Health Committee on Nov. 20th, 2013

[Earl Dreeshen, Conservative, Red Deer, AB]

I think the other—

[The Chair, Conservative, Ben Lobb]

Thank you, Mr. Dreeshen. You are right on five minutes. That's a perfect job there.

Ms. Adams has the next round.

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

Thanks very much.

I want to follow up on a comment you made early on during the question period, which was about the large increase you're finding in prescription drug abuse among women. Could you speak a little bit to that?

[Michel Perron]

I was referring specifically to the prescribing of benzodiazepines for women as one area we are looking at.

All of this is on the basis of less than ideal and fulsome data; however, we are seeing some representation of effect in the fact that women are disproportionately if not much more significantly prescribed benzodiazepine than the male population, the question being whether this is an optimal prescribing rate and what effects would flow through with respect to these women. We're talking typically of adult women. The role of prescription drugs, opiates in particular, is fairly gender-neutral in terms of its application—

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

I know; I noticed that in your report, actually. You noted that prescription opiate use in the world has shown a more than 200% increase since the early 2000s, and that's partially why we're looking at this today. Things have dramatically changed since the early 2000s. That is a very remarkable increase, a more than 200% increase.

[Michel Perron]

What we've seen with that, since it is over 10 years, is that we went from being number six in the world in per capita use to number two, and I don't think we want to be number one—that's the U.S.

What we've seen with that 200% increase is a very similar doubling of unintended overdose deaths, a doubling of access for treatment services around opiates in particular, in a treatment system that I would suggest was already very much under duress or under stress to accommodate its existing clients.

We as a government, if I can say that, pay often for this. We pay to dispense it—often it was covered by formulary—and we pay in terms of the treatment modality and some of the lost productivity and mortality. This strategy, while it will require some financial investment, will undoubtedly decrease the entire cost load across the system because of the current situation.

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

Changing tracks ever so slightly, could you speak to the effectiveness of National Prescription Drug Drop-Off Day and recommend other similar practical measures that our government could undertake?

[Michel Perron]

Certainly.

There are two things. One is that your government is already at the table with First Do No Harm. They were part of the development of the strategy and were able to provide that commentary. Of course you are familiar with the commitment for the ministers of health, so that's important as well.

Drug Drop-Off Day took place in May of this year. It's being led, in part, by the police, and certainly in cooperation with Public Health. As I mentioned earlier, a lot of young people today are accessing medications for non-medical use, which they are getting from their medicine chests. The point being, if you have unused medications please return them.

You can return them any time to a pharmacy. However, there is some concern as to how that return is being managed once they're back in the pharmacy. Take-back day is an opportunity to signal the importance of the issue at a community level, to educate people, and to obtain drugs that would typically be left unattended in a medicine chest and are no longer required.

Last year, in I think about 18 cities, it was coordinated by Public Safety and the Canadian Association of Chiefs of Police. There were over two tonnes of drugs collected, not all opiates. If you can imagine the weight of one pill, you can imagine how many pills that actually was.

There are a variety of resources for any community that wishes to partake in this which have been developed and supported by Public Safety and are available to all jurisdictions. Again, that decreases the cost for the community that wishes to engage in that.

[Paula Robeson]

Further to that, one of the pieces that went to Alberta Health for support was the development of an evaluation guide for those who are conducting these take-back initiatives. We can get a better sense of how effective they are in terms of awareness, community mobilization, understanding of the safety precautions and issues that one can take, as well as the types of drugs that are returned.

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

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you, Ms. Adams.

Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

It's all very interesting, and I think the whole idea of how we got there is a very important question. But I want to remind everyone that this is not new, it's simply the global media that makes it new.

Back in the Victorian era, opium—from which “opiate” and “opioid” come—was taken by every good little Victorian lady. She had tincture of opium and she took it all the time. Opium was then a legal drug. Then it became illegal because of trade wars with China. So it isn't new, but what it points to is the fact that it's ongoing.

What we now know today, which we didn't know then, is that addiction is a chronic disease and it comes from lack of dopamine in the brain, which doesn't give you the right triggers to stop you from being addicted. This is why some people drink a lot of alcohol and don't become an alcoholic and others do become alcoholics. We've seen that happen. As teenagers we all went around trying to get drunk because we thought it was cool, then most of us went on to drink responsibly. But some of our friends, we know, never could stop. We now know that it's a chronic brain disease and that we need to deal with that.

You've all made a really good point about prescribing practices. Physicians—on the contrary, Mr. Lizon—don't know very much about addiction. We've only known a lot about addiction in the last 15 years. So you would give something, hoping you could take the person off it. If they happened to be the wrong person with the dopamine problem, they would stay on it and wouldn't be able to get off it.

I will tell you a story, because I think it's important and because I know I'm allowed to make comments as well as ask questions. Recently, a friend of mine had a baby and left the hospital. She had a C-section. She was fine, she got up, she walked out of there, great! For two days she was in the hospital. She was given OxyContin to help her with pain at home. I said to her, “You've been given what? Just tear up the prescription and throw it away”. That was a ridiculous thing to do. If you have pain, take Tylenol Extra Strength. But this is what we see. This is happening over and over, and then we have a problem.

