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 drugs.

Topics

Safe Streets and Communities Act
Government Orders

3:15 p.m.

Conservative

The Speaker Andrew Scheer

All those in favour of the motion will please say yea.

Safe Streets and Communities Act
Government Orders

3:15 p.m.

Some hon. members

Yea.

Safe Streets and Communities Act
Government Orders

3:15 p.m.

Conservative

The Speaker Andrew Scheer

All those opposed will please say nay.

Safe Streets and Communities Act
Government Orders

3:15 p.m.

Some hon. members

Nay.

Safe Streets and Communities Act
Government Orders

3:15 p.m.

Conservative

The Speaker Andrew Scheer

In my opinion, the yeas have it.

And five or more members having risen:

(The House divided on the motion, which was agreed to on the following division:)

Vote #156

Safe Streets and Communities Act
Government Orders

3:20 p.m.

Conservative

The Speaker Andrew Scheer

I declare the motion carried.

Drug Shortages
Emergency Debate
Government Orders

March 12th, 2012 / 3:25 p.m.

Conservative

The Speaker Andrew Scheer

The House will now proceed to the consideration of a motion to adjourn the House for the purpose of discussing a specific and important matter requiring urgent consideration, namely drug shortages.

Drug Shortages
Emergency Debate
Government Orders

3:25 p.m.

NDP

Libby Davies Vancouver East, BC

moved:

That the House do now adjourn.

Mr. Speaker, first of all, I would like to say that I will be sharing my time this evening with the hon. member for Beauharnois—Salaberry.

I would like to thank you, Mr. Speaker, for agreeing to my request to have an emergency debate on this very critical issue of drug shortages in Canada. I made the request on Friday and I am very glad that the House has an opportunity to discuss this very critical issue. Being in our ridings and our home communities over the weekend, I have no doubt that many members of Parliament probably heard from constituents how concerned they are about this escalating drug shortage in Canada.

We know that this shortage has been ongoing for a period of time, but in the last month or so it has become something that is now approaching a critical nature because of the closure of the Sandoz plant. We are also aware that this shortage is projected to last 12 to 18 months. Across the country many regions have had to change their prescription strategies to use replacements, often without experience about how they work, and to limit elective surgeries. As we gather information across the country and from ongoing news reports, we know now that pretty well every province and region is affected.

We need to put on the record that this shortage is having the most serious impact on patients in intensive care units and those who are dying and in need of pain management. We know that hospitals in Quebec are cancelling elective surgery and that hospitals in Ottawa are saying that they will probably have to do so in the next few weeks if their drug supplies are further depleted. We also know that in Alberta, Manitoba and B.C., they are also suggesting that they will have to do the same if the situation continues.

Although I am not a health expert, certainly from all of the information that we have before us, we know that injectable opiates are the main method of pain control for surgery, post-operative care and any hospital admission. With the hospitals running low on these drugs, they are now being forced to cancel elective surgeries and to save the medications for severely ill patients and those who need serious pain management.

We know, for example, that for patients in Alberta who are undergoing chemotherapy they are now being asked to buy their own anti-nausea drugs because the hospitals can no longer provide extra supplies. These drugs are very expensive. They can cost up to $13 a pill and it is good to know that the Province of Alberta has said it would reimburse the cost, but still it puts patients at a great hardship and disadvantage.

Right across the country there are stakeholders, health care interests, who are speaking out and I would like to read into the record some of what is being said about this crisis. For example, Dr. Rick Chisholm, president of the Canadian Anesthesiologists' Society, has been calling on the federal government to develop a national strategy to “anticipate, identify and manage shortages” of essential drugs.

We know that the Ontario Health Minister, Deb Matthews, has said that Ontario did not get any advance notice about the shortages. In fact, she pointed out that the provinces have no way of knowing when a supply is short because the federal government does not require drug companies to report gaps in supply.

We know that the Alberta Health Minister, Mr. Horne, has said that “We're not going to stand by and simply wait to hear from Sandoz”, the company that shut down, “or the federal government”.

We hear from a specialist nurse manager in Vancouver who specializes in pain management, who says that she cannot understand how the federal government has allowed the supply of all injectable opiates to be threatened.

The Cancer Control Society has pointed out that Health Canada is the regulator of drugs. It approves and certifies drugs for sale and monitors safety and regulates the way drug companies operate. It also points out that other countries have taken much more action to protect patients, including mandatory reporting and inquiries to address the root causes. It calls for a plan that must focus on the needs of patients.

We also know that the Canadian Medical Association did a survey more than a year ago where 74% of doctors surveyed said that they had encountered shortages of generic drugs, most commonly antibiotics.

