Ford government opioid experts say they were never consulted

Some experts the Ford government claims to have consulted in the creation of its opioids strategy say they were never contacted on the topic.

Others considered by Ontario's Ministry of Health to be experts on the opioids crisis include an anti-abortion group executive, a moderator of an anti-supervised consumption site Facebook group, the director of a Toronto business improvement area and an Ottawa police union president.

According to the ministry, the government consulted just one organization doing front-line harm reduction work — Toronto's Fred Victor Centre — an omission advocates say overlooks a key part of the crisis.

Through a freedom-of-information request, QP Briefing received "a list of experts consulted by the government in formation of its opioids strategy," between June 29, 2018 — the day the PC government was sworn in — and July 5, 2019.

QPB spoke with 11 people on the list, a number of whom expressed surprise they were included and said they were not specifically consulted by the government about how to address the addictions crisis. One said she has been trying for months to set up a meeting with the Ministry of Health, to no avail.

"I am surprised that they would say that they consulted me when that didn't happen," Ottawa physician Dr. Lisa Bromley said.

Bromley sent a letter to Health Minister Christine Elliott in August calling on the government to add drugs to the province's formulary that would allow for injectable opioid agonist therapy, which has been shown to help people addicted to opioids who don't respond to other treatments.

She said she hasn't received a response yet.

Bromley said many experts on the list are colleagues of hers, such as Toronto family doctor Dr. Jennifer Wyman, who also signed the August 7 letter to Elliott.

"If they had been consulted, I expect that it would've come up in conversation," she said.

Addictions experts have heavily criticized Ontario's approach to the opioids crisis. A cap of 21 supervised consumption sites across the province is still in effect, and the government has so far refused to explore options like prescription opioids for those dependent on street drugs, which are often toxic. A committee of experts on the crisis convened under the Liberals hasn't met since the Ford government took office. And Chief Medical Officer of Health Dr. David Williams has downplayed Ontario's situation, even as it has surpassed British Columbia's overdose death totals for the first time. There has been a 40 per cent increase in substance-related deaths during the pandemic, compared to last year, according to Dr. Dirk Huyer, Ontario's chief coroner.

Some of those on the list who were surprised at their inclusion, including Bromley, were involved with a Ministry of Health-funded McMaster University project to educate physicians about prescribing opioids to patients with chronic pain. The Ministry of Health said in a statement that this is why they were included.

"But work on that program does not constitute consulting for the ministry," said Dr. Abhimanyu Sud, who directs the University of Toronto's Safer Opioid Prescribing program. "Developers/contributors like myself had no relationship or direct interaction with the government."

"I was very surprised when I was informed by (the Ministry of Health) that my name was being released as a consultant re: opioids and curious to know how this happened," Sud said in an email.

"I am not a consultant on the opioid epidemic for the government," said Laura McDiarmid, a Queen's University family medicine expert who was on the McMaster project's panel. "My contribution was to provide educational best practices and design not medical recommendations."

Dr. Anthony Levinson, who was also involved in the McMaster project, said it was "kind of intriguing" that he was included on the list, adding that he was "marginally surprised."

He said he understood why others also felt it curious that they were on the list.

"I think there's a difference between being involved in the creation of these online courses, and feeling like you had direct consultations around it," he said.

In a statement, the Ministry of Health maintained that "all those named on the list were engaged to provide advice on initiatives or other approaches being taken by the ministry to address the opioid crisis" — which spokesperson Miriam Mohamadi said includes projects like the McMaster clinical primer, as well as advice on supervised consumption services and "analytic projects and indicator methodologies to support strategic work within the Ministry to address the crisis."

Parry Sound Mayor Jamie McGarvey, the former president of the Association of Municipalities of Ontario (AMO), said he was also not consulted about the opioids crisis.

Mohamadi said he was included because "AMO frequently provides feedback to the government on a large range of issues impacting municipalities across the province, including the opioid crisis."

“But was I personally interviewed, or asked personally, as me? No," said McGarvey.

"It's one of those things where our 43-person board would’ve been consulted," he said.

Dr. Howard Ovens, who co-chairs Ontario’s Emergency Services Advisory Committee, said he wasn’t consulted “separately or specifically" on the strategy, but said the advisory committee he chairs does discuss the issue of opioid use.

