Health Committee on Dec. 9th, 2013

[Peggi DeGroote]

There's a lot of polysubstance abuse.

For instance, it may be that the person is receiving a prescription from their family physician but in addition on Saturday night they did a line of cocaine. If you're asking for only the people who have their prescription abuse, there is a significant number. I can get back to you with what that exact number is. I would guesstimate that one-third of the people have issues of pain and don't want to admit any addiction issues. We know that if they were asked by their family physicians to stop cold turkey, they would be going through withdrawal, and that's part of the definition of the addiction.

What we try to do, because they don't want to accept that they have any addictions—it's just their family doctor who is writing the prescription for them, so how can they be addicted—is to reduce the pain. Our treatments are multitudinous, and there's a chart where it shows all of the different things we do. Then the physicians can actually titrate them to a lower, more acceptable level. In some cases people totally get off their medications. I would say probably one-third of the patients who come to see us have an issue with just the use or overuse of their medication from the family physician, without buying any street drugs or anything else.

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

What proportion would you say are actually purchasing prescription drugs?

[Peggi DeGroote]

A large percentage will supplement. People who live in pain will do anything they need to do to not live in pain. We shouldn't fault them for it. It's how they get through life. It's their coping mechanism to sometimes be able to get out of bed in the morning to get their children's lunch made and get to their soccer game.

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

Thank you.

One of the things we've been hearing from parents is the need to provide more information on how to keep prescription drugs out of their children's hands. You've got a very practical experience with the services that you've been providing at your clinic.

What would be the top recommendations that you would have?

[Peggi DeGroote]

Our top recommendation is to keep them in a locked med box. Even if your 14-year old jimmies the lock, you now have a springboard to have a discussion because you know that they've taken something from it.

In lots of cases, do you really pill count if you have medication? Say you had a sore back, and you don't use the medication all the time—you usually keep it in your golf bag when you go golfing and just take it then. Do you really know if you have 42 pills left or only 38? Did those other four pills go out with your kids on Saturday night when they went to a salad party? Do you know what a salad party is? It's where your kids will take legally prescribed medications, in most cases from your medicine chest. Their entrée into the party that night is to take things out of your medicine chest, have a pocketful of pills, then put them into a big salad bowl when they get to the party. They just take a handful whenever it's time and ingest whatever they get. They don't even know what they're getting because it's life on ground level.

[The Chair, Conservative, Ben Lobb]

Okay.

[Peggi DeGroote]

That happens, and so you need to make sure, if your kids are going to take things, that at least you know they're being taken so you can address that issue.

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

Thank you for sharing your insights.

[The Chair, Conservative, Ben Lobb]

Good. We're not having a salad party here after committee, I can tell you that.

Mr. Dion, you're up, for seven minutes, sir. Go ahead.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

Thank you very much, Mr. Chair.

One of the best experts I know on this issue is Dr. Hedy Fry, and I'm supposed to be her. I'm replacing her but I'm not at all an expert. She has certain questions I will ask, but first I have one of my own.

What would be your top recommendation to the federal government? We are not the provincial government; we don't have the same ability to intervene on these files, but I'm sure you have an idea about the federal government's specific role. I was the minister of intergovernmental affairs long enough to know that sometimes people put all their hopes in the federal government when the federal government has little means to intervene. But this does not mean we cannot find a way to intervene that would be helpful.

I would like to hear from each of you what top priority you would assign to the federal government.

[Dr. Lisa Bromley]

I would say, decide who owns the issue of opioid safety. We have road safety, which is a big and complicated issue, but I can't see.... There are lots of people who own a little piece of the opioid safety issue, but figure out who owns the issue and then make them accountable.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

But according to the Constitution, it's not us. So what specific role do you think we might play that the provinces are not doing alone?

[Dr. Lisa Bromley]

I would ask you to forgive my naïveté and ignorance, but does Health Canada not have a stake in opioid safety as a public health issue?

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

Yes, in public safety we have a role to play. That's why I need to ask you if you are able to clarify what exactly you would like us to do differently.

[The Chair, Conservative, Ben Lobb]

Mr. Dion, maybe what we'll do is to let Ms. Bromley think about it.

Mr. Buckley or Ms. Cooper, would you like to interject here?

