Health Committee on Nov. 20th, 2013

[Michel Perron]

Certainly. The notion of awareness of the issue crosses a number of populations. The first area is around the prescribers, for them to understand the impact and the extent of this issue, and second is around the patients themselves and the general population to understand how they can be more educated around the issue of prescription drugs.

The last thing we want to do is to create a phobia: “I can't take any prescription drugs.” There is a very real purpose for prescription drugs, whether they be opiates, stimulants, or sedatives, but it is appropriate for Canadians to be informed in a proper manner and to ask the right questions as they go into these kinds of treatments and to have that discussion with either their primary care physician or the pharmacist.

A variety of specific recommendations have been identified around this issue, including an awareness campaign that could be provided nationally to provide greater attention to the issue and where we would want to go on it.

I'll let Paula colour in the details on that one.

[Paula Robeson]

A number of the prevention-focused recommendations—there are 12 of these in the 58—include informing consumers, families, and communities of the nature of the issue, the extent of the issue, mechanisms for mitigation, tools to build community capacity and individual capacity to understand the issue and help protect themselves from it, including, as Michel said, an awareness campaign.

The basis of a lot of that information, however, is a clear understanding of the nature and prevalence of the issue itself, which comes back to data collection and being able to compare across jurisdictions and communities.

[The Chair, Conservative, Ben Lobb]

Thank you very much, Ms. Adams.

Next up is Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

I first want to ask the chair if it's possible for everyone to get a copy of the report of the Special Committee on the Non-Medical Use of Drugs, tabled in Parliament in December 2002. I think it answers a lot of the questions that I hear people asking here, and a lot of it is detailed. For instance, what does it look like when you are overusing opiates? What are the symptoms? What are the signs?

It's all detailed in this report. I think it would be interesting for people to read it so that they can be starting off at a jumping-off point with a lot more information than is written in here.

Now I just want to change the channel a little and congratulate you on your recommendations as written in here. I like the idea you propose that the responsible level of government lets you take the lead. I think that's good.

But I want to note that everyone talks about opiates and opioids, and no one really talks about things like benzodiazepines. If any of you are as old as I am, you can remember the book I'm Dancing As Fast As I Can, which talked seriously about the use of Valium, etc. These things go on. They have been subsumed by opiates, which take all the media headlines, but they are continuing.

So I think we can talk about that. We can talk about the use of a fair number of prescription drugs that we know young people—in this report, there is some of that—take out of their parents' cabinets because the drugs give them a buzz and do all kinds of things.

Could give just a quick rundown—I have two more questions to ask, and I only have seven minutes—on what you know currently about the data available on the misuse of benzodiazepines?

[Michel Perron]

I would direct your attention to the fact that we'll be leaving behind with the clerk some short summary documents.

Essentially, for 2010-11 approximately 1.5% of Canadian students from grades 6 to 12 reported past-year use of tranquilizers to get high or for non-medical purposes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Sorry, that was grade 6 to grade...?

[Michel Perron]

Grades 6 to 12, and it's about 1.5%; that's for non-medical use by young students.

What we are hearing, however, around the issue of benzodiazepines is primarily around the prescribing for women.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Housewives.

[Michel Perron]

In particular, we are hearing that this is a population that we need to be looking at in addition to seniors. So it's not limited to any age group, per se.

I would again underscore, picking up on Madam Adam's question, that the data here is as good as we have but by no means sufficiently robust to say that we all have to charge this way. I think we have to do more investigation in that area.

[Hedy Fry, Liberal, Vancouver Centre, BC]

That leads me to my second question, that the data is there but it's at provincial levels, some better than others.

Do you see there being a role for the federal government in acting as a clearing house, a place where they can collect all of the data that's coming through from provincial governments, and making some sort of national database out of it? It would be the same thing for best practices. If some provinces are doing some really great things about tracking physician prescriptions, about tracking misuse of drugs in terms of inappropriate prescribing, etc., then could we not pull that together into a database?

I think that's a real role for the federal government. We can get a scan, an environmental scan, of what's going on across the country, which helps us, as federal politicians, to understand the nature of the problem.

Do you see that as being of valid use?

[Michel Perron]

I would certainly agree.

Perhaps I'll direct the attention of the clerk to flag for the members afterwards in the report, under the monitoring and surveillance recommendations, point one in particular. It's really to standardize the key elements of the prescription drug surveillance system in Canada.

That's really for the federal government; professional associations; the Institute for Safe Medication Practices, which was identified as well; and the provinces and territories. I think there is absolutely a need for consistent national data collection. That means talking to the data holders, which are often the provinces, and looking at the different data streams that would come from that. It could be coroner reports and poison centre reports, as was mentioned earlier.

The bane of existence in these matters is common terminology. This includes a definition of how we're quantifying, what is the effect and impact of these, and the collection methods and the reporting.

As to the actual specific federal role, I think we could look to roles that the federal government plays in other national data collection mechanisms. Certainly the ability to have one understanding of what's going on in the country, as fed into by the provinces, would be useful.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

How am I doing, Chair?

[The Chair, Conservative, Ben Lobb]

You're doing quite well. You have two minutes to go.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

My next question has to do with something you say in First Do No Harm: Responding to Canada’s Prescription Drug Crisis. You state, in your second paragraph, “Develop and promote risk-reduction programs for individuals...”. Can you elaborate on that? As you said, the lead is Health Canada, the Public Health Agency of Canada. So perhaps you can elaborate on it.

