Thank you, Guy.

I'm calling in from the unceded territories of the Musqueam, Squamish and Tsleil-Waututh nations.

Thank you, honourable members, for this opportunity to speak with you.

Allow me to begin by situating myself in the work that I do. My name is David Tu. I am a non-indigenous family physician. For the past 24 years, I have worked as a family doctor in Vancouver's Downtown Eastside with a dominantly indigenous practice. I am grateful for the last four years to have been the recipient of a Health Canada SUAP grant, which has allowed me to explore the impacts of partnering indigenous elders with primary care providers to deliver services to indigenous people living with opioid use disorder in an urban setting in a meaningful way. I currently work at the Kílala Lelum health centre in the Downtown Eastside.

As Guy just said, we are eight years deep into a public health emergency in British Columbia, resulting in the deaths of seven individuals per day due to an increasingly toxic and unregulated drug supply. Indigenous people living in the Downtown Eastside are at the epicentre of this crisis. To illustrate this, I want to share a story that highlights some of the complexities of the situation.

Ms. M is 38-year-old indigenous woman of Métis and first nations ancestry. I've known her and she's been a part of my family practice for the past 14 years. She's the mother of a three-year-old son. She's incredibly witty and a fiercely loyal human being. She's also endured extreme levels of trauma in her life, and she lives with a long-term, severe substance use, opioid and stimulant use disorder.

For the two years after her infant son was taken from her and removed to care, Ms. M expressed no interest in controlling her substance use. Despite the support of her family and a dedicated care team, there was minimal engagement in opioid agonist treatments and only sporadic engagement with prescription alternatives.

During this two-year period, she experienced multiple overdose events. She could easily have died and been just a statistic in the sheer volume of indigenous people dying each day in B.C., yet with an increased sense of hope for reclaiming her role as mother to her son, I am pleased to say that Ms. M is now engaging in care and is on a fentanyl patch-based OAT program that has allowed her to significantly reduce her illicit opiate and stimulant use.

She is currently motivated to attend an indigenous family-centred residential treatment program with both of her parents, her sister, her partner and their son. Sadly, the only two indigenous-specific treatment centres in B.C. that accept families will likely reject this family, one, because they exclude people who are receiving OAT and, two, because they do not allow children under age eight.

We are hoping for an exception, but both centres have a six- to 12-month wait-list, and this is a harsh reality for this family. Eight days ago, Ms. M was discovered unconscious in a bathroom in her mother's apartment building. Thankfully, she was resuscitated, and she recovered in the emergency room.

Let me make a statement of fact. The unregulated drug supply is killing people, and first nations people are at six times the risk of death compared with non-indigenous people in B.C. To paraphrase elder Bruce Robinson of the Nisga'a people—you can't help people if they are dead.

Many individuals with a substance use disorder are not ready to address their addiction for a variety of reasons. This means that oftentimes treatment services are unlikely to bring about a recovery for them, similar to Ms. M in the two years following the removal of her child.

Alongside other harm reduction initiatives, prescribed alternatives and opioid agonist treatments can help reduce the risk of overdose; however, it is widely agreed among medical professionals like me that we can't prescribe our way out of this public health emergency. There are several things that we collectively need to do to change course.

The first is a fully functional continuum of care from harm reduction to recovery-oriented treatments.

The second is a pathway we can all be on to a regulated drug supply. We must also acknowledge that culture saves lives. For indigenous people specifically, whose route to addiction was often paved by the trauma resultant from colonialism, traditional medicines and cultural practices offer a meaningful means for many to gain control over their substance use and address the underlying causes of their addiction.

The third need is for more investment in programming focused on culture, traditional medicines and land-based healing. To be clear, we need investment in treatment programs. For indigenous individuals such as Ms. M, who are prepared to address their substance use, there is a need for increased access to culturally appropriate residential and community treatment.

Lastly and importantly, we must put an end to false dichotomies and divisive politics. I couldn't say it better than Guy did. We are a country of abundant resources, and the COVID-19 pandemic revealed our capacity to mobilize resources in response to public health needs. We need harm reduction services, including prescribed alternatives to keep people alive when they are not prepared to—