BY DR. ALEXANDER CAUDARELLA
CHIEF EXECUTIVE OFFICER, CANADIAN CENTRE ON SUBSTANCE USE AND ADDICTION
DECEMBER 10, 2024

Mr. 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 changing rapidly. The impact of drugs and alcohol are pervasive.

We recently hosted a delegation from the European Union Drugs Agency. Europe and Canada have much in common, including being home to multiple jurisdictions, communities, languages and cultures. While there are several differences, our work together is showing us that we are both facing a rapidly evolving drug landscape and similar challenges in sustaining healthy and safe communities. This rapid evolution and the threat it poses to people’s lives call for creative and tangible, reproduceable innovations that save lives and protect communities.
We have much to learn from each other.

But 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: elected leaders, public health officials, drug policy experts, local service providers, people with lived experience, First Nations, Inuit and Métis organizations, resource industry leaders, police services, and others. 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. So 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 them robustly. Fewer than 10% of people access the care they need, and opioid agonist therapy rates in Canada are half of what they are in Europe. We know that an increased capacity for assessing future challenges, issuing early warnings and analyzing related risks can lead to more effective and timely responses that save lives. We also know that treatment rates remain low, and that access to quality care is difficult when we don’t invest in holistic prevention and don’t create the right community environments. We need recovery-informed environments and health systems; ones that can help people get well and stay well. But we have an implementation problem, and we need innovation. As I and many of my colleagues have said before: there is no one-size-fits-all approach for people dealing with the harms of substance use.

What we need now — or dare I say yesterday — is real impact. We’re building the army. Help us arm it with the evidence-based tools we know can help us win this fight.

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 

We should start with what we know works, and that’s better co-ordinated access and treatment options. For alcohol and opioid use disorders, for example, there is an injectable form of naltrexone that has shown incredible results in helping people remain substance-free and stay on their path to health. This monthly injection is a great example of innovation in substance use health care and is much more manageable and empowering than having to visit a pharmacy or community health centre daily for other types of life-saving medications. 
But injectable naltrexone is not available in Canada.

We also can’t close our eyes to the reality that there is no intervention that won’t cause harm. As we do in every aspect of healthcare, we must weigh the benefits and the risks to make informed decisions that serve us best. We must also engage in these interventions with our eyes wide open and prepare for unintended consequences. This requires humility, speed, flexibility and science. We must elevate the conversation beyond ideology. If we don’t, more people will die, and more communities will suffer. 

Thank you.