I also want to thank you for your last answer, because I think all of us who have been involved in looking at this issue know that if you're going to set up, you're going to evaluate, you're going to monitor, and you're going to look at indicators, then you're going to need data first. You're going to need data that has been broken down by particular groups and demographics, and other data that tells us who's more prone, etc.

Thanks, Mr. Perron.

[Michel Perron]

Thank you, Dr. Fry.

The issue of risk reduction is a key principle throughout this entire document, the first point being that we should not immediately turn to a pharmacological response to pain or to some ill that someone is facing.

There's a variety of other interventions, whether they be chiropractic, massage, or a variety of other ones. Simply put, I think, in a very blunt form, there was a general sentiment that we are overly reliant on a pharmacological response to dealing with issues that are facing Canadians. That's at the base of this strategy. Second is that if in fact a pharmacological or therapeutic drug is required, that it be an informed manner of prescribing and how that goes into it.

There's a variety of risk reduction measures also built in throughout the strategy, which you'll see under the treatment element around some of the specifics, in terms of naloxone at home and so on and so forth. There's a variety of initiatives, and again, all of them are soundly evidence-based, sourced, and contextualized within the broader context.

Often in this world, which is fraught with a lot of political attention—and which we welcome—sometimes it's laser-picked as to certain issues. To address the strategy writ large, we really have to look at all streams, and we have to ensure that we're collectively advancing the agenda based on what was put on the table. Again, that brings us back to the CCSA role.

[The Chair, Conservative, Ben Lobb]

Thank you. You were great on time. Very good.

Next up for the last seven-minute questioning is Mr. Hawn.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you very much, Mr. Chair.

Thank you to our witnesses for being here.

I want to turn to first nations for a minute. Obviously they are one of the most vulnerable populations, the first nations reserves and so on, in the country. We recently spent about $90 million—or committed that—on addiction prevention, addiction programming, and so on.

Can you comment on the effectiveness of some of those investments. Really, is it enough? Do we need to do more? Do we need to do something different? Are there changing trends on first nations—I'm talking about first nations and Inuit—reserves?

[Michel Perron]

The way I would address that is perhaps in the manner that we pull together the strategy.

First of all, the federal government is very present, as you know, on reserves, first nations, and non-insured health benefits and the like; there's a significant investment. I'll let Health Canada speak to their actions.

When we undertook this process, the last thing we really wanted to do was define for first nations people writ large what it is that we need to be doing in the area. We heard very clearly from groups such as the Assembly of First Nations and from National Chief Atleo and others that prescription drugs are one of the very significant factors in their communities and need to be dealt with.

We are very pleased that the Assembly of First Nations participated in this process. In fact, National Chief Atleo formally endorsed the strategy as well, as being consistent with how they wish to be guided in terms of their own decisions vis-à-vis the variety of programs that we've outlined here.

Also, I think that was helpful in connecting the activities of Health Canada. I know that they have a prescription drug abuse coordinating committee that is co-chaired with the Assembly of First Nations, so I think that all of the first nations interests were well represented in the strategy and that the recommendations are consistent with how they would like to see action move forward on this. In terms of the specifics of where it needs to go, clearly there is a massive amount of need in a variety of areas, but again, the strategy allows for that to unfold.

Did you want to speak a bit more to that, Paula?

[Paula Robeson]

In the strategy document itself, we have a number of areas where there are strong linkages with first nations. As Michel mentioned, the first nations representatives at the table were an integral part of the development of this strategy and in tailoring some of the recommendations to take into consideration cultural sensitivity and competence, community-driven solutions, and ensuring access to remote and rural communities. Parts of those issues are built into the strategy recommendations themselves.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Thank you.

This may be a bit of a stretch, but of course there are first nations around the world. I was in Taiwan in April or May. They have I think 12 identifiable first nations communities. The resemblance was striking, not just physically, but in traditions, dance, and music—and in challenges. We've talked to their people a lot about some of the challenges those communities face in Taiwan.

Have we done any kind of comparison—maybe it's apples and oranges, I don't know—or information sharing with other first nations in countries around the world?

[Michel Perron]

From a CCSA perspective, we would look to the AFN to be a guide in this. There was no systematic examination of first nation needs in other jurisdictions. I was recently asked to chair the development of a consensus strategy for New Zealand, where the Maori and Pasifika people were very much represented. The need was well defined in a manner not inconsistent with how it is here. I won't speak to scope and size, but there was a need to recognize them as specific populations—acknowledging without stigmatization that they need particular attention. We feel that attention is best placed by the first nations leaders themselves.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Do you know if they're looking at any of that?

[Michel Perron]

Absolutely. The Assembly of First Nations is looking at this matter. I don't know if there has been a systematic look across the country.The only point I would underscore is that the problem we're facing here is a problem of rich countries. If you go to the United Nations tomorrow, you'll be arguing for access to essential medicines. There's a paucity of access to many of these drugs in a lot of the countries. Our problem comes from having a significant amount of supply. How do we manage that supply in the most prudent way, understanding that we need to attenuate needs while mitigating harm?

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Taiwan, Australia, and New Zealand are all pretty rich countries, so they may have similar problems.

[Michel Perron]

Exactly.

I also want to underscore the fact that we learned, as we usually do when we sit down with first nations folks, that the construct of pain is very different among first nations people. As they describe it, the intergenerational pain doesn't necessarily have to be a physical pain. It might manifest itself that way, but as we look at how first nations people have been affected by prescription drugs, and we consider mitigating some of those challenges, the legacy of intergenerational trauma is a significant component.