Health committee  Sure. I mentioned it in my talk, but I think one of the big issues is the rise of phenyl-2-propanone meth. I said that earlier in my introduction. When they were making crystal meth.... There are two enantiomers, two types. They're like handedness. The l-methamphetamine is a nasal decongestant, and the d-methamphetamine is the psychoactive component.

Health committee  I have not been in Portugal.

Health committee  I want to take my opinion out of this and I just want to look at what the government has produced. There is a document called “Youth Unregulated Drug Toxicity Deaths in British Columbia”. What they looked at were the years 2017-2022. What they found was that, if you looked at the deceased youths, there were zero per cent deceased youth with hydromorphone in their systems in 2017, 2018 and 2019.

Health committee  I would tell them that any sort of opioid is addictive, and that with something like hydromorphone, if you become tolerant, you might actually move on to more dangerous things like fentanyl—to be careful around any sort of opioid use.

Health committee  One thing that's important is that I don't think we should rule out any intervention outright, but we need to apply the precautionary principle in the development of such protocols. What does that mean? There is an author, Nassim Taleb, who produced a paper in 2010. What he said was that you have to look at two factors.

Health committee  I think we definitely need to have a 360° view in these things. We need to look at the upsides and downsides, not just for the treatment population, but when you're looking at the supply of addictive drugs you have to look at the population writ large. In the nineties, when physicians were pushed to prescribe opioids, it was to treat pain as the “fifth vital sign”.

Health committee  Sure. There's a lot to unpack, and I'll start with the last point you were mentioning. When you look at schizophrenia, one of the most robust statistics that we have on it is that about 1% of the population will have schizophrenia. In British Columbia, where there are about 5 million people living in the province, there will be about 50,000 people with schizophrenia.

Health committee  I work in addictions and I also work in forensics. I do both. There are education campaigns to help people understand the toxicity of the drugs out there, but there are other programs available. For instance, in Iceland they had a program where they gave vouchers to families to put their kids in extracurricular activities.

Health committee  I think it's taking all the information in, and comparing what happened with Portugal. Again, in Portugal it wasn't public drug use that was allowed; it was that either you would face legal sanctions or you would go into treatment. Seeing what's happened in Oregon as well, and also seeing what's happened in British Columbia, overdoses have only increased with decriminalization.

Health committee  Sure. Thanks for the question. Something that would worry me is that what is provided will not be able to compete with the illicit market. The illicit market is often described as a "poison" drug supply. From the data available, it seems the market is supplying the demand of the end-consumer.

Health committee  Sure. One thing that we should look at is the supply of opioids in a population. If you look at the countries that had the highest overdose rates in 2020, the number one country was the United States of America. I think it was around 271 deaths per million population. This is also the country that had the highest supply of opioids among the population.

Health committee  I'll start with decriminalization. If you look at decriminalization, there are different models for it. It's important to distinguish the two. For instance, you had a model like Oregon's, which was very similar to what they did in Vancouver, where they allowed public drug use. What they found was that between 2022 and 2023, there was a 45% increase in overdose deaths, which was the highest increase of any state.

Health committee  For anti-psychotic medication, you will find that if someone has a substance-induced psychosis and they have an anti-psychotic medication on board, the anti-psychotic medication won't prevent their from becoming psychotic. Earlier in my talk I spoke about a kindling effect that occurred with substance use.

Health committee  Regarding cannabis use in Canada, we've seen in an increase in cannabis use disorder. We've also seen an increase in ER visits for psychosis related to cannabis. Legalization of cannabis hasn't decreased that. However, a balance needs to be struck. Has that downside been outweighed by the upside of decreased criminalization of people who are using cannabis?

Health committee  That is a large question. Psychosis is a symptom and a loss of touch with reality. These could be fixed false-beliefs, which are delusions, or it could be hallucinations, which are false sensory perceptions, or you could have disorganized thought. Whether someone has an intrinsic, organic psychiatric illness like schizophrenia or whether they have a substance-induced psychosis, such as cannabis-induced psychosis or amphetamine-induced psychosis, it's very difficult to tell these apart clinically.