Health Committee on Dec. 4th, 2013

[Dr. Susan Ulan]

Currently there isn't an obligation to do it because there may not be any reason to be concerned. If somebody is coming in for antibiotics or you've got a very low risk patient who's on a very small amount of medication, we can't require nor would it be recommended to create barriers to appropriate treating.

This is a tool that many physicians use and it's not just related to medications. Physicians can access X-ray reports. You can actually go and look at the actual film. You can access lab data, surgical reports. It's more than just medications, but if you've got a high risk patient or a patient you're concerned about, one you don't know, you've got the ability to look a little bit further and to just minimize the risk of harm.

I think it would be a problem to obligate physicians, but it's certainly a very useful tool, and often it's a way that physicians pick up on patients that they were unaware were multi-doctoring.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you very much, Mr. Hawn.

Mr. Morin.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chair. That's much appreciated.

Before I ask witnesses questions, I would like to make a comment. I know that this is not common practice in the committee, but I would still like to send a message to the Conservative members opposite. Earlier, Ms. Adams talked about what the Conservative government had announced in the Speech from the Throne regarding the drug policy's renewal. Since we began our study, the government has not seemed to be open to what I have suggested to all the experts regarding harm reduction, which was the fourth pillar of the National Anti-Drug Strategy before the policy change, in 2007. My colleague Libby Davies suggested the same thing to Dr. Selby and Mr. MacPherson.

Since we began studying this issue, I have clearly seen that health experts want the Government of Canada to reintroduce harm reduction into the drug policy. I really hope that the Conservative government will heed the experts' advice.

Dr. Selby and Mr. MacPherson, thank you for once again reminding us how important it is to include harm reduction in our drug policy.

My next question is for Mr. MacPherson.

You spoke to us in your presentation about the guidelines regarding opiate prescriptions. Could you elaborate on that? What kind of guidelines did you have in mind when you talk about opiate prescription guidelines?

[Donald MacPherson]

We're referencing one of the recommendations of the “Do No Harm” document. Clearly that is one of the key areas that needs to be looked at, although it's one of several areas that need to be looked at. We're just promoting the notion that we've taken a very hard evidence-based look at what is the evidence around prescription guidelines internationally, in the U.S. where they clearly are ahead of us in the sense that they have some more experience on this.

I would defer to Dr. Selby in terms of the actual detail of what those guidelines would look like.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

So I invite Dr. Selby to continue.

[Dr. Peter Selby]

The national opioid use guidelines for chronic non-malignant pain are now housed in the national pain centre at McMaster University, and every national college of physicians was part of it. Work is ongoing in trying to help disseminate and implement this.

The real focus there is how to use opioids safely, how to minimize the harm, how to make sure people are monitored appropriately, advised and educated about the risk, and also know when the medication should not be used and when it should be stopped because it is causing harm. It's not a lack of knowing what to do, it's the actual doing, which is where we are in Canada. We are not doing what we know we should be doing.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much.

Do I still have time?

[The Chair, Conservative, Ben Lobb]

You have a minute and a half.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I'm going back to Mr. MacPherson.

In your presentation you also spoke about accidental overdose death and other witnesses also raised that issue. This study is about the abuse of prescribed medication. I noted that in some of those overdose deaths, sometimes it is not accidental, but what can the federal government do to protect people from accidental overdose deaths?

[Donald MacPherson]

First of all, the federal government needs to be playing a huge leadership role in education. It comes in under the prevention language in the CCSA document. It's finding a way to show the leadership to make responding to accidental overdose deaths common knowledge in communities in Canada, in families in Canada, that people in families that have someone on a pain medication or addicted to an opioid have access to naloxone. They understand what an overdose looks like. These are things we can talk about forever, and they are not complicated things to do, helping find a way to get naloxone on provincial formularies. In other jurisdictions children have reversed overdose deaths. A simple intramuscular injection of naloxone immediately reverses an overdose.

While we look at the complexity that you've heard today, we could be doing things in communities in Canada in the next few weeks and months to at least begin to prevent or stem the loss of life that's occurring across the country from overdose deaths. In the process we can educate the public at the community level that there are things they can do, they can recognize, and they can help their fellow community members who have severe addictions to opioids.

[The Chair, Conservative, Ben Lobb]

Thank you, Mr. MacPherson.

Mr. Wilks, you have five minutes, please.

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

Thank you very much, Mr. Chair.

I have two questions, one for Mr. Selby and Mr. MacPherson and the other for Mr. Harris. I'll ask them both and then get you to respond.

I'm interested in naloxone. In my previous life as a police officer, I've seen what I'll refer to as Narcan provided to people, especially to those overdosed on heroin. Reactions, let's say, can be different from person to person. When we talk about having it provided to a person and/or being able to have a variety of people administer naloxone, I'm just curious to understand, should we be determining the dosages that need to be provided? If you give too much you get a different reaction from what you may be expecting. Certainly, I've watched people get quite agitated, shall we say, and you best get out of their way because they're not really happy with what just happened to them. I would like an answer to that.

