House of Commons Hansard #94 of the 41st Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was health.

Topics

Drug Shortages
Emergency Debate
Government Orders

5:30 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Mr. Speaker, the member is on the health committee as well and knows or should know that when a shortage arises, Health Canada, consistent with its mandate and authority, works closely with purchasers and suppliers to ensure that any new supplies of needed drugs are safe, effective and high quality. That is the federal jurisdiction.

Health Canada has a variety of tools available to help do this. It works closely with companies so they can quickly resolve manufacturing quality and distribution issues, which is happening right now, and works with manufacturers to ensure alternative suppliers. Changes in the manufacturing process or location can be reviewed and the market is authorized on a priority basis. These are all things to help the drug shortage situation.

Drug Shortages
Emergency Debate
Government Orders

5:30 p.m.

NDP

Alain Giguère Marc-Aurèle-Fortin, QC

Mr. Speaker, my question and my comment are relatively straightforward.

Has Canada become a third world country, one that cannot produce the drugs it needs? Does it really need to rely on foreign companies that are raking in huge profits and, unfortunately, are not delivering the goods?

Canada is not a third world country. If this government wants to take measures to correct the situation, all of the political parties will support that decision. When will we finally have such a policy?

Drug Shortages
Emergency Debate
Government Orders

5:30 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Mr. Speaker, as the member knows, this is a provincial jurisdiction. The provinces decide whom they want to do business with.

At this level right now, the federal government works with all international counterparts, such as the U.S. Food and Drug Administration, to identify additional sources of supply and to share needed safety and quality information to assist the provinces. It also provides priority access to alternatives on an emergency basis.

Federal jurisdiction and provincial jurisdiction are very important, and the Minister of Health has shown real leadership in ensuring that both jurisdictions are addressed in the proper way.

Drug Shortages
Emergency Debate
Government Orders

5:30 p.m.

NDP

Chris Charlton Hamilton Mountain, ON

Mr. Speaker, I will sharing my time tonight with the member for Saint-Bruno—Saint-Hubert. I am delighted to be able to participate in tonight's emergency debate on the critical shortage of drugs currently facing our hospitals and their patients.

I particularly want to commend my NDP colleague, the member for Vancouver East, who requested this debate and without whose leadership this issue would never have come to the floor of this House. For sure, the government would not have taken this kind of positive initiative. On the contrary, while patients, hospitals, and provincial and territorial governments are all looking to the federal Minister of Health for leadership, the minister is ducking, weaving and passing the buck. It is patients who are paying the price.

Let us be clear: It is the federal government that can and must take responsibility for anticipating, identifying and managing shortages of medically essential medications. The government knows it, but thus far has simply abdicated all responsibility.

Let us take a look at how we got here, who is being impacted and what needs to be done to ensure that we never end up here again. The issue, of course, is that Canada is currently experiencing a shortage of medically essential drugs, projected to last 12 to 18 months.

Across the country, many regions have had to change prescription strategies, use replacements, often without experience of how they work, or cancel elective surgeries altogether. It is patients who are paying the price.

The medications in question are painkillers, anesthetics, anticoagulants, antibiotics and cancer drugs. One set is injectable opioids, the main method of pain control throughout surgery and in the post-operative setting, and with most hospital admissions.

Thus, with many hospitals running low on these drugs, the shortage is having the most serious impact on patients in intensive care units and those who are dying and need pain management. Nurses working in palliative care have told us that many of those in palliative care are dependent on injectable opioids since they cannot take medications by mouth. It is imperative that we have supplies for these patients or they will go through withdrawal, adding further pain and suffering to their last few days or months.

The Canadian Pain Society has reported a spike in suicidal callers concerned that they will not be able to manage their chronic pain without the necessary pain medication. Indeed, the impact of the shortages is being felt right across our country.

Here is what we are being told. Two hospitals in Quebec are cancelling elective surgeries, and hospitals in Ottawa are saying that they will have to do the same if their drug supplies are further depleted. In my hometown of Hamilton, Hamilton Health Sciences expects to run out of at least 10 types of mostly intravenous medications within the next 90 days, and has identified roughly 50 drugs that are affected. As a result HHS is warning of cancellations to surgeries and procedures as early as this week.

Alberta, Manitoba and British Columbia are suggesting that they, too, may have to cancel some surgeries. Patients in Alberta are being asked to buy their own anti-nausea drugs because hospitals can no longer provide extra supplies to patients.

Clearly this drug shortage is creating a crisis from coast to coast to coast. I am so pleased that you, Mr. Speaker, allowed us to have this emergency debate here in the House tonight. However, I must also point out that it did not need to be this way.

The crisis we are facing today could and should have been prevented. The problems with drug shortages sadly are recurrent and systemic. In fact it has been a few years now since Canadian doctors and hospitals have become increasingly aware of the risk of a substantial drug shortage. They have spoken out and have advocated. In the process, they have made it clear that the crisis we are facing today could have been prevented.

