Evidence of meeting #12 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A recording is available from Parliament.
9:55 a.m.
Conservative
February 6th, 2014 / 9:55 a.m.
NDP
Isabelle Morin NDP Notre-Dame-de-Grâce—Lachine, QC
Thank you very much, Mr. Chairman.
Thank you all for your testimony.
Mr. Mander, my first question is for you. You spoke about the increase in crime that is due to prescription drugs. In Canada, how many of those crimes are committed on a yearly basis?
9:55 a.m.
Chair, Drug Abuse Committee, Canadian Association of Chiefs of Police
I'm still looking at that. I wouldn't know, but if you talk to any chief of police, generally most crime is driven by drugs. I wouldn't be able to tell you whether it's prescription drugs or heroin, but most crime is driven by drugs.
9:55 a.m.
NDP
9:55 a.m.
Chair, Drug Abuse Committee, Canadian Association of Chiefs of Police
On prescription drugs and what drives that? No. That's part of our research project.
9:55 a.m.
NDP
Isabelle Morin NDP Notre-Dame-de-Grâce—Lachine, QC
Thank you.
You provided us with several examples, including driving under the influence of drugs. Do you carry out tests? How do you know whether or not an individual is driving under the influence of drugs?
9:55 a.m.
Chair, Drug Abuse Committee, Canadian Association of Chiefs of Police
There are DRE, drug recognition expert, officers across the country who are specifically trained to identify that. From a policing perspective and talking to my colleagues, we're seeing an increase in folks who are not driving while impaired by alcohol but are driving while impaired by drugs.
9:55 a.m.
NDP
Isabelle Morin NDP Notre-Dame-de-Grâce—Lachine, QC
Are these cases of drug abuse, or rather poor indications for use?
I would like to tell you about a personal case. When I had to take my driver's licence exam, I was very young and I had taken a medication. A dentist has prescribed codeine for me but there was no indication on the label that I could not drive after taking it.
Do you think we need better practices that would involve informing individuals that they should not drive after taking certain types of medication, or would you say that drugged driving always involves abuse?
9:55 a.m.
Chair, Drug Abuse Committee, Canadian Association of Chiefs of Police
It's a little bit of both, but if you do look at the labels of the drugs prescribed now, it says to avoid operating heavy machinery. I would include a car as heavy machinery. When we talk about education and labelling on any drug that can affect a person's cognitive ability or ability to drive, it should be very specific.
That's where education comes in for the physician or prescriber that prescribes it, like your dentist and/or pharmacist. That's where they can come in and say, “By the way, you shouldn't be driving with these, and especially when you have that combination of opiates and alcohol.” That increases the risk.
9:55 a.m.
NDP
Isabelle Morin NDP Notre-Dame-de-Grâce—Lachine, QC
Thank you very much.
My next question is for you, Mr. Bishop. You said that there is a conflict of interest when pharmaceutical companies are selling both anti-addiction treatments and addictive drugs. I also think that is a conflict of interest.
Do you have any recommendations to make in that regard? Do you feel there should be regulation or laws about this? Should pharmaceutical companies be prohibited from selling one or the other of those products? What measures should the federal government take?
9:55 a.m.
Director, Government Affairs and Health Policy, Reckitt Benckiser Pharmaceuticals Canada
What our committee has said is that if somebody wishes to manufacture a painkiller or an addiction treatment, the minimum standard should at least be that it has to be abuse-deterrent; that is the minimum standard, if you're going to bring them into market.
Ideally, if we, marketing Suboxone, decided that we were going to start to manufacture prescription opioids that could be treated by the very drug that we manufacture, that to me would be wrong. If you talk to the average person, and I've talked to folks.... Mr. Young will know Ada Thompson, from the association of responsible prescribing for opioids. She agrees as well that you cannot allow the double-dipping, because you're essentially allowing volume driving.
If the federal government can look at that when they are doing NOCs, they should have that bare minimum standard of abuse deterrence, but the end goal should be that nobody should be able to do both.
10 a.m.
NDP
Isabelle Morin NDP Notre-Dame-de-Grâce—Lachine, QC
Are many businesses currently finding themselves in this situation?
10 a.m.
Director, Government Affairs and Health Policy, Reckitt Benckiser Pharmaceuticals Canada
I'm sorry. The audio cut out at the end.
10 a.m.
NDP
Isabelle Morin NDP Notre-Dame-de-Grâce—Lachine, QC
Do many pharmaceutical companies find themselves in that situation at this time?
10 a.m.
Director, Government Affairs and Health Policy, Reckitt Benckiser Pharmaceuticals Canada
There are some coming onto the playing field, yes, especially when you get into the conversation about unbranded or generic manufacturers. There are standards, but there are not aggressive enough standards to prevent this.
As a person, I find it unfortunate that we would allow that kind of stuff to be happening. I don't think it's right, and I think the average person doesn't think it's right either.
10 a.m.
Conservative
The Chair Conservative Ben Lobb
We have gone past five minutes.
For the committee's knowledge, Mr. Bishop is going to have to leave at approximately 10:10. He has to appear before a Senate committee.
Next up we have Mr. Wilks, for five minutes.
10 a.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
I want to continue with what my colleague, Mr. Young, was speaking about concerning deaths that are investigated by police, commonly referred to as sudden deaths, that involve these types of drugs.
You may not be aware, Mr. Skinner, but my previous career was with the RCMP, and I have investigated a significant number of sudden deaths.
