fact, there are no psychologists in Fort St. John right now, so we’re reaching out through to Prince George, where you’re put on a year-or-more waiting list to see someone. That’s just Fort St. John. This is across the health services regardless.

I guess my question to you, if it’s maybe a loaded question, is: what are your recommendations to the province, to us, that we need to make these recommendations to get these supports? I really don’t think sitting on one or two Zoom calls a month with a psychologist does the trick, either. I think there’s a critical shortage. So if you have any insight or ideas, we would love to hear them.

[1:45 p.m.]

C. Waddell: I really, really appreciate the points that you’re making. I think there are disproportionate effects across the province when we look especially at rural and remote communities, where the services were always in even greater shortfall to begin with.

One of the things I would say to the province, which I did say to each of you in one of those slides near the end…. We need to really increase the services going to children’s mental health, and that means increasing the investments in the funding. If less than half of kids were getting any services pre COVID…. You might argue that in your areas…. In rural and remote communities, it likely was well below half.

We need to be…. If it’s half, why can’t we think of doubling what we invest in children’s mental health in this province? Doubling in a smart way, though. That means looking at not just late-stage treatment but looking at those prevention programs. They could be offered in rural and remote schools, things like unplugged, which we’ve been talking about. Quite inexpensive. It could be a B.C.-wide curriculum, B.C.-wide training for efficiency.

What you get when you offer that kind of prevention program…. It’s looking down the road quite a ways, but you start to see 30 to 50 percent decreases over time in the number of kids that ever get into trouble with substance use. You’re taking a visionary approach to say: “We’re investing now in the long-range future.” Coupled with that, of course, there needs to be treatment and not just for substance use, as you’re alluding to, but the full range of children’s mental health programs.

If we’re looking at less than half of kids getting help before COVID, we need to look, at a minimum, at doubling what we offer through the provincewide services and through the health authorities, making sure those new services are effective services and having them be well coordinated for efficiency. So if Northern Health can be doing something to help out with MCFD within the rural and remote communities in the North and with the First Nations Health Authority, to get together on that, to break down the silos….

It’s not just about more money and more service providers. It’s about efficiencies that come from coordinating and ensuring that we offer the most effective interventions.

That’s the message that made me include that slide about Australia. It sounds preposterous to say: “Let’s double what we invest in children’s mental health.” Australia essentially doubled the number of kids receiving needed prevention and treatment services. They didn’t entirely have to double the budget. That is my understanding. They were very judicious, picking really effective interventions, coordinating really closely.

I think those things could see us…. If we did those things now, in five years, we could be in a much better place. We could be a long way towards pandemic recovery, also, and equity for kids in rural and remote communities.

N. Sharma (Chair): I don’t see any more questions. So it’s my pleasure, on behalf of the committee, to thank you so much for your presentation, which was clearly filled with a lot of passion and expertise. We learned a lot from you. Thank you for that.

Committee, we are in recess until our next speaker at two o’clock.

The committee recessed from 1:48 p.m. to 2:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s a pleasure to invite our next guest and speaker, Dr. Clive Weighill, the chief coroner of the province of Saskatchewan.

Welcome, and thank you for joining us. My name is Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair of this committee.

I’m going to do a go-around so that you can introduce everybody that you’re presenting to. Please know that we have all your materials that you’ve sent in on our screens. After we do introductions, you’ll have 15 minutes to present, and there’ll be 45 minutes after for the questions and answers.

I’ll go to our Deputy Chair first.

Go ahead, Shirley.

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

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

P. Alexis: Good afternoon. I’m the MLA for Abbotsford-Mission.

S. Chant: Hi there. My name is Susie Chant, and I’m the MLA for North Vancouver–Seymour.

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

T. Halford: Trevor Halford, MLA for Surrey–White Rock.

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

D. Davies: Good afternoon. I’m Dan Davies, the MLA for Peace River North, up in northeastern B.C.

CLIVE WEIGHILL

C. Weighill: Thank you very much. To start with, I’m not a doctor. Thank you very much for that title, but I’ve not made it that far yet.

I’m very happy to see the MLA from North Vancouver here, because my daughter lives in North Vancouver. So it’s nice to have somebody from North Vancouver here.

I’ll just go through and read off my written proposal to you, and then I guess we’ll open it up for questions after that. First off, my name is Clive Weighill, and I’m the chief coroner for the province of Saskatchewan. I’m also the chair of the National Forum of Chief Coroners and Chief Medical Examiners. I co-chair a collaborative between the Public Health Agency of Canada and the chief coroners and the chief medical examiners. I’m very pleased to present to the committee today.

The crisis we’re experiencing in relation to drug toxicity and overdose affects almost every segment of society. It’s a national and international problem, and it’s certainly not unique to British Columbia. The National Forum of Chief Coroners and Chief Medical Examiners recently met in Victoria for our annual meeting. Deaths related to drug toxicity was one of the major agenda items.