Mr. Harris, we heard a witness explain that rural and remote areas have higher rates of prescription opioid drug use than urban areas because there is limited access to comprehensive pain management services, such as physiotherapy and pain management specialists, in the regions. I use rural and urban specific to Alberta. Consequently physicians in these areas may be limited to prescribing opioids to acute and chronic patients. How does the use of prescription drugs vary from region to region, both within and among provinces in Canada? What are the differences, if any, in the rates of misuse and abuse of prescription drugs in rural and urban areas?

I'll start with Mr. Selby and Mr. MacPherson on that question, and then I'll lead to Mr. Harris. We can limit to about a minute and a half, Chair.

[Dr. Peter Selby]

I want to concur with you. As a physician, I actually have seen that happen. When you've given people Narcan, they wake up.

Here's where we have to manage what the risk is. The issue is that I'd rather have somebody a bit agitated, as opposed to dying. From that perspective, in Ontario we are actually looking at the naloxone program so that it's not only Public Health Canada handing it out. We're trying to work out that at the point where opioids are handed out at the pharmacy level, that's the place where the person is. Can we actually educate the family, whoever is picking up the prescription to take the naloxone?

Much like an EpiPen injection, we need to have that innovation in Canada. Right now, you have to fiddle with the syringe and it dries up. It needs to be cheap, and it needs to be like an EpiPen and you just inject it. I think there's some huge opportunities for Canada to show leadership in this innovation piece of developing products that can be used, similar to an EpiPen, for overdose prevention.

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

I'll get back to you in a second. I want to hear Mr. Harris's response, and then I'll get back to you, in case I run out of time.

Thank you.

[Det Collin Harris]

Thank you for posing the question to me.

You were an RCMP member, so you worked federally, and I, unfortunately, am a muni.

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

We won't hold that against you.

[Det Collin Harris]

Our data is specific to the city of Calgary. I wouldn't be in a position to answer your question as accurately and correctly as I possibly could.

However, Dr. Ulan would be able to provide that information.

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

Please.

[Dr. Susan Ulan]

Our prescription monitoring program data in Alberta has been in place since 1986. About four or five years ago, we developed analytic tools to be able to mine our data, so we can actually create geographic mapping for Alberta.

We can look down to population subzones at the rate of prescribing of a particular medication and compare it to the rest of the province. We can identify hotspots in certain communities. Say we were looking at OxyContin. We could identify the highest prescribing communities, and we could look at how to interact with the physicians, or provide that information to the public health officials in that area so they can look at how to address that.

We are just beginning to use that data. It's available publicly on our website. We're sharing it with government officials so we can work collaboratively to develop initiatives.

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

Thank you very much.

Mr. MacPherson, back to you with regard to naloxone.

[The Chair, Conservative, Ben Lobb]

Mr. MacPherson, if you could keep it to a minute or less, that would be great. We're running up against the clock on Mr. Wilks' round.

Thank you.

[Donald MacPherson]

Absolutely.

I agree totally with Dr. Selby. Having an agitated person in front of you is much better than having a person who is not alive.

It's great that Ontario is doing their work. The BC Centre for Disease Control is doing a pilot program too. These programs seem to be having some success in reversing a significant number of overdose events.

This hasn't come about really quickly, so we need to figure out how to accelerate the dissemination of this information and get this stuff happening in other provinces. Every day that naloxone is not available, or is only available through ambulance attendants or in emergency wards, is a day we risk losing more lives.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Ms. Morin, for five minutes, please.

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

Thank you very much.

I want to thank the witnesses for participating in our meeting today.

I have three questions, which I will ask right away, so that you can then answer them.

Ms. Giudice-Tompson, thank you very much for your testimony. I have read the recommendations you sent us. However, you did not talk very much about one of them during your testimony. So I would like to give you an opportunity to do so. I am talking about the third recommendation, which consists of the “abolition of specific marketing practices for prescription drugs with potential for abuse”. Could you elaborate on that?

Ms. Ulan, at the end of your testimony, you requested funding. Can you tell us exactly how much money you want and how you intend to use it?

My last question is for Mr. MacPherson.

At the beginning of your testimony, you talked about why opioid consumption is growing. I thought that was very significant. We are told that there is not much data on that issue. When answering a question from our parliamentary secretary, Ms. Ulan talked about Ritalin. She said that all kinds of people use it—young people, students, and so on.

Is any data currently available on that issue? If we were to conduct a study on the causes, where should we begin? How long would the study take and what kind of a sample would be needed?

I will let you answer. Perhaps you could each take one minute.