Health Committee on Oct. 4th, 2016

[Rita Notarandrea]

Absolutely, it is. That comprehensive approach, when I referred to the “First Do No Harm” road map, did speak to all of that comprehensive approach. It did speak to prevention. It talked about consumer education and public awareness; how to have that conversation with your physician; how to speak about other options besides opioids in terms of pain management. That is one of them.

The other part of that is the physicians themselves, primary care. I did mention in my remarks about primary care not having the competencies, as they have reported, in terms of pain management, in treating and recognizing addiction, also the whole treatment continuum. I talked about prevention, education. In terms of that treatment continuum, what does that treatment continuum entail? Do we have all the evidence to support the treatment that is out there?

As I mentioned earlier, some residential treatment facilities.... I think in B.C., there was an interesting article that spoke to 150 residential facilities and some of the information they were providing to desperate families that were looking for care for their loved one. The evidence is there. I think we have to ensure that that evidence is applied all the way in that continuum, from prevention, from education, from treatment, and in recovery.

[Rachael Thomas, Conservative, Lethbridge, AB]

In your estimation, what are some of the best treatments? What would evidence show us? What should we be pursuing with regard to treatment?

[Rita Notarandrea]

It's very comprehensive. That's why I indicated I'd be more than happy to share that report. It speaks to the latest evidence and it speaks to the strength of the evidence along that continuum, including the prescribing of opioids.

[Rachael Thomas, Conservative, Lethbridge, AB]

At the end of the day, if you had to name the root cause of this opioid crisis we're seeing in Canada today, what would you estimate that to be?

[Rita Notarandrea]

I'm sorry to say that I don't think there is one cause, and I do think it's all the things that you touched on. It is about prevention. It is about prescriber education. It is the whole continuum. It is about enforcement and what more can be done there. It is about the public knowing that you don't have 40 opioids sitting in your cabinet, because three-quarters of the students said they were getting their opioids from home. I believe it is a comprehensive approach, as has been stated. There is no one solution.

[Rachael Thomas, Conservative, Lethbridge, AB]

Thank you.

[The Vice-Chair, Conservative, Len Webber]

Thank you. Time is up, Ms. Harder.

I'm going to move to Mr. Kang.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

I thank all the witnesses for coming here before the committee to address this very, very serious issue. I know in Alberta we too are going through a tough time. It's very serious in Alberta, and I wish we could get some direction from the committee to come to some resolution on this issue, and the sooner, the better.

I will pass the rest of my time on to Ms. Sidhu so she can ask a question on this. Thank you.

[Sonia Sidhu, Liberal, Brampton South, ON]

Could you clarify something briefly? Under the previous government, was Bill C-2 regarding safe injections sites a stand-alone bill that can be amended?

[Hilary Geller]

No, Bill C-2 contained a series of amendments to the Controlled Drugs and Substances Act.

[Sonia Sidhu, Liberal, Brampton South, ON]

We have heard comments from some people that the current process for applying for safe injection sites is too difficult or obstructive. I recall most recently seeing the mayor of Vancouver talk about this. I know the minister has said that there should be a review of the legislation.

Can you tell me the status of that review? What areas of the legislation could be improved if there is a review?

[Hilary Geller]

That review is ongoing, so I think it's premature to say any conclusions have been drawn yet, but we are assessing the bill, the CDSA portions that relate to the specific provisions on applying for a supervised consumption site, against the experiences we're having now.

Over a period of many months, we've had numerous discussions with potential applicants. There is actually currently only one applicant that has submitted, which is well known, and that is Montreal. Obviously, we have the most experience with Montreal, because they are furthest along. We are trying to have very detailed conversations with them to understand whether there are any specific criteria that are problematic for them. If perhaps it's just more of an issue around not really understanding what's required, as I think I mentioned earlier, they are finding it very useful, particularly when we can very accurately describe for them in the context of Insite's application precisely the type of information they need to submit.

In that context of the real lived experience we have had over the last year along with analyzing that against the legislation, we will be able to make some recommendations to the minister in due course.

[Sonia Sidhu, Liberal, Brampton South, ON]

You said just one application is currently being processed.

I noticed in particular that the discussion was headed in the direction of CDSA, and the minister recently commented regarding it. I would like to understand the impact of overdose and addiction problems on addicts and whether there are any effects on the broader community that we should be aware of. Has there been any discussion?

The question is for Rita Notarandrea.

[Rita Notarandrea]

If I understand your question correctly, you're talking about different populations that have been affected. Matthew has some more recent information, but I would say that the population we are seeing is the older adults. As well, in some of the work on utilization, we are seeing increases among youth and first nations communities. When we look at the different prescription drugs, I know we're dealing with opioids, but certainly when it comes to women, it has to do more with benzos.

