Health Committee on Nov. 18th, 2013

[The Chair, Conservative, Ben Lobb]

A brief response, if you can, please.

[Insp Jean Cormier]

I can answer this. My colleague wants to add something to it.

Certainly, we do have a strategy. When it comes to enforcement, we have enforcement strategies in place that include multi partners. We believe that addressing the problem involves not only the RCMP but is more a whole-of-government of Canada approach, all partners who would have enforcement or prevention or whatever their role in it may be.

As well, I believe in targeting the problem to address it, not only the symptom but the root cause of it. That is where we get involved into deeper investigation of criminal organizations that may be involved in this type of trafficking.

[The Chair, Conservative, Ben Lobb]

Thank you, Mr. Cormier. We appreciate that.

Next up is Mr. Lizon for five minutes.

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

Congratulations, Mr. Chair. I came late, and I would like to take this opportunity to congratulate you on your position and to thank our witnesses for coming here this afternoon.

I have a very basic question that may allow us to understand the problem better.

On the enforcement side, you have this group of people who abuse prescription drugs, you have those who commit criminal offences—obtaining them and then distributing them—and of course, you take appropriate actions. But now we have a group of people who would fall under prescription drug abuse because they go to the doctor and they somehow get hooked on the drugs. Technically, they don't do anything illegal, because they obtain drugs by getting a prescription from the doctor, or maybe from a few doctors if they wish to, and then they take them. And sometimes, if they have children or have some young people visiting, maybe they can get hold of the medication as well.

Now, how do you address that issue? The way I see it, there's really no criminal activity here, but the problem is here. So how do you address this? Do you have any examples, especially the RCMP, working with law enforcement agencies in different countries? Are there ways to limit it? Are there ways of approaching the problem that other countries have, other law enforcement agencies, and the medical profession as well?

I know it's very general, but it's a part of the problem that's not necessarily a criminal activity.

[Paul Saint-Denis]

Thank you, Mr. Chair.

Part of the answer is that under the CDSA, the Controlled Drugs and Substances Act, the offence of seeking or obtaining an authorization.... It is a requirement for anyone who obtains a second prescription to declare to the physician any prescription obtained in the 30 days prior to the second attempt to obtain. So there is an obligation for patients or individuals seeking to get a prescription to inform the doctor that they have obtained a prescription in the 30 days prior. That may be part of a response to your question.

Beyond that, perhaps our colleagues from law enforcement may have some views.

[Insp Jean Cormier]

Not really. I'm not aware of any other program in other law enforcement that would address that. Obviously, the development of prescription drug dependency would come down to control to start with, as to the amount of what is prescribed.

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

But if we look at the ways of monitoring drug use, this is something we can address. We can create an integrated computer system at least across the province or across provinces. The new technology of electronic labels, which will be on the market very soon, not only records usage of purchased drugs but also records and transmits that data to the system.

The technology is there. How far are we from actually adopting it? Is there anything that's being done? Is there anything you're aware of as far as monitoring goes?

[Trevor Bhupsingh]

I don't think it's an issue of the technology. I think there are programs and I think there are other more complicating factors that make it difficult to adopt that. Privacy with regard to the sharing of information is one factor. There are jurisdictional issues in terms of who is responsible for what. I know that is not something we can't overcome. I guess as we move through this, we're going to need an integrated way of looking at it. You mentioned in your opening that the complexity of this is that we're trying to deal with a lot of different populations, and the solutions aren't the same.

If as a starting point we're looking at a technology-based solution to track what we're doing with prescription drugs, I think there are some provincial models out there that are working well. Again, whether or not we need a national system is up for debate, and there are limitations around information sharing and jurisdictional issues.

[The Chair, Conservative, Ben Lobb]

Thank you very much, Mr. Lizon.

Next up is Mr. Hawn, for five minutes, please.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you very much, Mr. Chair.

For our Department of Justice folks, privacy legislation can sometimes, with the new laws particularly, be an impediment to sharing information and so on. Is it an impediment to sharing information, and are there any differences among provincial, federal, and territorial privacy laws that exacerbate that?

[Paul Saint-Denis]

There are differences between federal and provincial privacy laws.

My colleague from the department is a specialist in privacy law, if you would like him to address that question, Mr. Chairman.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Sure.

[Denis Kratchanov, Director and General Counsel, Information Law and Privacy Section, Department of Justice]

Good afternoon.

Your question is very good. It deals with what was said previously, in that obviously if someone is prescribed drugs for medical purposes that prescription is personal information about them, and it's information that is regulated under privacy laws in place at the federal level and in the provinces. Some of them deal with the public sector; others deal with the private sector. Certainly in the health environment, information is being created and used by different actors. Some of them are private actors; some of them are state actors.

It does make for some difficulties in that the purpose of such legislation is not necessarily to prevent the sharing of that information but to regulate it for certain purposes. Even though the legislation across the country is to some extent similar and based on the same broad principles, it's not exactly the same everywhere, and each case tends to be treated on a case-by-case basis.