Recorded deaths due to illegal opiates have risen steadily in British Columbia, Alberta, Saskatchewan, Manitoba and Ontario. The deaths are mainly attributed to fentanyl and its derivatives. Atlantic Canada has not been affected to date. There is speculation that the closing of the borders in Atlantic Canada during COVID-19 may have temporarily slowed the influx to those provinces. As a sample of increases to other provinces, I’ve included a graph in my presentation, illustrating the increase observed in Saskatchewan.

Saskatchewan has a similar death rate to B.C., of 43 people per 100,000 population, in relation to illicit drug deaths. Alberta, Manitoba and Ontario are facing similar increases. You can see by the chart that I’ve put in, from Saskatchewan, showing drug toxicity deaths from 2010 to 2021, that we really started to see an increase in Saskatchewan in 2018-2019.

[2:05 p.m.]

Up until that time, we were experiencing about 78 deaths, back in 2010, and we’re looking at a prediction this year of 561 deaths in Saskatchewan. So it’s a big issue here for us. As I mentioned earlier, our death rate in relation to drugs is quite equal to British Columbia.

In most cases, toxicology analysis shows polysubstance results. Seldom is fentanyl or a single opiate involved. There’s usually a combination of fentanyl-cocaine or fentanyl-methamphetamine and etizolam or fentanyl and alcohol, etc.

On one positive note, the number of cases is increasing, but they are predicted at a slower rate compared to the past four years. So whether or not we’re starting to hit a plateau…. I’m hoping we are, in Saskatchewan. I can’t speak for B.C. I haven’t seen the recent numbers there yet, but I’m hoping that we’re going to see a kind of a watermark for us.

The committee is examining deaths attributed to opiate use, but we shouldn’t lose sight of the countless drug overdoses that, fortunately, do not result in death. It’s not uncommon for first responders to assist a person that has repeatedly overdosed multiple times but is saved due to naloxone or hospital or EMS intervention. This puts a tremendous strain on our health systems, police and EMS resources.

The factors for illicit drugs vary. Finding solutions is very difficult because there’s not one common user profile and, therefore, not one common approach. People turn to illicit drugs for one or many of the following reasons: they were once prescribed opiates for pain relief and can no longer receive a prescription from their family physician, and therefore, they turn to the illicit drug market; drug addiction — knowing the danger but seeking that fentanyl high; experimenting with illicit drugs, using drugs such as cocaine and not knowing the drug is mixed with fentanyl or its derivatives; depression or mental health issues; or homelessness.

There has been public messaging and media coverage. However, I believe the public does not understand the drug overdose situation. Many people still see this stereotypically as an issue of young people within a homeless, addicted population. Our data clearly shows that the median age of a person dying is in the range of 30 to 45 years of age. Many had good jobs and family situations prior to drug activity.

I’ve attached the age breakdown related to the opiate deaths in Saskatchewan. If you refer yourself to that chart that I provided, you can see, under the accidental category there, that most of our drug toxicity deaths are attributed to accidental overdose. You’ll see that for females, the common ages range from 20 to 29 all the way up to 40 to 49. That’s the biggest cohort. For males, it ranges from the age of 30 up to 59 — the common ages there. So it’s certainly not a young person’s failing to adhere to their own health situations. It’s mainly, almost, middle-aged adults.

This issue can’t be resolved by one agency or government ministry alone. It will take the collaboration of entities such as health, mental health, police, justice, social services, persons with lived experience, community-based organizations, etc. I suggest the following may assist with reductions in deaths due to illicit drug activity.

One, support for the recommendations put forth in the British Columbia coroner’s service death review panel, under illicit drug toxicity deaths. It was released on March 9, 2022. I was fortunate to sit as an observer on this panel.

The panel consisted of medical professionals, mental health professionals, clinicians, government officials, police, justice, pharmacists, persons with lived experience and peer clinical advisory, First Nations, and persons working with harm reduction, only to name a few of the panel members. The recommendations are well-thought-out and provide useful strategies.

Two, in April 2016, the British Columbia provincial health officer declared a public health emergency. A public health emergency declaration provides additional powers and funding. I recommend that the province of British Columbia continue with this strategy. This will allow the funding and support for public awareness campaigns to break the stereotypical perception of the issue only affecting young, addicted individuals. It will help with public awareness, in general, of the harm and dangers of illicit drugs and will also help with funding to address addictions harm reduction and preventative programs.

[2:10 p.m.]

Three, a reduction in deaths associated to illicit drug toxicity requires a wholesome collaborative of many partners. There are cornerstones to such a collaborative, and I’ll name a few.

