432-00287 (Health)

The Government of Canada is deeply concerned about problematic substance use in Canada, including the ongoing opioid overdose crisis and the devastating impact it is having on the well-being of individuals, families, and communities. Tragically, there were more than 16,364 apparent opioid-related deaths between January 2016 and March 2020.

The Government recognizes that the complexity of this crisis has only increased due to the ongoing COVID-19 pandemic. Public health guidance around physical distancing and self-isolation presents a unique challenge for people who use drugs. Health Canada and the Public Health Agency of Canada have been working with provinces and territories and other partners, including researchers, advocates and people with lived and living experience, to help make sure that people who use drugs can continue to access treatment, harm reduction and other services during the pandemic.

Concerning the declaration of a national public health emergency, at the federal level, such a declaration is not required to access important responses to the opioid overdose crisis. The comprehensive federal response has included  legislative and regulatory enabling measures,  new prescription guidelines, marketing restrictions, awareness campaigns, improvements to the knowledge base, and emergency funding to provinces and territories; these were  put in place without a formal declaration of a public health emergency.

The Government of Canada remains committed to taking a public health approach to substance use through the Canadian Drugs and Substances Strategy. The Strategy includes four pillars – prevention, treatment, harm reduction and enforcement – and is designed to be comprehensive, collaborative, compassionate and evidence-based.  The Government is placing particular focus on:

• ensuring that life-saving harm reduction measures are available to Canadians who need it;
• 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;
• working with provinces and territories to improve access to evidence-based treatment options; 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.

The Government of Canada recognizes that the overwhelming majority of deaths caused by the opioid overdose crisis are due to a street drug supply that is contaminated with highly toxic substances, such as fentanyl. The situation is now such that anyone who uses drugs for any reason in Canada is at risk of a potentially fatal opioid-related overdose every time they use drugs from the contaminated illegal supply.

The Government of Canada has taken actions to reduce barriers to providing people who use drugs with a safer, pharmaceutical-grade alternative to the toxic illegal drug supply. For example, Health Canada has issued class exemptions to pharmacists, and eased restrictions on the transportation of controlled substances, to make it easier for people to access the medications they need during the COVID-19 pandemic while following public health advice, such as physical distancing. In addition, through Health Canada’s Substance Use and Addictions Program (SUAP), the Government of Canada is providing funding to support 11 projects in providing a safer supply of pharmaceutical grade medications for people with opioid use disorder in British Columbia, Ontario and New Brunswick. These investments will help provide pathways to care and treatment. Examples of funded projects include:

• The Vancouver Island Health Authority was provided approximately $2 million over 48 months for an innovative project that will provide pharmaceutical-grade medication as an alternative to the toxic illegal drug supply for people in Cowichan Valley who have not responded to other forms of treatment for opioid use disorder.
• The London InterCommunity Health Centre (London, Ontario) was provided more than $6.5 million over 50 months to deliver a safer supply program that will help reduce harms related to the toxic illegal drug supply by providing prescribed opioids to patients with opioid use disorder during the pandemic and beyond.

Findings from these initiatives will contribute to the evidence base to support the scaling up of effective models. In addition, to further bolster these efforts, on August 24, 2020, the Minister of Health sent a letter to Provincial and Territorial Ministers of Health and regulatory colleges to encourage them to provide people who use drugs with a full spectrum of care options, including access to a safer supply of drugs.

The Government of Canada has also taken a number of steps to provide options for those seeking treatment for severe substance use disorder. On April 25, 2019, the Minister of Health added diacetylmorphine to the List of Drugs for an Urgent Public Health Need. This makes it possible for provinces and territories to import this drug for the treatment of opioid use disorder. Amendments to federal regulations have also allowed health care practitioners to provide diacetylmorphine-assisted treatment outside of a hospital setting, if permitted by their province or territory. In addition, on May 1, 2019, Health Canada approved the use of injectable hydromorphone by qualified healthcare professionals as a treatment for adults with severe opioid use disorder. This is the first approval of injectable hydromorphone for this purpose in the world.

The Government of Canada is also providing guidance and leadership on the prescribing, dispensing, and delivery of opioids and other narcotics during the pandemic. For instance, through funding from the Canadian Institutes of Health Research, the Canadian Research Initiative in Substance Misuse (CRISM) has recently developed a series of national guidance documents related to substance use in the context of COVID-19. The guidance documents can be found here: https://crism.ca/projects/covid/. These measures help to ensure continued access to medications and ongoing management of health conditions such as chronic pain. Health Canada has also assembled a toolkit to provide clarity on prescribing for the treatment of substance use disorder and/or to provide a safer supply. The toolkit can be found here: https://www.canada.ca/en/health-canada/services/substance-use/toolkit-substance-use-covid-19.html.

