Expert Advisory Group on Safer Supply: Terms of Reference

Updated: June 2022

Preface

The overdose crisis continues to have devastating impacts on individuals, communities and families. The COVID-19 pandemic has worsened long-standing challenges regarding substance use and the overdose crisis, with most jurisdictions reporting record high rates of overdose deaths and harms. In addition, people who use drugs are also facing additional barriers and risks related to the toxicity of the illegal drug supply and limited access to health and social services.

The federal government's comprehensive, collaborative, compassionate and evidence-based approach to substance use issues in Canada incorporates interventions across the spectrum of care, including the provision of pharmaceutical-grade alternatives to the toxic illegal drug supply ("safer supply"). This includes funding pilot projects and bringing together an Expert Advisory Group (EAG) on Safer Supply.

The EAG provides advice to Health Canada on issues related to the effective and equitable provision of safer supply services, recognizing the diverse and specific needs of individuals and communities. Historical and intergenerational trauma, including the impact of colonization, loss of traditional culture and language, and experiences with Indian Residential Schools, has contributed significantly to the elevated risk of mental health issues and substance use amongst Indigenous Peoples. It is critical that we continue to take a distinctions-based, collaborative approach that recognizes the unique needs of First Nations, Inuit, and Métis communities, as well as the needs of individuals within these communities. Strengthening health, well-being, hope and resilience within these communities is essential to addressing substance-related harms and the overdose crisis. The considerations and needs of these communities, as well as others disproportionately harmed by substance use - including but not limited to: African, Caribbean, and Black populations, and racialized populations - will be centred and amplified in the EAG's work.

1. Scope and mandate

Health Canada sees a safer supply of pharmaceutical alternatives to the toxic illegal drug supply as a promising practice that has the potential to save lives and that:

• is low barrier (e.g., wide eligibility, low administrative requirements, etc.);
• is accessible (i.e., available in a variety of settings, such as supervised consumption sites (SCS), mobile sites, residential care, etc.);
• has an appropriate degree of prescriber/healthcare provider involvement; and,
• connects people with community and pathways for health and social supports (such as other harm reduction services, including SCS), where possible.

To help broaden options for saving lives, the EAG will provide Health Canada with ongoing expert advice on:

• Evidence from the safer supply pilot projects (e.g., addressing barriers, identifying best practices or gaps);
• Knowledge transfer strategies with respect to safer supply; and
• Emerging safer supply issues, including options for lower-barrier models.

Health Canada has the responsibility and sole authority to make decisions with respect to the mandate of this advisory body, and to the advice received.

2. Governance

The EAG operates under Health Canada's policy on external advisory bodies. All elements of this policy applies to the EAG.

The EAG provides advice to the Controlled Substances and Cannabis Branch (CSCB) at Health Canada. The Director General of the Controlled Substances Directorate (CSD) within CSCB acts as the Executive Secretary to the EAG. CSD provides Secretariat support to the EAG.

3. Membership

The EAG was preceded by the Safe Supply Implementation Task Team (ITT), assembled by Health Canada in February 2019, to provide expert advice and recommendations on the development of operational guidance to scale up and expand urgently needed safer supply services. In July 2019, all members of the ITT were invited to join the EAG. If members were unavailable to continue as part of the EAG, they were asked to suggest an alternate member that could contribute a similar perspective.

Members of ITT were recruited through a targeted nomination process. Health Canada consulted with provinces and territories through the Federal/Provincial/Territorial Assistant Deputy Minister Committee on Problematic Substance Use and Harms and the Special Advisory Committee on the Epidemic of Opioid Overdoses.

The goal of this process was to ensure that members of the group represent a diversity of regions, genders, and areas of expertise, knowledge, and experience relevant to the treatment and harm reduction of substance use, including people with lived and living experience. Health Canada promotes diversity and inclusiveness in advisory body membership and has added new members to this group over time to ensure that the EAG represents a range of perspectives and expertise.

3.1 Composition of EAG

The EAG will consist of up to fifteen (15) external members appointed by the CSCB who collectively possess as best as possible an appropriate range of knowledge, expertise, and experience related to substance use, including:

• evidence-based approaches and best practices;
• clinical management and service delivery;
• public health, epidemiology and drug policy research;
• health program evaluation;
• medical professional regulation;
• lived or living experience of substance use;
• stigma associated with safer supply; and
• impacts of substance use and related policies on Indigenous Peoples, Black people, and other racialized and/or marginalized populations

The Co-Chairs, one of whom will be a member with lived and living experience, are to be appointed by the Executive Secretary.

3.2 Tenure

The EAG's mandate was extended to June 30, 2023. Health Canada may consider further extending its mandate.

3.3 Resignation process

It is preferable for a member to provide 14 days notice of the intent to resign. The resignation letter must be in writing and be addressed to the Executive Secretary, with a copy to the Co-Chairs and Secretariat. The letter should state the effective date of the resignation.

3.4 Reasons for termination

Health Canada may end a member's appointment by writing to the member stating the reasons the appointment is being concluded and the effective date. Appointments may end for a variety of reasons: the member's term is complete; the mandate of the advisory body has been completed; the advisory body's mandate has changed, thus requiring a different membership, etc. An appointment may also be ended for cause when, for example, a member fails to act according to the Terms of Reference, or breaks the Confidentiality Agreement, or misses three consecutive meetings without a satisfactory reason.

