Health Committee on Oct. 25th, 2016

[The Chair, Liberal, Bill Casey]

Okay.

Moving right along, we have Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much.

Thank you for your testimony today. As you are aware, we've been studying the opioid crisis across Canada.

Claudette, to your concern, I think our goal as a committee is to bring some concrete recommendations forward to the minister, to Parliament, and to Health Canada to address the crisis.

What I've heard is that the opioid crisis in Canada is absolutely magnified in first nation communities, both in terms of rate of use and lack of treatment.

The frame I've been using for this, which came from one of our earlier presentations in testimony, is that we need to move from a specialized model of addiction treatment to primary care. We need to have primary care physicians and nurses, providing treatment. We need a nationally agreed to and evidence-based treatment plan, so that we are all using the same frame and are moving forward on treatment. There has to be far better access to treatment programs, both from ER referrals and from safe consumption site referrals, so that people are getting follow-up and are not just left in that state of addiction.

Also, there has to be a dramatic increase—and this is what I wanted to come back to—in funding directed to treatment centres, not filtered through a mental health frame but directly to those treatment centres.

Listening to your testimony, I'm looking for specific recommendations to deal with first nation communities. What I heard was that for northern communities in particular it's going to be very difficult to get treatment programs and centres based in those northern communities. I think the terminology was “land-based”. Does that mean services right in those communities? We don't want to fly people out for treatment, right?

[Carol Hopkins]

Right.

[John Oliver, Liberal, Oakville, ON]

We want the treatment services there.

The second thing I heard was that there are significant problems with Health Canada program restrictions, particularly around scope of practice for RNs, with almost artificial time limits in terms of what service limitations they can provide.

The third was an overreliance by first nations on pilot funding and year-by-year funding. You can't get these programs established and funded and get permanent staff recruited. It's really hard to recruit people in southern Ontario on year-to-year contracts, let alone in northern Ontario or northern Canadian communities.

The fourth thing was health care worker burnout and the fact that there doesn't seem to be adequate training and adequate consultation services for the health care workers. They burn out much more rapidly in northern communities.

First of all, is that a fair summary? Those four things are differentiating a bit in first nations, without getting into root causes, without getting into why—

[Carol Hopkins]

I want to clarify. It's not just a northern Canada issue; it's first nations, indigenous communities. While in northern, remote, and isolated communities, we have transportation issues and access to stabilized health human resources, the opioid crisis is not just in remote, isolated communities, however—

[John Oliver, Liberal, Oakville, ON]

Yes.

[Carol Hopkins]

—the example being southern Alberta. In every first nations community that is dealing with an opioid crisis—

[John Oliver, Liberal, Oakville, ON]

Other than the treatment centres, the others I meant to refer generally to all the first nations.

[Carol Hopkins]

Yes.

[John Oliver, Liberal, Oakville, ON]

Besides those four, are there any others that you would add to the list that would add to the complexity of treatment in first nations?

[Chief Isadore Day]

Yes. I think integration of aftercare is one. I think it's really important to recognize that one of the bigger complex issues is poverty. Often how people get involve in addictions, for example—

[John Oliver, Liberal, Oakville, ON]

I'm sorry, Isadore, but I only have seven minutes. I totally get that there's the mental wellness framework. I actually wanted to come back and ask you a question.

[Chief Isadore Day]

Housing and social income—

[John Oliver, Liberal, Oakville, ON]

Yes.

[Chief Isadore Day]

—that's a very important piece. They're the basic needs.

[John Oliver, Liberal, Oakville, ON]

Here's my question on that. What we heard from a physician is that we need to end this crisis right now and deal effectively with the people who are suffering from quite significant addictions and overdose and death. We need to direct funding directly at the treatment programs, not through the mental health lens that sort of filters the money, and then limited funding seems to trickle through to the treatment programs.

Given that there is the first nations mental wellness continuum, and I totally understand that, is it your priority to fund that right now or to get the money into the treatment centres? If you had to choose, what would your...?

[Chief Isadore Day]

We need both.

[John Oliver, Liberal, Oakville, ON]

You need both.

[Chief Isadore Day]

We definitely need both. On this continuum, the work has been done. We have the capability. We have the experts in our communities. We need both. We need the treatment and we need to fund the continuum.

[Dr. Claudette Chase]

Could I speak briefly?

I don't think there's a problem with getting the program started in the community. I have been humbled by the skill set at the local level.

The support isn't there.

One very specific thing that I think could be done to decrease mortality is that the nursing stations are allowed to give out safer injection kits between the hours of 8 a.m. and 5 p.m., and I think naloxone should be included in those kits.

[John Oliver, Liberal, Oakville, ON]

Thank you for that.

Are there any other recommendations around treatment?

[Dr. Nady el-Guebaly]

I just want to mention that there's a crisis right now and I think the short-term solution is the long-term solution. The short terms are not as long, but people are dying every day. Something has to be done about this. Then that gives us an opportunity to think also in the long term.

One of the things we've done, I think, is that we're not satisfied with the way services are delivered in our country. I'm sure it's better than others, but we take an international perspective, and I'm humbled by the fact that I cannot think of any country that has found a magical solution, including the Scandinavian countries, which are are supposedly providing more of a social cushion than ours is. However, when you go there, opioids are there, and everything else is there, so it's really a humbling experience.

For me, it would be around overdose and longer-term education of physicians—and health professionals, by the way, not only physicians— and looking at what's evidence-based and so forth, because what we're providing right now is not evidence-based, I have to admit.

[John Oliver, Liberal, Oakville, ON]

[Technical difficulty—Editor] Big pharma: the prescription practices of physicians seem to be following through on advice, direction, and training from pharma on the use of opioids. Do you have any thoughts or comments on the role and responsibility of pharma in this crisis?

[Carol Hopkins]

They need to be held accountable for the education they provide. We've seen that history with Purdue Pharma, specifically with the misinformation they provided to prescribers related to the issues of OxyContin.

The only other one I would add to your list, now that I have the mike on, is harm reduction.

[John Oliver, Liberal, Oakville, ON]

Sorry?