Bill C-307 (Historical)

An Act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence)

Controlled Drugs and Substances Act

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

moved that Bill C-307, An Act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence), be read the second time and referred to a committee.

Mr. Speaker, it is indeed a pleasure to rise in House and debate my private member's bill, Bill C-307. Let me say to all members of Parliament that many times they can go many years, even a decade, before they have a private member's bill drawn, so obviously when they do have an ability to debate their own private member's bill, it is a real honour in this place.

This is an act to amend the Controlled Drugs and Substance Act (tamper resistance and abuse deterrence).

The issue of prescription drugs and illicit drug use has touched every riding in this country. It is an issue that, as hon. members know, we face in the communities we represent, an issue that has ravaged some communities, destroyed families, and has taken far too many lives.

Most tragically, it has taken a disproportionate number of young people, including young indigenous Canadians, from us. Every day we open the paper we see another death, or, this past week in Winnipeg, three or four deaths.

The intent of Bill C-307 is to enable the federal Minister of Health to require prescription medicine, specifically opioids, as defined under the Controlled Drugs and Substances Act, or the CDSA, to have abuse deterrent formulations and/or tamper-proof, tamper-resistant properties. By doing so it would make these drugs more difficult to crush, snort or inject, and reduce their potential for misuse, abuse, and diversion to our streets by criminals.

The bill will make it possible for Canada's Minister of Health to take immediate action whenever Canadians are being hurt or killed by a specific prescription drug.

We have all heard about the crisis of illicit fentanyl wreaking havoc in our communities. The Minister of Health, the Minister of Public Safety and Emergency Preparedness, and our law enforcement agencies across Canada are addressing part of the problem. However, before some people, especially our youth, abuse these dangerous, illegal drugs, they are often exposed to these chemicals that can give them a powerful and addictive high by their tampering with legitimate fentanyl or legitimate opioids, but especially legitimate fentanyl patches, or a host of other prescriptions: codeine, morphine, OxyContin and others.

Some people who abuse opioid pain relievers, for example, do so by tampering with prescription opioid products by crushing the pills and snorting, liquefying, injecting, or ingesting these crushed and altered substances. Instead of the pill being digested or dissolved and releasing its payload of pain relief into the body as intended, as most pill forms of medicine, from digestive drugs to heart medicines, are designed to safely work, the abuser gets, with an eight to 12 hour dose of pain relief, a significant euphoria or a high in as little as eight to 10 minutes or less.

Abuse-deterrent or tamper-resistant technologies are evolving fast, and these advancements in medical science are absolutely exciting. Aside from making pills harder to crush, to snort, or to inject, companies are also making pills with antagonist formulations. I am not a scientist, but these pills may contain an active ingredient like Oxycontin or hydromorphone, but also naloxone. If someone can break the protective casing, manipulating the active ingredient or the opioid within the pill, for example, it will not cause a high because the naloxone would mitigate the effect.

It is amazing some of the science that is now being used in tamper-resistant or abuse-deterrent formulations. New drugs coming to the market are also in what are called pro-drug formulations, so the only way the opioid can be released is by digestion. If the pill is manipulated beforehand, its active ingredients are encased in a way that it makes them almost impossible to extract from the formulation or from the pill.

Moreover, some companies are investing in technology to stop patients from pill-popping these medications. Basically, once a pill is being broken down in someone's stomach, any others with active ingredients would be rendered inert; they would not work.

Still other technologies are being developed that introduce aversive agents in the same pill as an opioid. For example, naltrexone can be combined with an active opioid so any tampering or manipulation will precipitate symptoms of withdrawal, not the intended high that the abuser would seek.

The science changes things very quickly. In the crisis we are in, we need a government that can adapt as well. I can appreciate that my colleagues may be skeptical of some of the science or see this as some type of science fiction out there. Before I really started looking at this and studying it, I had no idea. I thought that tamper resistant meant it came in a package, but it is so beyond that. It is amazing what technology, innovation, and science have done to the point where now today we should be taking advantage of it.

In fact, just south of us, the Americans are taking advantage of it. The United States FDA has now approved seven of these products, which are having a dramatic impact in reducing levels of prescription opioid abuse. As well, the FDA and other bodies have conducted independent studies to attest to this fact. Even more promising is the fact that the FDA reports that over 30 such new ADF medicines are in development by both brand and generic manufacturers.

Because the molecules for all opioids, including oxycodone, codeine, fentanyl, hydrocodone, hydromorphone, and others are off patent, the competition in this area is fierce, which depresses any premiums manufacturers may want to charge. Cost is not an issue for these medications since the pan-Canadian Pharmaceutical Alliance, involving all FPT governments, can aggressively bulk buy and bulk reimburse them at a cost amenable to taxpayers.

If Bill C-307 were available to be used by Canada's Minister of Health, then whenever we found that a specific drug in the opioid class and beyond was being abused through physical manipulation, the minister could ensure that this particular drug only be dispensed in an abuse-deterrent or tamper-resistant form when it is available. These technologies should be the exception and not the rule in powerful pharmaceutical products.

Passing Bill C-307 would complement the work already undertaken by the previous government, and commendably accelerated by our current government in providing guidance to manufacturers this past March on how to bring these drugs to Canada to make abuse-deterrent label claims in Canada.

While it may surprise my colleagues in the House to compliment the government of the day, this issue is about public health. It is about saving lives. It is about doing the right thing. It is too big and too important for partisanship. It is too important to be critical of the science. We should all be encouraging the government to move on this.

As I mentioned earlier, all members of Parliament know about the waves of drug abuse that are impacting Canada and many other nations. Canadians are calling on government and health authorities to take action. Bill C-307 is one answer to that call. It is an answer that would be an effective, upstream harm reduction intervention to prevent abuse in the pharmaceuticals before it can occur. It is a ready complement to other downstream measures being taken by public health authorities, first responders, addiction workers, and law enforcement. I am hopeful my colleagues will agree that Bill C-307 would provide a non-partisan and practical measure for Canadians.

All members of the House were pleased when the Minister of Health took action this past summer to further control six ingredients known to be used in the illicit drug trade. I thank her for that action. I was working on this private member's bill and I heard that she was taking action on fentanyl. Although it did not cover it to the extent that I would have liked, I commended the government for doing that.

Bill C-307, though, is a very small part of legislation that was tabled in the House by the previous government in the final days of the 41st Parliament.

In November 2013, the Senate committee on social affairs, science and technology issued a unanimous all-party report and recommended that Health Canada pursue abuse-deterrent formulation technologies and regulatory change.

In April 2014, the House of Commons health committee issued a unanimous report on the federal government's role in prescription drug abuse. Three of the recommendations supported tamper-resistant and abuse-deterrent formulations. In fact, the opposition Liberal Party at the time said that we did not go far enough as a government on the issue of tamper resistance and abuse deterrence. I encourage all members to read those reports.

This is an expeditious regulatory change that can save lives.

I am aware that the current government continues to work towards a new drug strategy. We are on the eve of a national opioid summit this weekend, with many experts drawn from across Canada. I am a member that will be attending that. I commend the government again for having this summit. Yet I also believe that Bill C-307 would allow all members of Parliament to take some action together and immediately.

Bill C-307 is an opportunity for us to get behind a measure right now. We look forward to what the health minister will propose, but we do not have to wait. We can do some things right now.

I want to thank the employees of the House of Commons who help members of Parliament with private members' bills. I have had a great deal of help drawing up Bill C-307, and I am following much of their advice. The final two sections of Bill C-307 would allow the minister an appropriate amount of time to prepare the necessary regulations. I have accepted their legal advice that I have received to establish the timeframe. Apparently, it is a reasonable time period and there are precedents, but I am not a lawyer.

Outside the House, there is considerable support for abuse deterrence and tamper resistance to be applied to prescription opioids. Many companies, brand, generic, and start-up, with both the United States and Canadian roots, are in various stages of research and development on their own products.

Fifteen industry members of the Abuse Deterrent Coalition wrote to Canada's Minister of Health in support of abuse-deterrent and tamper-resistance formulations so they would be able to apply them across the entire class of opioid medications. Also, 37 of Canada's leading pain and addiction specialists have written Canada's health minister in support of abuse-deterrent formulations.

Many Canadian organizations have commented on the value of abuse-deterrent and tamper-resistant formulations. Some of them support these formulations as part of a comprehensive approach to addressing the issue of prescription drug abuse, misuse, and diversion.

I am not opposed to a comprehensive approach, but every weekend when we pick up the paper and see more and more deaths, we ask ourselves what we can do right now. This bill is one of those things.

Some of those associations and groups that support this type of technology, tamper-proof and abuse-deterrent formulations are: the Canadian Medical Association, Canadian Pharmacists Association, Canadian Association of Chief of Police, Canadian Public Health Association, Paramedic Association of Canada, Canadian Centre on Substance Abuse, Centre of Addiction and Mental Health, Canadian Society of Palliative Care Physicians, Centres for Pain Management, and I could go on with the list.