Similarly, the Canadian Pharmacists Association took the absence of any reliable national data or reporting into its own hands. It decided in September 2010 to conduct a survey to better understand the extent of the problem. The report indicated that out of 427 pharmacists from across Canada, 93.7% of those pharmacists indicated they had trouble locating medications to fill a prescription in a week, and 89% of them indicated that drug shortages had greatly increased since the previous year.

On December 15, 2010, using the information from the Canadian Pharmacists Association's report, The Globe and Mail wrote that the shortage of common drugs was becoming more and more widespread across the country, pointing to the shortage of key ingredients as one of the causes of the increased shortages.

Just a month later on January 27, 2011, anesthesiologists warned in an article in The Globe and Mail that the discontinuation of the production of sodium thiopental in the U.S. combined with the potential shortage of propofol could make it impossible for anesthesiologists to do their work and could postpone surgeries.

On May 13, 2011, both The Globe and Mail and CTV reported that the cancer drug carboplatin was in short supply and that hospitals were worried that patients receiving chemotherapy could face delays. Staff at Princess Margaret Hospital in Toronto were forced to scramble and get stock from an Australian hospital just to meet patient demand.

On August 18, 2011, the National Post reported that Health Canada had added 16 more medications to its list of drugs in short supply across the country. Health Canada blamed the situation on a manufacturer in the United States.

I am not suggesting that this list is exhaustive, but it does serve to point out that both drug shortages and calls for federal government action well pre-date the current crisis.

In fact, in August 2011, the health minister herself raised this issue with the pharmaceutical industry, but she stopped short of taking meaningful action. Instead, she set up a voluntary reporting system that clearly has not worked. Rather than mandating pharmaceutical companies to inform the government whenever there is a slowdown in production, the Conservatives made it voluntary. That is where the current drug short shortage at Sandoz, the pharmaceutical drug company based in Quebec, becomes illustrative in showing why voluntary measures do not work.

Sandoz knew last November that it was going to be slowing down production because it had received a warning letter from the United States Food and Drug Administration regarding “significant violations” at its manufacturing sites which could cause the drug products to be “adulterated”. Sandoz stopped or reduced production of 110 different drugs while it was making quality control improvements to its physical plant in Boucherville, Quebec. The company did not give prior warning of this production halt, despite the fact that it knew months before that such action would be necessary. That is the problem with voluntary reporting. If it is going to affect the bottom line, why would a company voluntarily report on itself?

If mandatory reporting were in place, the federal government could have acted to protect Canadians and the provincial partners could have developed a complementary response.

As it stands now, federal-provincial co-operation has been virtually non-existent. In fact, the federal health minister's preferred modus operandi is to point the finger and assign blame rather than accept responsibility. Here is what she said in this House on March 7 in response to a question on drug shortages posed by my friend and colleague, the NDP health critic and member for Vancouver East:

I want to be very clear that the shortage has been created largely by the decision of the provinces and territories to pick a sole source supplier, and that supplier cannot provide the drugs now.

Really? Is it the fault of the provinces and territories? I do not think so. Instead of blaming health providers and the provinces, the minister should protect and defend their interests. That is what real leadership is about. That is the kind of leadership that would give Canadians confidence that their minister is on top of her file.

Instead, patients and health care providers are witnessing a mad scramble by Health Canada to speed up the approval of offshore medications, rushing them through testing for quality and effectiveness. That is probably of small comfort to the many patients who fear that quality control will be compromised in the name of sheer expediency.

We have the opportunity to do the right thing. I would urge the minister to start collaborating with drug producers and health care professionals, as well as her colleagues in the provinces and territories, to find lasting solutions, solutions to both the current crisis and to maintaining the integrity of the supply chain so that future issues can be prevented or, at the very least, mitigated. It is about showing leadership. Canadian patients deserve nothing less.

Drug Shortages
Emergency Debate
Government Orders

5:40 p.m.

Lotbinière—Chutes-de-la-Chaudière
Québec

Conservative

Jacques Gourde Parliamentary Secretary to the Minister of Public Works and Government Services

Mr. Speaker, I thank my colleague for her speech. What is her perception of respect for federal-provincial jurisdictions in this evening's debate?

Drug Shortages
Emergency Debate
Government Orders

5:40 p.m.

NDP

Chris Charlton Hamilton Mountain, ON

Mr. Speaker, I very much appreciate the question, although I have to say that when a member of the government asks about whether I respect federal and provincial jurisdictions, of course, I do.

However, that is no reason for abdicating all leadership on a file where there is unanimity outside the Conservative caucus that the government must show leadership to ensure that essential drugs are there when patients need them.

