Thank you, committee members, for this opportunity to speak with you today.

My name is Sarah Larney. I have a Ph.D. in public health, and I'm an associate professor at the Université de Montréal. My research focuses on the health and well-being of people who use and inject drugs.

I have conducted several projects that are relevant to the committee's remit. The most recent of these was an analysis of toxicological findings from people who died of overdose over the past decade in Quebec. These data showed that while Quebec was shielded from the worst of the toxic drug supply and overdose epidemic prior to 2020, this is no longer the case. In recent years, fentanyl is increasingly present in people who died of overdose, alongside a growing variety of highly potent and toxic compounds, including non-medical benzodiazepines, nitazenes and xylazine.

The number of opioid overdose deaths in Quebec increased dramatically in 2020 and has remained high. There were 319 opioid overdose deaths in Quebec in the first six months of the year compared with 236 in the same period last year—a 35% increase. The rate of overdose mortality is low relative to provinces in the west of Canada, but it is probable that the situation will continue to worsen as a result of the toxicity of the drug supply.

We have also studied use of supervised consumption sites in Montreal since 2018. In this work, we found that the proportion of visits to supervised consumption sites requiring an overdose intervention increased markedly in 2020 and has remained high since. However, these overdoses were not fatal because staff were able to quickly respond, providing oxygen, naloxone and further care as necessary. Supervised consumption sites must be a central part of the response to the overdose epidemic. The number of deaths that would occur without them in major cities, regional areas and across the country is unthinkable.

The current overdose epidemic is often dated to 2014 or thereabouts. Recent work in the United States, however, has shown that overdose deaths have in fact followed an exponential growth pattern for nearly 40 years. Using publicly available data from Statistics Canada, we have identified a similar growth pattern in Canada, with an average increase in the overdose mortality rate of 9% per year, every year, since the year 2000. There is no sign of this trend slowing down.

I want to emphasize that exponential growth does not just mean rapid; it means a specific pattern that is underpinned by a process or processes that continually catalyse further growth. While the toxic nature of the drug supply is the immediate cause of the overdose epidemic, these underlying processes contribute to the sustainment and growth of the epidemic. These are most likely socio-economic trends such as increasing housing costs, increasing income inequality and declining income mobility. These trends intersect with and influence each other. It is not a coincidence that overdose deaths have increased in Montreal at the same time that housing costs have increased dramatically and income inequality has also increased.

My point here is that well-funded, low-threshold harm reduction services are essential to manage the acute overdose crisis. These services, however, are hamstrung by a policy environment that permits growth in overdose deaths to continue. Interrupting this growth requires social policy reform, attending to the housing crisis, income stagnation and other issues including overburdened health systems, particularly mental health systems, across the country. Drug policy reform is also essential to address the perverse incentives that drive drug traffickers to produce ever more potent substances.

No single one of these issues that I have mentioned is the sole cause of the overdose epidemic, and no single policy will bring an end to this epidemic. Rather, it is likely that all of these will need to be addressed in some way and the social safety net strengthened if we are to successfully interrupt the epidemic curve.

Thank you.