Health Committee on Dec. 9th, 2013

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Chair, I apologize as I know it is the holiday season, but on a point order, I don't think this line of questioning is relevant to the current study before us.

[The Chair, Conservative, Ben Lobb]

Thank you for that interjection, Ms. Adams.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Can I answer?

[The Chair, Conservative, Ben Lobb]

Yes.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Regarding those clinics that help people struggling with addiction—the topic we have been discussing since the beginning of the study—Ms. DeGroote talked about experiencing a similar situation, where people were afraid of how individuals with addiction issues were being treated. I know that your government has conducted a relevant campaign, and I want to know whether it thinks that this kind of an attitude is appropriate. I think that this has as much to do with the witness's testimony as with the topic of discussion.

In addition, Ms. Bromley talked about supervised injection sites during her testimony. Consequently, I truly believe that my comments are not outside the purview of the study.

[The Chair, Conservative, Ben Lobb]

Okay, Ms. Adams. By the way, your time is not getting used up here, unless you want it to be.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Mr. Chair, I believe that our honourable colleague from the opposition is really trying to reference and debate Bill C-2 here in the committee. It's really not the appropriate forum for it. We are here to study prescription drug abuse, and while witnesses may speak to the broader experiences that they may have had, it's incumbent on the members of Parliament to stay directed and focused in their questions.

[The Chair, Conservative, Ben Lobb]

Thank you for those comments. What I will add is that to my knowledge this study to this point has been very professional and non-partisan. The questions, if they are trying to get around that way, are done in a very respectful manner.

I think it has been a fine point of order. That point of order should go out to all members on this committee.

Mr. Morin, you have five and a half minutes to go with your time, sir. I'm not going to tell you how to ask your questions; it's for you to ask your questions. However, we'll try to keep it to the point.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

So I will let Ms. DeGroote answer. She should also feel free to tie her answer into today's topic of study. I think her answer will explain why I asked this kind of a question.

[Peggi DeGroote]

I think it's very important to differentiate the various clinics and sites that are available. I came to my definition of what I wanted to have at my clinic by having a bottom-up model. We clinically helped people in our community with whatever their needs were.

I don't want to denigrate or make claims for other people who offer their services to others. I can tell you that my early education in this field was very enlightening; it was frightening, and I couldn't believe it was Canada. I have been in clinics in third world countries that I have felt safer in, and that's what led me to say that we need a new model. Within that model, and by educating people in our community, I think we can change the face of what's out there so that people are not afraid to accept other people in their communities.

We originally had some people on the front page of our local newspaper, who said, “Don't bring these heroin addicts to our location. Children are going to get hurt on the way to school. This is going to be awful.” Those people have now come forward because of the model we use—and because we're no nonsense, zero tolerance, we run a tight ship, and we're by appointment only, like a traditional medical clinic would be—and are now welcoming us in their community. People who once were on the front pages of our papers, in fact, now have come for treatments and are very, very happy that we're there.

I think we need to educate our communities. We need to educate our physicians. We need to educate our pharmacists.

One of the things we do that's perhaps different from other places is that we ensure that every one of our prescriptions is automatically faxed to a pharmacy, so nobody takes a prescription out of our office. On the bottom of every prescription is a notation to the pharmacist, which he must adhere to and which is directed by our physician, that says “Any opioid prescription must be dispensed in a locked box”.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Madam DeGroote, thank you so much. I have other questions. That's why I have to cut you off. I'm very sorry.

My next question is to Dr. Bromley. The topic of this study will eventually become a part of Canada's anti-drug strategy, which is the end goal of this study. We know that the Canadian anti-drug strategy was changed in 2007 by the Conservative government to remove the fourth pillar, that is, harm reduction.

Do you think it was smart to remove that fourth pillar? The other three pillars are prevention, treatment, and enforcement of the law. Do you think the fourth pillar should be brought back again as part of the continuum of care for those people who are suffering from addiction, who abuse prescription drugs and other types of drugs?

