Health Committee on Feb. 6th, 2014

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

I'd appreciate that.

[Dr. Roger Skinner]

That's the National Advisory Council on Prescription Drug Misuse under the direction of the CCSA, which Mr. Bishop and I participate in.

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

When was that published?

[Dr. Roger Skinner]

That was released in the fall, I think. Do you remember?

[Chief Mark Mander]

I have the report here.

[Dr. Roger Skinner]

It was later in 2013. That's correct.

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

It was March 2013.

That was good teamwork demonstrated there.

If I have just a moment left, I'll flip it over to my colleague Terence, who has a burning question.

[Terence Young, Conservative, Oakville, ON]

Thank you, Mr. Lunney.

Chief Mander, I don't want to put you on the spot, because I realize you might not have accurate figures, but if you could, please give your most informed answer to this.

If no one were addicted to prescription drugs, if that problem did not exist, how much of your administrative and police officers' time would be freed up to investigate other important police matters? In other words, what percentage of your resources in the police services are used to deal with crimes related to prescription drug addiction?

[Chief Mark Mander]

I can only look at my own police service and you could probably extrapolate that for other places.

Probably about 5% to 10% of our time is driven by just prescription drugs.

[Terence Young, Conservative, Oakville, ON]

Dr. Skinner, take as much time as you want.

What measures should governments take to stop creating new addicts to opioid prescription drugs in Canada?

[Dr. Roger Skinner]

Are you asking me on behalf of the federal government, sir, or all governments?

[Terence Young, Conservative, Oakville, ON]

I mean on behalf of all governments. If you could make the decision for all governments to try to prevent creating new addicts to opioid prescription drugs, what would you do?

[Dr. Roger Skinner]

Do I have an unlimited list or are you going to make me pick one?

[Terence Young, Conservative, Oakville, ON]

Please start with your priorities.

[Dr. Roger Skinner]

I think the difficulty is—and this is what we have found as folks across the country have put their heads together—there isn't one answer. If we don't look at it from all of the perspectives of prevention, enforcement, education, and treatment, and integrate those, we miss. If we pick one, we just don't get anywhere at all.

If you're asking me what could be done on a federal level, I think some of the things that have been highlighted are the control of access to these dangerous preparations, the resourcing of appropriate research, and the resourcing of initiatives like that of the national action council. We could somehow help to lead the way to develop a program of data collection and sharing and surveillance so we could do research, but also so we would know who the bad prescribers are and who the troublesome dispensers are, so we can pick those people out and educate them and improve their practice.

Finally, the piece that hasn't been mentioned is the need for a comprehensive pain and addiction treatment plan in first nations communities where the problem is absolutely astounding.

[The Chair, Conservative, Ben Lobb]

Thank you.

We have our last questioner of the day, for five minutes. Ms. Fry, go ahead, please.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I don't think I'm going to need five minutes, Mr. Chair.

What I wanted to ask Dr. Skinner about is that among all the recommendations that were made, I don't notice one that talks about triplicate prescription. I'm not harping on this because I think it's a cute thing; it seems to have to worked in British Columbia to diminish the amount of prescription drug overdoses.

One of the reasons is that if you prescribe an opiate, every physician on the triplicate prescription must write a prescription. One must go to the college of pharmacists, one must go to the college of physicians, and one must be kept by the physician. It allows for monitoring on how these prescriptions are being written, whether they're appropriate or not. It allows, therefore, an identification of the patient who is seeking opiates and double or triple doctoring. It allows identification of the physicians who are inappropriately prescribing opiates, and for them to be given that, as you say, education, to be hauled out and called up by the college, which says, “Look, you're inappropriately.... Here's what you should be doing.”

That seems to have worked very well in British Columbia. I wonder why this isn't something that other provinces are looking at. It's not a federal thing; it's a provincial thing.

Can you explain that to me?

[Dr. Roger Skinner]

I would agree with you completely, Dr. Fry, that it has worked not just in B.C., but in other provinces. For example, Alberta, I think, led the way with the triplicate prescription. It's a beautiful low-tech way to collect data.

Some of the difficulties are in accessing the data in a timely manner, and so on. For example, in my situation in the emergency department, if I have somebody in front of me asking for OxyContin, how can I find out where they got their last three prescriptions and when that happened? There would be a significant time delay in the triplicate process. It's better than not having any data, but it still has some limitations.

In the absence of an electronic database, I think the triplicate form is an excellent way to provide some of that data and to give the professional college and the provincial ministries an opportunity to get a bird's-eye view of what's happening, and to identify the outliers, as you've said, and bring them up to speed.

[Hedy Fry, Liberal, Vancouver Centre, BC]

To follow up on that, when I was practising in British Columbia, one of the things we had was daily computer-generated information coming out of the college of pharmacists and the college of physicians. Every single day we got lists of the people who were double doctoring, triple doctoring, and all of the alias names that they gave to doctors, so that we were able to flag these people as they walked into the office.

This doesn't work in the emergency room, as you say, because you won't get it within 24 hours, but it does work to curb the practice by physicians in the office who do this kind of stuff and don't think about it, who have been pushed by patients with a sob story saying their stuff fell down the toilet, and la, la, la. You get a sense of the people who are the ones you should look for. As well, the colleges get a sense of the doctors who are very easy marks and tend to prescribe very easily.

[Dr. Roger Skinner]

I would agree with that.

Do I have time for a brief comment?

[The Chair, Conservative, Ben Lobb]

Yes.

[Dr. Roger Skinner]

The incident that led to the inquest with the two deaths was a situation where it was a single prescriber, two deaths separated in time, two different coroners investigating, so there wasn't that link made. Thank goodness the local police called me and said it was the same physician in both of those cases, and that he wasn't just doing it for them, that there were others.

You're right. If we had the ability to access that information of who was prescribing what to whom, there would be an opportunity for intervention, yes.

[The Chair, Conservative, Ben Lobb]

You have time, Chief.

[Chief Mark Mander]

Certainly not to brag about Nova Scotia, because that's where I'm from—

[Hedy Fry, Liberal, Vancouver Centre, BC]

But you will.