We also know, and this is very concerning, that the Canadian Pain Society has reported that it is seeing an increase in people who are feeling suicidal because they are so worried about the lack of medication that they depend on every day. We are facing an incredibly serious situation.

There have been many reports over the years from the Canadian Pharmacists Association. The pharmacists have been sounding the alarm on this issue for a very long time and there have been media reports. Yet the response we have seem from the federal government has been, at best, completely inadequate and in fact really quite pathetic.

What has the federal government done? Well, it set up a voluntary reporting system. As we have heard from some of the provincial health ministers, setting up a voluntary system does nothing to require these companies to report information when they know they are going to have a shortage.

I think it is very interesting that in the United States, by contrast, in October 2011, President Obama issued an executive order directing the FDA to require drug manufacturers to provide adequate notice. In fact, there is currently legislation in the American Congress to require, not just ask, all companies to give six months' advance notice of potential shortages, punishable by civil fines for non-compliance that could reach $1.8 million under the proposed bill.

We can see that this problem is very widespread. It does not just involve Canada, but other countries have taken much more serious note of what is happening and are being proactive in intervening and ensuring that patients are not suffering.

It is very sad and disturbing, unfortunately, to see that the federal government and Health Canada have not taken such action in Canada. Therefore, I think it is very important to have this debate to hear the perspectives of different parties on the nature of the crisis and what we believe should be done.

I would suggest that the first issue we need to focus on is the need for Health Canada and the federal government to become much more involved in this issue. A voluntary committee is just not going to cut it. We know that provincial health ministers are now having daily calls to try to sort out this mess and the very real threat they face in deciding what to do in their individual jurisdictions and with the hospitals that depend on these now unavailable drugs.

I think it is imperative that Health Canada and the federal government acknowledge that they have not been proactive on this issue. Calling for voluntary measures to set up a website has not done anything to mitigate the crisis now before us. They need to take much stronger action.

We believe that there should be a review, an inquiry, about why these shortages exist and that we should put in place a mandatory reporting system. This is being done in other countries and is working for them. I think there needs to be a much better explanation from the drug companies about the problems they may encounter and if there are other factors at play such as mergers or a focus on marketing more expensive drugs, which, in effect, diminish the supply of generic drugs. This is a major issue that requires investigation.

It is an important first step to have this debate tonight to investigate what is going on and to say to the federal government that more has to be done. All of the stakeholders in Canada, some of whom I mentioned tonight, are calling for strong leadership and action by the federal government.

I hope that as a result of this debate tonight and the focus on this issue, we will see action and not see the health minister basically blame everyone else and in saying, oh well, it is the drug companies, it is the provinces, it is the territories and it is their problem. This is all of our problem; this is something that requires our attention.

We need to focus on the needs of patients. We need to make sure that people are not left in dire circumstances without proper pain management or the drugs they require because of a shortage that can be prevented and managed. We can put in place a plan that would work for people.

I look forward to the debate tonight and the various points of view that are offered.

Drug Shortages
Emergency Debate
Government Orders

3:35 p.m.

Liberal

Bob Rae Toronto Centre, ON

Mr. Speaker, I want to congratulate my friend from Vancouver East for moving the motion and encouraging us all to address this question. All of us have been very troubled by it and have been raising it as an issue. My colleague from Vancouver Centre will be participating in the debate. We are all very concerned about it.

I would like to ask the hon. member the following. I still did not hear in her speech what she thinks are the actual causes of this shortage. There is obviously a huge market for a variety of products being produced by a variety of companies.

Is it that the companies do not feel they are getting sufficient payment for those products? Is it that they feel they can make more money by selling other products? If that is the case, would the member tell us, apart from a task force, and here I think we all recognize that something is required to get the discussion going, what she would envisage as a solution to ensure that the drugs, the painkillers and the supplies required by hospitals and doctors, will in fact be provided by the companies in question?

Drug Shortages
Emergency Debate
Government Orders

3:35 p.m.

NDP

Libby Davies Vancouver East, BC

Mr. Speaker, 10 minutes goes by very fast. I was barely able to touch on that very important issue. I do think this is why we need to have proper inquiry.

A number of reports, some of them American, have come out and given us some information on why these shortages are taking place. I did try to illuminate some of the causes or reasons.

Some of the drug companies say it is a problem with getting some raw materials, and so the production side and actually assembling what is needed is a problem. I think that needs to be investigated.

I do think there is an issue, and I have certainly been reading about this, with the increasing number of mergers of these drug companies in recent years. That means there are now fewer companies that are producing. Certainly the issue of sole-source supply is also a cause of concern and something that needs to be investigated. We saw this issue with the H1N1 vaccine when the federal government was scrambling to find an adequate supply.