The abilities of the government to regulate tamper resistance exists, to some extent, right now through a general power. However, Bill C-307 would provide a more specific power for our Minister of Health.

We are in the midst of a public health crisis when it comes to prescription and illicit drug misuse, abuse, and diversion. My time in this place, 16 years, has taught me that in the life of each Parliament, there are rare occasions when we come together to support a worthy private member's initiative. I have been encouraged in this term, as I have seen many of those happen.

I believe Bill C-307 affords us this opportunity to confront, combat, and curtail prescription opioid abuse in a meaningful way, while not impacting patients who benefit from these medicines.

Let us do the right thing, the right thing together and the right thing for our country, by supporting and passing Bill C-307.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Mr. Speaker, all parliamentarians take this issue very seriously.

I am the representative of Winnipeg North. Just the other night three people died from a drug overdose in the beautiful community of Meadows West. This type of thing is happening all over country. We recognize that there are 12 or more individuals being treated in hospital every day, that is one of the numbers I have heard.

The Minister of Health has acknowledged this as have other ministries. The government is aggressively pursuing what we need to do as a national government, meeting with the different provinces. In fact, I believe the minister of health for Manitoba is going to be in Ottawa tomorrow to talk about this very important issue.

It really important for all us to appreciate the fact that we all recognize this is a crisis situation. Our hearts go out to those victims and their families that have endured so much as a result of overdose.

Would the member agree that it is absolutely critical we incorporate all the stakeholders to ensure we come up with a plan to address this critical issue?

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Mr. Speaker, just as an aside, I saw this on my wife's Facebook account. A young girl who lives in our community put a picture on Facebook of the home where those in the member's riding where killed. She said that this was the home in which she was raised in Winnipeg.

Again, here is a beautiful young girl, almost like a second daughter to us, who is mourning these people she did not know, but that was the area, the community, and the home where she was raised.

I go back to the member's question, which is correct. On issues like this, we must work in a non-partisan way. I am pleased that the Senate committee issued a unanimous report saying that we should move towards this. I am encouraged that the House committee in the former Parliament said that we should move toward this. Even the Liberal Party said at the time that we did not go far enough and we needed to do this type of measure.

This is one small tool in the tool box. It is not going to solve the problem, and I recognize that. However, for those prescriptions, where there is abuse and misuse, let us use those tools and save the lives of young Canadians.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Mr. Speaker, there are molecules in the extended opioid family that we have known about for a fairly long time. They are available in generic form and are therefore relatively inexpensive. They are often used to treat cancer patients.

If the measure proposed by the bill is implemented and we require these medications to be available only in a tamper-resistant form, there could be consequences. For example, the fact that drug companies can obtain new patents for drugs that are modified to make them tamper resistant may drive up the cost of the new form of the drug.

Does my colleague have any suggestions to prevent a situation where the same basic molecule becomes much more expensive because a drug company got a new patent for a product that has been around for decades?

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Mr. Speaker, that is a very good question. When we start making these changes, is it going to drive the price way up? Are there only a few companies that have this technology? Those are all good questions.

The United States has adopted this in great measure. It is like anything else, it will initially drive up the cost between 8% and 12%. Most said that it was closer to 9.5%.

However, once the pharmaceutical companies see that there is a will of Parliament to move in this direction, many pharmaceutical companies can move on this very quickly. Like anything else, as more and more come on board, as we have heard, and I have talked to many of them, the price of this will again go down.

The member's other question was whether it would change the formulation of the drug. If the pill is changed so it cannot be crushed, will it still solve the pain people experience? The pharmaceutical companies assure us that pain relief and the active ingredient in the prescribed drug would remain constant and strong, but it could not be abused to degree it is now.

[Kamal Khera, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, before I begin my remarks on this piece of legislation, I would first like to take a moment to discuss the current crisis that is facing our nation.

Across this country we are facing a national emergency that has cost lives. This tragedy is something that I think all members agree is completely unacceptable and one that we need resources and initiatives to address.

Earlier today the Minister of Health, along with the Minister of Public Safety and the Parliamentary Secretary to the Minister of Justice , met with the premier of British Columbia and her cabinet colleagues to discuss the crisis in British Columbia. The province's delegation provided parliamentarians and Canadians with a glimpse of the real human impact of this crisis. This meeting built on a trip that the Minister of Health made to Vancouver last week where she met with local first responders, the mayor, provincial ministers, and the provincial task force addressing the crisis.

How we go about addressing this crisis is incredibly important. We do not want to create potential harm or unintended effects with well-intentioned ideas. This is why any action that the federal government takes must be based on sound evidence. With this thought in mind, I would like to speak to Bill C-307, an act to amend the Controlled Drugs and Substances Act, tamper resistance and abuse deterrence.

Insofar as the intention behind the bill is to address the opioid crisis, I share the member's concerns. The minister, I, and our government commend the member for wanting to work to address this crisis; however, while I appreciate my hon. colleague speaking about this, unfortunately our government cannot support Bill C-307.

As a brief reminder to members, in the case of pills intended to be swallowed, tamper-resistant properties could, for example, make them more difficult to be crushed or dissolved. If tamper-resistant regulations were put in place, it would mean that only tamper-resistant versions of certain drugs or classes of drugs could be sold in Canada.

I would like to make the point that we strongly support tamper-resistant products and continue to encourage pharmaceutical companies to continue to make progress and invest in this technology. We also know that any strategy to address opioids needs to be comprehensive and that there is no silver bullet to address this issue.

Our government acknowledges that making tamper-resistant products mandatory has an intuitive appeal. However, Health Canada's review of the evidence concluded that the introduction of tamper-resistant versions of one drug does not reduce the overall harm of opioid misuse. This is a concern that was also echoed by many witnesses studying the opioid crisis who appeared before the Standing Committee on Health.

These conclusions came about due to a number of factors, and the minister's decision not to move forward with these regulations at this time was not taken lightly.

I should make the point here that the minister already has the ability to do what this legislation intends, under regulation, and at this time the risks outweighs the benefits. Regardless of this legislation, if evidence changes, the Minister of Health will already have the ability to take regulatory action.

However, the evidence today points to several things that do not make it possible to support the bill. First, tamper-resistance has not been shown to prevent the most common form of misuse, which is swallowing intact tablets. Second, the small number of individuals who choose to crush or dissolve a drug are more likely to switch to non-tamper-resistant drugs, including illicit drugs, than to stop misusing drugs altogether. This is also known as the balloon effect. These people may even be at increased risk of harm or death if they switch to using street drugs such as heroin or illegal fentanyl.

Beyond the minimal impact that requiring tamper-resistance would have on opioid misuse, such regulations could also negatively impact patients who legitimately need access to these drugs. I would also stress that mandatory tamper-resistant formulations primarily benefit the patent-holder. New tamper-resistant formulations can be patented and sold at substantially higher costs than their generic equivalents. Passing regulations requiring pharmaceutical companies to only produce tamper-resistant forms of their products would increase the cost to patients and provincial governments, which in many cases pay for their prescription drugs.

These extra costs are estimated to run into millions of dollars if only one drug, OxyContin, is legally required to be tamper resistant. Therefore, the minimal potential benefits simply do not outweigh the risks and the costs.

I would also like to note that tamper-resistance technology is not sufficiently developed to cover the entire class of opioids, some of which come in the forms of patches, sprays, or injectable liquids.

As members can see, it simply is not in the public interest to move forward with regulations requiring drugs to have tamper-resistant properties.

This is not to say that Health Canada is not supportive of drug companies voluntarily including tamper-resistant features in their products. That is why Health Canada released a guidance document for all opioid manufacturers that will help guide them in making their products tamper resistant, should they desire to do so.

As I said earlier, over the next two days, the Minister of Health will be hosting a summit on opioids to bring together experts, patient groups, governments, and regulators to discuss the current crisis and identify actions for moving forward, building on our five-point plan announced earlier this year.

Other actions to save lives have also been taken. We are switching the status of naloxone and improving a user-friendly nasal spray version of naloxone following an expedited review. We will also be proposing a variety of regulatory changes, including requiring both a prescription for low-dose codeine products and new warning stickers to be placed on dispensed opioids. We will be approving properly established, managed, and community-led supervised consumption sites. We will be proposing regulations to control the precursors of fentanyl. We will be allowing physicians of certain patients to apply for special access to heroin-assisted treatment under the special access program. Also we will be supporting the private member's bill, Bill C-224, the good Samaritan drug overdose act, proposed by the member for Coquitlam—Port Coquitlam, a bill that would save lives, as Bill C-224 would encourage people witnessing an overdose to call 911 by providing immunity from minor drug possession charges.

In conclusion, I would like to once again reiterate our government's support of any measures grounded in sound evidence that would help address this troubling public health crisis, and once again, I want to thank the hon. colleague for raising this issue.

As previously stated, if forthcoming evidence demonstrates that there would be a positive net benefit impact from requiring drugs to be tamper resistant, there are already existing authorities within the Controlled Drugs and Substances Act to move forward with regulations.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

I am pleased to rise, Mr. Speaker, especially after the two hon. members who spoke before me.