On the use of prescription drugs, there are many circumstances that are perhaps different from others. Obviously you have patients who are law-abiding, who are using the drugs as they were prescribed, and you have others who may not be doing that. In different circumstances the law will authorize the sharing of information, and in others, perhaps not. Obviously that can be remedied by passing more laws, if that is necessary.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Or fewer laws.

I want to come back to that, but I do want to ask the RCMP a question.

We've talked a lot about kids taking drugs from the cabinet and so on. Where does organized crime fit in to all this? Can you outline the concerns with respect to organized crime in this whole area?

[Insp Jean Cormier]

Certainly it is a market that is of interest to organized crime. Organized crime is involved in it. We've investigated cases in which we have found organized crime to be involved.

I believe that available intelligence on that would indicate that there are probably in excess of 70 different organized crime groups involved with it as well. The total number of organized crime groups operating in Canada is well in excess of 70 as you may already know.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

In this area specifically, how do they do that from an organized crime perspective? Do they go out and just gather all these prescription drugs and then market them, or how do they do that?

[Insp Jean Cormier]

There are different ways. It's much like it has been described before. It can be from theft from pharmacies. Some of them do, I guess, traffic prescription drugs, but some of them can be counterfeit prescription drugs as well, so there are different ways for them to get involved in that market.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

On the counterfeit prescription drugs, are they involved with marketing those to pharmacies somehow? Are they putting them into the system?

[Insp Jean Cormier]

No. I'm talking about illicit trafficking.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Okay.

It's back to Justice again on the privacy laws and so on. You're an expert in this area. Is there something that can be done to balance that, to take away some of those impediments to sharing information? You said more laws; I would suggest maybe fewer laws.

[Denis Kratchanov]

I guess the laws we have right now do provide for communication and sharing of personal information in many circumstances. I guess from the sorts of problems I've heard about here today, there is a wide spectrum of situations that happen, from the patients who may lose their drugs, from those who might sell their drugs, from drugs that may be sold illegally, and the sharing for different purposes really needs to be looked at on a case-by-case basis.

Perhaps if there are certain scenarios that are more problematic in those types of situations, certainly we can find a standard response, but it would be difficult to give a complete answer to all of the problems you are facing here that would have a very simple solution.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Is that part of what you look at?

[The Chair, Conservative, Ben Lobb]

Mr. Hawn, you are out of time. Thank you very much.

Our final member to ask questions this afternoon is Ms. Fry. Go ahead, please.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Mr. Chair.

A lot of questions are about how prescription drugs get abused. I think the most important thing to know about this is there's a process here. The doctor prescribes a drug. Opiates and opioids are very useful to deal with pain: post-operative, cancer, chemotherapy, all of that kind of thing. They are probably the best known painkillers going, either opioids or opiates.

But if you wanted to look at how you stop the chain, physicians, who are self-policing in every province, have... That's why I asked earlier on about sharing best practices. I know when I practised medicine a lot of people came to me, cross border, to try to get prescription drugs for opiates. They came across the provinces. They told me their doctor in Alberta, or their doctor in Winnipeg, etc....and I never did. I always said, “Give me the doctor's name, and I will call your doctor and just check up.”

What happens in B.C. that captures this is the college picks up what is known as a triplicate prescription. Whenever you write an opiate or opioid prescription, you have to write a triplicate prescription, and the college is able to look at the prescribing practice of doctor X, and why doctor X gives so many opioids or opiates, etc. And if they can share that with other provinces, you can stop that from happening. That's why that national program or pan-Canadian program of sharing that information among colleges would be a very important thing to do, to stop that.

But I wanted to go to something about the obligation of the patient to say, “Oh, my gosh, look at...”, too. These are very addictive drugs. When you get hooked you need to take the drug all the time, and so this becomes the problem. The patient has to.

Kids get it out of their parents' locker. A lot of the spread of prescription drugs on the street is because you can get, what?, $45 a tablet for OxyContin. So kids take it and they make money. People get it and they make money. They practise it. It becomes not necessarily organized crime in terms of large organized crime—there is some of that—but organized in terms of small communities of people trying to make money off it.

I think the important thing is to deal also with the addiction component. I need to get somebody to answer this question, which has never been answered, given that the most used opiate—we are number one in the world, surpassing the U.S.—is OxyContin. The U.S. has stopped making generic OxyContin which is easily usable on the street, and they have asked that this happen in Canada. The minister last year allowed for six generic pharmaceutical companies to make OxyContin.

Now, the United States Attorney General is asking for this to stop. How, as the supply-side policing part of it, do you allow this kind of thing to happen? Don't you talk to Health Canada and say, “This is going to go out on the street, people. Why are you allowing this to happen when across North America now it's not happening except in Canada?” This is a really important question to ask. If we are going to work together to deal with the problem, there has to be some sort of way of coordinating action that makes sense, common sense.

Can anybody answer that question for me? How does that make sense?

Okay. Thank you. I got my answer.

[The Chair, Conservative, Ben Lobb]

If anybody has a thought at home tonight, please jot it down and forward it to the clerk of the committee.

That doesn't go into your time, Ms. Fry. Continue if you have any more questions.