Thank you. I'm Dr. Peter Selby, and this is Dr. Sproule on my left. I'm the division chief of the addictions program at CAMH.
CAMH, as you may or may not know, is the largest mental health and addiction treatment and research centre in Canada, affiliated with the University of Toronto. We have about 600 beds at the hospital, and about 48 of them are for patients with addictive disorders. We do have a large program to treat opioids addiction. We have a special program to treat people who have both pain and addictions, whether they've got the pain and addiction through recreational use or through the use of prescribed medication. We also have a specific program for injured workers.
We've been bringing out that perspective from the treatment side. We also have a large research program, as well as a large educational program. We are the providers for comprehensive education in Ontario for prescribers and other health care practitioners in the appropriate use of opioids, both for the treatment of addiction as well as for pain.
Having said that, and in working with CCSA on the report, in terms of looking at prescription opioid overdose as well as prescription opioids and the recreational use of prescriptions, there are roughly three things I'd like to say. There are three ways we can think about it.
First, we need to have the appropriate products on the market that have the least amount of risk to manage pain. We also need to have better use of the products that are lower risk on the market for managing pain as well as appropriate use of those medications for the treatment of addiction.
Second, we need to make sure the manufacturers have a monitoring program, that when they bring a product onto the market, the products is monitored. This is to make sure they follow the precautionary principle and no harm is brought to society, which is then borne by society and not by the manufacturer. Things can be done to make sure we have that level of safety when the product is coming into the market and to show what a promoter of that product needs to do.
Third, we heard a little bit about the prescribing practices. Education practices and regulatory practices need to go with those practices, to allow or to not allow prescribers to bring and use opioids for the treatment of pain, as well as for the treatment of addiction. Within practices, you do need to make sure we have a strong evidence-based and comprehensive management of pain disorders. The absence of good management of pain doesn't mean medication. It means other ancillary services required by Canadians to get back into the workforce are very necessary to make sure that people can manage.
We need to make sure there isn't a geographical divide in the access to these services. This is so that people even in remote areas don't have to resort to pills or anything like that for managing their pain, but can have things like physiotherapy, appropriate pain management to be functional again without the need for pain medications, or if pain medications are used, they're used sparingly.
Last, I would say we need to have in place policies that clearly bring in some of the regulatory aspects that have to do with how formularies are constructed and what medications are out there, that will promote the use of the least harmful but the most beneficial form of opioids for the management of pain. As well as promoting that, when these reforms are taking place, appropriate treatment for people who get addicted needs to also be in place. This will ensure there is an adequate number of providers for the treatment of addictions to help mitigate some of the effects.
In terms of policies, many were talked about, from reducing the risk of overdose by having, for example, naloxone either built into the medication or being available at pharmacies at no cost to patients who are at a high risk.
I'm now going to hand it over to my colleague, Dr. Sproule, on what role monitoring programs can play in shaping practice.