Health Committee on Dec. 2nd, 2013

[Mark Barnes]

The identification, to us, is at that point really no big deal. We just want it out of the public's access. We don't try to identify the medication at all. We just destroy it appropriately. Lots of times there are mislabelled bottles and whatnot. Certainly that's another conversation for another time. But from our standpoint on what's brought back....

As part of the prevention process, especially in a palliative care situation, we will say to people that when the time comes, make sure you get that stuff out of your house, because people will actually look at obituaries in the paper and look at addresses and different things; you're a target for theft, so make sure that's removed right away.

The palliative care team in Ottawa is actually extremely good. In my community the physicians themselves will remove it and bring it to me, which is great.

But you're right, there's absolutely nothing to identify them or anything.

[Isabelle Morin, NDP, Notre-Dame-de-Grâce—Lachine, QC]

What would you recommend? How can we make sure that it is all recorded in some form? I agree with you, 99.999% of pharmacists will dispose of them in a perfectly appropriate way. But a small percentage will not. How do we get an idea of what is going on?

I recall that people talked to us about National Prescription Drug Drop-Off Day. It was a pilot project in 2012. It happened this year and it will probably happen next year too. Huge amounts were turned in. If that could be done more effectively on a national scale, it could perhaps give us some interesting data. What should Health Canada be doing to make sure that the medications that are turned into you are better managed?

[Mark Barnes]

I think probably the best answer would be to provide standardized disposal techniques and processes. Unfortunately, this would have to be controlled at the college of pharmacists level in each province. Whether or not it's federally mandated—which would be great—it would actually be a part of the inspection process such that everything that has to come back has to be handled in a certain way. It has to be destroyed in a certain way. You have to have a certain container to place it in. It has to be removed in a certain amount of time.

The college could also mandate that only so much goes out, and that maybe there should be a follow-up call as part of the annual medication review: “You've had this controlled substance in your possession based on a prescription from six months ago. Are you still using it? Do you need it? If not, it needs to come to us.”

For record-keeping, we're looking at a complex situation with maybe no simple answer.

[The Chair, Conservative, Ben Lobb]

Thank you, Mr. Barnes.

Mr. Aspin, five minutes.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Thanks, Mr. Chair.

Thanks to our guests for sharing their expertise to help us with our study.

Officials from Health Canada, Public Safety, and Justice Canada have all alluded to a general lack of awareness of the risks associated with prescription drugs. I want to sort this out, and I want a very pragmatic, practical answer today. I'd like to hear you speak to any strategies our government could adopt to raise this level of awareness.

Perhaps I could start off with Dr. Gerace and Mr. Keon, and then have anyone else join in: most practical and pragmatic.

[Dr. Rocco Gerace]

I'm not sure how much I can help you with that in terms of strategies that have worked. We do know that we need more education of health professionals in the educational environment, and we do know that we need more education of the public, but I'm afraid I can't give you specific strategies.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

[Jim Keon]

I'll let Dr. D'Cunha jump in here.

[Dr. Colin D'Cunha]

Essentially, when it comes to the area of chronic medications, one way it potentially could be tackled is by controlling the amount of medication given. However, there are reimbursement consequences. Appropriately, a pharmacy has to be reimbursed every time it fills a prescription.

The challenge is in finding the right balance between the amount of medications dispensed to address the patient's needs, along with the education and counselling by the prescribing practitioner, the dispensing practitioner, and then the creation of a system, which has been indirectly alluded to by Mr. Barnes and others, of having unused prescriptions returned, documented, and destroyed appropriately.

We simply cannot afford to approach this on a one-off basis. A comprehensive “from supply chain to grave” strategy, ensuring that what legitimately needs to get into a patient's system gets in and what's not used comes back into the destruction chain, is the only way one can approach this.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Okay, thank you.

Is there anyone else who wishes to comment?

Ms. Bouchard.

[Carole Bouchard]

I agree that education is very important as a strategy. It's hard to really say exactly what it should be, but I think I'd like to emphasize it again. I know I mentioned that a lot in my presentation at the beginning. I think the best thing to do from the beginning is to revisit a framework under the CDSA in order to make sure that the regulations and the types of requirements that are there are really up to the current environment, and also that they can fulfill the needs out there in Canada. I think that is really key to success, starting from the basis of revisiting that framework and clarifying the role of everyone here around the table as well as in the federal legislature.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Thank you.

Mr. Barnes.

[Mark Barnes]

I'm wondering if we could add it to the education curriculum at the high school level. That's a simple answer. With regard to your first prescription drug, we all know we have to finish amoxicillin. It's an antibiotic; you have to finish it. It's something you learn when you're a young kid. It's a campaign that worked extremely well about 15 years ago. Certainly another campaign could be talking about mom's and dad's pills or your pills and what not to do with them, and that could be within the education curriculum in middle school or in high school.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Okay.

Gentlemen, Mr. Fefergrad. No?

Is there anybody else? Okay.

How much time is there, Mr. Chair?

[The Chair, Conservative, Ben Lobb]

There's a minute and 20 seconds if you have any other questions.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Previously, we heard from Health Canada officials on the successes of our national anti-drug strategy on illicit substance abuse. Are your organizations aware of the practices used in this strategy? Can any of the same practices be applied to prescription drug abuse?

Ms. Bouchard.

[Carole Bouchard]

First of all, I'm not totally sure what kind of practice you're referring to. Is it around the other drugs or the controlled drugs and substances, the drugs of abuse?

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

It says the national anti-drug strategy on illicit substance abuse.

[Carole Bouchard]

Okay.

If I'm not mistaken, the current strategy focuses on only a couple of pillars. I think what was forgotten at the time of the development of that strategy was really prescription drug abuse. That is missing and that's probably where we are here. There is a need to put more emphasis on this area. I think there are actions to be taken.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Okay, thank you very much.

That's fine, Mr. Chair.

[The Chair, Conservative, Ben Lobb]

Thank you.

Our final question—probably just a question—is from Ms. Adams.

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

I might commence, though, with a quick comment.

In fact, the national anti-drug policy does not currently incorporate prescription drugs. We made a commitment during the Speech from the Throne to expand that national anti-drug strategy to incorporate prescription-drug abuse. That is what brings us all around this table to seek your input as we move forward.

I have two very quick questions.

Mr. Barnes, you raised a very important point about the fact that we're now much more knowledgeable about having to consume our antibiotics, for instance, and about why that's important. We're looking for these very practical things we can do to help raise the level of awareness amongst Canadians. For instance, inasmuch as we often hear that you need to consume your antibiotics, I also get a very friendly, annoying, redundant, repeated sticker—

[Voices]

Oh, oh!

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

—on my antibiotic that tells me I must consume the entire bottle. I do think that repeating information over and over does raise a level of awareness.

Are you aware of any tools such as that to help in combatting prescription drug abuse—any very practical policies?

[Mark Barnes]

What you're alluding to is called an auxiliary label. There are certain requirements, again, implemented by colleges, that are expected. As a standard of practice, a pharmacist is expected to apply that label telling people to finish their antibiotics. Certainly we could come up with our own; the Canadian Pharmacists Association would be a perfect organization to actually champion that. There are sometimes simple solutions to larger problems. We can simply add a label saying, “This medication is addictive”. We would not be trying to be offensive, but certainly lots of times being direct and repetitive does work. There are lots of things a pharmacy could do at the point of dispensing to educate and make patients aware.