Prevention — a plan is needed to inform the public of the seriousness of the issue, with advice on consequences related to health and mental health from illicit drug use and how to get help personally or when assisting someone with an addiction issue.

Mental health availability in a timely manner and intervention for mental health, also in a timely manner.

Treatment — it’s paramount to assist an addiction issue in a timely manner, at the time of the intervention.

Enforcement — providing resources and strategies to reduce criminal infiltration into the drug market.

I’d like to commend the work that’s been done in relation to drug toxicity deaths in British Columbia. The strategies and programs implemented thus far have provided leadership and guidance for the rest of Canada. Many of the initiatives derived from B.C. have been implemented in other provinces.

Those would be my opening comments.

N. Sharma (Chair): Thank you very much. Maybe I’ll start us off for the questions. You had mentioned, based on the data in Saskatchewan, that you see it plateauing off, or you’re hopeful that it is. Is this based purely on a numbers analysis, or there are certain things that you know are happening and that are helping to reduce that rate of increase?

C. Weighill: So far, to date, in Saskatchewan, I think it’s just a numbers reduction. We’ve only got two safe injection sites in Saskatchewan, one in Saskatoon and one in Regina. They’re not provincially funded yet, so they’re running on donations. That may be helping a little bit.

I think we’ve maybe hit the watermark — I’m hoping, anyway — in Saskatchewan. Year to date, this year, we’re almost on par with where we were last year. That’s the first year in many years now that we’ve been just staying status quo.

N. Sharma (Chair): I have another question too. You mentioned the mix of drugs that people are found with in the toxicology reports, and you mentioned one that I wasn’t familiar with: etizolam. I wondered if you could tell me the class of drugs or what it is.

C. Weighill: Etizolam, yes. It’s a sedative-type drug. If it’s taken with fentanyl, naloxone will not help. It’s not the same.

N. Sharma (Chair): Yeah. We’re learning in B.C. that a lot of the drugs, at least, found on the street…. The illicit drug supply, benzodiazepine. Is it similar?

C. Weighill: Benzodiazepines? Yes.

N. Sharma (Chair): Okay. It’s a similar class.

C. Weighill: We’re seeing that right across Canada. As I mentioned, we just had our meeting with the National Forum of Chief Coroners and Chief Medical Examiners. Every province except for Atlantic Canada is experiencing this right now. We’ve seen deaths increasing. The same types of drugs are migrating right throughout Canada.

M. Starchuk: Thank you for your presentation. I’m kind of curious that you talk about how initiatives derived from B.C. have been implemented in other provinces, and you just had your national forum here in Victoria. You talked about the death reports. Tell us what’s happening in other provinces in relationship to what’s happening in the province of B.C.

C. Weighill: I think there has been quite a bit of replication that’s going on. I think almost every province now has some type of a drug strategy in trying to tackle the problem. I know a lot of the provinces now have opened up additional beds, addiction beds.

There seems to be a bit of controversy, though, across Canada and in other provinces, about what that really means. You know, governments announce additional addiction beds, but the true definition of an “addiction bed” may vary from province to province.

We’re trying to follow, I think, a lot of the things that British Columbia has done in the past in trying to stem the tide.

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

M. Starchuk: If I may, you said there’s a controversy about what the definition of an “addiction bed” is. What is that controversy?

C. Weighill: Well, it’s whether that bed is truly for somebody that’s just now saying, “I need help; I need an intervention,” and you have an addiction bed ready for them or not, or whether it’s time in a hospital bed that someone that comes into the emergency may use first and that may be open for an addiction afterwards. It’s how they’re actually using those beds for patients.

N. Sharma (Chair): Any other questions?

All right. Thanks for the information that you provided today. We really appreciate your coming and taking the time to give us not only your provincial perspective but the kind of national perspective that you offer from the tables that you sit at. It’s been really interesting.

Committee members, we’re in recess till the next presentation, which is at three.

The committee recessed from 2:15 p.m. to 3 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Okay, we’re back from recess, with our last speaker here today. It’s my pleasure, on behalf of the committee, to welcome Upkar Singh Tatlay, from Engaged Communities Canada Society.

I just want to welcome you on behalf of the committee. My name is Niki Sharma, MLA for Vancouver-Hastings and Chair of the committee.

I’m going to go around so that people can introduce themselves to you and you’ll know who you’re speaking to. Then we have your presentation. Thank you for providing it.

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

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

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

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

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

S. Chant: Susie Chant, MLA, North Vancouver–Seymour.

D. Davies: Good afternoon. Dan Davies. I’m the MLA for Peace River North. Welcome.

N. Sharma (Chair): I’m sure Trevor will be jumping in when he can.

We’ll pass it over to you, and it’ll be 15 minutes for your presentation, then the rest of the time for questions and discussion. We look forward to it.