4. Reporting

In keeping with Health Canada's openness and transparency policies, EAG information may be made available to the public. However, for a variety of reasons, including the protection of confidential information, it will not always be possible to make public an advisory body's existence, recommendations, or advice. The EAG will adhere to this guidance.

The EAG, through its Co-Chairs, will be accountable to and report to the Executive Secretary in CSD.

EAG meetings will take place virtually, as required (3-4 times per year) with the possibility of a face-to-face meeting if necessary. Additional ad-hoc meetings may be held on an as-needed basis at the discretion of the Secretariat, in consultation with the Co-Chairs.

EAG meetings will consist of discussion among EAG members to reach consensus on products and expert advice developed under the mandate of the EAG. Verbal advice and comments from EAG members will be collected by the Secretariat during each meeting. Where consensus is not reached, the Secretariat (in consultation with the Co-Chairs), will ensure that the diversity of opinion is noted in meeting records and final reports, as applicable.

Members act collectively as an advisor to Health Canada with respect to the mandate of their advisory body but they are not final decision-makers. The Department has the ultimate responsibility and accountability for any decision resulting from the advice received from an advisory body.

5. EAG Responsibilities

The responsibilities of the Co-Chairs are to:

• ensure that EAG discussions remain within its mandate;
• ensure that EAG members have the opportunity to contribute;
• ensure all EAG members act in a respectful manner towards one another;
• collaborate with EAG members and the Secretariat; and
• lead and participate in EAG meetings.

The responsibilities of EAG Members are to:

• review relevant documents provided by the Secretariat;
• apply their expertise and experience to provide input to the EAG's deliberations;
• actively participate in meetings and discussions, providing timely contributions;
• act in a respectful manner towards one another;
• support the Co-Chairs in their role.

6. EAG Executive Secretary

The Executive Secretary is responsible for making decisions about the administration and operation of the EAG (e.g., membership appointments/resignations, setting meeting agenda and times, etc.). The Executive Secretary works closely with the Co-Chairs and Secretariat.

The Executive Secretary, or a delegate, reports to the EAG at each meeting on next steps and, if applicable, the application of the advice received.

The Executive Secretary receives reports/advice developed and submitted by the EAG, and serves as the liaison between the EAG and senior leadership within CSCB.

7. EAG Secretariat

Health Canada will establish and cover the costs of a Secretariat to provide administrative and logistical support to the EAG.

The Secretariat will work closely with the Co-Chairs and Executive Secretary, and act as liaison between the EAG and Health Canada's program/policy subject-matter leads.

The Secretariat will administer EAG expenses, co-ordinate meetings, prepare meeting documents and share with members one week in advance of meetings; as well as manage the procurement of any contracts required to complete work related to the EAG, if applicable.

8. Compensation

All members serve on the EAG on a volunteer basis. Members will however, be reimbursed for expenses incurred on approved travel for the EAG, such as trip costs and accommodation, according to the Treasury Board's Directive on Travel, Hospitality, Conference and Event Expenditures.

Members participating as representatives of the lived and living experience community will be offered compensation for their participation.

9. Disclosure of Affiliations and Interests

To be considered for appointment, potential members of the EAG are required to complete and return the Affiliations and Interests Declaration Form.

In keeping with the Privacy Act, a completed Affiliations and Interests Declaration Form is considered confidential. Health Canada will not make public any information in the form without the member's permission. However, as a condition of membership, members will allow Health Canada to publish, on its website and in print, a Summary of Expertise, Experience, and Affiliations and Interests, based on the completed declaration form.

Health Canada or the Co-Chairs will ask members to make a verbal statement of their relevant affiliations and interests at the beginning of EAG meetings.

Members must update their declaration in writing whenever their situation changes. Health Canada will review declarations before making appointments and on an ongoing basis, at least on an annual basis, as well as any time the advisory body mandate is changed.

Members are expected to conduct themselves in an appropriate manner. They may not use their position on an advisory body for their private gain or for the gain of any other person, company, or organization.

10. Confidentiality

To support their ability to provide well-informed advice, EAG members may receive confidential information. Everyone must sign a Confidentiality Agreement before participating in the EAG as a member, presenter, or observer.

The Confidentiality Agreement prohibits the disclosure of any confidential information received through participation in the advisory body, including information received orally or in writing, through email correspondence, telephone calls, print materials, meeting discussions, etc.

Health Canada will mark information according to the level to which it is protected under the Policy on Government Security.

The Co-Chairs will ensure that everyone participating in the meeting, telephone discussion, email exchange, or in another form of communication has received clear instructions on the confidentiality of the proceedings.

Members must direct any media inquiries about the EAG to the Secretariat. The Co-Chairs will serve as spokespersons of the EAG unless delegated to a member. They may speak to the EAG's membership, mandate and activities, but not the Government of Canada's position or their advice or recommendations. In all communications activities, Co-Chairs and EAG members must abide by the confidentiality rules outlined in the Terms of Reference and Confidentiality Agreement.