Health Committee on Oct. 4th, 2016

[John Oliver, Liberal, Oakville, ON]

Thank you for your presentations.

I want to focus on changing the behaviours of the people who are illicitly seeking fentanyl and opioids. It seems to me there are three categories. There are the recreational experimental users, and I'm thinking young adults and teenagers; there are people with substance use disorders, mental health disorders, and addictions; and there's a third category of what I would call the unintended addictions from pain management.

Mr. Diverty or perhaps Dr. Sharma, have you done the analysis? I would think there are different strategies to deal with those three populations. Have you done the analysis? What's the percentage? How does that break down?

[Brent Diverty]

Thank you for your question.

We actually have a study coming out in about a month that looks at hospitalizations due to opioids, and one of the things we're seeing in that study is, in fact, that seniors and young people do have a different profile when it comes to the reason for the hospitalization. I'm talking about acute hospitalizations—

[John Oliver, Liberal, Oakville, ON]

Could you just get to the punch of the answer?

[Brent Diverty]

Sure. In the senior population you do see more of the accidental and unintended opioid poisonings. In younger people, they're more intentional.

[John Oliver, Liberal, Oakville, ON]

As a percentage, would it be 80%, or is it one-third, one-third, one-third? How would you see the distribution of this?

[Brent Diverty]

We're still finalizing the numbers for this study. That's why I can only give you the overall trend at this point.

[John Oliver, Liberal, Oakville, ON]

Right now you don't know. Okay.

Dr. Sharma, would there be different strategies? If you knew the majority were people who had unintended addictions and were now seeking them, would you have different strategies for that?

I'll come back to big pharma. Purdue, I think, for instance, has moved over to hydromorphone content, and they're still wrestling with getting that into a tamper-proof form. All provinces are using it now except, I think, for B.C.

What's the role of big pharma in educating doctors on prescriptions? Are we monitoring doctors' prescription-writing habits?

[Dr. Supriya Sharma]

I'll take the first part of the question.

If we have clear information on what the risks are, then you can have appropriate strategies. You're correct that for different circumstances there would be different strategies. The situation in Canada is more complicated than that because people may enter into a situation around use of opioids from one channel, but then it may be fluid, so that you might be moving from one place to another and, over the course of a single patient, that might change as well. I think that's why we're talking about a multi-pronged, comprehensive strategy, so that we're actually able to address various different factors simultaneously.

In terms of the role of the pharmaceutical companies, certainly they're the ones manufacturing and marketing the products, and they are partly responsible for the way that those are used. But there's also, obviously, the role of the pharmacist, the role of the physicians and the practitioners. That's why you have to address it as, very much as I said, a comprehensive strategy.

[John Oliver, Liberal, Oakville, ON]

Okay, great. So there are strategies under way to influence prescription writing. It seems that this is an increasing problem. Unintended addictions are still occurring. Have you seen any breakthrough strategies that will stop that particular group of people from falling into this behaviour?

[Dr. Supriya Sharma]

Well, from the Health Canada perspective, because we're the ones who actually authorize the medications, our goal is to make sure that people have accurate and adequate information to be able to make those decisions.

When I went through medical school, we were very trepidatious about the use of opioids. I think there was a change in terms of the use, and we're trying to re-centre the pendulum. One way is making sure that there is appropriate information that's available. As well, Health Canada is actually working with the DeGroote Pain Centre to provide guidance and guidance documents for practitioners to be able to use the medications appropriately.

[John Oliver, Liberal, Oakville, ON]

Thank you.

My last question will be for Ms. Geller.

For young kids—I don't know what percentage they are—who are experimenting with overdoses and hospitalization is occurring, it will be good to see the outcome of the study from CIHI. What are we doing at the school level of public health to talk about the dangers of fentanyl and the dangers of using the stamped green drugs that could potentially kill an 18-year-old experimenting at a party?