ENGAGED COMMUNITIES CANADA SOCIETY

U. Tatlay: Thank you very much, Chair, and thank you, everyone, for joining today, allowing me this moment to present.

I’m bringing greetings from the Semiahmoo First Nation’s territories.

Once again, thank you to the Select Standing Committee on Health, to the Chair, the Deputy Chair and everyone else.

The presentation — I understand, as you mentioned, that it was circulated before — is on community-based approaches to harm reduction and opioid poisoning prevention. As shared earlier, my name is Upkar Singh Tatlay. For brevity’s sake, I’ll forgo any elaborate introductions. It’s all there in the package.

You can see, though, from the biographical sketch in the information there, many of the roles are largely centring around public health and health innovation technology. I’m also the president at DIVERSEcity Community Resources Society, treasurer at Bridge for Health, and the founder and executive director at Engaged Communities Canada Society, a registered non-profit here in British Columbia.

As an organization and also as a health innovator myself, our work is largely focused on patterns of use of illicit drugs — which subsequently led to the development of many of the direct solutions that you may have seen in your package and that we can discuss later on, as well — delivering these solutions to combat the increases we’ve seen over the past decade, specifically over the last few years, and also coinciding with the global pandemic we’ve all been living through.

The evidence-based model is coupled with our harm reduction–based approach, which leads with community-centred cultures — those cultures largely being our First Nations culture’s salvation model. We continue to use these models — this collective-response model — in all of our efforts. You may have read in our package about Engaged Communities Canada. Some of our projects that use this model include the distribution of rapid-detection kits for COVID, emergency winter shelters, mobile vaccination clinics and a mobile health unit. We’ve just launched flood relief efforts in 2021, as well as cooling hubs throughout the heat dome last year and this year.

Engaged Communities will be entering our decade of operation very soon, largely focused on working alongside marginalized communities in many different ways: gender-based violence, food security, mental health, to name but a few. It was through this agency and this work in 2015 that we gained anecdotal evidence of the burgeoning crisis which indicated high numbers of overdoses in racialized homes.

[3:05 p.m.]

In your package, you may have also seen a lot of the research that was done. What happened was that we were able to take a lot of that anecdotal evidence and — if I put on my other hat, in the professional guise of health innovator working with the local health authority — we began to unpack data from the B.C. coroners division working with epidemiology teams to truly understand who was being impacted by the poisoned drug supply on our streets.

I’m sad to report that at the time, we did uncover that they were marginalized, racialized community members, a heavy increase in South Asian populations. In the presentation, you’ll see a 255 percent increase, over a three-year period, among South Asians. That report was then made public, but not for another few years. It had to go through its own vetting process and was subsequently released as a chief medical health officer’s report.

However, as a result of this body of work, we circumvented the traditional pathways and jurisdictional processes that were considered “protocol.” We went to the source, meaning that we went to the community, started our work in earnest and delivered solutions very rapidly. People were losing lives, and we did not have the luxury of waiting.

In delivering programming rapidly, we were effectively saving lives right away. We pivoted quickly and deployed projects direct to community within a matter of weeks, months. These are solutions that are community-based initiatives, with truly an eastern and Indigenous approach derived through dialogue with the community itself.

In the presentation, you’ll see that there was mention of a project called the SALMON project. We took the name from consultation with the Indigenous communities we work in, the regenerative cycle of the salmon. Really, the SALMON project’s intention was, for the first time, to make forays into a community to not only inform and provide resources but to heavily reduce the stigma in a community that oftentimes prevents people from seeking assistance or from even talking about the challenges.

What we did was take a collective response, empowering the community — a community of peers, a community of individuals, and the broader community, those who perhaps do not use substances — to really engage with us and make sure that everyone is participating in the dialogue. We did not want to leave peers, volunteers and community members with a lack of resources and simply send them out with conversations. We want to empower them with tools and resources, as well, which they are sorely lacking.

That’s when the overdose intervention app was created, a digital tool to ensure that racialized and marginalized communities, those who are heavily impacted, also had access to resources to offset the dangers of a poisoned drug supply. A lot of the resources we developed and created simply did not exist.

This digital solution — again, going back to the eastern collective approach, the Indigenous collective approach — galvanized the entire community to respond. No longer was it pointing the finger at a small segment of the community that is using substances, but it really engaged the broader community to ensure that they were also participating in the response.

I’ve mentioned our subsequent mobile health unit and the shelter. These are safe, welcoming spaces for delivery of harm reduction, your harm-reduction-centred organization delivering unofficial DCRs, drug consumption rooms, where our staff and volunteers are always present, providing sterile injection supplies, answering questions and assisting with peers to ensure that we are, again, empowering people and ensuring that this is not an isolated issue that is simply being relegated to one community. It’s a broader challenge that we’re all going to be addressing together.