Ovens said he personally supports safe consumption sites and decriminalizing prescription drug access for people who are dependent — “but those are my opinions as a citizen, not as an emergency care expert.”

Others on the list, such as University of Toronto professor Dr. Carol Strike, Beasley Neighbourhood Association director Mike Borelli, and the Ontario Chamber of Commerce, say they took part in a roundtable hosted by the Ministry of Health about drug policy.

Strike, whose research focuses on harm reduction and addiction treatment, said she was invited at the request of one of her community partners, "who thought it strange I had not been asked as one of the lead authors of the (2012 Toronto and Ottawa Supervised Consumption Assessment Study) report."

There were many different stakeholders, she said in an email. "Many supportive and some outright hostile, others in the middle. Seemed like overkill to have these sessions given the extant evidence base about (supervised consumption sites). What’s the point of government-sponsored research if government doesn’t use it?"

Elliott was at the meeting, and "seemed genuinely interested in listening," Strike said.

"Given what followed in terms of changing rules and requirements, I don’t think that what I said or what I heard was taken into consideration," she added.

Strike said the ministry instructed her not to disclose her participation in the roundtable, which she felt was a "crazy request," and did not abide by.

ICES drug policy expert Dr. Mina Tadrous said he and the other ICES researchers listed — Drs. David Juurlink and Tara Gomes — consult with the government frequently on the topic.

Some took issue with "NIMBY" groups being listed as opioids experts — like Mary Jane Kerkhof Sherman, who moderates the Facebook group "A Clean Cambridge." Members of the group have come under scrutiny for posting pictures of drug users and people experiencing homelessness, with comments calling them "disgusting and garbage," CBC reported in 2018.

While medical professionals and harm reduction workers have been frustrated with the lack of consultation from the government, the head of the Downtown Yonge Business Improvement Area said he got a personal visit from Elliott.

"I have to give the minister of health credit, she did come down to our neighbourhood and walk the neighbourhood to look at what I had referred to as ... the unintended consequences of supervised injection sites and the opiate crisis and the tainted drug supply that we had," said Mark Garner, who said he is not against the sites, but that businesses are suffering because of them.

Garner said he was then invited to give Elliott a presentation in her office about the BIA's viewpoints.

“It was a fairly robust consultation for sure,” he said.

Toronto harm reduction worker Zoë Dodd said groups like A Clean Cambridge and BIAs aren't experts on opioids.

“These people are about their businesses. They’re not experts in the lives of people who use drugs, or the issues at hand," she said.

"It's really insulting, actually. We give them too much power to speak on the lives of people that they have disdain for."

Also on the list is Gwendolyn Landolt, the national vice-president of anti-abortion organization REAL Women of Canada. The group has promoted misinformation about supervised consumption sites and used vitriolic language to describe people who use drugs, calling neighbourhoods where they operate "unwalkable" due to human feces, and alleging that "drugged out and sometimes dead addicts litter the sidewalks."

Dodd said she was angry when she saw the organization on the list of experts.

"They're pro-life for children, but ... they're kind of pro-death for people who use drugs," she said.

The government also listed Ottawa Police Association President Matt Skof and former Toronto city councillor Lucy Troisi as experts on the opioids crisis. Both have advocated against supervised consumption sites. (Skof was consulted before his arrest on charges of breach of trust and obstruction of justice.)

Also listed is Amir Farahi, a PR strategist who reportedly helped the Middlesex London Health Unit review documents around supervised consumption sites for the Ministry of Health — but who was also involved in lobbying against the sites, Global reported. Farahi has since admitted to creating smear campaigns against female councillors during the city's 2018 election.

It's “very concerning” that the government largely ignored harm reduction experts, said Gillian Kolla, a postdoctoral fellow at the Canadian Institute for Substance Use Research at the University of Victoria.

She said she understands the need to be broad in consultations, but "the balance is off" when groups like REAL Women of Canada take precedence over organizations who work to help people who use drugs.

“Their website is littered with not just factual inaccuracies, but absolute lies,” Kolla said.

REAL Women of Canada did not respond to a request for comment.

The government "was seeking a range of opinions" on supervised consumption sites, Mohamadi said, so a "diverse group of stakeholder representatives — from a variety of sectors — were invited to participate and provide feedback. This included health-care providers, health associations, police, community and neighbourhood groups, business associations, municipal officials, supervised consumption services and overdose prevention site operators, researchers and persons with lived experience to support an understanding of how any continuation of the sites can better connect clients to addictions treatment and other services."

