Evidence of meeting #22 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pharmacist.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Janet Cooper  Senior Director, Professional and Membership Affairs, Canadian Pharmacists Association
Phil Emberley  Director, Pharmacy Innovation, Canadian Pharmacists Association
Harold Lopatka  Executive Director, Association of Faculties of Pharmacy of Canada
Karen Cohen  Chief Executive Officer, Canadian Psychological Association
Roger Bland  Member, Professeur Emeritus, Department of Psychiatry, University of Alberta, Canadian Psychiatric Association

9:15 a.m.

Conservative

The Chair Conservative Ben Lobb

That's perfect timing, Ms. Davies.

Mr. Lizon

9:15 a.m.

Conservative

Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON

Thank you very much, Mr. Chair.

Welcome, all the witnesses.

The first question I have is on expanded scopes of practice and the prescribing of medicine by pharmacists.

Would this include, in your view, or should it include, diagnosis as well?

9:20 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

I think there's widespread awareness that diagnosis is strictly a physician capability. We do not feel that pharmacists have the education to diagnose disease. We do, however, feel that pharmacists are the drug therapy experts, so they can definitely weigh in on which medications are most appropriate for a given diagnosis. But no, I don't see diagnosis per se; that's something that physicians should be doing.

9:20 a.m.

Conservative

Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON

I'll tell you why I asked this question. When I was growing up—and I wasn't growing up in this country, I'm originally from Poland—for many things I didn't go to see the doctor. I would go to the pharmacist and say, sir—or ma'am—I have this; can you do something for me? It always worked. Seriously, it always worked; they knew very well. It was for nothing major, but for minor ailments you wouldn't go to the doctor. I don't even know whether it was regulated or not, to be honest.

9:20 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

Absolutely. Pharmacists perform that valuable function on a daily basis. Patients will come in with a bug bite or they have acne or they have an allergic reaction. Pharmacists are definitely capable of providing the medications to support and to treat those conditions. We're not talking strictly about diagnosis. Very often the patient knows what they have or has a good sense, and the pharmacist is essentially confirming it.

9:20 a.m.

Senior Director, Professional and Membership Affairs, Canadian Pharmacists Association

Janet Cooper

The other thing to add to that is, “What's new?” Pharmacists have been doing that with over-the-counter medications forever. Now, with expanded scope, they can prescribe prescription-only medications to treat these types of minor ailments.

9:20 a.m.

Conservative

Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON

This would probably work very well especially in areas in which we have a shortage of doctors. We have remote areas.

9:20 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

Absolutely it does. It also takes away some of the pressure on emergency rooms, because they are really being inundated with patients presenting with varying degrees of severity. If minor ailments can be handled at the pharmacy level, it will reduce some of that strain, most definitely.

April 10th, 2014 / 9:20 a.m.

Conservative

Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON

The committee just completed a study on prescription drug abuse. It's a growing problem. What is your view; would the new, expanded scope of practice for pharmacists add to the problem? Would it address the problem?

If someone comes to you as a pharmacist and says, l'm on such and such medication, especially with the abuse or misuse of opioids for both medical and non-medical use growing very quickly, would this add to the problem? If someone comes to you and says, “Listen, I'm travelling and I need this; I don't have any more”, what would you do? I guess it would not work very well and might actually increase the problem.

9:20 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

One thing I want to make very clear is that we're talking about appropriate drug therapy to enhance patient outcomes. In many cases, the proper thing to do is not to recommend a medication. I think that pharmacists are in an ideal position to make that assessment.

There's also an educational component to this, explaining the role of medication where it is warranted and explaining when drug therapy is not warranted.

I don't see expanded scope as increasing the prescription burden. I see it as a second set of eyes that pharmacists can provide to enhance patient outcomes in an accessible way and also do what is right for the patient's health, ultimately.

9:20 a.m.

Senior Director, Professional and Membership Affairs, Canadian Pharmacists Association

Janet Cooper

Let me add to that, to clarify, that prescribing of narcotics and controlled drugs is federally regulated, and pharmacists don't have that authority. The government recently allowed a number of other providers to prescribe narcotics—midwives, nurse practitioners, podiatrists, maybe—but not pharmacists. So they couldn't.

We've suggested that pharmacists should be allowed to do this. Often it might be helping to get somebody off narcotics, because that is a slow process. Changing the dose to slowly wean them off their narcotics would be something pharmacists could certainly help with.

9:20 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

Or changing to a narcotic that might not be as problematic, as, for example, in the case of OxyContin changing maybe to another narcotic that is similar in terms of pain relief but doesn't have the same problematic attributes as a drug like OxyContin.

9:20 a.m.

Conservative

Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON

I have a question for Mr. Lopatka, to clarify this for me. You mentioned that quota of 1,000 per year. Can you tell me why would you ask to lower the quota?

9:25 a.m.

Executive Director, Association of Faculties of Pharmacy of Canada

Harold Lopatka

As I mentioned in my presentation, we believe that we've tipped from being in a shortage environment to being in a surplus environment. In Canada we're producing more than 1,000 graduates from our own pharmacy schools—we're actually approaching 1,400—and we believe that, at least from what we can tell, this supply should be enough for our needs over the next little while, or at least until the time that we find what the true need is per year, with the pharmacists who would be exiting from the workforce due to retirement and such factors.

As to the precision of our calculations in knowing what CIC is doing, it is only from the conversations we've had with them that this 1,000 number has come up. We don't really have any better information on whether it's even more than that.