[Dr. Lisa Bromley]

What I will say is that in medicine nothing is black and white; it's not all or nothing. We strive in medicine to do the best we can with what we have. I think that we reduce harm in medicine all the time, by whatever means we can, and wherever that patient is at.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

If I understand correctly, it should again be part of the Canadian anti-drug strategy?

[Dr. Lisa Bromley]

Sure.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I have one last question. It's for Ms. Cooper.

Ms. Cooper, you talked a lot about people who were ashamed of their great suffering, while no one believed that they were in much pain. They are accused of faking symptoms, pretending to be in pain and abusing medication.

Can you tell us more about that? What can the Government of Canada do to assist those people in terrible pain who have so few tools to truly help them?

[The Chair, Conservative, Ben Lobb]

Please make it a brief response, Ms. Cooper.

[Lynn Cooper]

Thank you.

There is a great deal that can be done. The most important thing is to provide appropriate pain management, because once you have multidisciplinary pain care that you can access, once you know about your pain condition, once you're familiar with all of the coping strategies, you learn how to make adjustments in your life. You learn how to take control back in your life. Then it doesn't matter so much if someone calls you a druggy or a pusher or a malingerer, because you know that you've taken control back, that you are living the most productive life that you can. Limits that you thought you had when you could not access appropriate pain management and get the help that you needed, you no longer have.

[The Chair, Conservative, Ben Lobb]

Thank you. That was good.

Ms. Adams, for seven minutes, please.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Thanks very much.

Our government has been investing significantly when it comes to pain management. In fact, through the CIHR we've invested about $55 million into pain management research.

I recently met with one of the leading neurosurgeons in our nation. He's based in Montreal and does quite a bit of work at the CIHR. They were focused primarily on arthritis research, but they're very patient-focused. They had provided a questionnaire to their patients, asking them to rank their priorities. The patients came back and ranked as their number one priority pain management, which came as quite a surprise to the physicians and the clinicians. So they have completely changed their focus moving forward so that they are able to address this patient concern.

Can you tell me a little bit about the importance of research into pain issues to ensure that patients' needs are being met? Through you, Mr. Chair, if I might direct my question to Ms. Cooper first, and if there are any others who would like to augment the answer, please do speak up.

[Lynn Cooper]

I would defer to Dr. Buckley as well.

The importance of research into the effectiveness of pain management is key. With each study that is completed, we learn more and more about how different modalities will interact with one another and produce the best results.

As I said, I would defer to Dr. Buckley as well on this one.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Dr. Buckley, do you have anything further, through you, Mr. Chair?

[Dr. Norman Buckley]

There are a couple of things. One is that it is the case—and you can look at examples like the strategy against HIV—that concerted attention to a specific problem has led to dramatic improvement in our capacity to deal with conditions. Montreal is unique. McGill University, in particular, has a glorious history of leadership internationally in the problem of pain—except that's coming from somebody who lives at McMaster, so it's probably even valued more highly than the actual words—

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

That's okay, though. I was a Hamilton girl for 16 years, so I will accept your bias happily.

[Dr. Norman Buckley]

There you go.

Granted, $55 million is not trivial but relatively speaking, pain does not have a pillar. I appreciate the fact this sounds like scrinching, or something, because $55 million is not trivial but there are no pillars, for example, directed towards pain management. As you heard from Ms. Cooper, and if we are able to forward the editorial from Mary Lynch, you will see it delineates quite clearly the cost of untreated or inadequately treated pain, and it far eclipses HIV, cancer, and even cardiovascular disease in terms of its impact. The problem is that it's not a straightforward biochemical question. As I suggested, it is complex. It includes psychological responses and social situations, all of which have an impact. The importance of research cannot be underestimated. There is quite a bit known now. One of the issues is to try to move forward with quality treatment.

The CIHR is actually a splendid organization, and many kudos to them.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Thank you.

Ms. DeGroote, in the proportional breakdown at your clinic, how many folks are coming to you with prescription drug abuse issues and how many with illicit drug issues?