Health Committee on Feb. 6th, 2014

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

Once we have the e-health records fully available and accessible, that might be one way. I know that Alberta, for instance, is a leader.

[Dr. Roger Skinner]

Correct.

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

In Ontario we've had obviously the big scandal with the e-health investments that went astray under the Liberal government. Alberta actually has brought this to bear and are able to check what patients are requesting. Do you think that would be helpful?

[Dr. Roger Skinner]

Correct. Yes.

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

We are funding that as a federal government.

[The Chair, Conservative, Ben Lobb]

You're up around seven minutes there.

Thanks very much.

Our next round of questions is from Ms. Fry. Go ahead for seven minutes, Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I want to congratulate everyone on excellent presentations. They were very clear, very concise. There are a couple of questions that I want to ask.

Mr. Bishop mentioned that one of the biggest things was the tampering and the ability of our FDA or our Minister of Health to start looking at issues of tampering and tamper-proof formularies. Why do you think that we continue to have OxyContin as a drug when the federal Minister of Health was told about this by every single public health officer across the country? Every single minister of health across the country wrote a letter, and the United States also asked that Canada move away from the ability to use OxyContin on the street. This is one big step the federal government could take.

Do you have any idea if there's an argument why the federal government would not do that? That's my first question.

[Cameron Bishop]

No. To be honest, in this respect, I think that Health Canada should follow the lead of experts across the country, and the drug should be tamper-resistant 100%. There is no reason to have non-tamper-proof generic forms of oxycodone or fentanyl or anything. The technologies exist, and if you're going to bring them to market, you should be required to make sure they are tamper-resistant.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you, because not only did they not bring in the regulations with regard to tamper-proof, but they also allowed six new companies to start putting forward this very, very important drug that can be tampered with and used as a street drug.

Anyway, I wanted to ask something else. You talked a lot about Suboxone. I know the value of it and I appreciate your answers with regard to individual patient clinical information that might define what they go on, whether it's methadone or something else. Do you have any comment on the recent work that has been done in British Columbia by UBC researchers with regard to the use of hydromorphone and other morphine-related drugs being used with heroin? These are going to be drugs that have to be prescribed. What is your comment on that?

We know that in Europe, for instance, HAT, heroin assisted therapy, programs are going on in most countries with regard to that kind of substitution therapy for people who use street drugs and who need to have a prescription drug to help them get off street drugs. If we don't initiate that, what we're doing is forcing people who have had very good help under some of these programs to go back to street drugs.

Do you have a comment on that?

[Cameron Bishop]

This is why we will never say that our treatment is the best treatment, or that methadone is the best treatment. The reality is, as with cancer treatment or any other treatment, there is a variety of different ones that will work for different patient profiles. Treatment is what should be promoted, versus a one-size-fits-all model, which just simply doesn't work because the patients vary across the board. I would say that any treatment that has viability, that is safe for patients, should be explored, and if it's scientifically sound, then yes, I think that any treatment is worthwhile.

[Hedy Fry, Liberal, Vancouver Centre, BC]

We know, for instance, that it was recommended that this be an allowable treatment by registered and certified physicians by the Department of Health, and the minister stepped in and said no.

I think Mr. Mander talked about evidence-based policies, and I think this is clearly a matter of non-evidence-based policies. It's a matter of ideological interference in what the evidence has shown to be so. I know that the Chiefs of Police have looked at very creative ways of dealing with this and have actually been very concerned about the lack of harm reduction policies in many areas.

Do you have a comment on that?

[Chief Mark Mander]

First to Cameron's point about using tamper-resistant strategies, we would believe that has to be done proactively at the initial stage, versus reactively once you determine that something has caused harm within the community. We're all about getting at the front end, at the front end of the river versus the downstream impact. Quite often from a policing perspective, we see the downstream and then we see the reactions from health care from a reactive perspective.

We think we need to change our thinking and move to a proactive stance that for any drug, and not just the current drugs that we have now, but any new drug in the future, we need to be looking at what the potentiality for harm is within the community, and what we need to do to reduce that risk within the community.

A lot of it is education of the physicians and the entire system about the drug and the potentiality, and the steps and measures needed to put it in place. Certainly you can have a great prescription monitoring program across this country, but you also have to make sure that people use it. It's well and fine to have a system, but it has to be somehow more than just a guideline. It has to be one of telling the prescriber, “You need to access this before can give a script for anything.” That's our thinking on it.

[The Chair, Conservative, Ben Lobb]

You have a minute left.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I want to talk about one of the steps which I think has made a great deal of difference in terms of prescription drug use in British Columbia. Street drugs are the drugs in British Columbia, and not so much prescription drugs. Has the triplicate prescription program made a difference in British Columbia?

[Cameron Bishop]

Anecdotally, yes, I would say that the folks in B.C. are rightfully quite pleased with the triplicate program. I hear a lot of good things about it, and so yes, in that sense I think anecdotally...and I'm thinking about 30 doctors who I've heard from in that province, they have been very pleased with it.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Could it be nationally implemented in some way, shape, or form?

[Cameron Bishop]

I think anything that you can do to cut down on the diversion aspect, the abuse aspect in any way, shape, or form, best practices should be explored and if necessary made national, yes.

[Chief Mark Mander]

Could I add a comment to that?

[The Chair, Conservative, Ben Lobb]

Briefly, yes.

[Chief Mark Mander]

In Nova Scotia we have a very robust prescription monitoring program and double doctoring has virtually disappeared in Nova Scotia. The trouble is, they can then go to P.E.I. and get a scrip. That's why you have to—

[The Chair, Conservative, Ben Lobb]

That's a very good point.

We're on to our last section of seven minutes, and certainly someone who is no stranger to Parliament Hill, but a new member to our committee, Dr. James Lunney.

Welcome. You have seven minutes, sir.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thanks very much, Mr. Chair.

I thank the witnesses, all of you, for appearing today on a very important study that we're continuing with in 2014. We're wrapping up a study that began last year with a committee of different composition.

You've come up with a lot of very interesting suggestions collectively here on how to manage a very difficult problem.

One of the issues today, I think it would have been helpful for committee members if we had your written testimonies in front of us, but of course there was very much a shortage of time. I appreciate your being here on very short notice. There wasn't time to translate documents, and so on. Recognizing that, some of us were not quick enough on the draw to get down all the things that you listed, so I hope you'll forgive us if we repeat some questions on things you've already covered.

Dr. Skinner, you mentioned a rather alarming statistic, that by 2008 the opioid deaths exceeded the number of motor vehicle accidents. Am I correct in that statement, in understanding what you said?

[Dr. Roger Skinner]

Yes. The number of deaths due to opioid toxicity exceeded the number of deaths of drivers in motor vehicle collisions in Ontario. It continues to do so significantly now.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Do you have an idea of what that death number would be, going back to 2008? I think it was 2008 you'd mentioned.

[Dr. Roger Skinner]

The first year we broke the 300 mark was 2008. We approached about 350 in 2008. The number of deaths of drivers in the province was well below the 300 mark, but since then the number of deaths due to opioids has increased. As I said, it's in excess of 500 now.