Health Committee on Feb. 11th, 2014

[Peter Dinsdale]

Certainly we don't get that kind of direct feedback at our level. What we hear about are the delisted programs and the things that aren't being funded by non-insured health benefits. I think our engagement is slightly different.

We certainly encourage and support those monitoring programs that do help in this regard.

[Carol Hopkins]

I just remembered one other example.

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

Yes.

[Carol Hopkins]

We were funded by the provincial government of Manitoba to develop a school-based early intervention program that we then trained first nation community workers—both addictions workers and school personnel—to deliver. That program has had good success in terms of the outcomes in reduction of prescription drug use by youth in grades 7 and 8 in first nation communities.

In the schools, we've now trained over 40 first nation communities to use this program, and it has been well accepted and received. It has replaced the health curriculum in the first nations' schools because it matches provincial education standards related to health. It also aligns well with the Province of Manitoba in their health outcomes studies for school-age children.

It has also served as an alternative measures program for youth in trouble with the justice system.

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

Thank you.

I have just a quick question. In terms of the delisting, Mr. Dinsdale—just to follow up—since OxyContin was delisted in 2012, the number of clients receiving long-acting opioids has actually declined by 10%, and that was the entire purpose of removing a number of drugs from the formulary. So, for instance, generic Ritalin and OxyContin were removed, Demerol was removed, Tylenol with codeine was removed, but at the same time, alternative therapies that have a lower risk of abuse have had more open access.

Have you noticed that?

[Peter Dinsdale]

I think we're very supportive of that, of the delisting of those that are obviously being abused through different kinds of systems. I think the challenge is where there's this replacement generic drug that is a replacement that actually has the same potential for addictive properties. So I think we need the same vigilance in making sure that things that replace what has been taken off aren't being used in a similar manner as those that were delisted. I think that's part of the caution we're raising in our briefing as well.

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

Thank you very much.

[The Chair, Conservative, Ben Lobb]

Very good.

Now I'd like to welcome Ms. Murray to our committee this morning. You have seven minutes.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

Thank you for the wealth of information that you were both able to squeeze into your 10-minute presentations. Would the AFN be recommending a reversal of the approvals of these replacement prescription drugs that are potentially also addictive?

[Peter Dinsdale]

Absolutely. There's a new generic formula of oxycodone that has been approved, and that new generic formula, we understand, is not tamper resistant and can be used. So of course we would look at that no longer being available.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

So that's a clear recommendation by the organization.

Mr. Dinsdale, you talked about the need to recognize the causes of the health gap, and I think Ms. Hopkins also talked about some of the history of first nations residential schools and so on.

So what would that look like, the need to recognize the causes of the health gap? Are you asking for anything specific? Is it a statement?

What would recognizing it so that it's clear and an agreed-upon part of the whole systemic problem...? Is there a specific ask on that level from AFN? Ms. Hopkins could answer that as well.

[Carol Hopkins]

Yes, for certain. For instance, first nation communities are funded on a per capita basis. If we're going to be able to provide the resources for first nation communities, then we need to consider needs-based planning and formula funding.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Specifically about recognizing the cost of health care, what you're saying is that it's not about a statement or essentially an assertion that we recognize that. You're saying it should be in how funding is allocated. Actually I had a question as to whether resources for addictions treatment and health and wellness are keeping up with population growth. When you use the word “reprofiling” quite a bit that seems to mean that it may not be, that the additional funding that's identified, that may be needed for this, isn't there. So you're having to figure out what you can squeeze to do that.

Also, Mr. Dinsdale, if you have a thought about my first question, what does it look like to recognize that?

[Peter Dinsdale]

I don't think there's been one action that got us to this situation today and there won't be one reaction that gets us out of this situation today. I think frankly the residential school apology, the example of the kind of recognition of programs potentially in areas like education, we'll see this afternoon, I guess, if it's confirmed....

So much other work needs to take place, whether it's housing, employment and training, or all these other outcomes that exist. I think taking that into account, it can't simply be this one health strategy that will resolve everything. It operates within a framework where you don't have clean drinking water. You can't wash your hands in your home.