There is a problem I want to bring to your attention. You questioned the problem, which I think is very valid, about the role of advertising. We know a lot of kids who take Ecstasy, etc. After awhile the amount of serotonin in their brain lowers and they become depressed after a good night on Ecstasy. So they go into their parents' medicine cabinet and take out an antidepressant and they get hooked on that, because that antidepressant raises the level of serotonin and they get to behave normally. So here is an illicit drug feeding the abuse of a prescription drug, which is a real problem. Advertising—all these names you see advertised on television about antidepressants—feeds that understanding of what drugs do what for you, for people who need to abuse them.

I do think the role of advertising of drugs, especially narcotics and opiates and barbiturates and antidepressants, all of those, is a really important thing for which this committee should think about making some kind of recommendation. Advertising really opens up this information for a lot of young people about what the drug can do for them. They open their parents' closet, their parents have it in their medicine cabinet, and boom, the young person takes it. I think it's a really important piece.

It's really not only about criminal activity, it's about what you talked about earlier on about education. I think we have to look at the advertising component of this. I think it's completely unnecessary and dangerous.

What do you think?

[Some hon. members]

Oh, oh!

[Hedy Fry, Liberal, Vancouver Centre, BC]

I did ask a question.

[Michel Perron]

I get the 30 seconds now, right?

[Voices]

Oh, oh!

[Michel Perron]

You made a lot of points there, Dr. Fry.

First on the point of advertising, it is a recommendation, but perhaps a bit different from what you might have conceptualized. It's advertising to physicians; it's how in fact the drug companies are advertising and marketing to physicians. Now, practices have changed drastically over the years, but this is an area that we have identified specifically under the prevention rubric:

Conduct an independent review of the evidence and make recommendations as appropriate on the link between promotion (e.g., advertising, marketing to clinicians) and the harms associated with prescription drugs.

To bring it back to your earlier point, this entire work fits into the broader context of how people may use drugs or not. What we do know is that a significant portion of Canadians got here because they happened to have their teeth extracted, or they happened to break an arm, or what have you. That is not to point a finger at any particular profession, other than to say that people have unwittingly become dependent on a drug, at times very powerful, from which an exit strategy is difficult to attain.

Everybody is agreed that this cannot continue and therefore we need to change the dial on it.

If I may underscore, Mr. Chair and members, in First Do No Harm a lot of the heavy lifting around who should be doing what has been articulated in what we hope is a very clear manner in this report. You can use this by going to the individuals listed and saying, “You sat there, you were part of this process. Have you agreed and will you commit to supporting these, and what will you do?” I say so because there have already been those suspicions.

This is about having a true national approach that will have to evolve over time in the context of broader challenges around youth and cannabis and the like. I don't mean to stump here, but the point is that we think this is worthy of the attention of not only the federal government and this committee, but also of others.

[Hedy Fry, Liberal, Vancouver Centre, BC]

You should have a TV advertisement.

[Paula Robeson]

Part of the strategy will be about informing consumers. So some of that will be related to the idea that just because it's prescribed doesn't mean it's safe, and just because you can get it doesn't mean you ought to, and if you're prescribed it, you need to ask a lot of good questions of your physician and care provider.

So that's part of the public education end of that.

[The Chair, Conservative, Ben Lobb]

Very good. Thank you, Ms. Fry.

We just have time for one quick question and then we'll suspend to get into committee business.

Ms. Davies was so judicious with her time in one round we're going to give her a quick question and a quick response.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, and first of all, thank you. We've had a very fulsome discussion and your answers have been very forthright. So I really appreciate that.

I just have a general question. I think drug policy overall has changed quite dramatically even over the last decade, notwithstanding whatever our government position might be, and it certainly has globally. I think there is more recognition now that whether a substance is legal or illegal, a regulatory approach may be desirable, as opposed to a suppression approach or a free market approach. A lot more people are discussing that, a regulatory approach. I wonder if CCSA keeps up with that debate. Are you involved in that debate at all in terms of how we look at a regulatory approach to these substances?

[Michel Perron]

Thank you. I'll be brief, as per the chair's request.

Of course, we do keep up with this discussion as it evolves. We just had a discussion very recently with another member of Parliament, and I guess the question is what harm are we trying to resolve? What are we trying to fix by regulating something? Some would argue that we already have a regulatory process for these substances and that it hasn't necessarily served us that well, if you look at some of the impacts. So I don't mean to throw it back with a question, but certainly we need to look at what we are trying to fix. What is the problem? What is the evidence pointing us to as the best means by which to do that? We've seen the tremendous damage from legal substances, controlled substances, and in fact illegal substances. So sometimes a regime in and of itself is perhaps not the panacea that some might make it out to be.

[The Chair, Conservative, Ben Lobb]

Thank you very much. It's been a great discussion and dialogue this afternoon, with great questions by our members.

We're going to suspend for a minute to go in camera to discuss committee business for a few minutes and we'll carry on.

[Proceedings continue in camera]