In my question to the Conservative member who is the sponsor of the bill, I raised some of the concerns I have with this bill. However, I will support it since the change to the regulations allows Health Canada to require drugs to be resistant to tampering and abuse. This is not mandatory, but Health Canada can opt for this requirement. It is not mandatory if the effectiveness of the drug is not proven or if there is a concern that it will drive up the cost too much. However, this bill gives Health Canada the option and that is why I will support it.

The bill introduced by my colleague seeks to respond to the problem of substance abuse, mainly fentanyl, a very powerful substance compared to other drugs in the same family. Other opioid analgesics have been on the market for a long time and are generally used more than fentanyl.

As many of my colleagues know, I was a nurse. In the vast majority of cases, when doctors prescribe drugs to people at home, they prescribe Dilaudid, which is hydromorphone, or morphine, which has been in use for a long time. Fentanyl is rarely prescribed to people living at home. It is mainly used right in the hospital and is rarely prescribed elsewhere. It is typically administered by injection in a hospital setting or by skin patch for patients with cancer or terminal illness.

Other opioids are used too. One of these is Demerol, or meperidine, which has been around for a long time, but is not used much because of its serious side effects. Another is oxycodone, which has also been associated with overdose and addiction, and codeine, a medium-strength opioid typically used to treat more moderate pain that is not severe enough for morphine.

Most of the people who are prescribed a drug go home with hydromorphone or morphine, generic versions of which are available for the reasonable price of about 40¢ to 50¢ per pill.

Long-acting tablets, on the other hand, can be much more expensive. For instance, tamper-resistant medication can easily cost between $10 and $20 per tablet. Forcing people to use these products could have a serious impact, given that they are much more costly. In addition, these products are often under patent protection, because the fact is, pharmaceutical companies work very hard to develop these drugs.

The most common form of tampering is crushing the drug in order to snort it or inject it. In most cases, patients with a legal prescription are not the ones doing these things, but rather people who steal the drug from patients they know. For instance, some people might raid their grandmother's medicine cabinet to see what they can get. Sadly, these people will steal from their friends and family.

Some measures could be introduced in terms of prescription practices, for instance, and the services offered by pharmacists. It could be a question of giving patients smaller amounts of medication. Perhaps they could be given a week's worth at a time, rather than a month. We need to find ways to ensure that smaller quantities of drugs are found in peoples' homes. This would also mean that patients would be less likely to be robbed.

We also need to educate patients about this phenomenon. They could be told not to keep their medication in plain view, for example, on the kitchen table where everyone can see it. We could try these kinds of measures.

As for skin patches, I have heard stories of people using syringes to pull out the liquid from inside fentanyl patches. It is extremely dangerous. With these kinds of practices, an overdose is almost guaranteed. That is another serious danger.

It is entirely appropriate to want drugs with tamper-resistant properties. My only fear is the higher cost for patients, especially when we are talking about terminally ill cancer patients. They should not find themselves in situations where they can no longer pay for their medications.

We could also work on doctors' prescribing habits. People could be prescribed drugs that are less likely to be stolen. For example, I believe that oxycodone should be used as a last resort when prescribing opioids. The use of this drug should be limited.

Clearly, there needs to be some soul searching if injectable drugs are being used at home, unless they are required for home palliative care, which usually does not last very long. We should perhaps limit as much as possible the use of pills at home. We could ensure that pharmacies only dispense small quantities to avoid having large quantities in people's homes and to prevent others from being tempted to take the medications after the patient's death.

We could also be more proactive when a patient dies. The pharmacy could request that the medication be returned so that it is not left in the home. That could prevent someone from searching and finding these drugs. There are several modest measures that we could put in place.

There are drugs, in pill form, that are available for a reasonable price and that limit problems. For example, there is long-acting morphine. Inside those capsules are tiny beads that are almost impossible to crush. Therefore, people cannot snort or try to inject them. This type of pill is sold at a fairly reasonable price compared to the tamper-resistant forms that can be used.

We can put several measures in place. I think that it would be worthwhile to move more and more toward tamper-resistant forms, particularly for molecules that are especially likely to be used by addicts and in cases where the molecules are already patented in their other form so to speak.

However, we must also not make it harder for patients to access medication. I think that my colleague's bill is balanced because it allows Health Canada to take action, but does not require it to do so. Health Canada would therefore have the freedom to determine whether the risks outweigh the benefits. It will have the flexibility to proceed if necessary. I believe that this approach is well balanced because it is cautious enough to provide some flexibility, which will ensure that patients are not deprived of treatment.

We must also give ourselves the means to act in the event that the benefits outweigh the risks.

I thank the House. I was pleased to be able to speak to this issue.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Mr. Speaker, I am truly honoured to stand today and talk about Bill C-307. I want to thank the member for Battle River—Crowfoot for allowing me to second this bill, for supporting me in terms of the debate, and for bringing forward this incredibly important issue. He did an excellent job talking about what the bill is about, what it will do, and why he has moved it forward. However, I will talk about a few areas that I do not think have been covered yet in this debate.

We have a record. Often when we hear we are number one or number two, it is something that we are very proud of. However, we are not and should not be proud of this particular record. Canada and the U.S. are the world's heaviest opioid users, with the rate of overdoses and deaths increasing dramatically. In 10 months in British Columbia alone we had 622 deaths. I wrote these notes yesterday. I had to revise that. It is now 623. This is in British Columbia alone. Of those, 322 have been related to fentanyl. Over 2,000 naloxone kits have been handed out, which is the antidote. Therefore, there were 2,000 potential overdoses and death might have been prevented with the use of the naloxone kits.

Back in September, I spoke in favour of the member for Coquitlam—Port Coquitlam's bill, Bill C-224, the good Samaritan drug overdose act. At that time, I talked about a young man and his wife I knew. They had both died from an overdose, leaving behind a young baby. However, I want to give another face to this crisis. I think it is important to give faces to the crisis and that it is important for the government to hear this if there is any way that it will help. I will talk about some of the evidence later, but I hope the bill will at least go to committee to get the most up-to-date evidence and to really have it looked at.

There was a young man who lived in Kamloops named Paul. I knew Paul as a very young boy. He had the cutest little smile, and he was a hockey player. I watched him grow up from someone who tottered around on skates to someone who was very skilled in the arena. He was a very fine young man. I saw Paul in September. I was at a golf tournament. I had not seen him for a long time, and I chatted with him for a while. I asked him what he was up to. He had graduated from university, he had a job with the Investors Group, he had a girlfriend, he was smiling, he was happy, and he seemed to have the world by the tail. That was in September. In October of this year there was a wedding. Paul was a groomsman at this wedding and did his duties for the day. Then he made a fatal error. He kissed his mom, and he and four friends went upstairs to the hotel room and decided to ingest some drugs. That was a fatal mistake, a silly mistake, and the wrong thing to do. The groom noticed that his friends were missing and decided to go and find out what had happened to them. He went upstairs and five of them had overdosed on fentanyl. They were unconscious. What had been a joyous occasion ended in panic, mayhem, and tragedy. There were four who lived after being given the antidote naloxone. However, Paul's mom and dad had to come and say goodbye to him. This is our neighbour.

Today, we have the premier of British Columbia, we have the health minister here, and we have this conference happening. They have said that we are the face, the whole face, of this tragedy—and people need to recognize it is a tragedy. If it has not impacted members yet, we can only hope that it does not, because in the community where I am there is Ryan's mother, there is Jordan's mother, there are way too many who have tragically made a mistake that has ended in tragedy.

I do recognize that Bill C-307 is just one tool. We have talked about its tamper resistance and abuse deterrence. It is strictly one tool in the tool box, but it is a tool that could make a difference.

We have to have many strategies and I noted that one of the questions from the Liberals was about the importance of an overall strategy. Absolutely, we need an overall strategy, and I hope the conference over the next two days will get us to a better place with an overall strategy.

However, I want to point out that it did not stop the Liberals from moving forward with Bill C-224, which they recognized made sense. Again, I would suggest that it should not stop them from moving forward with Bill C-307 or at least taking it to the next step. We moved forward on naloxone, in terms of the nasal spray. We have moved forward in many ways. Just because there is a need for a comprehensive strategy does not mean that we should not move forward with this particular bill.

I heard the Parliamentary Secretary to the Minister of Health talk about the evidence and the balloon effect. To be quite frank, the evidence is actually contradictory. She talked about the worry about a balloon effect, but she did not cite references. I will follow up to see what her sources were.

The New England Journal of Medicine, which is a very respected publication, had a study where the new formulation decreased abuse from 35% down to 12.8%. That is one piece of evidence that needs to be taken into account.

A lot of work has happened in Australia, which has shown a significant decrease. The study focused on 606 people who had regularly misused opioids and due to the tamper-resistant and abuse-deterrent formulation, there was a significant decrease in the misuse, without the balloon effect that Liberals talked about as their reason for not supporting this legislation. The balloon effect was not there. There was not a shift, in this particular study, to using other drugs. There are a number of studies that have shown that is not an issue.