These radical challenges have already had, and continue to have, a tremendous impact. Hopefully, what will happen is that they will either supplant those strategies that have not been effective — that are leading to, perhaps, not the solutions we’re looking for — or they’ll work in tandem with templated approaches from the past so we can remain nimble and ensure that the response continues to evolve to match the unfortunately dynamic and ever-evolving crisis that we’re in.

[3:10 p.m.]

As shown by the solutions that we’ve delivered and I’m sharing with you today, what this crisis truly requires today is perhaps what it’s always required: a fluid response that truly takes its prompts from community and those that are directly impacted. At this point, I think, and some of our messaging does indicate this, it affects everyone in this province. It is truly turning the tables around and ensuring that the solutions are coming from community and rising up and we’re empowering and delivering those solutions.

My urging to this committee is to carry forward the recommendation that in place of historical and, perhaps, status quo approaches, we focus on delivery through the lens of community peers and our Indigenous and underserved, marginalized, racialized communities. There are three tangibles.

One, an overhauled communications strategy that reduces stigma and helps all British Columbians understand that we see that this is everyone’s role to engage and work together to solve. Galvanize the inherent strength that we have as citizens in this province by ensuring that everyone is a part of the response and not isolate or stigmatize and limit the crisis to one subset population.

This is accomplished through the development and promotion of many of the solutions akin to the ones I’ve just shared with you today — the SALMON project, the overdose intervention app, mobile health unit.

Two, empower non-traditional agencies, non-profits and grassroots entities like ours to lead the work in community. We have trust and prior relationships. I’d just share that we’re entering a decade of operation. This also provides an anchor and stewardship in an ever-shifting landscape based on, perhaps, election cycles and changing portfolios. We are that mainstay in community to deliver a response.

Thirdly, listen to community and truly understand the nuances in community to ensure that we are not unintentionally missing impacted communities. That tends to happen a lot. There are those stereotypes that if we say South Asian, that represents a huge community. When we say “racialized community,” south of the Fraser it represents Somali, urban Indigenous, Afghani, Syrian, Pakistani, Fijian and Punjabis like myself.

In closing, I would like to include, also, a personal note that I have lost and continue to lose people I am close to and grew up with in small towns right across this province. I know we have a member from the Interior here as well.

The in-kind work and countless hours dedicated to delivering solutions and working alongside community stems from the fact that many of us are deeply enmeshed. We’re members of the community we are working to serve. Every time there’s a void in service delivery and resources, those in our communities…. We are all suffering. So through this action-first approach that we’ve taken, we’re helping stakeholders see that this has to be a collective response that works for everyone.

Despite all of our work and ongoing research and collaboration with peers and community, I wouldn’t claim, and nor would any of our efforts claim that we have the silver bullet in hand, and anyone who does I would, perhaps, steer clear from. But having lived in this crisis on the front lines very intensely for the past decade, I can tell you that it is long overdue for a radically new approach, one that can take place, perhaps, only in this province because of the tapestry of this province. Most likely, it will set a new methodology for work to offset the dangers of poison drugs right across our country.

The solutions to this crisis are, probably, like I mentioned, inherent to our province. We just need to continue efforts to empower and engage everybody so that we can deliver effective and meaningful, long-lasting changes.

With that, I think I can open it up for questions if there are any.

N. Sharma (Chair): Okay. Thank you.

Colleagues, any questions?

R. Leonard: Thanks for your presentation and thanks for the work that you do. We’re looking at a couple of things around decriminalization and expanding safer supply, and you have portrayed an organization that’s very much connected in community. I’m wondering if you can comment on those two streams and what it feels like on the ground within community.

[3:15 p.m.]

U. Tatlay: Absolutely. I mentioned, in my comments, about our shelter operations. That’s really…. I, like everybody else…. It’s partly why we lead with peers. I’m a science guy. You don’t want to hear from me. I’ll talk numbers all day and lab stuff all day.

Being front-line, being operational myself, we do hear from community. One of the things that I found most interesting earlier this spring was that when I was putting up an alert, an overdose alert issued by the health authority, many of the individuals staying at our shelter who were using substances had questions about the alert itself. That brokered a conversation around safer supply, and, having that captive audience, I chose to ask a similar question that you’re asking me. Is that something that interests them, and have they had the experience of using it before? To this, many of them did reply that they either had tried it or were willing to try it.

The key for them was the effectiveness. If they found that safe supply was not effective to what their needs were, they would not use it, and they would simply go back to the streets. Hearing that, as someone who strongly advocates for safe supply, who’s really hoping that we can save lives with safe supply, I won’t say I was shocked, but it was a nuance that perhaps I did not have or I had glossed over.

Again, this goes back to my comments earlier that when we are delivering, when we are advocating for solutions, whether it’s safe supply or anything else, legalization, we really need to hear from community. We really need to hear from the people that we are delivering these solutions for, because oftentimes they’ll be providing us with insights that often go amiss.