I want to hear from both of you with regard to a problem.
Most of the sudden deaths that police go to involve an overdose of some form, whether it be of an illicit or non-illicit drug, or of alcohol for that matter. They are difficult to investigate. The police officer goes in, but his or her authority is not to remove the body; his or her authority is just to determine what has happened.
I can remember many cases in which we would go in and we would see a multitude of pills and would think “sudden death”. Yes, the person is dead. We call the coroner. The coroner gives the authority to remove the body. From there the police have no investigation at all, because it is turned over to the coroner.
It seems to me, from what I'm hearing today and from what Mr. Young said, that we need to better identify how far the police need to go in these investigations. It seems to me that if you go into a residence in which you have a sudden death and in which you have a multitude of prescribed drugs—from more than one doctor, let's say, for argument's sake—it should ring some bells really quickly, but there's nothing there, because it's a coroner's case.
Do you have any suggestions?
Let's hear from Chief Mander and then Dr. Skinner.
10 a.m.
Chair, Drug Abuse Committee, Canadian Association of Chiefs of Police
A certain part of our committee—we have Dr. Bowes, our chief medical examiner from Nova Scotia— is going to be looking at best practices across Canada in those situations. The police are doing it from an investigative perspective and learning what needs the coroners have in those situations.
You're right. Ten years ago when someone died from an opiate or an overdose, it was automatically determined that it was a coroner's case. Now what we're seeing is it's not just a coroner's case. This can have some police ramifications, not just from the investigative perspective that someone trafficked, but it could be that you have some doctor or physician or prescriber. That's the difficulty.
The other issue we have to wrestle with is that quite often we release the scene only to find out three months later that the person was full of a drug that they weren't prescribed, etc. That presents a lot of difficulty for police from an investigative perspective.
10:05 a.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
Prior to intervening, Mr. Skinner, I want to bring one more thing up. It has to do with Ms. Morin's question with regard to what I'll call “drug driving”. Aside from a police officer, as far as I understand, unless there are some new ways of doing it, the only way to convict on drug-impaired driving is through the receipt of a blood sample, which as all of us in this room know can be a difficult process and has to be done by a doctor. I believe that there need to be better ways for the police to be able to investigate these in a timely manner, because right now it ain't timely. It gets to the point, especially with drugs, that even though we have drug recognition people, you still have to formulate the demand and then go forward. We really need to focus on that.
I'll hear from Mr. Skinner, with regard to the investigations.
10:05 a.m.
Regional Supervising Coroner, Office of the Chief Coroner for Ontario, Ontario Ministry of Community Safety and Correctional Services
With regard to the investigations, in Ontario I'm blessed because our legislation actually gives us the authority to enlist the assistance of police in our investigation, which we do. In the circumstance that you're describing, where we would enter a scene and there would be prescriptions for multiple people or multiple prescribers, for example, the coroner has the authority then to ask police on their behalf to investigate both the prescriber and the dispenser. Often the police and the coroner together will obtain those records and investigate that problem
10:05 a.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
But that's not in each province, correct? You're specifically speaking about Ontario.
10:05 a.m.
Regional Supervising Coroner, Office of the Chief Coroner for Ontario, Ontario Ministry of Community Safety and Correctional Services
That is correct. I think the RCMP experience in some jurisdictions would be very different.
10:05 a.m.
NDP
Libby Davies NDP Vancouver East, BC
Dr. Skinner, I'd like to come back to something that you said at the beginning of your remarks.
A lot of the discussion today has focused on opioids, but of course in looking at prescription drug misuse, we're also talking about other classes of drugs, whether it's stimulants or anti-depressants. Something that you said caught my ear. I think you said that misuse increases with age. I think there is a stereotype of prescription misuse that maybe it's younger people, that it's younger addicts. The issue of seniors and what's happening is something which we haven't really paid a lot of attention to. I know from my work earlier as a municipal councillor in Vancouver, when we had a seniors committee it was a huge issue.
I wonder if you could speak a little bit about that and whether or not there are specific measures we need to pay attention to in terms of recommendations that focus on an older population, the fact that we are now seeing an older population, and what that means in terms of prescription use and particularly potential misuse. Is it more about education, or is it more about prescribing? How do you see that in terms of a specific problem?
10:05 a.m.
Regional Supervising Coroner, Office of the Chief Coroner for Ontario, Ontario Ministry of Community Safety and Correctional Services
What I said earlier—I think what I said and maybe I didn't say clearly—was that as people age, the source of their drug is more likely to be their prescription. Younger people are more likely to get their drugs from the street, and as you get older, you're more likely to get it from your prescription.
That being said, you're absolutely correct that from what we see and again—we only see the very end of the downstream as the chief has referred to—it is a problem in the elderly, either intentional or accidental drug toxicity.
Is the answer in education? I think probably it is. Again, it's physician education because we know that poly-pharmacy and the inappropriate use of opiates and other psychoactive drugs in the elderly is a problem. We see it regularly. Also it's education for patients to make sure they fully understand the appropriate use of the medication, that if one is good, five must be better doesn't apply when you're on sustained-release oxycodone, for example. If you're on a fentanyl patch, you really do have to take the old one off before you put the new one on. It's not an uncommon thing for us to see someone with five, and then we have to sort out if they simply did not understand to take the old ones off, or if they were actually intending to do that.
Yes, it is a problem, and yes, I think education probably is the way to go in that particular issue.