There was another study done by the National Drug and Alcohol Research Centre at the University of New South Wales. Opioids were used 3,500 to 4,000 times a month and once they established the tamper-resistant and abuse-deterrent formulation, it went down to 500 in terms of usage.

What I would tell the Liberals is this is such an important issue and they need to look at this very carefully. They need to vote for it, at least at second reading, because when it gets to committee, they will be able to review the evidence. When the Americans made their decision, they had a lot of evidence and moved forward. The previous minister of health for the Province of Ontario regularly asked for Canada to move forward with this.

We would be missing an opportunity to review the latest evidence. Concerns have been expressed around pricing. Again, things have changed over the last couple of years. As a result of studies done by the House of Commons and the Senate, they recommended we move forward. Those studies are a couple of years old now, so it would give us the chance to review this in light of new evidence.

To sum up, this is not the be-all and end-all and I am hoping the conference tomorrow and much of the other work will help us at least get a handle on this. The tamper-resistant and abuse-deterrent formulation has a very important role to play and we should not miss this opportunity. This is for Jordan, Hardy, and Ryan. Today the premier, with one of the mothers, laid out 54 pictures for the minister to see. These are 54 of the 600-plus who have died in British Columbia in the last few years, deaths that can be prevented.

I support this bill. Let us check the research and evidence and send it to committee to see where we are at.

[The Deputy Speaker, Bruce Stanton]

Before we resume debate with the parliamentary secretary to the government House leader, I will let him know that there are only about seven minutes remaining in the time allocated for private members' business this afternoon. Of course, he will have his remaining time when the House resumes debate on the question.

Resuming debate, the hon. parliamentary secretary to the government House leader.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Mr. Speaker, I believe that my colleague was going to be replacing me. I had the good fortune of being able to ask a question. People are aware of my thoughts on this, and I will let my colleague continue.

[The Deputy Speaker, Bruce Stanton]

I thank the hon. parliamentary secretary. I did happen to notice in my peripheral vision that the hon. member for Pierrefonds—Dollard was on his feet. My apologies for not having that cued up.

I believe he heard the same instruction. There are about six or seven minutes.

[Frank Baylis, Liberal, Pierrefonds—Dollard, QC]

Mr. Speaker, opioids are an important issue.

I personally happen to know a lot about the bill, because prior to becoming a politician, I had a medical device company, and we spent a lot of time developing pain management products and pain management devices. Many times people confuse devices with pharmaceuticals. I did not do pharmaceuticals. I did devices.

In that light, I had the opportunity to travel around the world to meet pain management specialists from many countries and understand the challenges faced by people who suffer from pain. What we strove to do was give people an alternative to opioids. Specifically, when it comes to palliative care issues, there could be opioid problems where someone is going to die. This happens a lot with some types of bone cancer, for example. It can be excruciatingly painful in the last six months, and people are then in a position of spending their lives drugged up, or they could be offered alternative tools. This is something that, as electrical engineers specializing in biomedical products, we worked to develop. I am happy to say that we were very successful around the world offering people alternatives to opioids.

The danger of becoming addicted to opioids is very real, and we should be, and we are, searching for solutions. As we speak, tomorrow and the next day our minister is having meetings with stakeholders.

What often happens with these issues is that we think there is a simple solution, and it does look simple at first glance, but there are challenges. My concern is moving forward without hearing the stakeholders, without hearing from the other ministers of health, without hearing from the physicians I know, the experts, and people working with the United Nations to make pain management a universal right, the right to avoid pain. There is a lot of work being done in this area and it warrants listening to those experts before we undertake any bill.

I do not criticize the idea. In fact, the overall objective is a good one, and it is one our government takes extremely seriously: How do we help people not become addicted? If we are going to take action to stop certain people from becoming addicted, we need to make sure that we do not inadvertently push up the price or take off the market or make it difficult for people who need them to get access to these medicines. This is an important and dangerous challenge if not done right.

Addiction is a disease, and that should be understood. Many times we tend to think of the person who is addicted as being weak-willed or not having strong character, and that is incorrect. It is an addiction, and it is a problem. I stand here lucky enough not to suffer from pain, so I do not feel I am in any position to ever criticize people who inadvertently become addicted because they have been in chronic pain for a long time. I have seen that. I have had people who have undergone procedures with devices I have made and designed tell me how it has changed their lives to not live in pain.

I say that to let people know that never should we criticize a person who becomes addicted to opioids. By the same token, when we take action to help them, we need to make sure that those actions are going to give us the results we want. In life, unfortunately, we have the law of unintended consequences. We set out to do something and inadvertently cause another problem. This is why, on such an important issue, I believe that our Minister of Health is taking the proper holistic approach. I believe it is right to hear from all these experts to understand which medications are more likely to lead to addiction and which ones are not. What are the dangers involved? What type of approaches, technological and psychological, should be taken? Sometimes we tend to think that the answer is always technology. That is not always the case. Sometimes it is a combination of many things.

I strongly suggest that we take the time to take this holistic approach. We listen to the experts from government. We listen to the experts from the medical field. We understand the challenges, and we move forward with a comprehensive approach while ensuring that we are monitoring the situation so we do not inadvertently cause a problem that we then try to backpedal on. Unfortunately, with addiction, if we do it wrong, we might condemn more people to all sorts of problems. We might make more addicts. We might have all kinds of issues that come from that, so we need to be extremely careful as we move forward on this issue.

For this reason, I agree with our government that this bill in its present form at this time is not ready to be supported. I do not say that it is a bad idea. I actually encourage the member for the thought process, and it is wonderful that we are talking about it. However, I want to move forward intelligently and very carefully. When we are talking about someone's health, if we get it wrong, there are serious consequences.

We stand here in the House of Commons many times and talk about this and that and joke around at times. Sometimes we insult and taunt each other. I do not agree with any of that, and I do not get into it. When we talk about bills of this nature that would actually impact someone's life, I always tell people that the person could be my mother, could be their brother, or could be someone's son or daughter. If we are cavalier about these things and we get it wrong, there are real consequences from these types of medical bills.

For this reason, I am always going to err on the side of caution and going forward intelligently and safely, because getting it wrong, I have seen. I have been in cases where patients have died from errors. This happens. We do not like to think about it. We do not like to believe it. It happens. Doctors, nurses, and patients are all human beings. They do not always get it right. In this instance, not getting it right can mean, in the worst case, death. It does happen. I have been there. I have seen it.

I strongly suggest, as we look to move forward, that we talk to everyone. Even when we do all that, it does not guarantee that we will get it right, but it would tell us that we did everything possible to get it right. That is all we can do in the end. We cannot do more than that. On these important issues, we can take the politics out of it. We can say that this is too important to play games. We play games in a lot of things, but in matters such as this, where it would impact people's lives, we take that responsibility as parliamentarians and representatives of our country extremely seriously.

That is why I am strongly suggesting that we go through the proper process and hear the experts. This is no guarantee that we will get it right, but we will have done everything possible to have done so.

[The Deputy Speaker, Bruce Stanton]

Just as a note to hon. members, they may have noted that the hon. member for Pierrefonds—Dollard did, in fact, have pretty much his full 10 minutes. I erred just in terms of the timing of this last particular speaking slot in this first hour for the bill that was before the House. In fact, we are at the end, and the floor is clear.

We will then say that the time provided for the consideration of this item of private members' business has now expired and the order is dropped to the bottom of the order of precedence on the Order Paper.

Pursuant to Standing Order 30(7), the House will now proceed to the consideration of Bill C-309 under private members' business.

The House resumed from November 17, 2016, consideration of the motion that Bill C-307, An Act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence), be read the second time and referred to a committee.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Speaker, I rise today to speak to Bill C-307, an act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence). This legislation proposes to allow the Minister of Health to implement regulations to restrict access to non-tamper-resistant controlled substances or classes of controlled substances. The bill also imposes an annual reporting requirement on the Minister of Health if no regulations are made “specifying controlled substances or classes of controlled substances that must have tamper-resistant properties or abuse-deterrent formulations”.

As we consider the bill, which is principally aimed at curbing prescription opioid abuse, it is important to remember how we arrived at the current overdose crisis, which has claimed an estimated 20,000 Canadian lives over the last 20 years.

For over two decades, opioids have been overused and over-prescribed by doctors for pain management and other causes, leading to many patients becoming dependent and addicted.

Canada has among the highest per capita volume of dispensed opioids in the world, totalling some 19.1 million in Canada in 2015 alone. That is up from 18.7 million the year before. This is about one opioid prescription written for every two Canadians last year.

Even though there are no credible peer-reviewed studies that demonstrate that opioids afford more benefit than harm for chronic pain, opioid use has been marketed beyond palliative care and cancer patients for regular use to people experiencing back pain and other common ailments.

Manufacturers, incorrectly, led prescribers to believe that addiction was a rare consequence of using prescription opioids long-term and that fewer than 1% of patients would become addicted. However, in reality, the addiction rate is estimated to be 10%, with 30% suffering from opioid use disorder.