I hope that answers your question somewhat.

M. Starchuk: Thank you for your presentation. You talked at the beginning about peers and resources. You know, it’s one thing to have a whole bunch of people, but if you send them out to the street with nothing in their hands, nothing in their pockets, nothing on a table, that doesn’t really do anything. But now your presentation makes it very clear that there are some tools that are there.

When you talk about the peers, and you spoke of the role they have, are they having a significant impact on curbing the number of overdoses that we’re seeing, or are they more valuable, tangible, whatever the word is, of their impact on the voices that they’re having in the community?

U. Tatlay: Thank you. I think the answer is both. I think what’s effectively happening is you’re giving voice by empowering peers to do this work by providing honoraria, by providing training, letting them lead the charge, by having them provide their insights at tables.

You are empowering a group that has largely been marginalized and ostracized from these conversations, and what that effectively does is stigmatize a community and lead people to further hide their use or, practically, their presence in community. So when you have peers who are galvanized, who are out there, who, over the period of our operation for many years…. Community members have gotten used to the presence of peers. They’re not just at peer tables. They’re joining us…. We had a round table with Simon Fraser University. Peers were present.

In addition to that, these are peers who are racialized, who are perhaps even “a further step removed” from these conversations. I was on a panel not long ago with an individual, a representative from the Downtown Eastside, a community advocate who said: “We often talk about marginalized populations, but the populations you’re talking about are not even heard of.”

What peers effectively do is give empowerment to the wider community, peers like themselves. But they’re also…. This goes back to the collective response that would be my recommendation for this committee. They’re effectively saying that yeah, we need a collective response. We need everybody to participate in this, not just peers but everybody, our family members or loved ones and everyone else who can help offset the dangers of this crisis. So peers are absolutely integral to offsetting this crisis.

[3:20 p.m.]

D. Davies: Thanks for your presentation. I represent a more rural area up in the North Peace, Fort St. John. We have a pretty decent-sized South Asian community here in the region.

As far as your organization and what you do to reach out to the not necessarily marginalized communities but the cultural communities that are in the Fort St. Johns, the smaller communities throughout the province, what is being done to reach out and offer these services? I really believe it’s probably something that is lacking here in my own community.

U. Tatlay: Yeah, and, sad to report, it’s lacking in many communities. We are, unfortunately…. Still, it feels sometimes like we’re in the infancy of our response, but it’s only because this thing is ever-evolving.

To answer your question, I can give you a tangible example of what we’ve done recently. Similar to yourself, we were reached out by an organization in the Okanagan which was a South Asian community, and they were new to this crisis. Now, I mentioned earlier that I, coming from the Interior, had lost loved ones recently in the Okanagan region. I guess it was time then.

They reached out and said: “We need resources desperately here. We understand that in the Lower Mainland — specifically Surrey, south of Fraser — given the demographics, you have developed these custom translations and resources, working with the health authority and delivering them to the BCCDC.” In addition to that, they had not even heard of naloxone.

So our first order of business was to stabilize that population. We were able to take our teams out there with peers, again, having that exposure — I guess going back to answering MLA Starchuk’s question — and ensuring that they are now seeing that peers are reducing the stigma and having that voice and agency in community. But then also delivering naloxone, both nasal and injectable, and then also leaving them with the resources and tools, including the Overdose Intervention App.

Now, all of this work was done in kind, because these are our community members who, sadly, are dying. We know that this work exists in the Peace and other regions of the province. It’s, perhaps, that personal, passionate drive to save our fellow British Columbians that we will continue to deliver. But we really need to be empowered by stakeholders, such as government, to make sure that we can continue that work.

Similarly, we were contacted by another local area in the Fraser Valley, in Mission. Their crime prevention services reached out to us, and their community members do not have naloxone training. They put us in touch with the district of Mission, who contacted us, and we’re currently in the plans to perhaps provide multiple, I guess, departments within the city there with training as well.

In addition to that, leaving our province, Alberta contacted us. In Edmonton last year, I believe the provincial government in Alberta started to release their numbers, which they hadn’t for a very long time. Sadly, their numbers were quite high as well. They were aware at that time of the resources we’ve developed. We did deploy our resources there, trained up their team members, and now we effectively have a chapter of the SALMON project, called SALMON YEG, YEG for their airport code up there.

I hope that answers….

N. Sharma (Chair): Okay. Thanks.

I have a question. Thanks for all the work you do. I’m really curious if you could dig just a little bit deeper, for the committee’s sake, about your work in the South Asian community and what you think is working directly and what your experience is. Particularly, I know you described your SALMON project, but when you see the number of deaths in the South Asian community increasing at such a rate, particularly with young men, it seems like…. It’s tragic.

