Emergency Debate – Opioid Use – 6 March 2017

Taken from the Alberta Hansard for Monday, March 6, 2017.

Emergency Debate – Opioid Use

Notices of Motions
The Speaker
: The hon. Member for Calgary-Mountain View.

Dr. Swann: Thank you very much, Mr. Speaker. It’s my honour to rise and today provide notice that at the appropriate time I’ll move the following motion.

Pursuant to Standing Order 30 be it resolved that the ordinary business of the Legislative Assembly be adjourned to discuss a matter of urgent public importance; namely, the growing number of deaths from opioid use and abuse, including the use of fentanyl, which now constitutes a state of emergency.

The Speaker: Hon. member, I want to remind all of the members again. When there is one of the members speaking, try not to get out of your chair while the Speaker is speaking to the member present.

Emergency Debate

The Speaker: I believe we have a Standing Order 30 application. The hon. Member for Calgary-Mountain View.

Dr. Swann: Yes, Mr. Speaker. Thank you. I can circulate it to the members and proceed at your will.

The Speaker: Hon. member, at this stage we are arguing the importance of the urgency of the matter.
Dr. Swann: Thank you, Mr. Speaker. I rise today to ask you to approve my motion under Standing Order 30 to adjourn the ordinary business of the Legislature to discuss a matter of urgent public health importance – namely, the growing number of deaths from opioid abuse, including the use of fentanyl – which now constitutes a state of emergency.

To be clear, I am not asking the Assembly to declare a state of emergency. Rather, I’m categorically stating that a state of emergency exists, and that it is up to the Assembly to urgently debate this issue in this Assembly. The issue is being debated everywhere but here, Mr. Speaker. It’s happening at the federal level, at the municipal level, in the media, in our health and justice systems, by our police, fire, and ambulance services. MLAs on both sides of the House are touched by personal stories which are being sent to our constituency and our caucus offices. And Albertans are talking about it around their dinner tables.

It is time for this Assembly and this government, which has jurisdiction over the areas of health, justice, social services, and emergency management, to have the courage to talk about it here. It is time to put aside pride and partisanship and discuss how, together, we’re going to stop this scourge and make lives better or even possible for Albertans. We will leave it up to the government to determine if it is going to keep being reactive or show stronger leadership for what matters. After hearing this debate, should the government decide that calling a state of emergency is needed in order to tackle this epidemic, then I would encourage it and applaud it and thank it for this leadership.

Now, in terms of the specific requirements for this motion I am confident that the Speaker will find it is in order. Standing Order 30(1) states:

After the daily routine and before the Orders of the Day, any Member may request leave to move to adjourn the ordinary business . . . to discuss a matter of urgent public importance when written notice has been given to the Speaker at least 2 hours prior to the afternoon sitting.

This is clearly a matter of urgent public importance given that it is, in fact, a genuine crisis which is putting public health and safety at risk. As well, proper notice was given to the Speaker. It clearly meets these criteria.

Beauchesne’s section 387, on page 113, says: It must deal with a matter within the administrative competence of the Government and there must be no other reasonable opportunity for debate.

Certainly, the government has the administrative competence to deal with whether or not a state of emergency exists.

Furthermore, should the government want to act on the matter, the Emergency Management Act also gives the Lieutenant Governor in Council the power to formally declare a state of emergency should she be satisfied that “an emergency exists or may exist.” In that context, an emergency is defined as a public health risk that exceeds the capacity in technical, human, and material resources. End quote.

In terms of opportunities for debate there is no proposed legislation or motion before the Assembly that would provide us with another opportunity to debate this matter.

Beauchesne’s section 387, page 113, also says: In making his ruling, the Speaker may, on occasion, take into account the general wish of the House to have a debate.

I believe the Speaker will find that at least on this side of the House there is a general wish to have this debate. There are also people in the galleries who have joined us to hear the debate and would like to see it proceed.

Beauchesne’s section 389, page 113, says: The “specific and important matter requiring urgent consideration” . . . must be so pressing that the public interest will suffer if it is not given immediate attention.

The current opioid crisis is ending lives, destroying families, disrupting communities at an incredible rate, and clearly is a matter of public interest, approaching more than two deaths a day and a greater number of deaths than motor vehicle injuries, motor vehicle deaths, and homicides combined. Clearly, failing to recognize this as an emergency or refusing to talk about how to address it will cause the public interest to suffer.

Beauchesne’s section 390, on page 113, also says: “Urgency” within this rule does not apply to the matter itself, but means “urgency of debate”, when the ordinary opportunities provided by the rules of the House do not permit the subject to be brought on early enough and the public interest demands that discussion take place immediately.

