Health Committee on Dec. 4th, 2013

[Dr. Peter Selby]

Yes. That's exactly right. People end up resorting to using medicines or pain medication like opioids in the belief that this will fix the problem, and they don't have access to covered services like physiotherapy, massages, or relaxation. There are those kinds of issues, and they then resort to opioids because that becomes the easy, magic bullet solution available to them.

There's this whole issue of inequity around health care services availability in general, where people who have private insurance, for example, and are living in urban areas can access those services, whereas if you go further north they become less available. Medications, especially opioids, become the magic bullet that everybody gravitates to for management of their pain. As we've heard before, the chronic use of opioids in some situations can actually worsen the pain. We have to use it judiciously in doses that make sense, and it's not for everybody.

[Earl Dreeshen, Conservative, Red Deer, AB]

Thank you very much.

To Dr. Ulan, I've gone through some of your terms of reference for CoOPDM. This is something that Mr. Harris had spoken about, so I'll just touch on a couple of aspects of that.

I know that you're reviewing and understanding the determinants, the context, and the effect of prescription drug misuse in Alberta. As an Albertan, I was just wondering if you could go through some of those things. Also, part of your mandate was to create a model to demonstrate how the health care community, law enforcement, and the provincial and federal governments should be able to work together. This is what you started back in 2008. I'm just wondering if you could tell us a little bit about the progress that you've had in that scope within your mandate.

[Dr. Susan Ulan]

Thank you, and I'm happy to answer that.

Initially, our work began as information and data gathering from groups with lived experience in high risk areas and the focus group information from treating professionals and front-line workers. What we recognized at that time was there wasn't a lot of leadership more locally within our province, and so we held a symposium in March 2010. We brought key stakeholders, decision-makers, and leaders together. The Bruketa family was there. They were our first speakers and discussed what happened.

We really got the attention of the chief medical officer of health, who recognized this was an issue that was having a profound impact and it wasn't currently on the radar as a significant public health and safety issue in Alberta. I think that was a key measurement of success.

In order to quantify things, we have since moved forward in looking at what kind of data we have in Alberta. We engaged, first, literature review, looking at different surveillance systems around Canada and in other countries. We also had a group called OKAKI Health Intelligence. We contracted them to interview key stakeholders who had data in Alberta, so the chief medical examiner, the College of Physicians and Surgeons. We looked at the Alberta College of Pharmacists, Alberta Health, Alberta Health Services, and law enforcement.

We looked at what kind of data was being collected, what that data was being used for, and whether or not that data was being shared with other organizations, and we saw large gaps. There is good data, but it's not being utilized effectively. That was another key thing. We're moving forward with that, because we now are engaged in working in Alberta to establish a governance model that will include the groups that are at the table of CoOPDM. We're looking at how front-line workers and how law enforcement, physicians, pharmacists, patient groups, nurses, and service delivery, like addiction treatments, can actually work together more collaboratively to influence and minimize the risk of harm.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Your time is up, Mr. Dreeshen.

Mr. Aspin, for five minutes, please.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Thank you, Chair.

Thanks to our guests for coming and helping us with this study.

Particularly you, Mrs. Giudice-Tompson, thank you. You're a brave woman and we're certainly going to gain from your courage.

My first question would be for you. You've listed several recommendations here and I'd like to focus on your second recommendation to establish a multi-disciplinary, expert level, ministerial committee. Maybe you could describe or outline it for us. It's basically to assist Health Canada's regulatory process. Could you talk a bit about that and paint a picture for us of what you envision?

[Ada Giudice-Tompson]

What I was envisioning was that we have a group of experts who assist Health Canada. Right now what happens is there are clinical trials conducted by drug companies, and Health Canada accepts that information as gospel. We really don't get to see the harm or the effects of that medication until it's used by the public. We're really the guinea pigs.

In this recommendation I was hoping that we could get some experts from all the different medical fields and also people with lived experience and family, who could assist before the approval of a drug. We need more scrutiny of these drugs before they go to market. If we talk about prevention, prevention has to start at the beginning. No prescriber with all the tools that they have, all the resources that they have—there's an opioid risk tool, there are the prescribing guidelines across Canada but they reflect a lot of information that came from industry, from drug companies. We need to remove that somewhat. We need to have people at the table who have the expertise, the researchers who can say “No. This is what will happen.” We cannot rely solely on someone who makes a product to tell you when and how to use it.

Prescribers don't have the power over addiction. Patients don't have that power. A doctor can't look at you and say, “Fill out this questionnaire. I think this is a good opioid risk tool. You're low risk so I'm going to give you these opioids”, or “You're high risk and I'll give you these opioids.” All the monitoring in the world isn't going to prevent the addiction. Addiction is a progressive, worsening, sometimes fatal disease. We have to prevent it, not talk about all these issues that are more reactionary.

The monitoring programs are great. Naloxone, sure it's great. I wish I had it; I could have administered the drug to my son. Those are all reactionary. We have to go to the initial preventative, proactive way. Tell a patient what the drug is. But a doctor can't tell me what it is, and they didn't by the way. They prescribed it to my son for pain when we left emergency, because he had renal colic kidney stones, and look what happened to him. It was prescribed legitimately. There's this false dichotomy I speak about as well. They don't have to abuse it.

We need the controls to assist Health Canada with what these drugs actually are. Look at the molecular structure of heroin. Look at oxycodone. They have the same effects on the brain, on the mind, and on the body. We shouldn't be surprised that people are dying, and whether it's one person or 5,000 people, we don't need all these statistics. We should be able to do something now.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Thank you. That seems like a key recommendation to me.

I have a second question, Chair, if I have some time.

[The Chair, Conservative, Ben Lobb]

Just for you, Mr. Aspin, we'll allocate you an extra minute, sir.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Detective Harris and Dr. Ulan, according to your group, to address prescription drug misuse or abuse there is a need to eliminate scientifically unsupported, unethical, marketing business practices of pharmaceutical companies.

In your view do the marketing and business practices of pharmaceutical companies contribute to prescription drug misuse or abuse in Canada?

[Dr. Susan Ulan]

I actually don't think that's one of our recommendations. I'm wondering if that's more Ada's recommendation from her group.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Maybe to you then...?

[Ada Giudice-Tompson]

I really believe we need a firewall between industry and what prescribers are told. We cannot take at face value what they tell us about the drug.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Would you see this as an advisory group of experts?

[Ada Giudice-Tompson]

Yes.

[Jay Aspin, Conservative, Nipissing—Timiskaming, ON]

Thanks, Mr. Chair.

[The Chair, Conservative, Ben Lobb]

Thank you very much. We're right up against the clock again.

I want to thank all of our witnesses who have taken the time today to provide great insight into our study and the report that hopefully will come out of it.

We'll see everybody on Monday.

For the committee, I mentioned that we were going to do a little thing some evening. After the meeting on Monday, we'll have it in the meeting room. We don't want everybody to have to move around. If everybody could make a note of that in their calendar, that would be great. If you can make it, that's great.

We have our Christmas party tonight, so I have to go back quickly and get my hair fixed up for the event.

I hope everybody has a safe and good evening.

The meeting is adjourned.