Health Committee on Nov. 20th, 2013

[The Chair, Conservative, Ben Lobb]

You still have a minute and a half to go if you'd like.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Do you want me to?

[The Chair, Conservative, Ben Lobb]

Yes.

[David Wilks, Conservative, Kootenay—Columbia, BC]

You're such a gracious chair. It's probably because we look a lot alike.

[Voices]

Oh, oh!

[David Wilks, Conservative, Kootenay—Columbia, BC]

One of the things you mentioned in the enforcement portion of the document you provided us was to conduct a cost impact assessment related to prescription drugs on law enforcement resources and public safety.

Would you briefly talk about that, because there would be an impact, certainly, on law enforcement from their perspective of resources.

[Michel Perron]

Thank you.

There are two sides of the coin. One is that police currently incur significant costs, we would argue, around the illicit use of prescription drugs. They might simply not be aware of it.

The police leaders and the Canadian Association of Chiefs of Police were the lead external partners on the development of recommendations around this, along with Public Safety. They have identified that the police community needs to have a better understanding of what the flow-through impact is on policing.

Public Safety has to date, as they have in the past, invested in the development of that analysis. It has begun. It is under way, which is a significant step forward in articulating where that might go. This would tie in—and I know it's not part of the remit of this committee—to the whole issue of the economics of policing and how the government wants to see where you are going vis-à-vis policing resources.

A cost impact analysis of understanding what is the flow-through, how that fits into efficient policing, and where that goes and where you want to spend your dollars best, is really what's going to come out of it. Public Safety is at the table, and that's part again.... As a committee or as a nation, how do we know all of the different parts that are occurring? That's where First Do No Harm can bring people back to the same table and make sure that the connectivity stays within the group.

[The Chair, Conservative, Ben Lobb]

Thank you, Mr. Wilks.

Next up is Mr. Marston.

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

Thank you, Mr. Chair.

I want to follow up a little further on Mr. Wilks' point of view because he was a police officer on the ground, which is where my interest is. From your point of view, the package is very high-level, and the information we've received from various people coming to this committee is quite striking.

The Narcotics Control Board found that Canada had the second-highest per capita misuse of prescription drugs. It says “use” but it's misuse.

Mr. Head, from the prisons, was here yesterday and said that 80% of the new inmates to prison are coming in with addiction problems. Pause for a second, because if that's accurate, this thing is much larger than we thought.

Why do you think that in Canada we seem to be more predisposed to this abuse than in some other countries? Have you come across anything that led you to understand why?

[Michel Perron]

I suppose that's the central question of how did we actually get here? I think there is no one answer. You hear that a lot, I'm sure, from your witnesses, and I apologize for repeating the line.

One would argue that the emergence of opiates as a heavily marketed product to deal with a variety of pain elements was done with the confidence of trying to ease the pain of Canadians. There was no malice. This was people trying to help people. But we have gotten to a point where the volume and supply have grown at such a rate that there has been the collateral effect of a doubling in overdose deaths in a matter of 10 years, a doubling of access for treatment, a doubling.... I mentioned earlier that the status quo could not carry on. At this point, we have said, “Okay, we’re not sure how we got here, but we know we can't carry on”. That's the purpose of the strategy.

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

My generation was among the first—I'm announcing that I'm really old by saying this—that turned to antibiotics. People were surviving illnesses that destroyed people before. As a result, to some extent, we started to think of pharmaceuticals, in general, as some kind of great saviour, and of course we know there are negative ramifications for many.

I read a piece today, and I clipped a little bit to put in here. Niagara Falls police today are reporting that since OxyContin was taken off the market, there is a new concoction being used, including by people who can't access heroin. They call it Krokodil. I don't know whether anybody has heard of it. I hadn't heard about it before today, but this is monstrous. It's a blend of iodine, gasoline, industrial cleaning oil, lighter fluid, and paint thinner, mixed with codeine and injected. It's called Krokodil because of what it does to the skin, leading to necrotizing fasciitis or flesh-eating disease. This flowthrough that's happening, ending in this place.

I know we have a philosophical difference with the other side on InSite because of the withdrawal from heroin. If there's anything I've ever heard to say that InSite could protect people from that—and I'm not asking you to comment.... It's just that this thing struck me hard when I read that people are so prepared to inject that kind of concoction. We're in a desperate place.

[Michel Perron]

Thank you for the comment.

I have a couple of points. One is that we learned as we entered into this discussion that there's a tremendous amount of mobility among markets, in people who want to use drugs. That's part of the reason for having effective prevention in the first place, of course, but also reaching out to those who are in difficulty when they are dependent.

Here in Ottawa, the issue is not so much OxyContin, but fentanyl. We've seen that if you push down on one drug, another will emerge.