There are different populations and there are different issues, and utilization is certainly showing increases, as I mentioned, in two key areas, and those are the older adult and youth, as well as first nations.

[Sonia Sidhu, Liberal, Brampton South, ON]

I'll pass my time to Ron.

[The Vice-Chair, Conservative, Len Webber]

Mr. McKinnon

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

It was nice to hear your testimony. I'd like to thank Don for his cue to me to mention that this committee was expeditious in its study of my good Samaritan drug overdose act, which will facilitate allowing people to be less concerned about calling the police.

Since I have no more time, I will leave it at that.

Thank you.

[The Vice-Chair, Conservative, Len Webber]

Sorry about that, Mr. McKinnon.

We'll move back to the Conservatives. Mr. Carrie, you have five minutes.

[Colin Carrie, Conservative, Oshawa, ON]

I wanted to point out that the Liberals seem to be focusing on safe injection sites, and the truth is they are only putting resources into that. In the budget, there was no new money for treatment, prevention, or education. One of the frustrations I have is that in Oshawa, if an addict wants treatment, he has to wait. Sometimes he waits weeks and weeks. Then he relapses before he even gets the treatment. It would be easier for him to just go to a place and keep injecting and injecting.

I just don't think, unless you put the priority on treatment, that we're going in the right direction. It was interesting to see the minister's priorities. I think that treatment was number three. I liked it when the Canadian Centre on Substance Abuse said that treatment is number one, because this whole obsession with safe injection sites.... Bill C-2 doesn't stop safe injection sites. It lets people who have the right to know have some input. If the community doesn't support the injection site, then it's not going to be successful.

I want to get back to my question for Dr. Young.

Our government was moving in step with other people around the world. I know we received letters from United States governors and the White House asking us to look at this entire class of drugs and move them toward tamper-resistant or abuse-deterrent formulations. That was where we were going. This past June, Minister Philpott, at a Toronto drug policy conference, said there was strong anecdotal evidence that the introduction of a tamper-resistant form of OxyContin in Canada caused the current fentanyl crisis in Canada. I just wondered, is this true, or is this situation more nuanced and complex than that?

[Dr. Matthew Young]

One of the things we've seen for quite some time is that there are a lot of interventions that have been put into place that will ideally, if they are effective, decrease the demand for opioids in the long term, but one of the immediate impacts they've had is to decrease the supply. I think that probably these formulations fit into one of those. One of the things is that if you have a supply that is in excess of the demand, then you have what we see now, which is organized crime stepping in and filling a market.

I don't think that directly answers your question, but that's the landscape that we're in right now.

[Colin Carrie, Conservative, Oshawa, ON]

I know that we're in that landscape now, but it seems that—and it would make sense to me, and be the proof of the pudding—once OxyContin was made tamper resistant, people couldn't use it, or it would be much more difficult to use it. If you had a strategy to make the entire classification of drugs, if they are available, tamper resistant, then that should slow down the access of diverted OxyContin or a similar type of opioids. It doesn't make sense to me. Isn't it true that generic OxyContin is available in Canada even after 2012, and that provincial regulatory colleges started to advise of shorter prescription lengths and lower opioid dosages in 2012? For those who are suffering from addiction, don't they just chase the next drug that is around? By moving away from tamper resistance, doesn't it make sense to utilize the technologies that are out there when you're looking at an overall strategy toward opioid abuse?

[Dr. Matthew Young]

Around 2014, we became aware of organized crime taking fentanyl and putting it into counterfeit OxyContin tablets. I don't know a lot of the answers to your specific question about whether that intervention was the key one that should have been done. I do know that around that time, there was a market that was satisfied by organized crime using counterfeit OxyContin tablets, and presumably that was because there was a decreased supply of diverted pharmaceutical opioids into the illicit marketplace.

[Colin Carrie, Conservative, Oshawa, ON]

I think one of the challenges now, having generics out there so readily available.... I think the governors of northern states have written to the Minister of Health. I was wondering if we could ask Border Services if we are starting to see this generic OxyContin going back and forth. Is it causing problems at the border with the northern governors? Are they getting a little upset about this?

[Caroline Xavier]

I can't speak to whether it's specific to OxyContin. I'd have to get back to you on that specifically, if that's what you're looking for. What I can tell you, as I mentioned in my opening remarks, is that we are seeing increased contrabandists trying to make their way through, for example, a courier in our postal stream, specifically. As was mentioned by our RCMP colleagues, contraband management continues to be dealt with within the larger context of illegal contraband activities.

[The Vice-Chair, Conservative, Len Webber]

Okay, thank you.

Your time is up, Dr. Carrie.

We'll move to Mr. John Oliver.