441-00547 (Health)

The overdose crisis is one of the most serious and unprecedented public health threats in Canada’s recent history, which is having devastating impacts on individuals, friends and families, and communities across the country. The Government recognizes that substance use is a health issue, and is committed to a public health approach to address the crisis. Tragically, the most recent national data indicates that 29,052 apparent opioid toxicity deaths occurred between January 2016 and December 2021. Fentanyl and its analogues continue to be major drivers of the crisis, with as many as 86% of accidental apparent opioid toxicity deaths in 2021 involving fentanyl.

The Government of Canada’s approach to the overdose crisis is comprehensive, collaborative, and compassionate, guided by our federal drug strategy – the Canadian Drugs and Substances Strategy (CDSS). The CDSS takes a public health-focused approach, and lays out our framework for evidence-based actions to reduce the harms associated with substance use in Canada. It includes four key pillars – prevention, treatment, harm reduction, and enforcement. In the context of the worsening overdose crisis, and taking steps to reduce harms and deaths related to substance use, the Government is placing particular focus on:

• ensuring that harm reduction services are available to Canadians who need them;
• working with stakeholders to reduce stigma directed at people who use drugs, which acts as a barrier to accessing critical health and social services and often leads to social isolation and further risk of harms;
• continuing to work with provinces and territories to improve access to evidence-based treatment options;
• continuing to address illegal production and trafficking, with a focus on organized drug crime; and,
• implementing additional surveillance and research activities that will further build the evidence base and allow us to pursue innovative solutions to this public health crisis.

Addiction is a diagnosable and treatable medical condition, not a choice. Harm reduction refers to services that aim to reduce the negative health, social and economic impacts of substance-related harms on individuals, families and communities, without necessarily requiring or promoting abstinence. Evidence clearly shows that harm reduction services help to save lives, improve health and play an important role in achieving a comprehensive and effective response to the overdose crisis. These services can also help to connect people who use drugs to broader health and social services, including housing, income supports, employment and training, and drug treatment services for those who are ready.

As part of its response to the overdose crisis, the federal government has supported the provision of a range of evidence-based harm reduction services across the country through investments and legislative and regulatory action, which have been critical to saving the lives of Canadians by preventing drug overdose deaths and help reduce the transmission of infectious diseases that can result from the sharing of drug-use equipment. For example, the federal government has streamlined the exemptions approval process for supervised consumption sites (SCS) in Canada, resulting in a significant increase in the number of approved SCS currently operating in Canada (from 1 site at the end of 2015 to 39). SCS are facilities where people can consume pre-obtained drugs under the supervision of trained staff. SCS provide people who use drugs with a safe, non-judgemental environment, sterile consumption equipment, and services that include social, medical, and mental health care. The main goals of SCS are to help prevent overdose deaths, facilitate entry into addiction treatment programs, reduce the spread of blood borne infections (e.g., HIV, hepatitis C), and reduce the strain on emergency medical services. As of July 2022, these sites have:

• been visited more than 3.6 million times
• reversed some 40,000 overdoses without a single death
• made over 185,000 referrals to health and social services

In addition, the federal government provides $7 million in annual funding through the Harm Reduction Fund (HRF). This fund supports community-based projects, which help reduce the incidence of HIV/AIDS and Hepatitis C among people who share drug injection and inhalation equipment. People who use drugs can be at an elevated risk of acquiring sexually transmitted and blood-borne infections (STBBI) due to the practice of injecting drugs and substances using unsterile/shared needles, which can be a common transmission route for the acquisition of HIV and hepatitis C. Community-based organizations play a critical role in engaging Canadians at risk of infection. In 2018, nearly 14% of new HIV infections in Canada were among people who inject drugs, and 60% to 85% of all new hepatitis C infections were attributable to the sharing of drug-use equipment.

Furthermore, the Government of Canada is also addressing the overdose crisis by providing support for safer supply programs. In the face of high rates of death and overdose, some Canadian practitioners have initiated safer supply programs, which involve the prescribing of pharmaceutical-grade medications as alternatives to the illegal drug supply with the goal of saving lives and reducing other harms associated with the use of drugs from the illegal market. Safer supply is one of many options that practitioners may consider to support their patients who use drugs among a wide continuum of care that includes other forms of treatment, harm reduction services, and referrals to other supportive services (such as ongoing counselling, housing, employment training, child care supports, etc.). Health Canada has committed over $73.5M through the Substance Use and Addictions Program (SUAP) to support 25 safer supply service delivery projects in British Columbia, Ontario, Quebec, and New Brunswick, as well as a National Community Practice (note: the number of active projects is subject to change as sites open and close).

The Government of Canada has contributed over $282 million to SUAP through the 2020 Fall Economic Statement, Budget 2021, and Budget 2022, in support of community-based organizations responding to substance use issues, including investments to help them provide frontline services in a COVID-19 context, to scale-up key lifesaving measures and increase access to a safer drug supply as an alternative to the contaminated supply. Health Canada provides funding for a wide range of responses to the ongoing overdose crisis through SUAP. Projects target a range of psychoactive substances, including opioids, stimulants, cannabis, alcohol, nicotine and tobacco, at the community, regional and national levels. Project activities include wraparound supports, recovery and treatment initiatives. For example, one of the projects SUAP supports through the Sinai Health System in Toronto, Education for Integrating Opioid Use Disorder within Primary Care, is developing a national training program module to help health care providers better treat opioid use disorders. Another example is a project led by the McMan Youth, Family and Community Services Association in Calgary called, Journeys - Addiction Supports for Women. This project provides access to a wide range of health, social and community services for women who need support with their substance use issues while they wait for residential addictions treatment. The Government of Canada recognizes and supports the needs of individuals across the harm reduction spectrum, from measures that can prevent deaths and the spread of diseases, to supports that can help people stabilize their personal situations “where they’re at”, to programs and research that can better help those on their own paths to recovery.