Given that this is the first day of regular government sitting, obviously it is the first opportunity for us to debate this. This is also our first opportunity since the government released the report called Opioids and Substances of Misuse, fourth-quarter report, to discuss the shocking data that it contained. I don’t know how we could in good conscience just let that report hang over us without taking the time to take a critical look at what has been reported and what it means for the future.

It is fitting and right that we take this opportunity to debate a matter of such urgent importance instead of throne speeches, which were on the agenda for today. Likewise, I would draw your attention to the fact that despite the release of this alarming report, the government only gave the issue one sentence in the throne speech. Finally, perhaps now would be a good time for the govern-ment to tell Albertans more about what it plans to do in response to this opioid crisis.

There is also the matter of precedent. The Speaker has previously permitted debates to occur on similar matters under Standing Order 30. As recently as November the Assembly held an emergency debate on the deaths of children in government care. I would argue that the need to discuss the opioid crisis is equally or more serious and urgent, and it is getting worse.

Finally, under SO 30(7): (a) the matter proposed for discussion must relate to a genuine emergency, calling for immediate and urgent consideration.

With regard to whether this is or isn’t a genuine emergency, the facts speak for themselves, Mr. Speaker. In fact, if these numbers were related to an influenza epidemic, a public health emergency would already have been declared. There’s been a steady increase in fentanyl-related deaths for four years. Our last fourth quarter shows 343 deaths, a 33 per cent increase over 2015. That is not counting roughly 150 unspecified opioid-related deaths that have still to be characterized by the medical examiner.

In 2016 there were 2,267 emergency medical service responses in Alberta to opioid-related events. Eighty-four per cent of these events occurred in the following large urban settings: Calgary, Edmonton, Grande Prairie, and Medicine Hat. There is a continual backlog in the medical examiners’ office, causing lengthy delays in confirming suspected opioid-related deaths. This week I got a letter from a gentleman whose stepson’s death occurred 11 months ago. He has yet to hear from the Chief Medical Examiner. His is one of many stories I’ve heard over the past year, and I’m sure my colleagues have heard similar stories.

There is also a rise in overdose deaths in Alberta’s correctional facilities and remand centres, eight deaths last year compared to one in 2015 and 27 near deaths that presumably were overdoses reversed by naloxone. We don’t know about those 27 near deaths because the medical examiner hasn’t finished the deaths and doesn’t cover the near deaths.

Police services have expressed frustration at the lack of co-ordinated wraparound health and social service supports. There’s a clear lack of strategic leadership for large-scale, co-ordinated, and well-funded intervention with police, health, social services, and even our education institutions.

The Speaker: Hon. member, I want to urge you to speak to the matter of urgency and then to the substance of the debate.

Dr. Swann: Fair comment, Mr. Speaker. Thank you.

The list goes on. The opioid crisis is literally a matter of life and death for those who are facing it, and we need to talk about it. Therefore, with respect, I’m asking you and my colleagues in this House to recognize that the growing number of deaths from opioid abuse in this province, including the use of fentanyl, is a genuine emergency requiring our urgent consideration and debate.

Thank you, Mr. Speaker.

The Speaker: All opposed, say no. The motion is carried. The debate on this matter will now proceed. The Member for Calgary-Mountain View.

Dr. Swann: Thank you, Mr. Speaker, and thank you to the mem-bers of the Legislature. This is a debate that’s long overdue here and recognizes the deep sadness, grief, and anger developing at the inadequate and fragmented response to five years of increasing deaths due to addictions and mental illness, especially of our young adults and First Nations. Most members and professionals have been surprised, I included, at the devastation this has taken and at how quickly and quietly it has overtaken our health care, our justice system, our social services system. Surely there is enough statistical evidence and anecdotal stories to suggest this is indeed a public health and safety emergency in this province.

Our two major municipalities are having their own discussions on how to better tackle this issue. Edmonton’s mayor, Don Iveson, is quoted as saying that there’s no doubt this is a serious and escalating crisis, so the time well may come for that declaration to be issued. End quote. Calgary’s mayor, Naheed Nenshi, is reported saying that we lost more people to opioid overdose last year than the combined deaths from homicide and car collisions. We’re not talking about this enough. We’ve got to do something. End quote. The Calgary Police Service is holding a public discussion on opioids March 7, this week, expressing frustration at the lack of co-ordinated social and health services. Health stakeholders are hold-ing a public panel discussion this week, March 9, at the University of Alberta, Edmonton Clinic Health Academy, on opiates.