The Government of Canada continues to make substantial investments to address the overdose crisis. Recent examples of key federal investments in this area include:

• investing an additional $66 million over two years to support community-based organizations responding to substance use issues, including to help them provide frontline services in a COVID-19 context;
• investing $76.2 million to take action to protect Canadians and prevent overdose deaths. This investment will be used to scale-up key lifesaving measures and increase access to a safer drug supply as an alternative to the contaminated supply. These measures build on the Budget 2019 investment of $30.5 million over five years, with $1 million ongoing, to expand access to safer alternatives to the illegal drug supply and support better access to opioid overdose response training and naloxone in underserved communities;
• providing $1.7 million to the University of Saskatchewan to increase access to chronic pain services, and providing Alberta Health Services $1.2 million to implement and evaluate pathways to care for people living with pain and opioid use disorder, both funded through the Substance Use and Addictions Program;
• providing $231.4 million over five years through Budget 2018 for additional measures to help address the opioid overdose crisis, including a one-time $150 million emergency treatment fund for provinces and territories to improve access to evidence-based treatment services;
• providing an additional $200 million, with $40 million per year ongoing, to enhance the delivery of culturally appropriate addictions treatment and prevention services in First Nations communities; and
• allocating $13 million over five years to launch a new national, multi-year public education campaign to help reshape Canadians’ attitudes and perceptions about people who use drugs.

In order to prevent and reduce the harms of problematic substance use, including to enable access to evidence-based treatment and support recovery, the Government has undertaken a broad range of policy, legislative and regulatory actions, including:

• Approving supervised consumption sites (with 37 currently in operation across Canada), and providing class exemptions to facilitate the establishment of overdose prevention sites;
• supporting the passage of the Good Samaritan Drug Overdose Act, which encourages people to call for emergency help at the scene of an overdose by providing protection against simple drug possession charges;
• establishing effective Federal, Provincial and Territorial public health emergency governance, including the Special Advisory Committee on the Epidemic of Opioid Overdoses and the Federal/Provincial/Territorial Assistant Deputy Minister Committee on Problematic Substance Use & Harms;
• collaborating with provinces and territories to better understand the evolving crisis, and undertaking timely monitoring and reporting of opioid-related deaths and harms in Canada;
• deploying public health officers from the Public Health Agency of Canada to support public health surveillance systems in provinces and territories; and,
• supporting the development and dissemination of national clinical practice guidelines to treat opioid use disorder, which include a recommendation for medication-assisted treatment as a front-line option for patients, through the Canadian Research Initiative in Substance Misuse.

As outlined above, the Government of Canada takes a public health focussed approach to addressing substance use, working with civil society organizations, first line responders, academics, people with lived and living experience and other key stakeholders  to assess options that could better support the needs of people who use drugs during this difficult time.

In terms of decriminalization, early evidence suggests that in places that have decriminalized drug use, there has been a concurrent investment in robust treatment services, and this has been shown to be instrumental in helping people to address substance use issues. Since early 2016, the Government of Canada has taken urgent action to address the opioid overdose crisis through significant federal investments, legislation, and regulatory action. The Government is working with provinces and territories to improve access to harm reduction services, raise awareness of the risks of opioids, and remove barriers to treatment such as addressing stigma.

The Government of Canada continues to encourage the use of diversion programs that create pathways away from the criminal justice system toward appropriate health services and social supports. For example, Health Canada has recently provided three-year  funding for a project in Peterborough, ON, to develop a multi-sector response, with a team dedicated to caring for people at risk of experiencing overdoses, in order to direct people away from the justice system and into care. In addition, on August 18, the Public Prosecution Service of Canada issued guidance to prosecutors directing that alternatives to prosecution should be considered for simple possession offences, except when there are serious mitigating circumstances. This policy is available at: https://www.ppsc-sppc.gc.ca/eng/pub/fpsd-sfpg/fps-sfp/tpd/p5/ch13.html. 

In Canada, our circumstances require that we undertake a comprehensive and collaborative approach across all provinces and territories.  No single organization or level of government alone can solve the opioid overdose crisis.  All levels of government, a wide range of stakeholders and all Canadians who are impacted by opioid use must work together to reduce opioid-related overdoses and deaths, and improve the health and well-being of Canadians who use drugs.

Through the Canadian Drugs and Substances Strategy, the Government of Canada remains firmly committed to addressing all forms of problematic substance use with a public health approach that is comprehensive, collaborative, compassionate, and evidence based.