In 2012, Purdue Pharma Canada, the manufacturer of the potent prescription opioid OxyContin, pulled OxyContin from the market and replaced it with OxyNEO, a tamper-resistant alternative that is difficult to powderize, snort, or inject. Purdue strongly supports changing legislative and regulatory regimes to mandate that over time the entire prescription opioid market be tamper-resistant.

Under the previous, Conservative government, Health Canada drafted regulations that would have compelled opioid manufacturers to make their oxycodone products, and eventually all opioids, tamper-resistant. However, the current Liberal government abandoned that plan in April 2016, on the basis that there is insufficient proof to back up claims that tamper-resistant formulations have positive policy benefits.

Health Canada concluded that requiring tamper resistance would not have the intended health and safety impact of reducing overall drug abuse. At the time, the Minister of Health told the Standing Committee on Health, “It would be wise if it worked, but the result is that the introduction of tamper-resistant products only serves to increase the use of other products on the market. You can't take a single approach to a drug.”

To be sure, independent expert opinion on tamper resistance ranges from the view that its application has very limited efficacy for addressing opioid abuse, to the view that tamper resistance is a counterproductive move aimed in part at extending the drug manufacturers' patent protections.

Testifying at the health committee's fall 2016 study of the opioid crisis, proposed by the New Democrats, Dr. Philip Emberley, director of professional affairs for the Canadian Pharmacists Association, said:

...we still see tamper-resistance as one solution, [but] not the only solution.... [T]here are some numbers out of the U.S. that say it has had some effect. However, we have to be very cautious of the unintended consequences, which may end up being even worse than what we were trying to prevent in the first place.

To understand these potential consequences, a U.S. study published in the academic journal JAMA Psychiatry looked at what happened in drug use patterns before and after tamper-resistant OxyContin came on the market. It found that abuse of OxyContin dropped significantly, from 45% to 26% of all users, but heroin use rose from 25% to 50% and effectively cancelled out any drop in OxyContin abuse. Many simply kept using OxyContin, and about one third of them found a way around the tamper-resistant formulation.

Another 43% were simply unable to crush the new, tamper-resistant pill, so they just swallowed it and got high anyway. Only 3% of those surveyed gave up the drug altogether when the new, tamper-resistant formulation came out.

Dr. Emberley's caution was reiterated at the health committee by one of Canada's leading drug safety experts, Dr. David Juurlink, who said this:

I think abuse-deterrent formulations are a good thing generally. You can crush them, and you can chew them, and you can get a much higher level in your blood than you would by taking them intact, but you can't powderize them, inject them, or snort them, but it is a mistake to think this is the way out of this problem. These products tend to materialize on the market as the patent on the original product expires, so a cynic might wonder if this is primarily a business decision.

The fact is that the primary route by which opioids are abused is oral. I know for a fact that physicians, when they hear about these abuse-deterrent formulations, think that these are somehow impervious to abuse. They are totally abusable. If you could snap your fingers and have them all be abuse deterred, great. It is not a major part of the solution to this problem, in my view.

At best, I could say that the impacts of tamper-resistant opioids are presently unclear. However, because New Democrats are unwilling to dismiss any potential tool to address the opioid crisis, we believe that this bill should be rigorously studied at the health committee, with extreme caution paid to the potential for unintended harm. Let me be clear. We will not hesitate to oppose this legislation if, based on the preponderance of evidence, we determine that tamper resistance is likely to be counterproductive.

Ultimately, New Democrats want a much more comprehensive response to the opioid crisis. Since last fall, our party has been calling on the federal government to declare opioid overdose a national public health emergency, because such a declaration would empower Canada's chief public health officer with the authority to open temporary clinics and supervised consumption sites on an emergency basis, and allocate emergency funding on the scale needed to comprehensively address the opioid crisis.

The Minister of Health has repeatedly dismissed our calls, on the basis that the federal government already has the ability to take these measures without an emergency declaration. However, here we are today, in April 2017, with no end in sight to the opioid crisis. The legislation to streamline supervised consumption site approvals remains stalled in the upper chamber, and budget 2017 fails to devote a single dollar in emergency funding to combat the crisis. Somewhat shockingly, budget 2017 also makes deep cuts to addictions treatment funding, when access to publicly funded programs is already appallingly insufficient across this country.

As the opioid crisis escalated in 2012, the Conservatives cut funding for addictions treatment by approximately 20%, allocating $150 million over five years. That is still $40 million more than the Liberals' entire allocation for the Canadian drugs and substances strategy just announced in the last budget. The Canadian drugs and substances strategy expands on the now defunct national anti-drug strategy's pillars of prevention, treatment, and enforcement to include harm reduction. In our view, that is a positive change, but it means a broader mandate with only 20% of the anti-drug strategy's funding.

With a federal reaction like this, one could be forgiven for believing that the opioid crisis is over. However, in my home city of Vancouver the crisis is getting worse by the day. Vancouver Fire and Rescue Services reported 162 overdose response calls for the week of March 20, a 56% increase from the previous week, when 104 calls were responded to. To date, in 2017, there have been 100 overdose deaths in Vancouver alone. There were 215 in all of 2016. If rates of overdose deaths continue at this pace, Vancouver could see nearly 400 deaths in 2017, double the number recorded in 2016.

In order to reverse this trend, the City of Vancouver is advocating for increased access to treatment-on-demand options. Apparently, this request has fallen on deaf ears at the federal level. Indeed, the Prime Minister seemed to acknowledge it last month when he visited Vancouver and pledged this: “It’s really important for all Canadians to consider that this is something we cannot continue to ignore, we cannot continue to stigmatize. We need to start addressing this as the real societal health problem it actually is.” However, as former U.S. Vice-President Joe Biden used to say, “Don’t tell me what you value. Show me your budget, and I’ll tell you what you value.”

Canadians do not need more empty words or broken promises from their federal government; they need real support to end the opioid crisis. I call on the Prime Minister to honour his word by taking emergency action to finally and fully address this immense human tragedy.

[Rachael Thomas, Conservative, Lethbridge, AB]

Mr. Speaker, I am pleased to rise in the House today in support of Bill C-307 to give the Minister of Health the authority to require tamper-resistant forms of drugs that are being tampered with and then used for criminal use.

Canada is in the midst of a massive public health crisis related to opioids. Codeine, fentanyl, oxycodone, hydrocodone, and morphine have become household names, it seems, in the Canadian public, and of course this has a lot to do with the crisis at hand.

Whether it is diverted pharmaceuticals, fentanyl purchased over the Internet from China, or stolen horse tranquillizers, dangerous and lethal opioids are making their way onto the streets of Canada and the consequences are fatal.

The most alarming thing is how quickly opioids are growing, both in use and in the number of overdoses. To put things in perspective, the chief coroner of British Columbia told us at the health committee that illicit drug deaths involving fentanyl increased from 5% in 2012 to 60% in 2016.

This is not just a crisis that affects those who find themselves without a home. There are 55,000 Canadian high-school students who reported in September 2016 that they had abused some sort of opioid pain reliever in the past year.

In Ontario, in 2010, one in eight deaths of individuals aged 25 to 34 was found to be opioid-related. Families are being destroyed; lives are being lost; and all Canadians are experiencing reduced access to health and social services because of the resources required to look after this crisis.

For me, this public emergency hits close to home. Lethbridge is near the epicentre of this epidemic in Canada. Last fall, five men in my riding were arrested for possessing just over 1,000 fentanyl pills destined for the streets of Lethbridge. Several subsequent arrests resulted in police recovering hundreds more fentanyl-laced pills.

What has this meant for Lethbridge? Without being alarmist, we have seen organized crime in our city increase drastically, and the users of these drugs have made parts of Lethbridge no-go zones. There is a playground in my community where children used to enjoy playing regularly, and now it is known as "needle park". This is a place where children no longer play and parents no longer feel safe, because of the needles that are left on the ground.

Even for those not in direct proximity to drug dealers or opioid users, the effects of this epidemic are still felt. In Lethbridge, our first responders have all had to divert significant resources to address this crisis. This means that other crimes committed within our community are under-investigated or not investigated at all.

It also means that EMS responders are increasingly overworked as they respond to the spike in drug overdoses. It means that firefighters have to deal with increased risks when they respond to residential fires for fear that they could be dealing with a contaminated illicit drug lab or equipment thereof.

This is to say nothing of the increased burden on our social service agencies. Lethbridge has punched far above its weight when it comes to the Syrian refugees who have come into our community. This influx of refugees has stretched our resources to the max because of the lack of support from the Liberal government.

Many of these organizations have had to punch above their weight and are now starting to reach their breaking point. This is on top of the opioid crisis and the mental health crisis that results from the jobs crisis in Alberta.

My heart goes out to the mental health workers in my community for the remarkable work they are doing around the clock and the way they are trying to divert this issue. This crisis has a human face, as sons, daughters, husbands, wives, cousins, brothers, and sisters are all lost to lethal street drugs laced with these opioids. I recognize that the opioid crisis is multi-faceted, but Bill C-307 is one key step to cutting it off at the source.

