Health Committee on Nov. 20th, 2013

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

Quickly, the first recommendation here is to encourage provincial regulatory colleges to develop and implement policies to promote appropriate prescribing practices. I would trust my doctor to prescribe the proper medicine for my medical condition, and I don't think the college would know better than my doctor, who knows what my medical condition is. How do you marry the two together?

[Michel Perron]

We're assuming that the physician is properly trained in the issues of a particular drug. The medical community who sat at the table with us has indicated that there isn't sufficient education, certainly around the issue.

Second, there's the fact that veterinarians receive far more training around pain management than physicians for humans do. It's not surprising; their patients don't talk back. But I'm not trying to be cheeky here. I'm simply stating that I think part of the problem that Mr. Marston asked about—how we got here—is that there was perhaps an assumption that there is a greater level of understanding and education than is currently being provided. The medical community has said that to us clearly, and has indicated they wish to see additional prescriber education, not only in terms of curriculum when you're going through medical school but also post-graduation. In that regard, a number of post-graduate education programs are largely funded by pharmaceutical industries. There was attention to that matter brought at the discussion as well, to ensure that there is a sufficient distance from any potential conflict of interest in education. Finally, the role of the colleges of physicians is essential to ensuring the uptake of appropriate clinical practice. That is a check and balance that physicians themselves indicate is absolutely critical to knowing if they're prescribing rightly or wrongly. It's our only early warning system, if you wish, and it's one that's managed by their own practice as professionals.

I'd urge you to save or repeat that question for Dr. Susan Ulan, who will be here with the College of Physicians and Surgeons of Alberta. That's precisely their role. You will probably get a better and shorter answer from her.

[The Chair, Conservative, Ben Lobb]

Okay, thank you very much.

Thank you, Mr. Lizon.

Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much.

I have just a couple of follow-up questions, Mr. Perron.

Just in terms of the money, I think you said in answer to Ms. Morin that you're requested a million dollars a year for the strategy. Could you tell us whether you have costed out the whole strategy, even in ballpark terms? And are there timelines? Is it five years? Ten years? How does this roll out? And I have one other question after that.

[Michel Perron]

I'll start with the easy ones. We haven't costed it out. In terms of what this entire thing would look like, fully costed by all levels of government for all engagement, we haven't done that.

[Libby Davies, NDP, Vancouver East, BC]

Are you going to?

[Michel Perron]

No. I say “no” because the answer that we would likely get from a lot of people would be, how long is a piece of string? Rather, as co-chair of the process, I'm interested in knowing who's prepared to put what on the table, now that we know where we need to go.

[Libby Davies, NDP, Vancouver East, BC]

Okay. Do you have a timeline, then, for certain priorities?

[Michel Perron]

Correct. There are two things.

Because we are not the government and therefore cannot commit governments at any level, or the others, we have said two things. One is that we will push through toward implementing a process around the action streams, and that's what Madam Robeson referred to earlier. Part of that is forcing people to remain at the table and commit to what they said they were going to do around the recommendations. That work is under way now. That is what we need the financial support for.

Second, we've committed to a public annual report on progress around the strategy, which is currently focused on a 10-year lens.

[Libby Davies, NDP, Vancouver East, BC]

And is the million dollars a year for your agency? Or is it overall that you think it's required for your agency?

[Michel Perron]

It would be for our agency to support the implementation of the teams—

[Libby Davies, NDP, Vancouver East, BC]

Okay, I got it.

[Michel Perron]

—so that we have the people actually coming to the table, supporting their work. We often don't know what we know in this country. Part of this challenge is ensuring that there is adequate knowledge to practise and a follow-through around the knowledge exchange practices. It's all been costed out in terms of our role and how we'd support the partners.

[Libby Davies, NDP, Vancouver East, BC]

Okay.

I'd just like a quick follow-up of Mr. Marston's question. I think he outlined very well what lengths people will go to, whether a substance is legal or illegal, and so the emphasis on prevention and education and treatment is very important. I just wonder whether the CCSA ascribes to the principle of harm reduction, which is a very important element in dealing with the reality. The idea that just suppression alone is going to work is really not realistic. Drug use exists, whether it's legal or illegal drugs. So the issue of harm reduction and reducing the risks and managing those risks, and then moving people into treatment are very important elements. Does the CCSA subscribe to that?

[Michel Perron]

Yes, and it's entirely one of the tenets or principles of the strategy. As you read through it, you will find that the challenge is whether this is a harm reduction strategy or a strategy that reduces harms.

[Libby Davies, NDP, Vancouver East, BC]

But even though the Government of Canada has dropped harm reduction as one of the four pillars, you still have it in your strategy, do you?

