e-2783 (Health)

The Government of Canada is deeply concerned with the ongoing opioid crisis.  Tragically, between January 2016 and March 2020, 16,364 Canadians lost their lives to apparent opioid-related overdoses. Many jurisdictions are now reporting record-breaking levels of opioid-related deaths and harms since the onset of the COVID-19 pandemic.

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

The Government of Canada’s approach to substance use issues has been comprehensive and collaborative, guided by our federal drug strategy – the Canadian Drugs and Substances Strategy (CDSS), which was first introduced in late 2016. 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. 

The Government has placed a 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, as stigma 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;
• 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; and 
• working and communicating directly with front-line workers including health practitioners, public health advocates, people who use drugs, and people with lived and living experience.

The Government of Canada recognizes that the overwhelming majority of deaths caused by the opioid crisis are due to a street drug supply 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, the Government of Canada is providing funding to support 11 projects in providing a flexible 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 has also made substantial investments to address the crisis in several areas. Recent examples of key federal investments in this area include:

• The investment of nearly $600 million committed by our Government in response to the opioid crisis has focused efforts on prevention, treatment, enforcement and harm reduction. This includes $150 million provided directly to provinces and territories through the Emergency Treatment Fund.
• As part of Budget 2019 and additional funding commitments, our Government committed to investing $106.7million to scale up key life-saving measures, help circumvent the toxic illegal drug supply, and identify and address emerging drug threats.
• In response to the COVID-19 pandemic, the Government of Canada committed an additional $500 million to address immediate needs and gaps in the support and protection of people experiencing challenges related to mental health, substance use, or homelessness. This investment is part of the more than $19 billion invested through the Safe Restart Agreement to help provinces and territories safely restart their economies and ensure Canadians have the support they need in these challenging times

The Government of Canada has also undertaken a broad range of policy, legislative and regulatory actions, such as:

• approving supervised consumption sites (with 38 currently in operation across Canada), and providing class exemptions to facilitate the establishment of overdose prevention site;
• consulting Canadians (from August 15, 2020 to October 14, 2020) on a proposal to develop proposed new regulations for supervised consumption sites and services;

• passing 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;
• collaborating with provinces and territories to better understand the evolving crisis, undertake timely surveillance and reporting of opioid-related deaths in Canada, and to encourage action at all levels to better provide care to people who use drugs with a full spectrum of options for receiving care;
• deploying 11 public health officers from the Public Health Agency of Canada to support surveillance systems in 11 provinces and territories;
• 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; and
• supporting a pilot project to provide pharmaceutical hydromorphone to eligible patients with opioid use disorder in British Columbia.

Further, in recognition of the importance of addressing pain prevention and management more broadly as efforts to address the opioid crisis must take people who live in pain into account, the Government of Canada released, in October 2020, the second report of the Canadian Pain Task Force, “Working Together to Better Understand, Prevent, and Manage Chronic Pain: What We Heard”. The report reflects the evidence, ideas, experiences, and practices that the Task Force heard throughout its extensive series of in-person, written, and online consultations about the gaps and challenges, best and promising practices, and elements of an improved approach to preventing and managing chronic pain

The Government of Canada is not currently considering the decriminalization or legalization of illegal drugs at this time. We will continue to work 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.

The Government of Canada continues to encourage the formation of partnerships between law enforcement and health and social services to help divert people who use drugs away from criminal sanctions and towards appropriate health and social services.  For example:

• Funding a three-year 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.
• Issuing guidance to public prosecutors to pursue suitable alternative measures and diversion from the criminal justice system for simple possession cases, 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.

The opioid crisis has had a devastating effect on Canadians from every walk of life and impacts communities in every region of the country. There is a need to look “upstream” at the root causes of the problem in order to better prevent substance use at the outset, and to consider substance use in the context of broader socioeconomic issues such as housing, poverty, discrimination and trauma. To this end, we will continue open communication with those most affected by the opioid crisis in order to determine what more we can do, and will work closely with community leaders, people with lived and living experience, as well as our provincial, territorial, and municipal partners, to advance innovative solutions to address this devastating public health crisis.