9:25 a.m.

Conservative

Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON

I don't know whether you have these or not, but if you have statistics from the past years, what percentage of foreign-trained pharmacists after arriving in Canada actually get accreditation?

9:25 a.m.

Executive Director, Association of Faculties of Pharmacy of Canada

Harold Lopatka

I don't have any numbers on that. But all I see from the information that is available from the current Canadian Pharmacist database is that over the course of probably five to eight years, the international graduates have now become one quarter of the labour force, if the numbers are all correct. So certainly the number of people who have made it into the system has grown quite significantly in the last four or five years.

But I don't have any other numbers about how many are out there who have not been accredited or licensed to practise.

9:25 a.m.

Conservative

The Chair Conservative Ben Lobb

Thank you very much, Mr. Lopatka.

Next seven-minute round, Ms. Fry, please.

9:25 a.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Thank you very much, Mr. Chair.

It was a very excellent presentation from all of you and I do support the concept of scope of practice expansion with pharmacists working in a team setting. However, I just wanted to pick up on some of the things that Mr. Lizon asked earlier on. I think I agree with Mr. Lizon. I believe that the ability to diagnose a patient is a scope of practice for a physician.

I have myself been the beneficiary of having my asthma medication quickly given to me from the pharmacist when my doctor has been away. I understand that this is all very appropriate scope of practice.

There is one thing that I keep hearing and so I wanted to ask about it. If someone walks into a pharmacist office and as Mr. Lizon asked, had what seems like a cold, it's very easy to say well let's give them some antihistamine, some Tylenol to bring down the fever, etc. Is that appropriate practice, however, if one hasn't had the ability to be in touch with the family physician or the attending physician to find out if that person has other coexisting reasons or is taking other kinds of medication? It may be inappropriate to give the kinds of medication you may be giving them.

For me, that ability to talk to each other before giving any kind.... Even over-the-counter stuff, as you well know, can be harmful if somebody is taking medication that's going to be contra-indicated to take those things. How does that happen if somebody just walks in? This isn't a patient you've always seen, somebody you've talked to the physician about on a constant basis and therefore shared the history and shared the knowledge about the patient.

That's the first question I want to ask. How does that work and what are the risks of that kind of practice?

The second thing is, and this is the one that I've heard possibly from physicians and others, so it's a biased question actually.... I'm just asking it because I really would like to hear the answer and I'm sure you have a good one. Is it because pharmacists, generally speaking, tend to benefit directly from prescribing anything or giving anything even if it's over the counter because they also own or run the pharmacy or drug store? Anytime they give anything, they get a financial benefit from that medication.

What are the ethical guidelines? Maybe the college might answer that better.

What are the ethical guidelines put in place to ensure that pharmacists are not being pushed from monetary gain only to make sure that everybody who walks in and has something, gets a medicine, over the counter or otherwise? That's a big question in terms of the ethics of it. I don't know if you have ethical guidelines on that. I don't know how one tracks how that works. Of course, the prescription fee that one gets for dispensing and all that.... I can see all of this working so well in a community care setting, as you said.

But I just wondered if there is a way of looking at how that ethical guideline is observed. What are the ways that one is ensuring that those monetary gains are not made from pharmacists who may or may not...? We've got doctors who do all kinds of things that they shouldn't be doing. I'm asking the same thing. How do you monitor that and make sure that there isn't medicine being given every time somebody walks in even for a little cold because one gets a monetary gain from it? So that's the ethical piece I wanted to talk about within the scope of practice.

9:30 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

I think, to answer your first question, very often the person who presents in a pharmacy and is asking for advice or help over the counter is not in an immediate position to access their physician or an emergency room. Often you see them in the evenings or weekends. As a pharmacist, you are presented with what appears to be something self-limiting. It could be a cold you detect.

What I think is important is after that consultation, the pharmacist will often say, “Keep an eye on this. If after a couple of days you're not feeling better, you need to see someone. You need to see a physician or you need to see another health care provider.” So we're not losing these patients to follow-up in situations where it could be something more severe than that because we don't want them to go home and think that every ailment they have can necessarily be treated in this way.

A lot of these patients are coming in to pharmacies and they are self-selecting these products. They are seeing advertisements on TV or on the radio and they come in and they choose something. The pharmacist's value-add is really being able to assess them, and given the information that they may already have about these patients in their database, suggesting something that is a realistic therapy for them. But there is a need to collaborate with other health care providers and not do it in isolation.

9:30 a.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

I understand that, but I'm talking about the times when you can't collaborate. For instance, somebody comes in and they pick up, say, Tylenol Sinus. Do you ask them what medications they are taking?

9:30 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

Absolutely.

9:30 a.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

You do. Okay.

9:30 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

Absolutely. You really need to do that assessment because there are definitely medications that are not appropriate for everyone.

9:30 a.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Yes, absolutely. That was what I was getting at.

The second one?

9:30 a.m.

Director, Pharmacy Innovation, Canadian Pharmacists Association

Phil Emberley

The second part is, as many professions, we have a code of ethics. Our code of ethics in pharmacy is very much to do whatever it takes to meet positive health outcomes for patients. To suggest something or prescribe something to a patient that could ultimately cause side effects or make things worse, I think all pharmacists are aware that it is not in our interest to do that. It's a short-term benefit that could lead to long-term pain. Especially from a professional point of view, to lose that scope of practice after coming so far as we have as a profession is not somewhere we want to go. I think most of our members have that same sense.