To bring together certain southern concepts of health care, drop them into a northern community with these kinds of challenges, you need to take into account the entire spectrum that you're coming into. I think that's somewhat what we're speaking of.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Okay. I think I understand better. I'm the critic for national defence. We've been working a lot with the issue and challenges of ill and injured soldiers. I think there's a clear recognition that the causes of operational stress injury are experiences the members have when they're out on operations. You can say there's a complex set of health challenges that come from that, but there is a trauma-related injury. So I heard that also from Ms. Hopkins—trauma informed. In understanding that this is a mental injury, perhaps, that occurred for the forces members, we are also recognizing that there are, in a way, those trauma-related mental injuries that may have occurred from abuse and trauma experienced by aboriginal peoples. I was thinking about the correlation there.

I do have another question that also comes from the concerns we have in the national defence committee. Some of the roles for experts to support the injured forces members have just not been put in place. Even the numbers that were identified by health experts in 2003, we're still almost 60 experts short.

When you're talking about community-based services and services driven by communities—comprehensive mental wellness approach—is there a challenge of not being able to have the medical expertise that's needed? Is it a recruitment problem? Is it a possible hiring freeze problem? It turns out in National Defence the 2010 hiring freeze is now being identified as one of the key reasons that 50 positions haven't been filled, even though there are people available to fill them. Are those same kinds of challenges occurring on the ground?

[Carol Hopkins]

On the ground in first nation communities you have a nurse, not always a nurse practitioner, who is the only resource for primary health care. If you have the nurse in the community who can't manage or is not licensed to take care of opioid replacement therapy, it's not an issue of personnel. There are first nation communities in northern Ontario where they don't have nurse practitioners and they have somebody flying up from Toronto on a regular basis to administer the opioid replacement therapy. That's northern Ontario.

There are other communities across Canada that don't have those kinds of resources, that don't have financial resources to support that, or any kind of comprehensive response. There are no doctors, no pharmacies. There is no transportation to methadone maintenance. Yet prescription drugs find their way into these communities quite readily. The access and availability is there, but the resources to respond to them are absent, both in funding as well as in personnel. Relationships with governments provincial, health care systems....

[Joyce Murray, Liberal, Vancouver Quadra, BC]

The funding for the positions and the recruitment could be a combination.

Do I have time for another question?

[The Chair, Conservative, Ben Lobb]

You do not in this round, no. Thank you.

Mr. Young, go ahead, sir, for seven minutes.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Thank you both for being here today.

Carol Hopkins, I'd like to ask you what the extent of the problem is, on the front lines, of prescription drug abuse amongst first nations. I'm talking about OxyContin, morphine, methadone, codeine.

[Carol Hopkins]

Thank you for that question.

We actually don't know. We don't have any prevalence data. It's absent for most of Canada. There is some information, but there is absolutely no prevalence data for first nations in Canada. That is something that we need to look at. We have been talking about it, but we haven't had the resources to do it.

[Terence Young, Conservative, Oakville, ON]

We're operating with a study from 2008 to 2010, the first nations regional health survey, which says that 4.7% of first nations people aged 18 and older on reserve or in northern first nation communities reported use of illegal heroin or prescription opioids—morphine, etc. But that was at least three years ago. Could it be higher?

[Carol Hopkins]

Currently in the national native alcohol and drug abuse program, we know that at least 30% of the clients in residential treatment report an opioid use, but there is no distinction between the opioids and heroin, for example. When I say that we don't have good prevalence data, I mean that we don't know what different types of drugs are being used. We don't have data that tells us specifically how they access the drug, how they use it, or what the impacts are on themselves as well as on their families and their communities.

[Terence Young, Conservative, Oakville, ON]

When they go into treatment, doesn't anyone ask them what drugs they've been taking?

[Carol Hopkins]

Yes.

[Terence Young, Conservative, Oakville, ON]

Where does that information go?