[Michel Perron]

I'm saying that the strategy has a variety. To ensure that we have everyone at the table and that we can all focus on the common signal, we're talking about how to reduce the harms related to.... And that is a very clear element throughout: you'll see a lot of recommendations in here that are consistent with the term “harm reduction” that you're referring to. But this is focused on specific actions.

Second, these are controlled legal substances. This in fact underscores the challenge of looking at this through a lens of “legal” or “illegal”. These are highly controlled, presumably difficult-to-access substances, and yet we have a crisis on our hands.

The reduction of risk is by far maximally advantaged by looking first of all at how these drugs are accessed. It is largely through prescribers and through areas in which we can see that there might be some diversion on the illicit side.

This speaks to a very comprehensive strategy, focusing not only on one particular element, as I mentioned with Dr. Fry, I think, but starting with prevention and education of the prescriber and going straight on through the supply chain. I think that everybody who sees and reads these recommendations will see that concept of reducing harm throughout.

[Libby Davies, NDP, Vancouver East, BC]

Thank you.

[The Chair, Conservative, Ben Lobb]

You still have a little bit of time, if you like, Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

No, that's fine.

[The Chair, Conservative, Ben Lobb]

Okay. Thank you very much.

[Michel Perron]

I'm sorry; that may have been my fault.

[The Chair, Conservative, Ben Lobb]

No, actually we're under time on that one.

Next up is Mr. Dreeshen.

[Earl Dreeshen, Conservative, Red Deer, AB]

Thank you very much, Mr. Chair and witnesses.

I also want to thank the CCSA. When I first came on the health committee, I had an opportunity to be briefed by your organization. I got the chance to look at how you fit into the entire health system and how you can help to bring different groups and organizations together. I certainly appreciate it.

One of the things we're looking at now is the national framework for action. You've certainly discussed the First Do No Harm strategy. The national treatment strategy, I think, is also significant here.

But I'd like to focus on the third, which is the Canadian standards for youth drug prevention, and along with those, also on some of the information you've had. You spoke about cannabis use by youth in Canada—that's rather a tongue twister. One point was that youth are at particular risk for experiencing related harms, given their ongoing brain development and the significance associated with it. Also, you have this response in “Clearing the Smoke on Cannabis”, the series that is associated with that, in which you talk about chronic use and cognitive functioning and mental health, from the report that was done in that area.

I'd also point to the “Respiratory Effects of Cannabis Smoking”.

Then you are also talking about some of the upcoming research on cannabis and the brain.

I'm wondering whether you could put on the table some of the information you have there, so that we can take a look at this particular substance and get some of the real facts on it.

[Michel Perron]

Okay.

If I could step back a little bit, I think the point was made—I perhaps introduced the issue earlier—about alcohol and treatment. In Canada we have what's called the national framework for action, which is meant to be a national, pan-Canadian blueprint for how we can deal with alcohol and other drugs. Part of that identified thirteen national priorities, eight of which CCSA is leading on. One of those strategies is around prescription drug misuse. But as we cut into the prescription drug misuse strategy and identify prevention activities that we wish to undertake, the issue for us is what is good prevention.

You can then change the channel to recent work that was funded by the government under its national anti-drug strategy, whereby we have come up with Canada's first national youth drug prevention standards for schools, families, and communities.

In other words, if you are in Estevan, Saskatchewan and want to do a prevention program in your school, the standards allow you to have the confidence that the programs are consistent with what good evidence is telling you is the right kind of prevention, so that it's not only time spent with youth, but time well spent.

The point with CCSA is that we try to knit together a variety of these elements, whether they be alcohol, youth, campus, and stimulants, as was raised earlier, or prevention standards to support the prevention element that we've identified here in terms of the practice with the provinces. This is part of that connecting-the-dot element that we will bring.

The issue of cannabis certainly is one that preoccupies us quite significantly, not only in terms of prevalence of use by young people and the changing components of cannabis with the molecular change between tetrahydocannabinol—the active ingredient that makes you high, if you wish—and CBD, another molecule, which would attenuate some of the psychoactive effects of cannabis.... The point is that cannabis is very present in Canada. We are concerned about its impact on the developing brain.

There are various proof points that we can know much more about, and we plan to bring them forward. The federal government has in fact recently supported CCSA to advance knowledge around this area: around prevention, around the competencies for people who will do prevention, and focusing on cannabis and sport as an element to help with prevention. This is recent funding that we've received from Health Canada, in particular around the national anti-drug strategy.

The last point I'd make is that it will be interesting as this committee goes forward, as a health committee looking at prescription drugs, that one thing we really never discuss in earnest is what happens about medical marijuana and where it fits into this scheme at some point. This is something we will have to look at on a go-forward basis. It's a 10-year strategy. Clearly, as the ground shifts with respect to how that substance is being made available medically, we will have to look at this.