All we are asking the government to do is instead of having voluntary reporting on some website, that it take its responsibility seriously for actually ensuring that drug shortages are managed and that the provinces have the tools for them to meet patient needs within their respective jurisdictions. That would be a sign of leadership. That is what Canadians are demanding. Frankly, patients deserve nothing less.

Drug Shortages
Emergency Debate
Government Orders

5:40 p.m.

Liberal

Hedy Fry Vancouver Centre, BC

Mr. Speaker, we are drilling down to the source of the problem tonight.

We are talking about a problem for ORs, ICUs and emergency departments. That is just the tip of the iceberg, because there will be more shortages of common drugs that people are trying to buy.

Many seniors depend on generic drugs. Many provinces buy generic drugs because of the cost issues. Many generic companies do not wish to make low-cost generic drugs mainly because they do not make a profit, or so we are told.

What will happen when the global supply of generic drugs begins to deplete itself? How will we find substitute drugs for patients, whether they are in an ICU, emergency or whether it is a parent whose child needs asthma medication? How will we deal with that problem? That is the root of the problem.

Drug Shortages
Emergency Debate
Government Orders

5:40 p.m.

NDP

Chris Charlton Hamilton Mountain, ON

Mr. Speaker, that is exactly the question at the heart of tonight's debate. This is exactly why we are calling on the federal government to do some planning, to do some management of this file which has been so badly lacking.

The member is right. It is an issue about generic drugs. It is an issue about dealing with the entire supply chain and managing its integrity, not just for today, not just in the middle of a crisis, but frankly for years down the road.

This is why we are having this debate. I wish the government would answer this question because it deserves an answer and in fact is what triggered tonight's debate.

Drug Shortages
Emergency Debate
Government Orders

March 12th, 2012 / 5:45 p.m.

NDP

Jean Rousseau Compton—Stanstead, QC

Mr. Speaker, I thank my colleague for her excellent speech.

With Health Canada and a Minister of Health that have failed to carry out their responsibilities, we might as well transfer all responsibilities to the provinces, which would perhaps accept them.

With Health Canada and a Minister of Health who does not carry out her responsibilities, we are always in improvisation mode, as we were a few years ago when there was an isotopes crisis that affected people suffering from cancer and serious illnesses. Improvisation prevails, and the government always takes emergency measures at the last minute, unless it is forcing people to go back to work to prevent a strike by workers who are just standing up for their rights.

Why does the government not do some long-term planning and accept its responsibilities in order to ensure an adequate supply of drugs for such serious diseases as cancer?

Drug Shortages
Emergency Debate
Government Orders

5:45 p.m.

NDP

Chris Charlton Hamilton Mountain, ON

Mr. Speaker, the member is absolutely right. In fact, he has put his finger right on the core issue in this debate tonight.

It is about the need for the government to anticipate, identify and manage shortages of medically essential medication. Without that, as we have seen in media coverage from coast to coast to coast, the people who are suffering as a result of the government's abdication of any responsibility are people in intensive care units and people in long-term care who need help with pain management.

The federal government is abdicating its responsibility on the backs of the most seriously ill patients. This is completely outrageous. That is why I would suggest that you, Mr. Speaker, have actually granted an emergency debate tonight, to underscore the importance of this crisis, and I welcome the continuation of this debate. I hope the government will follow up on the findings of tonight's discussion.

Drug Shortages
Emergency Debate
Government Orders

5:45 p.m.

NDP

Djaouida Sellah Saint-Bruno—Saint-Hubert, QC

Mr. Speaker, this is the most severe drug shortage that our country has ever experienced. The current shortage is having serious consequences. Among other things, surgeries had to be cancelled in some hospitals in Quebec, many pharmacists, health professionals, as well as managers and administrative employees in hospitals are working extremely hard to find alternative drugs and new suppliers. Health professionals do not know whether they will be able to give the treatments required and patients are unsure whether they will be able to receive treatment.

And these are only the direct and visible effects of the current shortage. What I find even more fascinating is the government's reaction; once again, it is improvising. The government seems surprised by the shortage. I am prepared to admit that the unfortunate events that occurred at the Sandoz facility, which is located very near my riding, could not have been predicted. However, a possible drug shortage created by the temporary closure of a generic drug factory, regardless of where it is found and what drugs it manufactures, is a much more predictable situation.

We do not have to look very far back in history to see that the current phenomenon is not an isolated or unique event. It is a recurrent trend. I can list some problems that have occurred in just the past few months.

In August 2011, as a result of the temporary closure of the Ben Venue Laboratories factory, there was a shortage of about a dozen drugs in Canada, some of which are used to treat cancer and have no substitutes. The situation was the same as that at Sandoz. In December, we learned of a shortage of misoprostol, a drug used in obstetrics to reduce post-partum hemorrhaging. There is no substitute for misoprostol available on the market and, according to an article in La Presse, the drug will not be available until 2013.