There is also an issue, and there have been many queries and concerns about this, that this is so reliant on the marketplace. To me, this is in the public interest and it is imperative that the federal government intervene. When we leave it to market production and see mergers and issues with generic brands possibly being decreased in favour of more profitable brands, this is not serving the needs of patients.

These are all factors that contribute to the shortage that we are seeing and that need to be investigated with a proper reporting mechanism and a proper inquiry.

Drug Shortages
Emergency Debate
Government Orders

3:35 p.m.

NDP

Pierre Nantel Longueuil—Pierre-Boucher, QC

Mr. Speaker, I would like to congratulate my colleague on her speech.

She talked about the infamous H1N1 epidemic that the government had to place an emergency order for. This issue is especially important to me because the Sandoz plant is in my riding. Many of my friends and neighbours work at the plant, and I have met a lot of people who work there too. These people are feeling a lot of pressure from the whole country. I am talking about individuals, not the company. These people are under enormous pressure.

As a Canadian, I was astounded to find out that a single company was providing nearly 100% of certain drugs, narcotics, and 90% of injectable drugs. I cannot believe that a single provider has been allowed to have a monopoly on something so crucial. I would like my colleague to comment on that.

Drug Shortages
Emergency Debate
Government Orders

3:35 p.m.

NDP

Libby Davies Vancouver East, BC

Mr. Speaker, I think the issue at Sandoz, as my colleague has outlined, is something that has really made the situation very serious, but it is part of an overall shortage.

The whole issue of sole-source suppliers is something that does require a very thorough investigation. We do know that Canadian hospitals relied 100% on this one company for their injectable opiates, for examples, and they were not given adequate warning. In fact, we know that this company was initially warned by the U.S. Food and Drug Administration that they had to make upgrades, and yet this information was not properly communicated.

It does raise the question, just as we saw with the H1N1 vaccine, that the federal government as a major player has to be involved to ensure that these kinds of developments can be prevented. We could have prevented this. I am sure that the people at the plant want to get back to work and do the job they know needs to be done. However, if there is no system in place and no involvement by the federal government, then we have a disaster on our hands.

Drug Shortages
Emergency Debate
Government Orders

3:40 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Mr. Speaker, I thank my hon. colleague from Vancouver East for taking the initiative with this evening's emergency debate on the drug shortage that Quebec is experiencing right now and that could affect the rest of Canada. As I rise here this evening to speak to this crucial issue, thousands of patients are wondering if their surgeries will go ahead as planned or if they will receive their cancer treatments.

Last week, dozens of surgeries in the Outaouais alone had to be postponed. At this time, Quebec hospitals are doing an inventory of their essential drugs in order to plan for possible shortages, and pharmacists are following the situation across Canada hour by hour. On voluntary disclosure websites that track drug availability, the list of drug shortages is now six pages long: pravastatin, fluconazole, dobutamine, feproz, amoxicillin and methotrexate, a drug used to treat leukemia that has been in short supply since last fall.

A number of health experts consider the current situation to be critical, but let us not forget, the current crisis is just the tip of the iceberg. Drug shortages have become more frequent over the past few years; since 2008, in fact. There are a number of reasons for this. There is the global shortage of molecules for producing drugs and the production shutdowns at certain companies for technical reasons or because of problems meeting quality and safety standards.

The situation at Sandoz in Boucherville, Quebec, falls into the last category. It was the United States Food and Drug Administration that criticized that pharmaceutical company's drug production methods, saying that the company did not satisfy American safety rules. The most troubling thing about this case is that the company knew for months that it had to make changes. The correspondence between the American agency and the company goes back to last November. Inspections were done in the summer of 2011. It was not until February 2012 that the information on the drug shortage at Sandoz was made public. Why did the company fail to inform the provincial and federal health authorities sooner? Did Health Canada know that the company was going to slow down production?

Obviously, the fire in the plant's roof did not help matters, but it is completely unacceptable that the governments, pharmacists, doctors and patients learned about the shortage at Sandoz so late in the game.

Let us not forget that Health Canada has a responsibility to ensure that the products offered on the Canadian market meet rigorous safety, effectiveness and quality standards. It is also the responsibility of the federal government to ensure that Canadians receive the health care they need. What is Health Canada doing to resolve the shortage problem? Not much for now. The federal government should show some leadership and work with the provinces to come up with a plan for the long term.

Currently, there are two websites for the voluntary disclosure of information about shortages. Pharmaceutical companies can use them to publish the names of their drugs for which production has slowed down or stopped. Unfortunately, the system is not reliable because there is also a shortage of information. Not all pharmaceutical companies contribute to updating the sites, and some refuse to disclose certain pieces of information.