Health Canada continues to work with partners to build the evidence base and support the scaling up of effective safer supply models. To better understand the implementation of Health Canada-funded safer supply programs, the Department commissioned an independent contractor to conduct a preliminary assessment of ten safer supply projects in Ontario, British Columbia and New Brunswick. Information was gathered over four months, December 2020 to March 2021, through surveys and interviews with safer supply program leads, staff, and participants. Program participants reported that having access to safer supply services improved their health, wellbeing and quality of life. Program staff reported a significant change in participants’ substance use, including decreased overdoses and decreased use of street drugs. The findings also highlighted the importance of wrap-around care, peer involvement, and external partnerships for program success. Health Canada is also supporting an arms-length evaluation of eleven safer supply pilot projects funded through the Canadian Institutes of Health Research (CIHR), in Ontario, British Columbia, and New Brunswick. A research team from the Canadian Research Initiative in Substance Misuse (CRISM) is conducting a multi-year evaluation of these projects focussing on program design, outcomes, and connections to other services for people who use drugs. The results of this study are expected in 2025.

With respect to the petition’s specific request for the federal government to provide funding to support access to withdrawal management services or detoxification services, it is important to note that in addition to supporting access to harm reduction services, the Government of Canada is also making significant investments to support the provision of treatment services, including enhancing access to withdrawal management services provided by provinces and territories.

Since 2017, the Government of Canada has taken urgent action to address the overdose crisis through significant commitments of over $800 million. This includes $150 million through the one-time Emergency Treatment Fund (ETF) to provinces and territories, which, when cost-matched with the provinces and territories, will result in an investment over $300 million to improve access to evidence-based treatment services by the end of March 2023. Provinces and territories have used ETF funds to help reduce wait times, increase access to treatment beds and withdrawal management services, expanding Rapid Access Addictions Medicine clinics, improve virtual supports and bolster access to culturally-appropriate care for Indigenous communities. In addition, ETF funds have also been used to provide training to health care providers, improve outcomes for people who use methamphetamine, and fund initiatives that enhance health systems and build community-level capacity. The Government of Canada has also invested $200 million, with $40 million per year ongoing, to enhance the delivery of culturally appropriate addictions treatment and prevention services in First Nations communities.

Health Canada is also working with the Standards Council of Canada to support the development of the national standards for mental health and substance use services across six key priority areas: Integrated Youth Services; Primary Care Integration; Digital Mental Health and Substance Use Apps; Substance Use Treatment Centers; Substance Use Workforce; and Integrated Services for Complex Health Needs. These standards will help address a range of mental health and substance use service needs and are a tool for promoting consistency and quality service delivery in mental health and substance use services across Canada.

In terms of the petition’s specific request for the Government of Canada to provide support for housing and life skills and other supports for people who use substances, the Government has also made significant investments in these areas through the National Housing Strategy, including the Rapid Housing Initiative and Reaching Home: Canada’s Homeless Strategy. Under the first two rounds of the Rapid Housing Initiative, the Government of Canada is investing approximately $2.5 billion beginning in 2021-2022 through to 2022-2023 to support the construction of modular housing, as well as the acquisition of land, and the conversion of existing buildings to affordable housing for vulnerable populations, including individuals with mental health and addiction issues. Budget 2022 proposed an additional $1.5 billion for this initiative, starting in 2022-23, with at least 25 per cent of funding going toward women-focused housing projects. The next round of the Rapid Housing Initiative will build on the success of the first round. The first round constructed over 9,200 new units for those most vulnerable.

Since the launch of Reaching Home, we have committed to investing approximately $3 billion over nine years to address homelessness, and as part of Budget 2022, our government made a further investment of $562.2 million over two years, beginning in 2024-25, to support communities in their work with people experiencing or at risk of homelessness, who are also at greater risk of harm from the overdose crisis.”

Furthermore, Budget 2022 also announced the intention for the Government to launch a Veteran Homelessness Program. Together with funding provided with Budget 2021, there is approximately $107 million available over five years to provide wrap around services and supports, including mental health and substance use services, and rent supplements to Veterans experiencing homelessness in partnership with community organizations.

Finally, Budget 2022 will also provide $140 million over two years, starting in 2022-23, to support the Wellness Together Canada portal, which provides Canadians with tools and services to support their mental health and well-being. Through the Wellness Together Canada online portal, people of all ages across the country can access immediate, free and confidential mental health and substance use supports, 24 hours a day, seven days a week.

Moving forward, under the mandate of the new Minister of Mental Health and Addictions and Associate Minister of Health, Health Canada will continue working with its partners and stakeholders to advance a comprehensive federal strategy to address substance use in Canada, including the overdose crisis. Canada will continue to support provinces, territories and Indigenous communities to improve access to a full range of evidence-based treatment and harm reduction services, in addition to leading efforts to reduce stigma and create national standards for substance use treatment programs. The Government of Canada believes that substance use is a health issue, and is committed to examining all options and evidence to respond to the tragic increase in overdoses and to help save lives, while also ensuring the safety of communities across the country.