As an MLA I’m hearing these concerns raised almost on a daily basis from constituents, advocacy groups, and professionals in the medical, policing, and social services systems. As a physician I can confidently say that the current levels of opioid addiction overdose are beyond anything I’ve ever experienced in a lifetime of medical practice and constitute indeed a threat to public health and safety.

Assuming that these last-quarter reportings, that showed 343 deaths related to fentanyl, which was a 33 per cent increase over the previous year, similarly constituted only 57 per cent of all opiate-related deaths, as was reported in previous quarterly reports, then another 43 per cent of deaths have actually occurred this year than has been reported and are still awaiting final medical examiner confirmation. That would mean roughly 500 deaths last year, Mr. Speaker. We’re approaching two deaths per day in this province. I happen to believe that the provincial health officer cannot be expected with the resources she has to manage this extraordinary multi-disciplinary, multidepartmental crisis. Consideration should be given to reinstate the provincial mental health and addictions officer that was let go last year. It’s critical to have someone in place with a mental health and addictions leadership background.

I’d also like to see a clear, comprehensive plan for mental health and addictions, specifically on the opiate crisis, that is related to a collaborative stakeholder consultation; adequate, shared resources; more open communications between these organizations; and a close monitoring to see what is working and what is not working in our systems of care. I hear too many reports that people are not getting help, are pushed from place to place, do not have a clear plan, and do not have the emotional or mental support to go through the very difficult, painful family challenge of getting off opiates.

I also believe that resources beyond those currently being used are needed and that the federal government has recognized this. It means that we have to recognize other resources outside of Alberta, which is the definition of an emergency, when current resources fail to meet the needs of the emergency.

While we don’t necessarily understand all the dimensions of this epidemic, we must address the urgency. We must acknowledge that we do not have the resources or expertise currently or the co-ordination of resources needed to bring this under control. Five years surely has shown us that. With the recognition that we need resources, consideration should be given, as we have in other natural disasters, to call an emergency under the Emergency Management Act if not the Public Health Act. This would demonstrate (a) that we now appreciate the unpredictable devasta-tion of this evolving and increasing crisis. It would demonstrate (b) that we will develop a comprehensive plan and more effectively manage and mobilize the resources we have within this province as well as seek other resources from outside the province – why? – because we recognize that this is a national crisis needing federal, provincial, and municipal collaboration, because unprecedented numbers of people have died, and the rate has increased progres-sively over the last five years despite the welcome distribution of free naloxone that saves lives every day.

It’s not enough to save lives. We have to get ahead of this and get people off the drugs. Harm reduction elements are important – the tremendous and growing cost and the failure of our current approach with tremendous loss of money and morale in our police service, in our social service, in our front-line health workers, who see the same people coming in again and again without getting the appropriate supports they need.

Finally, “why” includes the need for strong and expert leadership focused on developing the plan that includes policing and the justice system; human services; our education, including the post-education system; and, of course, Health, which should be leading the charge and co-ordinating this effort as well as nongovernmental agencies, some of whom are represented in the gallery today; and the professionals outside the health system that are dealing with this: social workers, psychologists, counsellors.

What is needed? The government of Canada signed on November 19, 2016, a joint statement of action to address the opioid crisis with eight provinces and the Northwest Territories but not Alberta. Why is that? Why was Alberta not at the table?

More money needs to be directed at various sites and harm reduction approaches, especially supervised substitute therapy, and approaches to more focused leadership and a plan that includes all stakeholders. I believe, Mr. Speaker, that new and expert leadership focused on co-ordination and integrating the partnering of these various organizations and stakeholders with experts in mental ill-ness, addiction, as well as the police, social services, and schools is essential. Clearly, enhanced funding for supervised injection sites and opiate replacement therapy are needed. Other harm reduction programs are needed beyond the big cities, where we know that we have much stronger resources available to deal with poverty and homelessness, including their families in a comprehensive approach to their care.

Doctors, too, are fundamentally involved in this crisis. They have been involved in prescribing too many opiates, failing to monitor the opiates and other psychoactive drugs, and according to the college’s triplicate prescription program requiring all doctors prescribing opiates to register these, there’s been a failure of doctors to check on individual patients on whether they’re taking more drugs than they should be or continuing to take opiates from more than one physician. That is the responsibility of the medical profession and the college. To its credit the college has finally brought in this week standards for opiate prescribing. Now they must monitor and enforce more stringently, confronting the painful truth that most addicts were begun on prescription opiates.

My final comments, Mr. Speaker, have been said.