Many stakeholders in the health care field are calling for better monitoring. Ontario's health minister, Deb Matthews, believes that there should be a mandatory drug information system. The Quebec order of pharmacists is calling for the same thing. The spokesperson for the Canadian Pharmacists Association, Jeff Morrison, called the existing system frustrating because it is up to drug companies to decide what information to share with the public. Today, the Canadian Cancer Society called on the federal government to fix the problem and released the following statement:

The Canadian Cancer Society believes that cancer patients must have access to high-quality, timely care no matter where they live in Canada. We are concerned and disheartened about reported drug shortages in Canada, including cancer drugs. For patients who are already going through a difficult time, not having access to appropriate drugs can be stressful and trying.

While the Society applauds the efforts being made by hospitals, doctors and pharmacists in dealing with this issue, we believe a national coordinated approach is needed to find effective solutions. Other countries have taken a more pro-active approach to drug shortages. The Society urges the Federal Minister of Health to provide leadership to address this critical healthcare issue...

When will the federal government take responsibility?

Ottawa cannot simply say that the supply issue falls under provincial jurisdiction, as we have been hearing for the past four or five days. Health Canada must work with the provinces and with the industry to find concrete solutions, particularly since this is a worldwide crisis and since closer co-operation with other regulatory bodies is vital to finding a sustainable solution right away.

But what is this government doing? It is in panic mode and so it finds a hasty solution by importing the injectable drugs that cannot currently be obtained on the Canadian market. This is a temporary and short-term solution that does nothing to resolve the problem in the long term. We must get to the root of the problem. One of the major causes of the drug shortage is the way the supply system operates in Canada. We should explain that bulk buying groups purchase drugs on behalf of hospitals. Clearly, buying in bulk reduces costs, which is a great benefit; however, the adverse effect of this way of doing things is that it considerably reduces the number of suppliers, as is the case with Sandoz in Quebec.

The drug shortage shows what can happen when we leave the market unsupervised and unregulated. Drugs are essential products upon which millions of Canadians depend. They are different from other goods. Dr. Peter Ellis, an oncologist at the Juravinski Hospital and Cancer Centre in Hamilton, believes that Health Canada must play a bigger role in this area. In his opinion, the only way to prevent future shortages is to better regulate the industry. This opinion is shared by SigmaSanté, the buying group that represents health institutions in the Montreal and Laval region.

While we wait for this government to finally realize that it is time to act, here are a few suggestions that may inspire the Minister of Health.

First, Health Canada could make a list of essential generic drugs. Before approving them, the department could require the pharmaceutical companies that produce the new versions of these drugs to commit to supplying them for five years.

Second, the federal government could ask companies for at least six months' notice—something like what is done in the United States—before they stop producing these drugs.

Third, Health Canada should always have a plan B because accidents can happen anywhere. A fire, contamination, a power outage—any of these things could have an effect on drug production.

Fourth, a government enterprise could also produce essential drugs to ensure a safe and continuous supply, as is currently done in Sweden.

The best solution is to enforce the regulations on an ongoing basis. We might wonder whether Health Canada has the means to do so. Need I remind the government that, last fall, the Auditor General sounded the alarm with regard to the drug verification process? He said:

The Department does not take timely action in its regulatory activities...In particular, the Department is slow to assess potential safety issues. It can take more than two years to complete an assessment of potential safety issues and to provide Canadians with new safety information.

If problems were identified sooner, as they arose, then catastrophe could be averted and the problems addressed gradually. It is high time for Health Canada to take action. It is the federal government's responsibility to work with the provinces and with the industry to find solutions to the drug shortages.

I hope we will be able to reach conclusions and learn lessons from this crisis because this is about Canadians' health—the health of all patients who need drugs for their well-being.

I hope that the Conservatives opposite will follow suit and find solutions that are more sustainable than importing drugs from other countries. I hope that they will introduce more effective monitoring to ensure a sustainable, long-term plan so that people can get the care they need.

Drug Shortages
Emergency Debate
Government Orders

3:50 p.m.

Conservative

Ron Cannan Kelowna—Lake Country, BC

Mr. Speaker, I would like to thank my hon. colleague across the way for her insightful comments this evening on a very important issue for all Canadians from coast to coast to coast.

I was advised of this issue last month. My daughter's fiancé is a pharmacist. The head pharmacist for the Interior Health Authority contacted my office. I immediately did some investigating. I realized that there was only one supplier in Canada for morphine and other drugs that are vital for surgeries across Canada. The more I investigated, the more I realized that it is the province's jurisdiction and it did not have a plan B. I was very surprised, just like all of us here. It is important that we all work together, take the high road and do not blame anybody. There is an issue within our Constitution that each province and territory is responsible for providing the necessary medication.

I would ask my hon. colleague this. In the future, as we move forward in finding a solution, does she think that the provinces, out of due diligence, should not go to a single-source supplier and allow for a plan B?