The point is that we need to have a very comprehensive and holistic appreciation for how we wish to deal with this issue, and how we want to have a coherent strategy across the nation that involves all levels of government, the not-for-profit and private sectors, and that involves some of the other elements I referred to.

On Krokodil, I should mention that we are part of a novel psychoactive-substance network, because a lot of these new drugs are emerging, and that will always be the case. There's a new chemist born every year, so that will just carry on.

On novel psychoactive substances, we have an alert system, if you wish, that CCSA works with in the regions. We have asked specifically about the issue of Krokodil. There have not been any known reports of it, just yet, in Canada, if I'm not mistaken. That was the latest information we received.

That said, I will look into this element, because one of our challenges is to have the right kind of quality of information. I think Dr. Fry made the point and that we need to act on it. But at the end of the day, I understand the point you made in terms of—

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

This is being reported today in The Hamilton Spectator, that there were three cases in the Niagara area, just to be specific.

[Michel Perron]

Yes, and that would possibly be some transborder stuff going on there—

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

Well, it's very close, Niagara Falls.

[Michel Perron]

—because we haven't seen it in Canada yet.

Exactly.

If I might, Mr. Chair, comment on the other point about the corrections system and 80% of new inmates having addiction problems, one of the strategies that CCSA has long advocated is that we have a coherent offender strategy in this country. Most people don't go to federal jails immediately, they graduate from the provincial ones. Understanding how we can treat and address the needs of incarcerated individuals around alcohol and drug dependence from the very beginning is important. Those 80% would not necessarily have addiction problems with prescription drugs only, of course, but all drugs.

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

No, I realize that, but just in general terms, when we start talking about the fact that we have access—

[The Chair, Conservative, Ben Lobb]

Excuse me, Mr. Marston. We're over time, but thank you very much.

Mr. Lizon, you're up next.

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

Thank you, Mr. Chair.

And I thank the witnesses for appearing here.

It's a very interesting discussion, but going to the basics, I truly am trying to understand how we properly define drug abuse or prescription drug abuse. Where do you actually draw the line, and who falls on which side? I'm not talking about the obvious places, where people are addicted and they get drugs that are prescribed for medical purposes and they use them. But if someone, for whatever reason, gets hooked on drugs and doesn't use an excessive amount, let's say a tablet a day, and there's a need, would it fall under “abuse”? How does it show in the statistics?

Now we're talking about prescription drugs. What about drugs you can take off shelves, say, and use every day? I don't know how this is recorded and how this would be different from the prescription drugs. And we're talking about opiates, amphetamines. In many countries there are labs in homes. People are making it left, right, and centre.

How do we, first of all, define it? How do we deal even with non-prescription drugs in this context?

[Michel Perron]

Hopefully that was a one-minute round, because that's a long and tough question.

[Voices]

Oh, oh!

[Michel Perron]

Thank you for your question, Mr. Lizon.

We can talk prescription drugs for moment, and you will get a variety of different answers depending on the witness, whether we want to talk about drug addiction, drug dependence, drug abuse, or drug misuse. For the context of our discussion here around prescription drugs, we're seeing either non-therapeutic use, with people using them for non-medical reasons, or secondary negative effects as a result of people using them even for therapeutic reasons. Let me explain, please.

You break your arm, you go to the hospital today, you will likely be prescribed an oral opiate or some sort of analgesic because of the pain in your arm. You might have that prescription for a week to deal with whatever the ailment is. You should not carry on with an opiate beyond that timeframe. Some of the issues that we're seeing concern how many opiates would you provide to Mr. Lizon with a broken arm. Would you ask him to come back at an earlier time? How would you dose it, and so on and so forth.

There are other people who have chronic diseases for which opiates have been indicated as relevant treatment, and these people, by definition, are dependent on the drugs. But that outweighs the conditions of not having access to those drugs for those chronic diseases.

The issue is really about what is the condition, what are we trying to treat for, and is it diverging from what are known to be acceptable practices for therapeutic purposes?

Paula.

[Paula Robeson]

If I could add, the strategy focuses on the harms associated with those prescription drugs regardless of whether they are misused, abused, whether it's addiction or dependence. It's really focused on those harms that are associated with them, which include addiction, overdose, death, and other harms.

[Michel Perron]

Some would argue that if you use any substance for a non-therapeutic or illegal use, it's immediately called “abuse”. Now we're getting into taxonomy, definitional issues. But the point is that you don't necessarily need to be dependent to have immediate harms from the use of a drug. We see that in people who drink too much and kill themselves driving home. There's a variety of ways of looking at it.

I'm sorry if it's less than a full answer, but I think the point made by Paula is really trying to focus on what we know are the issues flowing from non-therapeutic use and therapeutic use that is not consistent with what best practices are called for, either in prescribing for or in terms of treating specific conditions.

[The Chair, Conservative, Ben Lobb]

You have 30 seconds.