Health Committee on Feb. 13th, 2014

[Libby Davies, NDP, Vancouver East, BC]

It certainly appears the scrutiny was not very close because we've just heard in the Canadian context what some of the problems were in terms of the lower abuse claims that were made, which were false.

Would you agree that there needs to be some sort of independent oversight by the federal government in terms of the claims that are being put forward? Do you also agree that there needs to be a separation between your industry and what is communicated to doctors in terms of marketing?

[Dr. Craig Landau]

Simply stated, yes and yes.

On the first suggestion, I don't know precisely how things happen here within Health Canada, but in the United States, for certain, external expertise is often sought, because it is impractical to house the requisite expertise within the building.

On the subject of the pharmaceutical industry's influence of medical practice and understanding and misrepresentation of facts, I agree with Dr. Persaud on the point that there needs to be separation. We're not interested as a business—maybe I can speak for the industry—in misrepresenting facts. We're interested in producing high-quality data that's acknowledged by experts, internal and external to Health Canada, and communicating them appropriately and not influencing unduly through continuing education or other means to drive prescriptions. That's not good business because it's not good medicine.

[The Chair, Conservative, Ben Lobb]

You are pretty well done. You have 15 seconds.

Okay, Mr. Lizon, you have five minutes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Mr. Chair.

Thank you to all the witnesses for being here this morning.

I have a question that I keep repeating at almost every meeting.

Dr. Kahan, in your presentation you mentioned how in the 1990s there was a change—an explosion in prescribing OxyContin and the aggressive marketing, etc. Other witnesses also brought this up earlier, that in the 1980s and later, doctors started prescribing opioids for non-cancer treatments and the practice eventually spread to the degree that we have a crisis here.

I'm trying to understand one thing. When they put OxyContin on the market in 1995, it wasn't really a new invention. We've known about opioids for over 200 years. If I have the dates correct, morphine came onto the market in 1804 and was distributed in 1817. Merck sold it commercially in 1827.

So we have 200 years of a history of opioids, and we know very well—and I guess medical practitioners know very well—that they are highly addictive. So how is it possible that an aggressive advertising campaign by a pharmaceutical company did not raise any red flags with medical professionals, with the regulating body, or with anyone else?

I'm trying to understand, so I will give you the floor.

[Dr. Meldon Kahan]

That's an excellent question.

Purdue conducted focus groups with family doctors throughout the United States, and they found that the concern about addiction was a major barrier, so they tailored their advertisement and marketing towards that. They said controlled-release opiates are not as addicting as immediate-release. This was based on, I would say, a misinterpretation of the studies. Controlled-release opiates are, in fact, way more addicting than immediate-release opiates when they are contained in extremely high doses.

They also said—they made this false distinction between pain patients and addicted patients—that pain patients don't get addicted. In other words, it's all the problem of these dishonest addicts who flock to the doctors and lie to them to get the prescriptions. That's completely false. The patients who get addicted are patients who have legitimate pain problems and who are exposed to it.

You made a very good point. It was amazing how the medical profession rolled over. They rolled over like teenage boys confronted with smoking-cigarette ads. Medical researchers, educators, and everyone else was lecturing family doctors and saying, “you're opiophobic if you're concerned about prescribing controlled-release opiates”.

There was no critical thinking, or there was a very major absence of critical thinking, and in fact, people who were speaking out at public meetings and in writing were criticized by those who said, “You don't want to treat pain. You lack compassion.”

So I think it is going to be one of the most tragic and scandalous episodes in medical history, that we as a profession were taken in by this kind of marketing campaign.

[The Chair, Conservative, Ben Lobb]

Dr. Persaud, Mr. Lizon wondered if you'd like to make a comment.

[Dr. Navindra Persaud]

I would. Thank you for the opportunity.

I think the short answer is billions of dollars in marketing. That is how the fact that opioids and other medications are addictive was overlooked through all of this. They are overlooked by physicians and overlooked by regulators, because the people marketing the medications know what they're doing when they approach regulators and they know what they're doing when they approach physicians, and they have billions of dollars behind them to change people's minds.

