Thank you, Chairman, for this invitation to speak before the House of Commons Standing Committee on Health.

I am a physician licensed to practise in the Province of Ontario, which I have done for 49 years. Initially, I engaged in general practice and then specialized full-time in addiction medicine, commencing in 1990. I'm certified by the International Society of Addiction Medicine and, in the management of substance misuse, by the Royal College of General Practitioners, U.K. I was the first physician to prescribe methadone for the management of opioid dependence—which is the same as addiction—west of Toronto, and that was in 1991.

I co-authored the first edition of methadone treatment guidelines, published by the College of Physicians and Surgeons of Ontario. Subsequently, I became the medical director of Clinic 528, which at one time retained 22 physicians managing the disorder of opioid dependence for over 1,400 patients.

In the mid-1990s, methadone prescribing was closely regulated by Health Canada and the CPSO, otherwise referred to as “the College”, in order to minimize mismanagement of patients, drug diversion and overdoses. The protocols necessary to achieve these goals were followed strictly, and patient safety and improved health were noted.

Initially, the Clinic 528 operation met significant resistance from local businesses, but after anxieties were allayed, the clinic became a respected part of the community. Anecdotal information from the London Police department indicated that heavy crime decreased.

Since the introduction of what is called “safe supply clinics” in London, the number of patients enrolled at Clinic 528 started to decrease, and many of the patients who have remained have continued to exhibit instability in their recovery from the disease of addiction.

I accept that opioid replacement therapy in the form of methadone and Suboxone does not meet every patient need, and alternative opioid prescribing is acceptable, necessary and indicated, but this should involve long-acting opioids. The use of short-acting opioid preparations such as Dilaudid, which are not monitored nor regulated, significantly increases the risk for patient destabilization, overdoses, diversion, homelessness and crime.

The political situation in London has not helped to mitigate these risks. Both Health Canada and the College of Physicians and Surgeons of Ontario have seemingly abdicated all responsibility for oversight, resulting in many physicians and pharmacists engaging in the practice of prescribing short-acting opioids, which aggravate addiction.

It is important to recognize that those who suffer with addiction can be considered to be suffering with a disease, but the use of opioids is also a choice, a means of coping and a reflection of the decay in society. The remedy is not to prescribe abundant amounts of opioids. Instead, introduce controls and support systems, which will help not just patients, but also prescribers, dispensers and the local communities. Once patient stability is established, health, responsibility, pride and integrity can develop.

Safe supply, for the most part, does not induce such progress.

Thank you.

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