Criminal enterprises have far too easy a time diverting legitimate pharmaceuticals to illicit street drugs. This is because the most common forms of opioid-based drugs are easily manipulated. Prescription pills can be ground down to snort, or the active opioid compounds can be extracted and used as a building block for different street drugs.

Tamper-resistant forms of these pharmaceuticals can take several forms to reduce the ability to manipulate and extract the drug. The physical properties of the pill can be used to make manipulation much more difficult, such as providing a drug that cannot be altered without neutralizing the opioid compounds, or a chemical can be included that counteracts the euphoric effect of the opioid if the drug is manipulated, either by grinding or by heating it, making the drug useless to street providers.

In June 2014, our previous Conservative government provided a notice of intent to industry. We announced that new regulations were coming that would require tamper-resistant formulations of specific controlled substances such as oxycodone. The intent of the former Conservative government was to reduce the diversion of opioids for illicit purposes to keep them off the streets. Sadly, the current government chose to overturn this decision, which has now had failed consequences on Canadians from coast to coast.

One youth who I had the chance to talk to in my riding took the opportunity to brag to me that he was taking his prescription drugs and selling them for $25 a pill. His chronic pain allows him lifetime access to these pills and it now serves as his main source of income.

Diverting these drugs to the illegal markets can be stopped. If we can stop this illicit secondary market for illegal pharmaceuticals, it will decrease one of the sources that make these street drugs so accessible.

I will be the first to admit that this is a complex issue and that this one change will not solve the entire problem. There are a whole host of changes required in order to stop opioids from ending up on our streets. Canada's physicians need to overhaul prescribing practices for opioids. Reducing the number of people with legal access to these drugs will also decrease the number of Canadians using illegal alternatives after their prescriptions end.

Furthermore, I am pleased to note that the government has taken a recommendation from Conservative members to now allow the Canada Border Services Agency to check packages smaller than 30 grams. This decision came out of a report that was written by health committee. The fact that this could not be done before allowed an unlimited supply of fentanyl to be mailed in small packages and enter our country so it could be sold on the street market.

I am also pleased the Liberals listened to health committee on the need to regulate pill press machines. These machines allow the toxic and deadly mishmash of chemicals in these street drugs to be pressed into professional-looking products that can easily be packaged and shipped. The new import controls on pill press machines is a good start, although more could be done.

Finally, we need to tackle the source of this problem at the root, which is the lack of treatment options for those who suffer from mental health problems. This makes them susceptible to using street drugs in the first place.

If the ongoing mental health crisis is allowed to continue in our city cores, on our reserves, and in our schools and universities, the drug crisis in our country will only continue to grow. The money in budget 2017 with regard to this issue is a good start, but a national strategy and further initiative is a must when it comes to mental health care in Canada.

Whether it is fentanyl, crystal meth, or the next street drug that is easily produced and cheap to buy, at the heart of all of these drug uses, this epidemic that we face, are people who are emotionally hurting. This is why the human face of this epidemic is so heartbreaking to acknowledge. These are vulnerable people who have chosen drugs because they do not have the support and necessary tools to take on life.

This is why I ask all members of the House to understand the further pain that opioids cause to Canadian families and to individuals. I ask members opposite to support this important legislation, Bill C-307.

[John Oliver, Liberal, Oakville, ON]

Mr. Speaker, I rise to speak to private member's Bill C-307, an act to amend the Controlled Drugs and Substances Act. However, before I address the issues, it is a very special day for me. My son, Alexander Oliver, and his very good friend, Tiana Prince, have joined me in Ottawa. It is great to have them in our capital city with me for a few days.

The intent of Bill C-307 is to enable the federal Minister of Health to require prescription medicine, specifically opioids, to have abuse-deterrent formulations or tamper-proof, tamper-resistant properties. By doing so, it will make these drugs more difficult to crush, snort, or inject, reduce their potential for misuse, abuse, and diversion to our streets.

I strongly agree with the sponsor of the bill when he said that this issue was about public health, about saving lives and doing the right thing. Canadians are the second-highest consumers of prescription opioids in the world. Fifteen per cent of Canadians aged 15 years and older report using prescription opioids in 2013. It is estimated that about 10% of patients prescribed opioids for chronic pain become addicted. Furthermore, the increased availability of prescription opioids in households has meant that Canadian youth have begun using them for recreational purposes. Six per cent of youth aged 15 to 19 years indicated they abused opioid pain relievers in the past year.

These trends result in significant harms. In Ontario, one in eight deaths of individuals aged 25 to 34 years was found to be opiate-related in 2010. Similarly, there has been a substantial increase in the number of opioid-related deaths in Quebec, reaching almost three deaths per 100,000 persons in 2012.

The response to the crisis by the government has been rapid, and I am pleased to see an evidence-based, health centric focus on harm reduction return to our health policy and legislation.

The Minister of Health has already responded to the crisis through a five-point action plan that includes better informing Canadians about the risks of opioids; supporting better prescribing practices; reducing easy access to unnecessary opioids; supporting better treatment options for patients; and improving the evidence base and data collection. The minister also convened a two-day pan-Canadian conference on opioid abuse in November 2016, which generated many of the changes that were introduced to the House in Bill C-37.

Further, the Standing Committee on Health, which I am proud to be a member of, issued a comprehensive report and recommendations on the opioid crisis on December 12, 2016. In the committee study, the issue of tamper-resistant technologies did not emerge as a preventive strategy. During the course of its study, the committee held five meetings, in which it heard from a range of stakeholders, including federal and provincial government representatives, health care professionals, addiction experts, emergency front-line responders, representatives of first nations communities, and individuals with lived experience in substance abuse and addiction. These witnesses outlined specific ways to address the opioid crisis and implored the committee to make recommendations that would lead to concrete action.

The 38 recommendations focused on harm reduction; prevention, including training for physicians in prescribing practices and public education; treatment, including addiction treatment and improved access to mental health services; and law enforcement and border security changes. Tamper-resistance formulations were never documented in witness testimonies as an effective strategy.

Let me expand on this point.

One of the debate points over the proposed change to the law in Bill C-307 is about whether an explicit legislative authority is needed to require certain drugs to have tamper-resistant formulations. The government's position is that the current regulation-making authorities under the Controlled Drugs and Substances Act are sufficient already to develop regulations should the evidence demonstrate a need for them in the future. From this point of view, Bill C-307 is unnecessary.

Further, nothing in Bill C-307 would speed up that regulation-making process. The sponsor of Bill C-307 outlined many tamper-resistance technologies currently under development. The government strongly supports opioid manufacturers who wish to take proactive measures to make their medications harder to abuse. That is why it recently published guidance to drug manufacturers on what evidence was required to demonstrate tamper-resistant properties for prescription drugs.

It is also clearly the sponsor's view that the technology has been sufficiently developed in the area of tamper resistance and there is enough real-life evidence of positive outcomes to move forward with regulations. I would disagree.

First, tamper resistance has not been shown to reduce the rate of addiction, overdose, and death related to opioid misuse. Remember, a tamper-resistant opioid is still an opioid. Based on current evidence it is no less dangerous and no less addictive. Data from the United States and Ontario shows that opioid-related deaths continued to increase even after the introduction of reformulated OxyContin to the market. Further, as I stated earlier, this strategy was not recommended by the many experts from whom the health committee heard testimony.

Second, only a small number of people who misuse OxyContin pills crush them or dissolve them; most simply swallow them. Roughly a quarter of those who were misusing OxyContin before the tamper-resistant version was marketed continued to do so after its introduction. They did so by moving from inhaling or injecting the drug to, again, simply swallowing them. A sizeable population defeated the tamper-resistant properties, with information on how to do this available on the internet. Of course, those who misused by swallowing OxyContin continued to swallow reformulated OxyContin. Tamper resistance does not mean tamper-proof.

Third, tamper-resistant technology is not sufficiently developed to cover the entire class of opioids, some of which come in the forms of patches, sprays, or injectable liquids.

Fourth, and perhaps most important to me, the introduction of tamper-resistant technology seems to only reduce the abuse of one type of drug in exchange for another. The most common response to the introduction of reformulated OxyContin in the United States was migration to other drugs, including heroin and fentanyl. In the case of tamper resistance, it can result in a substitution or balloon effect. Studies already have found that prescriptions for hydromorphone and fentanyl increased in Ontario after the province restricted access to OxyContin, suggesting a substitution effect could been happening in Canada already.

Members are, of course, all aware of the deadly impacts of the current surge in fentanyl-related overdose deaths in Canadians. Because of the high demand for this drug, organized crime groups began importing illegal fentanyl as analogs from China. These are then transformed into tablet forms in clandestine labs in Canada, using pill presses and disguised as other opioids, such as OxyContin. The unknown potency of illegal fentanyl and other synthetic opioids, coupled with the fact the users are often unaware that they are taking illegally manufactured pills, has resulted in a dramatic increase in illicit drug deaths in Canada.

British Columbia has become the epicentre of the crisis. The percentage of drug deaths involving fentanyl increased from 5% in 2012 to 60%. In 2016, with the involvement of fentanyl doubling the rates of drugs in the province, British Columbia experienced approximately 60 deaths a month by August 2016 from illicit drug use.

