Health Committee on Oct. 4th, 2016

[Rachael Thomas, Conservative, Lethbridge, AB]

That's great. Thank you.

My last question then, to close it off, would come back to you, Rita.

Mr. Oliver summed this up really well in terms of the three different groups of users. I find that framework helpful. I'm just wondering with regard to young experimenters, what the recommendation would be in terms of helping to prevent the use and abuse of opioids. This is a group that I'm very passionate about.

[Rita Notarandrea]

I would look at it as preventing the use and abuse of any psychoactive substance, so I would put it as part of a bigger.... I think opioids are one of those that we're dealing with today. Meth was in the past. Heroin was in the past. I think we need to look at it as I had mentioned earlier: what are some of the prevention initiatives that are proven in the evidence that address both the risk and protective factors. We have done, with respect to different substances...you think about cannabis, for example. We need to address how we deliver those messages in a way that resonates with the youth. We're doing the same thing pertaining to alcohol, and then delivering messages that resonate with the youth pertaining to alcohol.

Your question is a good one in the sense that we need to look at different substances to tailor our messaging, but the general framework that we use is the same in terms of prevention initiatives. We need to look at risk and protective factors, but tailor our messaging based on the particular substance.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

[The Vice-Chair, Conservative, Len Webber]

We'll move now to Mr. Don Davies for five minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Geller, I'll give you a chance to answer that question. Are there any federal funds planned to give to the provinces to help them open detox or treatment facilities that you're aware of?

[Hilary Geller]

I'm not aware of funds beyond all of the existing government programs.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Assistant Commissioner Shean, I think I read that the RCMP would like to see controls brought in on high-volume pill presses in this country. Can you confirm that for me and maybe elaborate on it?

[A/Commr Todd G. Shean]

I've been involved, as I said, when legislation comes forward to inform discussions on some of the things we're seeing. I've been involved in projects in the past through my involvement with the G7 when we looked at equipment. When we are asked we inform discussions on some of the equipment being used so that a determination can be made on whether it would be appropriate to include in future legislation.

[Don Davies, NDP, Vancouver Kingsway, BC]

I think there is broad agreement from all sources that we don't have a national data collection registry. We don't really know how many people are dying of opioid overdoses. We don't have clear information on prescription practices, etc.

Mr. Diverty or Ms. Geller, either of you, what steps would you suggest we take? Do we need to have national data on this issue, and if so, how do we go about getting that data?

[Brent Diverty]

I think it's critical that we have national data. You have the opportunity through national data to understand the problem in the whole of the country, to compare our situation with that of other countries and other jurisdictions.

There are challenges. On the harm side, you have death data. Detecting that a death is the result of opioid poisoning is challenging. We're working on some guidelines for coroners, with their participation, to help standardize this. You can have dramatically different results on a death certificate with respect to the cause of death, depending on who the coroner is. We really don't have comparable data nationally, and we need to work on that.

On the drug claims side, which is one part of the supply equation, we're working towards nationally comparable data for all drug claims. We don't have nationally comparable data in private prescription claims. We only have that for three provinces at the moment, but through some of the new electronic records, drug information systems, we ought to have more complete data soon.

These are priority areas that we're working on now, and part of the investment from Health Canada is directed toward those aims.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

Ms. Notarandrea, if you could suggest one measure we could take quickly that might have an immediate effect on saving people's lives from opioid overdoses, what would that be?

[Rita Notarandrea]

After all the messages I've given about a comprehensive approach, you want me to zero in on one.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'd just like you to prioritize.

[Rita Notarandrea]

I would say the most important thing would be a national drug observatory. Included in that would be prescription-monitoring programs in each jurisdiction together with an early warning system.

We need to have the data. We have it for physical health issues. If there is a flu across Canada, we can zero in on where the pockets of flu are. We need the same kind of data for substance use disorders and for what we're dealing with today, opioids and opioid deaths. If I had to really zero in, that would be it.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I want to talk about prescribing guidelines. In the U.S., new opioid prescribing guidelines were released by the CDC in March of this year that focused on rationalizing prescribing practices and patient education. The College of Physicians and Surgeons in British Columbia has released new professional standards and guidelines closely modelled on the CDC guidelines. I'm told that the B.C. standards are more strict than Canada's national guidelines, which have not been revised since 2010, and which may be out of date with current research on taking painkillers.

I know that the guidelines are expected to be updated in January, but given the severity of the overdose crisis, Ms. Geller, do you think that we should be speeding up that process so that we can update our national prescribing guidelines?

[Hilary Geller]

The updating of Canada's national prescribing guidelines, which I think date from 2010, was one of the initiatives funded out of the 2014 budget. It is very close to finalization. I think it's going through the final peer review process, which is an important last step.

There is also a lot of work being done to ensure that these guidelines end up in the hands of prescribers very quickly after the guidelines are in place. I think that's a very important step. The U.S. Surgeon General wrote to every single physician in the United States providing copies of the guidelines in an easy-to-use form. That's certainly something we would like to see here as well.

We are hopeful that other provincial physician regulators will copy British Columbia and perhaps adopt the new Canadian guidelines as a standard of practice, because that is one of the key ways to get at one of the root causes of this problem, which is physician prescribing.

[The Vice-Chair, Conservative, Len Webber]

Thank you.

We have one more minute. I'm going to ask Ms. Xavier a very quick question.

What percentage of the postal stream that comes in internationally is tested and traced for opioids?

[Caroline Xavier]

All mail, both postal and courier, must be presented to the CBSA. We use a risk assessment lens.

In terms of any mail coming in from Asia, we are looking at it 100%, as a result of knowing that's one of our high-risk areas.

[The Vice-Chair, Conservative, Len Webber]

Once it's detected, you find the package, and obviously, it is then passed over to our law enforcement agencies. From there, do you continue on and perhaps try to make an arrest here in the country?

[Caroline Xavier]

Correct.

When we do seize a package and have determined that it has potential links to organized crime or it's breaking a particular contraband law, we work with our police of local jurisdiction or our RCMP colleagues and then share that information. From that, there are decisions that are made as to how to get to the source aspect of it.

[The Vice-Chair, Conservative, Len Webber]

Thank you very much.

I appreciate everyone coming today. That concludes our day. We will be back on Thursday to continue this study.

The meeting is adjourned.