If you want another illustration of how it happens, I think you can refer back to some of the comments made in this committee today by the president of Purdue, who's made similar comments about the new formulation of oxycodone that they are marketing today.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

The last round is to Mr. Scarpaleggia, please.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Thank you, Chair.

Ms. Strang, you were mentioning initially that you thought more data should be collected and shared nationally. Was that you who said that you hoped—

[Lorinda Strang]

Yes, I did.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Could you give us a few examples of the kinds of data that you think should be collected and shared nationally?

[Lorinda Strang]

Yes. I have submitted a document and some graphs.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

What kinds of information would be useful to be collected?

[Lorinda Strang]

I'm having a hard time hearing.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

I'm sorry. Just very briefly, what kind of data should we be collecting and why? Maybe give three examples of that.

[Lorinda Strang]

You should be collecting the current drug trends, the rates of clients that are coming in that are....

We list three drugs of concern. We're going to up it to six. Currently, we can tell you how many of our clients coming in are listing OxyContin as their number one drug of concern. Going forward, we've seen a huge increase in other medications as well. The whole prescription epidemic right now is across the board and we can tell you what drugs our clients are coming in on. Alcohol is still the number one, but it's closely followed by prescription medications or in combination with prescription medications.

I can also give you testimonials from the addicts who are going through withdrawal who will tell you things like: “I got started on OxyContin from a shoulder surgery. The pain of the surgery is much less than the withdrawal. If I could go back and now knowing what I know, I would have sucked up the pain”; or “My name is Eddie, I'm 21 and OxyContin almost made me end my life”.

They should have those warnings like on the cigarette ads so we can provide information from marketing.

The statistics we can give you are factual: who's coming in, what drugs of abuse are current.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Thank you.

Just to end, I would like to ask all four on the teleconference how they would like to see the $45 million that was put aside in the recent budget spent. Where would you spend that money starting, say, with yourself, Ms. Strang?

[Lorinda Strang]

I would spend a lot of it on a marketing campaign and I think the Government of Canada right now has started a marketing campaign and it's good—there are commercials. But I think reversing this trend in prescription medications by awareness campaigns....

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Dr. Durnin.

[Dr. Maire Durnin]

I'd like to see universal funding for opiate-agonist therapy and I'll draw to your attention to the analogy of HIV anti-retroviral therapy in B.C. and the lowered incidences of HIV from good care and open access to medications. I would also like to see industry incentives for people to take back-to-work opportunities that allow them to engage in recovery activities simultaneously.

A lot of my patients end up in low-paying jobs and have to daily walk the line between deciding to come and see me or engage in the other things they need to do for their recovery versus losing their jobs. There needs to be retraining and graduated return-to-work programs that are funded by incentives such as you have available to you.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Thank you.

Dr. Kahan.

[Dr. Meldon Kahan]

I'd like to see, similar to what Dr. Durnin said, that opiate substitution therapy—methadone and buprenorphine, as well as naloxone the important opiate overdose prevention tool—be available to all Canadians, including those in first nation communities and in remote communities that right now don't have access to any of those medications.

I'd also like to see an intense campaign similar to Purdue's campaign, but this time focusing on improving physicians' prescribing of opiates and their recognition of opiate addiction in ways to prevent it.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Finally, Dr. Persaud....

[Dr. Navindra Persaud]

Thank you.

I'd like to see the resources put towards stronger regulation of marketing and more effective monitoring of harms of prescription drug abuse, and also investigation of previous mismarketing and previous harms that could actually generate revenue for future investigations and future regulation.

[The Chair, Conservative, Ben Lobb]

You're right on time.

We just have a couple of minutes to go. We were going to go in camera, but I think for the sake of time I'll just say it right now.

On February 25 I think the best thing for our committee to do is to have a planning meeting, a working meeting to discuss our next study. We can have a fruitful discussion there.

On February 27 it's quite likely our committee won't sit. In regard to witnesses and having to have them in by the end of this week, I think we can allow some latitude. You're not quite up against the wall there, but certainly over the break next week, think about who you may or may not want to have as witnesses.

Mr. Young, did you have something that you'd like to add here?