Do you have a sense over the years of working of what you think the reasons for that is, that increase? But also, what’s working on the ground when it comes to combatting that? I would love a little bit more detail on that.

U. Tatlay: Absolutely, yeah. I hope it’s okay to answer it in a roundabout way and kind of work backwards.

One of the things that’s not working for this specific community, the South Asian community, is the fact that — I mentioned it earlier — we deliver the resources, although well-intended, in the wrong direction.

[3:25 p.m.]

What happens is that if there’s a problem, much as what was revealed in the chief medical health officer’s report and all our efforts, that there were South Asian men who were dying from overdose…. There were, immediately, solutions starting to be delivered to gurdwaras, Sikh temples, and places of worship. The challenge was….

Now, I was having that presence with the epidemiology team, working with the researchers and the B.C. Coroners division, so I had a good insight into the data. What that data showed us was that within that broader South Asian demographic, these were largely Punjabi males, Sikh Punjabi males, and a lot very similar to my demographic — specifically, in that early 40s, either born in British Columbia or had been here for 15-plus years, had families, had loved ones, had employment — and they were the ones who were dying.

Solutions that began to be delivered were directed at Sikh places of worship, oftentimes people who — not to say that they would not use drugs but certainly were not the predominant group that was using. It was often like one of those tickety-boo things, like: “Hey, we checked this off. It’s done. It’s accomplished. We’ve addressed the community.”

In addition to the Punjabi males that I was talking about, who perhaps, like myself, do not attend any places of worship, there were also individuals, although less in percentage, of the Fijian community. They had gone largely unaddressed and had not received resources. So really, it specifies, or what I’m trying to specify, is that we really do need to lean on the data and the information that we collate to understand who these resources should be directed at.

Then we need to go to the community agencies who have the insight as to who these communities are and where they can be contacted and how we can collaboratively work with them. Or we have prior relationships, similar to engaged communities, where you have a body of work, where you’re going to be able to go into those communities and address those challenges. So what you had was perhaps misplaced, although well-intended, resources going the wrong direction.

Meanwhile, the numbers continue to tick up, and individuals who, like I said, many like myself and those in the construction industry, trucking industry — they continue to lose lives. So it’s imperative that we understand, when we talk about South Asians, who we’re talking about.

N. Sharma (Chair): Just if I can, a quick little follow-up on that. How is the conversation of decriminalization landing in your work?

U. Tatlay: This goes back to the conversation around peers. Decriminalization within a South Asian context is a very, very contentious issue. You’ll have mainstream radio that will talk about it in a very firebrand way. You’ll have people, perhaps of my demographic, who were born and raised here, who will talk about it in a different way. So you have loggerheads within the community. You have huge division.

Where it does seem to break is when you are able to have one-on-one conversations — either through media, through outreach, go directly to community — and help people understand. When you have a peer with you who speaks the same language, who walks the same walk as the people that they’re talking to, it does a tremendous amount to reduce this stigma around legalization and what it could potentially mean.

There are a lot of misconceptions around what it means. The decriminalization of a small amount, that had…. I mean, I was busy that week. It was a busy week for radio, so helping people understand — the RedFMs and everybody — what that truly meant, that it wasn’t truly legalization, and what the carry amounts meant and what the particulars were of that.

I think those are effective approaches. Otherwise, yeah, you are looking at a divided camp.

M. Starchuk: Upkar, one last thing for me. It’s regarding the overdose intervention app, because we’ve heard from another industry out there about the Lifeguard App that’s there and gets used. Yours seems to be a little bit different in the sense that it’s multilingual.

I guess my question is: do you know who’s using it, the type of users and how often it’s being used?

U. Tatlay: The key there, the point of distinction, is that this was actually built, bluntly, not for the substance user. This was built for the family and network of supports and, in fact, for all British Columbians.

[3:30 p.m.]

You know, we have individuals…. I recall talking to an individual, in the Interior again, who said that her husband had found someone in one of those ATM vestibules at the local bank, and he had no idea what to do. While waiting for the 911 response, he just simply put him into recovery position.

The conversation really was around: this is who that tool was built for. It was built for just Joe and Jane Blue. This is who it’s for. It’s to ensure that every single British Columbian knows how to respond in the moment of crisis.

I think that’s why I mentioned, in my comments earlier, that this affects every single British Columbian, whether we like it or not. How we feel about legalization and how we feel about the actual consumption of substances — it doesn’t matter. This is affecting every single individual in our province. It’s incumbent on the individual to get empowered, but it’s also incumbent on stakeholders and government and health authorities to make sure that they have the tools to be empowered.

