Good morning. Thank you for the opportunity to speak.
My name is Evan Wood. I'm a professor of medicine at the University of British Columbia, where I hold a tier 1 Canada research chair. I'm also an addiction medicine physician and medical director for addiction services at Vancouver Coastal Health.
As you are aware, the costs of substance use in Canada are substantial, estimated to be over $40 billion annually. This is, of course, before the opioid crisis emerged. I think you'll be very familiar with some of the interventions required to address the opioid crisis, but I thought I would take a moment to share with you some of the structural reasons this problem has emerged and some of the structural barriers to fully and effectively addressing it.
The first issue I think Canada can really pursue, to the betterment of public health and public safety and exploring this challenge, is the fact that we have not traditionally, in Canada, as in other jurisdictions, trained health care providers in addiction care. I'll just ask you to imagine a scenario of somebody having an acute medical condition like a heart attack. They would be taken into an acute care environment. They would be seen by a medical team with expertise in cardiology. The cardiovascular team would then look to guidelines and standards to diagnose the condition and to effectively treat it. Unfortunately, in Canada, because we haven't traditionally trained health care providers in addiction medicine, we have health care providers who don't know what to do and routinely do things that actually put patients at risk. With respect to the origins of the opioid epidemic in Canada, when it comes to prescription opioids like OxyContin, clearly there has been the exploitation of a knowledge gap, leading to unsafe prescribing. Of course, the failure to employ evidence-based treatments for alcohol and drug addiction suffers from this concern as well.
In addition to the lack of training for health care providers, the overall lack of investments in this area has meant that there aren't standards and guidelines for the treatment of addiction. In British Columbia the long-standing approach to treatment of opioid addiction has been the use of methadone maintenance therapy. That approach has been disconnected from recovery-oriented systems of care and has overlooked a much safer medication in the form of buprenorphine or naloxone.
In British Columbia, within Vancouver Coastal Health, we have recently developed a guideline for the treatment of opioid addiction, using an evidence-based medicine approach to look at what treatment should be first-line, second-line, or third-line as best ways to help people recover from opioid addiction. This is something we're looking to pursue nationally through the Canadian research initiative in substance misuse, which I'm happy to talk about.
Another structural barrier I want to flag for you is that in Canada we have increasingly lumped together the concepts of mental health and addiction. While we have large mental health challenges in this country, and I certainly support approaches to strengthen a system of care for people struggling with mental illness, when we look at addiction through the lens of mental health it results in a number of concerns. The first is that funding for mental health and substance use, when it's directed in that way, overwhelmingly goes towards other mental health conditions besides substance use.
Addiction really is one of Canada's most seriously neglected diseases, and I strongly encourage you to think about funding and support that's aimed at addressing substance use being clearly earmarked for that. Otherwise, it regularly goes into this sort of mental-health-and-substance-use black hole, and addiction is overlooked. There are tangible ways of focusing energy here, which I can talk about shortly, but certainly focusing on mental health and substance use has unintended consequences.
Of course there are individuals who struggle with both mental health and substance use, but your average person who becomes addicted, whether it be to tobacco or alcohol or opioids, shouldn't be thought of as a mentally ill person. The interventions they commonly receive are more tailored toward people with serious mental illness and can actually worsen an overdose crisis. For example, there are the benzodiazepine medications that people with anxiety traditionally have been prescribed. Individuals with addiction regularly are prescribed these medications, again due to a lack of physician training. These medications themselves are associated with increased risk of fatal overdose.
I anticipate that you saw the report released earlier this week on the need for prescription monitoring programs. British Columbia actually has one of the nation's leading monitoring programs to look at prescriptions being provided by physicians. It enables us to look at the patient in front of us, see what prescriptions have been filled, and address such issues as people getting multiple prescriptions and selling medications on the street. Even in British Columbia, however, it's a reactive approach. There is the ability to establish monitoring programs where colleges of physicians and surgeons could actually look for unsafe prescribing and routinely address that concern. It's certainly something that needs to be done in Canada.
A point that I think needs to be made is that we continue to overwhelmingly treat substance use and addiction as a criminal justice issue. Ultimately that worsens public health and safety. Of course we need to support law enforcement due to the intersection between drug use and crime, but we really need to look at solutions that are evidence-based, that support addiction treatment, and that can support people in their recovery rather than take an approach that reinforces stigma and ultimately worsens community health and safety.
I'll leave a couple of take-away points with you. Then I'll be happy to take any questions.
The first point is with regard to the training of health care providers. The college of physicians and surgeons and the college of family physicians are currently pursuing these strategies. I certainly encourage you to support this. A point I didn't make earlier, which I think I'll leave with you, is that addiction is much too common a disease to be left with specialist physicians. We should really be looking to family practitioners being adequately trained in the prevention and treatment of addiction.
My next point is with regard to a focus on addiction as a disease that's both preventable and treatable, and not getting lost in this muddy mix of mental health and addiction. I would use as an example something that could be done by the Canadian Institutes of Health Research, for instance, in terms of dedicated resources toward substance use. In the United States there is a dedicated institute focused on drug use, and that's the National Institute on Drug Abuse. CIHR has no such institute. It means that Canada is kind of punching in the dark when it comes to approaches to substance use. Certainly through the Canadian research initiative on substance misuse, which is CIHR funded, there are positive things happening, but certainly we could do much more with focused intervention.
As I alluded earlier, prescription monitoring programs provide a huge opportunity to reduce unsafe prescribing and to ensure that the issues that emerged with oxycontin don't happen again. We obviously need strategies for the safe treatment of pain. We are increasingly learning that in the context of chronic pain, opioids can be very dangerous for conditions that could be addressed with non-opioid medications.
I think I'll leave it there. I'll just reinforce the point that we improve community safety and public health by treating this as a health issue. That certainly requires dedicated focus and energy, and that obviously is the point of your meeting today, so I'll stop there and thank you for the work you do.