Chair, vice-chairs and committee members, thank you for inviting the Canadian Centre on Substance Use and Addiction, or CCSA, today.

As you know, the world is rapidly changing. The impact of drugs and alcohol is pervasive. We recently hosted a delegation from the European Union Drugs Agency. We have much in common. We're home to multiple jurisdictions, communities, languages and cultures. There are several differences, but our work together is showing us that we're both facing a rapidly evolving drug landscape.

Drugs are increasingly everywhere and touch everything. This rapid evolution and the threat it poses to people's lives calls for creative, tangible and, perhaps most importantly, reproducible innovations that save lives. There isn't a silver bullet, but I believe our future will be saved by millions of little things and everyone has a role to play. We have much to learn from each other.

However, Canada has earned a reputation as a land of one thousand pilot projects. When it comes to moving beyond these efforts, we have much to learn from each other and from listening to communities and diverse perspectives. Every community deserves to feel safe, and every person deserves access to the services and care they need where and when they need it. Those two concepts can and must coexist.

We’ve had some successes in bringing communities together. For example, CCSA is working with mayors of small cities across the country to create the first municipally led pan-Canadian playbook of evidence-based solutions for the substance use crises so many communities are experiencing. This involves bringing together all facets of a community. We know that people are tired of being lectured by experts and having their real concerns discounted. They want menus of options they can tailor to their communities. Together, we are working towards actionable solutions, adaptable to local realities, community goals, and budgets.

We find ourselves in interesting times. We know what is needed and what works, but we have failed to implement it robustly. Fewer than 10% of people have access to the care they need. Opioid agonist rates in Canada are half of what they are in Europe. There's little accountability. We don't set ourselves goals. We don't set ourselves timelines. We know that there's an increased capacity for need and for future planning, but we continue to just react. We don't live and invest in appropriate community and family prevention, and we don't create the right community environments. Specialists and specialty services won't save us. We need recovery-informed environments and whole health systems, ones that can prevent harm but also help people get well and stay well.

We have an implementation problem. We need innovation. There isn't a one-size-fits-all approach. We can't tell people what works and we can't go about doing blanket bans on things, either. What we need now—what we needed yesterday—is real impact. We're trying to build a future. Please help us arm it with evidence-based tools to make it a reality.

We should start with what we know works. We need coordinated access and treatment options. For example, for alcohol and opioid use disorders, there's an injectable form of naltrexone. It's shown incredible promise in helping people stay on their path to health. It's even shown promise with methamphetamines. It's a monthly injection. It's an innovation in substance use health care. It's more empowering than going to the pharmacy every day. Injectable naltrexone remains unavailable in Canada.

There’s an important discussion currently taking place in Canada around mandatory treatment, and it’s a great example of what requires a holistic approach. The current conversation largely ignores key aspects: What are we trying to achieve, and how will we achieve it? As a physician, I can tell you that I have no problem keeping people in hospital beds to save their lives. As a society, we need to talk about what it would mean to support people forced into treatment.

As a field, we keep making the same mistake over and over. We need to stop closing our eyes to the reality that there is no intervention that won't cause harm. We must weigh the benefits and the risks and make informed decisions. We must also engage in interventions with our eyes wide open and prepare for unintended consequences. The flexibility needed is what makes differences between jurisdictions that succeed and ones that don't. We must elevate the conversation beyond ideology. If we don't, more people will die and more communities will suffer.

Thank you.

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