We do not want to make uninformed policy decisions that could increase the substitution of OxyContin to illegal fentanyl. The substitution effect can also lead to higher risks of administration, such as injection, which is associated with the spread of hepatitis and increased risk of overdose.

I want the residents of my riding of Oakville to be protected from the opioid crisis and illicit fentanyl distribution. I want all Canadians to be protected from misuse of opioids. I have been meeting to discuss addiction and prevention with key agencies in Oakville, including the medical officer of health, service providers at the Halton Alcohol Drug And Gambling Assessment Prevention and Treatment Services, ADAPT, and, most recently, with the Halton chief of police, Steve Tanner. Tamper-proof has not come up.

I applaud the sponsor of Bill C-307 for the attempt to help address this crisis, but for the reasons stated above, I do not believe the bill would change the government's ability to respond to the crisis. Nor do I believe evidence-based research supports the underlying position taken by the bill.

Finally, I do not think the bill would help the vulnerable and at-risk people in Oakville.

For these reasons, I will not be supporting Bill C-307.

[Dave MacKenzie, Conservative, Oxford, ON]

Mr. Speaker, I am pleased to participate in the debate on the private member's bill from my colleague, the member for Battle River—Crowfoot, Bill C-307. This is a bill to amend the Controlled Drugs and Substances Act and is intended to save lives.

The intent of this bill is to enable the federal minister of health to require specific controlled substances or class of controlled substances to have “abuse-deterrent formulations” and/or “tamper-resistant properties”. This will make these pharmaceutical substances more difficult to abuse.

Bill C-307 will make it possible for Canada's health minister to take immediate action whenever Canadians are being hurt or killed by a specific drug. We can do something, one thing, to help keep Canadians safe. We can do something when it becomes apparent that there is a deadly narcotic substance available that we no longer want available in its current form because it is dangerous and can be too easily abused. We can do something, by supporting Bill C-307. While this bill can apply to any substance under the two categories of drugs in the health legislation, this bill may in fact only be implemented on rare occasions, and yet it will help Canada's minister of health take swift action to save lives and prevent terrible suffering.

The government does have opposition to Bill C-307. In the previous hour of debate on November 17, 2016, Canadians learned of the Liberal government's initial response to Bill C-307, and we were disappointed. However, we hope that following today's second hour of debate, the Liberal government will agree to support sending this bill to committee for further study and consideration.

I want to address the reasons for opposing Bill C-307 from the parliamentary secretary to the Minister of Health. I want to remind everyone that abuse-deterrent and tamper-resistant technologies across the class of opioid medications are only one tool among many others to combat prescription opioid abuse.

Crushing and snorting of these powerful narcotics is often the gateway to other forms of abuse, including pill-popping and the movement to more dangerous illicit substances, such as fentanyl, carfentanil, W-18 and U-47700, especially for young Canadians. I am hopeful that we would do everything in our power to stem this tide.

Would all drugs be required to be tamper resistant? No, this bill will not result in only tamper-resistant drugs being available in the Canadian market. This is precisely the point. The United States is leading the way and moving forward to provide Americans with many drugs in a tamper-resistant form. This movement is supported by the Federal Food and Drug Administration, the DEA, and the Trump administration. Seven medications with tamper-resistant or abuse-deterrent formulations, with more to come, are now approved in America.

The parliamentary secretary did not report much of the growing body of evidence to this House in her speech during the first hour of debate. The speech she delivered did include references to a selective literature review on the benefits and risks of abuse-deterrent formulation, tamper-resistant medications.

The recently concluded health committee hearings and the opioids conference did not hear from all stakeholders, including actual pain patients taking these abuse-deterrent formulation, tamper-resistant medications; representatives from the industrial producers of abuse-deterrent formulation, tamper-resistant medications; nor any international and independent experts in the field of abuse deterrence. There is more consultation needed by the government. In fact, the health minister's public statements often acknowledge the value of wide consultation, and it is one of the orders in her mandate letter from the Prime Minister.

The government's opposition to Bill C-307 expressed by the parliamentary secretary did not follow another instruction to the Minister of Health in her mandate letter from the Prime Minister. That directive asks the minister to provide Canadians with science and evidence-based approaches to inform public policy. There is strong scientific confirmation of tamper-resistance technology and abuse-deterrent formulations. There are no maybes or guesswork about these technologies. They work. Tamper-resistance and abuse-deterrent formulation technology is here to stay. It is sound science. It is the future.

Increasingly, powerful medications will be available in the protected forms contained in Bill C-307. Someday, all powerful medications will be released to the public in these forms. These technologies are a product of the scientific advances of the western pharmaceutical technology. Doctors want to prescribe to their patients medications that will not harm them. Doctors want to prescribe to their patients medications that patients cannot hurt themselves with, even if they try.

Patients want their doctors to prescribe them medications that will not hurt them, even if they make a mistake while trying to follow the instructions on the prescription. Everyone wants prescriptive medications that cannot be cut up, crushed, and sold as drugs to be abused.

We can do this now. The technology does exist. We can protect ourselves and others right now. Someday our society will be able to protect our population from the risks and the harmful effects of strong medications that are being abused. This technology will be widespread and used on virtually all potentially harmful medications.

Bill C-307 proposes to provide our Minister of Health with the power to name a single substance and declare it unavailable to Canadians unless and until it is in a tamper-resistant or abuse-deterrent formulation. This would save lives every time that we find a particular substance is being abused with deadly results. The health minister could invoke this tool immediately and stop the loss of lives and terrible suffering at any time.

We have seen numerous drugs, one at a time it seems, being the latest drug of choice to abuse. Some of them are producing deadly results in large numbers. With the passage of Bill C-307, we could stop any of the newest drugs from being available for abuse. We could demand that they are are only made available in a tamper-resistant or abuse-deterrent formulation.

There is a question of costs, and the concerns about the possible increase in costs for public and private payers of medications with abuse-deterrent and tamper-resistant formulations have been addressed. The introduction of these products in the United States and Canada has been shown to drive down prescription volumes for these medicines. The result is that the costs remain the same, not higher.

Again, the parliamentary secretary did not provide us with the evidence of this fact; she reported that her government continues to be concerned about costs. However, the cost issue has been addressed, with evidence. There needs to be more up-to-date research on the facts and figures concerning the deployment of medications with both abuse-deterrent and/or tamper-resistant properties.

The federal government and the provinces have every cost-containment tool at their disposal today to rein in drug costs. The highly successful pan-Canadian Pharmaceutical Alliance is a very effective alliance that operates to set the best prices for public pharmaceutical plans. In turn, the work of the alliance also affects, and sometimes dictates, the prices in private plans. This system ensures that patients are getting medicines at affordable levels.

The provinces and territories have the power of bulk buying. There are numerous examples of medications available at reasonable costs and even lower costs following negotiations between governments and producers. The pharmaceutical firms can employ scale pricing if they know they will realize specific large numbers of sales over specific time frames. This common marketplace practice accommodates the costs to the consumer and makes abuse-deterrent and tamper-resistant medications available and affordable.

I remind all members of the House that every single opioid molecule known to medical science is already off patent. Regulations designed in the previous Parliament make it clear that any company can bring in a competing technology to any abuse-deterrent medication.

I am reminded frequently of the use of the term that we do not need 99 reasons for why we cannot do something, we only need one reason for why we can. This is one reason for why we can work to save lives across this country, by adopting Bill C-307.

[Earl Dreeshen, Conservative, Red Deer—Mountain View, AB]

Mr. Speaker, it is an honour for me to speak today to Bill C-307, and about the great work that has been done by my colleague from Battle River—Crowfoot. As someone who has spent a great deal of time with young people as an educator for 34 years, I have seen the effects and the terrible things that happen because of drugs. I do not think there is anybody in this House who is unaffected by that same type of damage. When we know there is something out there that could possibly help, this is critical. With the opportunities that young people have when they get hold of drugs, and the partying and other stuff that ties into it, we realize that the damage hurts many families.

The intent of Bill C-307 is to enable the federal minister of health to require specific controlled substances or classes of controlled substances to have either abuse-deterrent formulations, ADFs, and/or tamper-resistant, TR, properties. This bill would make these pharmaceutical substances more difficult to abuse and would make it possible for Canada's health minister to take immediate action whenever Canadians are being hurt or killed by a specific drug. Bill C-307 would help keep Canadians safe when it is determined that a particularly deadly narcotic substance that is available in its current form is too dangerous and can too easily be abused. While Bill C-307 could apply to any substances under the two categories of drugs in the health legislation, the provisions of this bill may in fact be implemented on rare occasions.

We are led to believe that the Liberals will someday announce a package of measures that they think will help combat the scourge of drug abuse in Canada. We also know that the Liberals are supporting legalized marijuana. I will have a lot to say about that in the future, again as someone who has seen the serious damage to families and young people that has taken place, especially to developing brains. We can only hope that when adopting this measure in Bill C-307, at a time in the future when the Liberals announce their further policies on drug abuse, maybe they will have something they can tie in to that. I heard one speaker earlier talking about discussions where there were a number of recommendations. We have to look at some of the other damages that exist as well, to find out exactly what is taking place.