[Hilary Geller]

The problem with the younger people, not exclusively but in general, tends to be more about using prescription medication recreationally that they find in their parents' medicine cabinets. Surveys show that somewhere between 2% and 4% of young people use prescription medication recreationally in that way.

There has been a campaign run by Health Canada over the last number of years that's designed to get at that problem. That work will continue and as part of the minister's five-point plan, she's also undertaken to ensure that international best practices on prevention are part of our plan. It has been proven that the scare tactics, the “just say no to drugs” approach doesn't work. The approaches that do work are much more about building resiliency in very young children.

[The Vice-Chair, Conservative, Len Webber]

Thank you.

We'll have to move on now to Mr. Don Davies, for three minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Xavier, I'll give you a chance to answer that question I asked you. Why has the CBSA not responded to the B.C. task force's request to search small packages for fentanyl?

[Caroline Xavier]

The Customs Act, section 99, subsection 2, stipulates that the CBSA is not able to open packages under 30 grams. As a result, we wouldn't be able to open those packages or we'd be breaking the law.

Having said that, it is stated in the act to not open small packages without consent, so we ask for consent. If it's not received within 30 days, we work with Canada Post as well as our RCMP colleagues to determine what to do with the package. Although we can't open it, Canada Post may be able to and, working with police jurisdiction, have a different approach to deal with it. Our primary role is to ensure that it does not get into the domestic stream and that's what we do to prevent that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Would you recommend that we change that legislation to permit CBSA to open packages under 30 grams?

[Caroline Xavier]

As part of the ongoing review of our own mandate and of the work we're doing with our partners, we review legislation to see whether or not this will be one of the options in the way forward against this crisis.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I wanted to export fentanyl into Canada and I knew about this, I would be sending my fentanyl in packages under 30 grams, wouldn't I?

[Caroline Xavier]

We do use all the various detection technology tools that I talked about. My goal is to ensure that if there's something that I suspect is of that type of contraband or something that should not be entering, it does not enter the stream based on my mandate, whether I open it or not.

[Don Davies, NDP, Vancouver Kingsway, BC]

Right, but the fact is that CBSA has to sift through a package they might find suspicious and you can't open it. You have to contact the person sending it, right?

[Caroline Xavier]

Correct.

[Don Davies, NDP, Vancouver Kingsway, BC]

Leading up to this process, the best evidence that I've been able to locate is that 10% of opioid users are addicted and 30% have what's known as opioid use disorder. There's no question that physical dependence happens very quickly. Withdrawal is unpleasant and difficult. Clearly, we need a large injection of funding for treatment in our country.

Ms. Geller, are there any plans in your department to provide increased funding, so we can open up treatment facilities in this country to help people recover who are addicted to opioids?

[Hilary Geller]

Certainly, within our area of responsibility for first nations and Inuit health, there has been a significant influx of funds to improve approaches to treatment in areas where we are responsible. There's also been a significant influx of funds to organizations like the CIHR to do some extensive research on the best approaches to treatment.

Rita could speak more to that, but the CCSA is also doing work in that regard. At the provincial level, I'm aware that B.C. has been doing some innovative things. I'm sure you know more about that than I do, including the premier's announcement last week, I think, of $5 million. We are, within our area of jurisdiction, beyond the first nations and Inuit health, looking for ways to support the provinces and others in making sure that the treatment that is available is the most efficient and effective possible.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is the federal government making any funds available to the provinces?

[The Vice-Chair, Conservative, Len Webber]

Your three minutes are up, but you'll have another five-minute opportunity here to talk to the parties and we'll each have an additional five minutes.

I would like to ask one very quick question with respect to the opioid antidote naloxone. I don't know who to ask this question, Ms. Geller or Ms. Sharma, with regard to the availability.

I know our police force carry naloxone but I don't know if all our first responders do or not. Would it not be a good idea to have our safe injection sites stocked with that drug as well? Why can't it be distributed out there more than it is right now?