Just as concerning as who is on the list is who was left off, some experts say.

Front-line harm reduction workers, who were absent from the list except for Jane Eastwood, the director of programs and services at Toronto's Fred Victor Centre, raised concerns that the government is prioritizing "medicalization" of the issue, instead of engaging with those working on the ground.

"My worry in seeing so much privileging of the medical perspective is that when we medicalize substance use, we tend to slip into pathologizing substance use very, very easily," Kolla said. "And we neglect the wide range of drug use in communities."

Kolla noted that many medical experts on the list are colleagues, and are doing important work. But heavily prioritizing medical perspectives over front-line advocates can also set up "a false antagonism" between treatment and harm reduction approaches, she said. "Ideally, we have a spectrum of services for people that meet them where they're at."

Mohamadi said "front-line harm reduction workers were included in the consultation (as part of the Opioid Emergency Task Force)," though members say the group has not been active under the current government.

"They talked to us on the phone one time, and that was it," Dodd said, adding that Elliott was not on the call.

The committee includes firefighters and paramedics, who are also absent from the expert list, she noted.

Mohamadi said the ministry "continues to engage with consumption and treatment services operators on an ongoing basis."

Dodd noted that Indigenous people are disproportionately impacted by the opioids crisis, but no Indigenous organizations are on the list.

"Fly-in communities are really struggling," she said. "That is missing from here."

Mohamadi also said the ministry consulted with "anonymous persons with lived experience across Ontario; including individuals who use drugs, formerly used drugs and/or are affected by drug use (i.e. friends and family)."

Dodd said that's not good enough when there are many people who use drugs who are vocal and would be happy to talk to the government about the issue.

NDP mental health and addictions critic Bhutila Karpoche said it was "very interesting" that anti-supervised consumption site groups and an anti-abortion group were consulted while front-line harm reduction workers — the "true experts" — were mostly ignored.

Karpoche said the government should be transparent about how it weighed each contributor's recommendations.

“We know what these experts are saying, so to me it's clear that the Ford government sought out anti-OPS people and excluded front-line harm reduction workers. And so behind closed doors he’s secretly trying to stack the deck in order to justify his cuts to overdose prevention and mental health and addiction services," she said.

NDP poverty and homelessness critic Rima Berns-McGown said the list should've included experts on homelessness, poverty and health like Dodd, Stephen Hwang, Naheed Dosani, Nanky Rai, Ruth Cameron, and organizations like Anishnawbe Health Toronto or Inner City Health Associates.

"It seems to be no wonder that opioid deaths have skyrocketed during the pandemic when they aren’t following the advice of people on the front lines of this work," she said in an email.

The full list of experts provided to QP Briefing is as follows:

