Health Committee on Oct. 18th, 2016

[Lee Lax]

To follow up on Chris's point, what a lot of these members of society need starts with housing. Stability of housing leads to mental stability.

When you're travelling the street day to day, walking through the cold winter rains in Vancouver, you don't have the opportunity to find mental stability. You're just looking to survive. You're looking for the next place to lay your head in the evening. It's about survival. If you start with the basic needs of food and shelter, you can move your way up to dealing with mental wellness.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My other question has do to with naloxone. I know it's a temporary relief. Do you agree with it being available to remote, rural, northern, and urban communities, and being easily accessible?

[Chris Coleman]

Is it currently accessible?

[Sonia Sidhu, Liberal, Brampton South, ON]

Yes, to all the communities, if they want it, rural, urban....

[Chris Coleman]

I don't know absolutely, but I assumed it was, yes.

[Sonia Sidhu, Liberal, Brampton South, ON]

There are no barriers?

[Chris Coleman]

It's not a prescription drug.

[Sonia Sidhu, Liberal, Brampton South, ON]

There are no barriers. It's easily—

[Chris Coleman]

That's right, yes. There's a cost.

[Sonia Sidhu, Liberal, Brampton South, ON]

Okay.

This question is for the CPhA.

Do you think the over-prescribing of fentanyl contributes to the opiate crisis?

[Alistair Bursey]

I think the vast majority of the fentanyl that is causing this problem is not coming from traditional fentanyl patches that you would see for treating patients such as cancer patients. The majority of this is coming from outside of Canada in tablet form. It's slipping through, and unfortunately it doesn't take much fentanyl to be able to provide these people with euphoria. The majority of it is coming from sources external to this country.

[Sonia Sidhu, Liberal, Brampton South, ON]

We've heard that the number of fentanyl prescriptions has increased. Why is that?

[Alistair Bursey]

There was an increase in the opioid prescriptions. I'm not 100% sure if it's fentanyl, morphine, or hydromorphone. Personally, in my practice, I have not seen an increase of fentanyl being dispensed, but I can say from talking to law enforcement that we're seeing an increase in synthetic fentanyl from outside of the country. That's primarily where it's coming from.

[Sonia Sidhu, Liberal, Brampton South, ON]

We heard from previous witnesses that telling someone a drug is a strong drug makes people want it more. They want to look cool.

Can you elaborate on that? Is it a fact?

[Alistair Bursey]

Sorry, could you provide some more context for me on that please?

[Sonia Sidhu, Liberal, Brampton South, ON]

We had a witness here who said that telling someone that fentanyl is a strong drug makes them want to look cool. Is that a fact?

[Alistair Bursey]

I can certainly say that in my own practice I've never used the phrase “strong drug” to a patient. I would say this is going to provide significant pain relief or it's a medication that we have to be careful with. When we counsel our patients day in, day out, we want to make sure they're fully educated on the particular medication. If it does seem that it's an inappropriate medication, we consult with physicians and prescribers to make sure that we keep patients safe.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Mr. Webber, you have four pages of questions there.

[Len Webber, Conservative, Calgary Confederation, AB]

To tell you the truth, all four pages of questions have already been asked.

I do want to focus right now on our first responders and get some more specifics on the administration of the drug naloxone. What exactly has to be done in order to administer it to a patient? Is it an injection into a vein? I hear there's a nasal spray out there now that you can use. Can you just describe how you administer it to your patient?

[Chris Coleman]

The first responder arriving on the scene would have to establish the patient's level of consciousness, and determine that there is an overdose. Usually there are good signs because there are needles close by in an alley to determine that. Then a little pain stimuli to see if you can arouse the person. You would next assess and assist the breathing and then we have a small vial that we load the needle with and it's an intramuscular injection. I'm not sure of the dose. Sometimes you'd have to do multiple injections, but when the naloxone does take effect, you have a patient coming out of their high in 20 seconds and often quite upset you've taken their high away.

[Len Webber, Conservative, Calgary Confederation, AB]

That's very interesting. It's basically an EpiPen that you can just insert.

[Chris Coleman]

That's exactly right.

[Réjean Leclerc]

In Quebec, the situation is different. In cases like these, we use a vaporizer. The drug is drawn from a vial and put in a syringe, and a vaporizer is added to that to administer the drug through the nose. The patient then has to be monitored. Withdrawal is virtually instantaneous. The patient may be very agitated, and the sort of aggressiveness associated with that new state has to be controlled. An electrocardiogram is necessary as part of the monitoring. Depending on the quantity of drug absorbed, the antidote stops having effect after 30 to 40 minutes. If the person is still under the effects of opioids, they can relapse into an overdose. So every time, the patient has to be monitored for about 30 minutes and taken to hospital quickly.

[Len Webber, Conservative, Calgary Confederation, AB]

Great, thank you for that. Mr. Leclerc, you had mentioned that in order to administer an EpiPen of naloxone that there's a four-hour training program that needs to be done in order to learn how to administer this drug. I find that surprising that it would take four hours to be able to work an EpiPen.