Last October, the media reported a recurrent shortage of some anti-epileptic drugs. For many drugs, a shortage means that a new supplier or an equivalent drug must be found. Things are not that simple in the case of certain anti-epileptic drugs. Many of these drugs are not very profitable and thus are not manufactured by very many factories. So, when production is temporarily stopped, there are few or no alternate suppliers.

Over the past few years, some patients have been told at the their local pharmacy that their medication was out of stock. What adds to the problem is that, for patients who take anti-epileptic drugs, it is very dangerous to suddenly change medications. Change must be made gradually in order to ensure the patient's safety. The problem is that, without a mandatory reporting system for drug shortages, it is difficult for patients to transition smoothly to new drugs when their regular drugs are not available.

I have brought these facts before the House in order to make two very specific points. First, the drug shortage has real and concrete impacts on Canadians, and we should be concerned. Second, I wanted to show that the current drug shortage was a foreseeable situation but that the government ignored the warning signs.

Speaking through its mouthpiece, the Minister of Health, the government seemed so proud of its plan when the NDP questioned it during a Standing Committee on Health meeting. Today we see that the plan is completely ineffective and inadequate. I hope that the minister sees that she should have done more and that earlier shortages should have raised a red flag.

I would like to add that the Canadian Medical Association consulted its members on this subject in January 2011. The results of the consultation were very interesting. Three out of four respondents said that they had had problems with drug shortages in the previous year. Two-thirds of respondents said that the shortages caused what they considered to be serious consequences for patients.

Once again, Canadian patients are paying for the Conservatives' bad health care decisions. What is of even greater concern is the fact that patients are living in fear, wondering whether the surgery they have already been waiting a year to have will be postponed once again because of the minister's complacency. They are the ones who go to the pharmacy hoping that they will not have to run all over town to get their prescriptions.

Today, the drug shortage in hospitals has led to this emergency debate, and we must examine the problem. However, we must never forget all the Canadians who need their medications on a daily basis.

According to the Canadian Medical Association survey, the majority of drugs that are in short supply are once again, first and foremost, antibiotics such as penicillin, anti-depressants and antihypertensives. These drugs are used on a daily basis by thousands of Canadians and a shortage creates uncertainty that should not exist.

The events of the past few weeks with respect to Sandoz have highlighted a problem that has existed for quite some time.

We must now find a solution to guarantee that Canadians can have the care they deserve and to which they are entitled. We must find a solution to guarantee the supply of drugs for our hospitals and our patients.

In closing, I would simply like to say that the drug shortage is a public health problem.

We need to make people the focus of our actions and our deliberations. We need to act immediately, for the people.

Drug Shortages
Emergency Debate
Government Orders

5:50 p.m.

Simcoe—Grey
Ontario

Conservative

Kellie Leitch Parliamentary Secretary to the Minister of Human Resources and Skills Development and to the Minister of Labour

Mr. Speaker, does the member know who has jurisdiction for health care services in our country?

My patients and my clinic knew that the provinces had jurisdiction. I, as a physician, know who has jurisdiction for health care services in this country, and that is the provinces. This clarity of responsibility is something that helps make our health care system run so well, the clarity that the provinces have responsibility for health care services.

Does the member opposite know who has responsibility for this jurisdiction? Will she work with us to ensure that we, as a federal government, are working with our provincial partners to ensure we are dealing with these issues as opposed to her approach today?

Drug Shortages
Emergency Debate
Government Orders

5:55 p.m.

NDP

Djaouida Sellah Saint-Bruno—Saint-Hubert, QC

Mr. Speaker, I want to thank the member opposite for the question.

I think we are talking about a drug problem, not health care delivery. I realize that health care is a provincial and territorial jurisdiction, but we are talking about the Conservative government's lack of leadership with regard to forecasting shortages and coming up with proposals for imposing mandatory reporting requirements on the pharmaceutical companies. If that were already the case, we would not be here this evening having this debate.

Drug Shortages
Emergency Debate
Government Orders

5:55 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Mr. Speaker, I know that each province has its jurisdiction. Clearly, the provinces are in charge of ensuring they get the manufacturers they want. Sandoz was a sole source for a lot of the provinces. Therefore, Quebec, Manitoba and Saskatchewan made those decisions.

Is the member suggesting that the federal government should impose its will on the provinces and take over the provinces jurisdictions?

Drug Shortages
Emergency Debate
Government Orders

5:55 p.m.

NDP

Djaouida Sellah Saint-Bruno—Saint-Hubert, QC

Mr. Speaker, I want to thank my colleague and chair of the Standing Committee on Health for her question.

I never said or mentioned today—neither I nor my colleagues on this side of the House who spoke before me—that we need to impose anything on the provinces. We are just asking the federal government to work with the provinces and territories to find common solutions for Canada as a whole.