• Tara Gomes; Ontario Drug Policy Research Network, ICES
• Mina Tadrous; Ontario Drug Policy Research Network, ICES
• David Juurlink; Ontario Drug Policy Research Network, ICES
• Regan Murray; Office of the Chief Coroner
• Lynn Wilson; Vice Dean, Partnerships, Faculty of Medicine, University of Toronto
• Jennifer Wyman; Assistant Professor, Dept. Family and Community Medicine, University of Toronto; Addiction Specialist, Women's College Hospital
• David Daien; Lecturer and Family Physician, Dept. Family Medicine, University of Toronto; Division Head, Primary Care, Trillium
• Ahmed N. Hassan; Assistant Professor, Department of Psychiatry, University of Toronto; Staff Psychiatrist, Centre for Addiction and Mental Health (CAMH)
• Katherine Hodgson; Educational Consultant, Post MD Education, University of Toronto
• Arun Radhakrishnan; Assistant Professor, Dept. Family and Community Medicine, University of Toronto; Clinical Lead, Centre for Effective Practice
• Anita Srivastava; Associate Professor, Dept. Family and Community Medicine, University of Toronto
• Abhimanyu Sud; Lecturer, Dept. Family and Community Medicine, Program Director, Post MD Education, University of Toronto
• Suzan Schweeweiss; CPD Associate Dean, University of Toronto
• Anthony J. Levinson; Associate Professor, Faculty of Health Sciences, Director, Division of e-Learning Innovation, McMaster University
• Norm Buckley; Professor and Chair, Anaesthesia, Director, Michael G. DeGroote National Pain Centre, McMaster University
• Greg Carfagnini; Assistant Professor, Emergency Medicine, Northern Ontario School of Medicine; Community and ER Physician, RAM lead
• Megan Messenger; Associate Professor, Northern Ontario School of Medicine; Community Physician
• Deborah Smith; CME Medical Director, Northern Ontario School of Medicine; Family Physician
• Ruth Dubin; Associate Professor, Dept. of Family Medicine, Family Physician, Queen’s University
• Laura McDiarmid; Educational Manager, CPD & Faculty Development, Queen’s University
• Terry Soleas; Educational Consultant, Faculty of Health Sciences, Queen’s University
• Paul Hendry; Vice-Dean Continuing Professional Development (CPD), University of Ottawa
• Lisa Bromley; Lecturer, Faculty of Medicine, Family Physician with Focused Practice in Addiction Medicine, University of Ottawa
• Kim Corace; Associate Professor, Dept. Psychiatry, University of Ottawa; Director of Clinical Programming and Research, Substance Use and Concurrent Disorders Program, Royal Ottawa Mental
• Eric Wooltorton; Director of Faculty Development, Dept. Family Medicine, University of Ottawa; Family Physician
• Michael Brock; Educational Developer, Schulich School of Medicine and Dentistry, University of Western Ontario
• Lisa Bitonti-Bengert; Director, Clinical Improvement and Informatics, Health Quality Ontario
• Dr. Ahmed Bayoumi; Physician and Scientist, Centre for Urban Health Solutions, St. Michael’s Hospital; and Professor, Department of Medicine, University of Toronto
• Mike Borelli; Beasley Neighbourhood Association (Hamilton)
• Ashley Challinor; Vice President, Policy, Ontario Chamber of Commerce
• Sarah Cipkar; Community Development Coordinator, Downtown Windsor Community Collaborative
• Dan Clements; For A Better Cambridge
• Jane Eastwood; Director, Programs and Services, Fred Victor Centre
• Amir Farahi; Executive Director, London Institute for Public Policy
• Mike Franklyn; Physician and Program Director, Sudbury Rapid Access Addiction Medicine Clinic, and Associate Professor of Family Medicine at the Northern Ontario School of Medicine
• Mark Garner; Chief Executive Officer and Executive Director, Downtown Yonge Business Improvement Area
• Mary Jane Kerkhof Sherman; A Clean Cambridge
• Dr. Robert Kyle; President, Association of Local Public Health Agencies, and Medical Officer of Health and Commissioner, Durham Region Health Department
• Gwendolyn Landolt; National Vice-President, REAL Women of Canada
• Dr. Christopher Mackie; Chair, Council of Medical Officers of Health, and Medical Officer of Health, Middlesex-London Health Unit
• Jamie McGarvey; President, Association of Municipalities of Ontario, and Mayor of Parry Sound
• Jeff McGuire; Executive Director, Ontario Association of Chiefs of Police
• Kate Mulligan; Director, Policy & Communications, Alliance for Healthier Communities
  Cynthia Olsen Drug Strategy Coordinator, City of Thunder Bay
• Dr. Howard Ovens; Staff Emergency Physician and Chief Medical Strategy Officer, Sinai Health System, and Medical Advisor, Sinai Health Foundation, and Chair, Emergency Services Advisory Committee (LHIN Emergency Department Leads)
• Barney Savage; Interim Chief Executive Officer, Addictions & Mental Health Ontario
• Dr. Peter Selby; Clinical Scientist, Addictions Division and, Director, Medical Education, Centre for Addiction and Mental Health
• Matt Skof; President, Ottawa Police Association
• Dr. Chris Steingart; Founder, Medical Director, Sanguen Health Centre and Rapid Access Addiction Medicine (RAAM) Clinic, Waterloo and Guelph
• Dr. Carol Strike; Professor, Dalla Lana School of Public Health, University of Toronto
• Lucy Troisi; Councillor, City of Toronto, Ward 28 Toronto Centre-Rosedale
• Anonymous persons with lived experience across Ontario; including individuals who use drugs, formerly used drugs and/or are affected by drug use (i.e. friends and family).