When we developed the tool, it was in consultation with community. We had actually gone out with…. There are three different apps. There’s Lifeguard…. I don’t recall the names. But they do a similar thing in that you can activate them if you’re using. It was when we rolled out with that to community…. At Bear Creek Park, we had an event called Pehla Kadam, which means “first step in understanding an issue.” The community came back during a survey portion of the evening…. MLA Judy Darcy was present and delivered the keynote that day. They came back and said: “We want solutions. We want resources. If my loved one is at home….”

I remember, specifically, an elderly woman saying this in Punjabi: “My son — who’s a truck driver, who does seven days long haul — comes home and has a deep, deep sleep. How do I know that’s a deep sleep, or is he overdosing? I have no idea. You’re creating solutions for him, and he’s not even able to use it. You’re creating solutions for individuals who don’t have cell phones. If they have a cell phone, they don’t have a data plan. Can you please build something for us?”

Well, that comment alone radically changed our approach. That’s why we built the digital tool in the fashion that it was built in — to ensure that the wider community of support…. I’m going to be assumptive here and assume that many of us in this meeting today…. We outnumber the people who are using substances. So why not empower and use our assets in the province and empower every single individual with a tool to respond effectively to overdoses? That’s a point of distinction, and I think that’s why it’s been effective.

Right now we are still…. Because the whole thing was developed in kind, we don’t have the marketing tool or the mechanisms and the funding behind it. It is very much a grassroots effort, and we’re still growing it. Like I mentioned earlier, it’s already been expanded to Alberta, into the Okanagan and definitely is being used effectively in the Lower Mainland.

It includes languages — Tagalog, Punjabi, Hindi, Spanish and simplified Chinese. We’re continuing…. These are custom translations. They had not been done, because many communities simply have not developed the dialogue, discourse or lexicon around these challenges.

S. Bond (Deputy Chair): We appreciate the written presentation and also your words today. You talk about community not being aware and having information sessions and then wanting to find ways to improve circumstances. What role does prevention, on the early end, play?

We’ve been hearing, today and throughout the course of our hearings, about the impact on youth and making sure we start early. So how do you engage with communities related to the prevention side, talking about risk? Once you start, there are all kinds of outcomes. Is there a prevention element?

U. Tatlay: Our origins as a non-profit really begin with youth. Ten years ago we started this non-profit to provide youth with barrier-free access to athletics. We did not believe in the prohibitive cost of participating in sport, so we delivered the model free.

That really set us on a course for developing these bonds with community, where they were able to see that we were there for community. “Perhaps I can share any gender-based violence challenges I’m facing. Perhaps I can share mental health challenges, food security challenges.” We would deliver adaptive responses accordingly. That sustains us to this day. In fact, that really is our bread and butter.

[3:35 p.m.]

I mentioned at the very beginning that I’m coming from the Semiahmoo First Nation territory. MLA Halford, I think, is on the call as well — in his riding.

Here, throughout the summer, we’re still delivering youth programming, both indoor and outdoor. In that programming, a lot of conversations happen not only with the caregiver and the parent but also with the youth. They do see our harm reduction tools. We are not, by any means, shy with showing: “This is what harm reduction means in this context. This is what foil is. Sometimes you might see individuals on the street. What does that look like? What could that mean? How was that path for them? How could that lead to consequences for them?”

We also have our peers come out to those youth events. We have weekly youth events where they are participating in athletics, and we’ve partnered with NatureKids B.C. to allow individuals and kids to access different kinds of programs. Peers are a component of that as well.

Like everything else I shared today, it’s really a different approach. It’s a collective response. It’s something that’s very radically different from what’s been delivered or tried before. It’s ensuring that the entire community responds to the crisis. We really take a holistic approach. That’s the same way we are delivering the response when it comes to youth to ensure, through exposure, through understanding, that it leads to prevention in the future.

N. Sharma (Chair): I didn’t see any other hands up. Did I miss anybody?

Okay. Trevor, go ahead.

T. Halford: No. I was going to give you a shot, Upkar. I’ll leave it alone. Anyways, it’s so good to see you.

I’ll say this. What you’re doing in the community is making a massive difference. I know the accolades you got recently were definitely well deserved. So keep it up. Keep going, man.

N. Sharma (Chair): Okay. I think those are all the questions we had.

As Trevor mentioned, we just really appreciate your time here today to help us learn from your perspective, also, the decade of work you’ve done in community and what you’ve seen working and what you’ve seen that didn’t work. We’ve learned a lot. We wish you all the best, and we are very grateful for the work you do in the province.

U. Tatlay: My thanks to the committee for not just my meeting. I know you guys have had quite a bit of work laid out for yourselves. So thank you very much for this. This is what it’s going to take to get ahead of this crisis. Thank you.

N. Sharma (Chair): Okay. It now moves us to adjourning for the day. So I need a motion to adjourn.

I saw a couple of hands up. Susie.

Then Trevor, I’ll give you the seconder.

We are adjourned.

The committee adjourned at 3:38 p.m.