[Dr. Norman Buckley]

The jurisdictional issue is a big problem, but what's crucial is the capacity to have readily accessible information transferred amongst provinces so that health-care providers at the front line are able to understand what is going on with their patients and know what medications they've had, what previous treatments they've had. There are individual provincial initiatives in these regards in many provinces right now, but there is not a unified strategy across the country to support a communications strategy. And even though the actual implementation may be provincial, it occurs to me that there should be a role amongst the federal transfer payments to link to communications strategies that require communication between the provinces as well as within provincial health care systems. In fact, if you look to your Canadian Centre on Substance Abuse strategy, you'll see that this group is working hard to try to bring the players together. I think supporting that strategy would be hugely effective, because one of the challenges we face all the time is the adequacy of information.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

Mr. Buckley, Madame Fry was leading towards this point, because she requested that I ask which provinces or communities have the best practices and what role the federal government may play to make them known.

[Dr. Norman Buckley]

Right now, to the best of my knowledge, Calgary has a multidisciplinary pain clinic that probably is unequalled—I'm not sure if this is a province-wide strategy or just specific to Calgary—in the country in its capacity to identify and treat patients with complex chronic pain problems.

Nova Scotia has rolled out an excellent strategy that includes support for pain education amongst its primary providers. It also addresses issues to deal with opioid prescribing, which obviously was one of the drivers in that province.

La belle province is perhaps one of the premier in terms of having developed a province-wide strategy. It includes linking I believe five key academic centres as tertiary resources responsible for secondary and primary care education and care delivery within five regions in Quebec.

British Columbia has a strategy under way. It was announced two years ago, I believe. It continues to work forward, but I suspect in terms of primacy it's going to be Alberta, Nova Scotia, Quebec at the lead, I think, or British Columbia close behind. Ontario is in the process of putting together a strategy that it has yet to roll out.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

Does anybody else want to address this issue? No? Okay.

I have another question from Madam Fry. We have heard that in remote and rural communities there are higher rates of prescription drug misuse because of limited access to comprehensive pain management services, such as physiotherapy and pain management specialists.

Is it true, and is there a role here where the federal government can help with more equivalency in the quality of service through the country?

That's for anyone who is aware of this issue.

[Peggi DeGroote]

It was a great surprise to find out that Halton was one of four areas that was noted as having a great need. It was a great surprise to me. So you don't have to be rural and you don't have to be remote to have lack of care. You can be in a central location, with everything available to you, to have services still not available.

That, for me, is one of the reasons I did what I did. I couldn't believe it wasn't available in our community.

[Stéphane Dion, Liberal, Saint-Laurent—Cartierville, QC]

Thank you very much.

[The Chair, Conservative, Ben Lobb]

Thank you. You're right on time there. Good work.

Next up is Mr. Lizon, please, for seven minutes.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Mr. Chair.

Thank you to all of the witnesses today, those on the screen and those who are here at committee this afternoon.

First I will allow myself a comment. We're doing this study on prescription drug abuse, and really, a lot of the witnesses during the meetings are focusing on opioids and pain medication. So far we've left aside others, but it would be good to know what the impact is of other medications that are misused, abused, or overused.

Since all four witnesses today deal with issues relevant to pain, my first question is this. And I'm not directing my question to anybody in particular. On the one hand, a doctor sees people who need treatment for pain, whether it's chronic pain or it's pain that occurs once in a while. Some people suffer from migraines once in a while and they can't function. The doctor is faced with the problem of giving some kind of pain relief to the patient. How do you strike the proper balance so that you as a doctor or a medical practitioner don't over-prescribe, or don't prescribe what is not needed, and then the right treatment is used? I guess sometimes the easiest way is to just prescribe the pain medication, and it's probably the easiest for the patient, because the pain goes away usually very rapidly.

Could you maybe expand on this? Where do you strike the balance?

That's for anybody.

[Dr. Lisa Bromley]

Perhaps I can start.

We have a most excellent Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. That is a definitive authoritative source for striking that balance.

I think it's good medicine to take a good history and to monitor your treatments after you've prescribed them.

Regarding your first question about other prescription drugs that are not opioids, this is where we need good epidemiological data.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Okay.

Would anybody else like to speak on striking a balance on how to deal with pain, or how to not prescribe opioids or other medication or pain relievers?