Again, abuse-deterrent and tamper-resistant technologies across the class of opioid medication is only one tool among many others that are there to combat prescription drug abuse. Bill C-307 would do something to prevent the ability to crush, snort, or ingest powerful narcotics that have been taken from pills, patches, or sprays prescribed by doctors. We hear disturbing things about some prescriptions and how they get into the hands of young people, and into the hands of older people as well. Sometimes the drugs are being sold because people would sooner be in pain and get money for their drugs. They know that there will be problems down the line. These are the kinds of abuses that we constantly see.

This kind of drug abuse becomes a gateway to other forms of abuse, including pill-popping and taking too many pills in order to get high at parties. It becomes like a Russian roulette as to what people will take. Abusing drugs that are available from doctors or pharmacies also leads to abuse of more dangerous illicit substances, as has been mentioned before, such as fentanyl, carfentanil, W-18, and U-47700, especially by young Canadians.

Passing Bill C-307 into law would result in tamper-resistant drugs being available in the Canadian market. However, these are only drugs that we discover are being easily and widely abused. They could be identified by the minister of health and taken off the shelves until they are manufactured with tamper-resistant or abuse-deterrent properties. I believe that people who are in the business of making sure that drugs are safely presented to Canadians would be able to deal with this and be more than pleased to help in protecting young people, and all people who seem to have gone off the rails in this particular area.

We have heard a great deal of rhetoric and slogans and we have heard the review of newspaper clippings by Liberal MPs who have spoken against Bill C-307, but we have not heard any better ideas than what is proposed in Bill C-307. We have not heard support for research into tamper resistance. We have not heard the Liberals pursue Bill C-307 as part of their innovation strategy. I imagine the current Liberal government is searching for ways to spend billions of taxpayers' dollars or borrowed money on innovation, so here would certainly be an opportunity.

At the same time, in a very few laboratories in Canada and the United States, teams of scientists are working to make these pills and patches and sprays tamper-proof, and they are succeeding. They are all going to tell us that they may need more money and more funding so the research can be accelerated and expanded. They want to go faster and someday have many of the more powerful medications that a doctor would prescribe either difficult to abuse or impossible to abuse. Canada could be leading the way on the conversion of some of these drugs to a completely safe state.

The government needs to get to work. Canadians want to hear from acute pain patients taking these ADF and TR medications, from representatives from the industrial producers of ADF and TR medications, and from international and independent experts in the field of abuse deterrence. This is one of the critical and important things that we have to be aware of. More consultation needs to be done by the government. Instead, it seems bent on simply voting down Bill C-307 and abandoning the wealth of opportunities that this field of medicine can provide.

Canadians are being hurt and killed by drugs that are available, drugs that can be broken into and abused in such a way as to cause overdoses. We could prevent that. The Liberals do not want this. All of this anti-recreational drug talk is boring to the Liberals. They have better things to do with billions of borrowed dollars than to help prevent death and serious injury from the abuse of drugs. They are more concerned about legalizing marijuana.

We hear terrible stories of house parties where someone hands out crystals crushed from pills to young people, who try it. Some might get really sick or go into trauma, and hopefully someone calls 911. Most often, though, we hear about these deaths the next morning. Having seen and recognized how serious this can be, people realize that something has to be done.

In the health minister's mandate letter from the Prime Minister, she is told to consult with Canadians. That directive asks the minister to provide Canadians with science- and evidence-based approaches to form public policy.

There is strong scientific confirmation of tamper-resistant technology and abuse-deterrent formulations. The minister should get to work and put Canadians to work developing this field of science in order to protect our children from the powerful medications prescribed by our doctors and found in our medicine cabinets. Whether the government agrees to help or not, powerful medication will be available increasingly in the protected forms contained in Bill C-307. Someday all powerful medications will be released to the public in these forms.

I hope enough Liberal backbenchers will show backbone and vote in support of Bill C-307 so that it can be sent to committee for further study. I hope enough Liberal MPs do not listen to the dictates from the PM and the health minister and will vote in support of Bill C-307. These brave MPs will be able to tell their constituents that they at least tried to save the lives of young folks who are getting hurt or killed by abusing drugs that are already at home and in the family medicine cabinet. The supporters of Bill C-307 will be able to hold their heads high when they go home, because they will have tried to convince their government to do the right thing.

Everyone should get behind this effort. It is just one thing, but these things add up. They save lives and they prevent suffering.

[Kevin Sorenson, Conservative, Battle River—Crowfoot, AB]

Mr. Speaker, it is a pleasure to stand in the House and have the final say in debate on my private member's bill, Bill C-307.

The creation of my private member's bill came about from having a wife and a daughter who are registered nurses. Especially, my daughter came to me and said, “Dad, something has to be done.” I live in a small rural riding where we typically do not believe we have the same problems, difficulties, and issues that are faced in cities such as Vancouver, which we heard the member of Parliament talk about this morning, but the issue of prescription and illicit drug abuse has touched every riding in our country.

This is an issue that we all face in the communities we represent as hon. members of Parliament. It is an issue that has ravaged some communities, destroyed families, and has taken far too many lives. Most tragically, it has taken a disproportionate number of lives from young and indigenous Canadians.

I listened as the New Democratic member of Parliament from Vancouver stated that 20,000 people in Canada have died from opioid abuse over the years. There were 156 call-outs in that one community in Vancouver to the fire department or to 911 dealing predominantly with fentanyl and opioid abuse. Canadians expect that we would respond to numbers and issues like that.

Can any member of the House forget the headline on September 17, 2016, in the National Post, which read: “Eight overdoses in 13 minutes and one devastated suburb”? That article stated that they did not have enough responders to get out to the various eight overdoses in that span of 13 or 15 minutes. It was one small-time drug dealer who contaminated a batch of cocaine he made with fentanyl that caused the tragedy. The alleged dealer said that he had no idea what he had done.

Right now—and I do not even have it printed out yet—the CBC is carrying a story. In New Brunswick, an individual's former physician—and they name the individual—is being charged with drug trafficking. It is alleged the 35-year-old doctor wrote prescriptions for 50,000 OxyContin and OxyNEO pills, picked them up herself, and did not give them to the patients.

We have a crisis in the country. Emergency responders know that when there is a fentanyl overdose, they use naloxone to save the lives of victims, but in this case we do not know where those 50,000 pills were going.

Tragically, as we have already heard this morning, far too often when we open the papers in the morning—especially in British Columbia and the west, but more and more across into the east—the papers are reporting the deaths of those who have used a drug without knowing that it had been laced with something like fentanyl. Bill C-307 would help prevent so-called dealers from breaking into medication that is available to Canadians from pharmacies. It would prevent these clandestine drug manufacturers from adding the active ingredients from prescription drugs to another drug and causing them to be deadly. The bill would give the health minister the power to quickly act and remove some of these from their availability to people who would abuse them.

No one should be using drugs, yet we live in a society where peer pressure, life stresses, and many other factors cause people to abuse drugs. These people do not factor in the possibility of dying when they try those drugs.

It is time that Parliament responded.

Let me end by saying this. The Liberal government said in the last budget that it was going to have an innovation budget. These are exactly the things that happen when research and development goes out with innovation money, looking at a problem, and asking whether it can be made abuse-deterrent, whether it can be made in a formulation that cannot be misused by those who get their hands on it. Therefore, I would encourage the governing party to allow the bill to go to committee—not to make it law today, but at least to allow the bill to go to committee, where it can be studied and the benefits of this measure can be seen.

I thank every member of Parliament for their consideration of this bill. I encourage everyone to support it Wednesday evening, allow the committee to do some work on it, and report back.

[The Deputy Speaker, Bruce Stanton]

The question is on the motion. Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

No.

[The Deputy Speaker, Bruce Stanton]

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

[Some hon. members]

Yea.

[The Deputy Speaker, Bruce Stanton]

All those opposed will please say nay.

[Some hon. members]

Nay.

[The Deputy Speaker, Bruce Stanton]

In my opinion the nays have it.

And five or more members having risen:

Pursuant to Standing Order 93, the recorded division stands deferred until Wednesday, April 5, 2017, immediately before the time provided for private members' business.

Suspension of Sitting

[The Deputy Speaker, Bruce Stanton]

The House will suspend until 12 noon.

(The sitting of the House was suspended at 11:58 a.m.)

The House resumed from April 3 consideration of the motion that Bill C-307, An Act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence), be read the second time and referred to a committee.

Controlled Drugs and Substances Act

[The Speaker, Geoff Regan]

The House will now proceed to the taking of the deferred recorded division on the motion at the second reading stage of Bill C-307 under private members' business.

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

Vote #249

[The Speaker, Geoff Regan]

I declare the motion defeated.

It being 6:30 p.m., the House will now proceed to the consideration of private members' business as listed on today's Order Paper.