All right.
Good afternoon. My name is Rachel Bard and I am the CEO of the Canadian Nurses Association that represents more than 150,000 registered nurses.
I will certainly be able to answer your questions in French.
A nurse's priority, above all else, is his or her patient's well-being. Whether a nurse works in a hospital or in a policy department for government, as a university professor or a researcher, the end result is always better health for Canadians.
Prescription drug abuse is a public health and safety issue across this country. According to a recent national Nanos poll conducted for CNA, nearly a quarter of respondents said they are concerned with a family member or friend's overuse of prescription drugs, second to alcohol abuse, and above illegal drug use.
Overdoses, family breakdowns, blood-borne infections, drug-related violence, and death are all very real consequences of the issue. But prescription drugs are necessary for many Canadians and can have important positive effects in their lives. The problem is not a simple one, nor is the solution.
Thank you very much for inviting CNA here today.
We have three recommendations to make: first, that the federal government support a national strategy to address prescription drug abuse, and we strongly endorse the recommendations of the First Do No Harm report from the National Advisory Council on Prescription Drug Misuse; second, that harm reduction be reinstated as a fourth pillar in Canada's national anti-drug strategy; and third, that the federal government provide for the educational and practice needs of health care practitioners, primarily prescribers and dispensers.
Our first recommendation pertains to the comprehensive, multi-faceted national strategy outlined in First Do No Harm. CNA was a member of the prescription drug misuse council. We contributed to the report and we are here today to endorse its recommendations. This report is a foundation to our recommendations today. The key aspect is multi-faceted because of the complexity of the issue. There is no simple solution and there are many challenges.
How well is the problem understood? A consistent, pan-Canadian surveillance system, including collection, analysis, and dissemination of information, is needed to better inform policy and practice.
How do we prevent and reduce rates of drug abuse? Due to the complexity of drug abuse, multi-faceted, preventive approaches must be developed and implemented. People who use drugs frequently experience physical and mental health problems and often are socially marginalized. Women, youth, and aboriginal people are especially vulnerable to the harms of drug use, often because they are coping with past trauma, such as physical or sexual abuse. Preventive measures to address these issues involve changes to social policies that leave some Canadians vulnerable, but also implementing policies that can decrease suffering.... Tackling the social determinants of health such as housing, income, education, and community connections creates stability, and that is a foundational step toward prevention.
Do patients fully understand how serious prescription drugs are? We must overcome the notion that prescription drugs are completely safe because that affects every aspect of their use: how they are taken, stored, and disposed of. The public needs to be educated about the risks.
How do we still address pain management, a very serious health problem? Just as we look to social determinants as a root cause of many health problems, we must also look to the health care system to determine what role they play. We cannot simply reduce the prescribing of controlled substances. Pain is the most common reason for seeking health care. But what about wait times, access to different health providers, and access to other types of therapy? The longer patients have to wait for surgery or procedures to correct their pain, the longer they are going to need prescription drugs. If they could have easier access to physiotherapy, occupational therapy, or counselling, could their drug dependence be reduced?
If the health care system improved access to collaborative provider teams, we could enhance the seamless, timely care we provide to Canadians. Consistent relationships and communications between providers and patients, enhanced by technology and electronic health records, allow us to better assess patient histories instead of just dealing with one episode or emergency. Similar to the surveillance system I mentioned earlier, Canada needs to implement prescription monitoring programs to ensure common definitions, reporting, and collection methods are used across all provider groups and throughout system levels.
The National Advisory Council on Prescription Drug Misuse and its many stakeholders put forth this excellent report, which contains a five-pronged approach to prescription drug abuse: education, prevention, treatment, enforcement, and monitoring. I want to underline how foundational this report can be. It contains real, actionable strategies to tackle this issue. What we need now is uptake.
Our second recommendation is that harm reduction be reinstated as a fourth pillar in Canada's national anti-drug strategy, and that the strategy be reviewed by the Auditor General every 10 years to ensure it is meeting the public health objectives. Harm reduction is a pragmatic public health approach that promotes safety while preventing death and disability. Evidence on drug use clearly shows that a harm reduction approach is the most effective method of intervention during periods of active or decreasing drug use.
As the most frequent health providers for people who use drugs, nurses are able to build trusting relationships with them, in part because we recognize that successful treatment includes acknowledging the difficulties of reaching marginalized groups with complex physical and mental health issues. We understand very well how a harm reduction approach supports client-centred delivery of care in a supportive, non-judgmental environment. They have few requirements for admission and are closely linked with much needed health and social services, as well as addictions counselling and treatment services.
In the 1980s, Switzerland was experiencing high rates of HIV and overdose deaths. Thousands of people were without access to services for their drug use issues because of too many requirements, such as abstinence. As a result, traditional health care and social systems were unable to effectively address drug use and its consequences. When services based on harm reduction principles were added to the system, immediate access was opened up to health, social, and other services that were delivered by professionals who understood addictions and were able to build relationships that led to more stability, housing, reconnecting with families, and many other positive changes.
Here in Canada, Vancouver's supervised injection site, Insite, resulted in a 30% increase in the use of detox and long-term addiction treatments. As one element in a comprehensive drug strategy that includes prevention, treatment, and enforcement, harm reduction services are essential to addressing the issue of addictions.
CNA's third recommendation is that the federal government provide for the educational and practice needs of health care practitioners, primarily prescribers and dispensers. Evidence-based information developed in consultation with providers about prescribing practices in relation to prevention and treatment of drug abuse must be available for providers. Nurse practitioners, who are registered nurses with advanced education and experience, are authorized to prescribe certain controlled drugs and substances as defined by the Controlled Drugs and Substances Act.
This development is one example of the positive steps this government is taking to open up access points to care for Canadians. However, it must be met with the development and updating of clinical guidelines that support nursing practice, and the provincial and territorial legislation and regulation frameworks that govern nursing practice. Everyone here today has a role to play in promoting a healthy Canada: health care providers, government employers, and Canadians.
The problem of prescription drug abuse and dependence is a very real one right now.
It is imperative that government and health providers start working together today to advance healthy public policies and to implement strategies at multiple levels of the system, to tackle the issues that contribute to prescription drug abuse and dependence.
Thank you for your attention.