Health Committee on April 6th, 2017

[Simon Kennedy]

To reinforce what the minister said, we certainly have been taking very seriously these recent violations around pesticides. We have begun a program of randomized sampling to keep the industry on its toes. Right now, there is a very strict list of which pesticides are authorized for use in the cannabis sector. That random program is going to be looking at that. Generally, certainly in the last number of years, we have found a very high rate of compliance in the industry. Generally speaking, as the minister indicated, a fairly heavy schedule of inspections and oversight takes place now. Obviously, we've had these incidents. We've adjusted the program to add this as a new dimension

Without in any way wanting to minimize what was discovered, the other thing I would point out—and we are taking action—is the department did do a risk assessment when these breaches were discovered.

[Colin Carrie, Conservative, Oshawa, ON]

Did you make the testing mandatory? Because, understanding from the article, you didn't. Is it mandatory that these companies are all going to be inspected? Random is good, you know, keep them on their toes, as you said. Are you inspecting these companies, and is it mandatory, yes or no?

[Simon Kennedy]

We want to see what the results of the randomized program indicate before we make a decision about what a final regime would look like. To date, we have not seen any information to suggest we need to have a program of inspecting every batch lot of every company.

[Colin Carrie, Conservative, Oshawa, ON]

No, no, but mandatory at each company.

[Simon Kennedy]

Right now, we have mandatory requirements around pesticide use, and the randomized inspections are designed to determine whether or not the companies are actually following that protocol. That's frankly pretty typical in the way in which inspection regimes function. In many regimes, you're not actually looking at every single lot, you're pulling them randomly to get a sense of whether people are following the rules or not.

[Colin Carrie, Conservative, Oshawa, ON]

How many inspections have you done?

[Simon Kennedy]

I'd have to get back to you with that. At this point I don't have it.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Chair, and thank you to all for being with us.

Minister, I want to start by congratulating your government for increasing funding to the Global Fund to combat HIV and other maladies internationally. However, I want to ask you about funding for organizations here in Canada.

Last year, it emerged that the Public Health Agency of Canada had expanded the number of agencies deemed eligible for support under the HIV and hepatitis C community action fund, but that the fund itself would remain fixed at $26.4 million. Under this new allocation, many established community-based organizations either lost funding, or had it significantly reduced. I know you have pledged to address this for this current fiscal year.

Can you confirm that the previously funded organizations, all of them, have in fact been made whole with full transitional funding for this year? More importantly, will you commit to providing these organizations the same funding in the years ahead, and to expand funding for the federal initiative on HIV/AIDS?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Thank you for highlighting this important issue. You're absolutely right, it's an issue that has global relevance and, like you, I am pleased that our country is supporting further investments in the Global Fund.

In Canada, we have a tremendous amount of work to do on these issues like HIV and hepatitis C. Like you, I'm recognizing there's more work to be done. One of the things we have increasingly done in the health portfolio is to bring together all partners, to recognize the important role that each of the members of the health portfolio have on the matter of HIV. We've increasingly made sure that the Public Health Agency of Canada is working closely with the first nations and Inuit health branch and the Canadian Institutes of Health Research, because all of the groups within the portfolio have a role to play.

In fact, we did get new investments in the budget to expand the federal initiative on HIV in the order of $30 million of new funding that will support this. That will allow us to look at the very questions that you're asking in terms of these groups that had concerns about potential funding cutbacks.

I will ask the president of Public Health Agency or Dr. Tam to clarify whether, in fact, every single organization was able to get bridge funding to make sure it continued right through until March 2018. With this new funding that came in the budget, we will of course be looking at all of those groups to make sure that we provide good, smart investments going forward to the groups that are delivering well on the ground.

[Don Davies, NDP, Vancouver Kingsway, BC]

Minister, I want to talk about the opioid crisis. As you may be aware, Vancouver Fire and Rescue Services reported 162 overdose response calls for the week of March 20, just a few weeks ago. That's a 56% increase over the previous week, where 104 calls were responded to. To date, in 2017, there have been 100 overdose deaths in Vancouver. There were 215 in all of 2016. In the first quarter, we're almost halfway there. If rates of overdose deaths continue at this pace, Vancouver will see nearly 400 deaths in 2017, double the number recorded in 2016. We know fentanyl is spreading across Canada to many communities, and that carfentanil is ever-present.

When I looked in the budget, which the government tabled a couple of weeks ago, on page 193 there is a line item that says, “Emergency Funding to Address Opioid-Related Public Health Emergencies” and it has an allocation of $16 million. This is what was allocated in 2016 to B.C. and Alberta, $10 million to B.C. and $6 million to Alberta, and nothing but zeros thereafter.

Given that the opioid crisis is not under control, and given that we have reason to believe it may even flare up, can you explain if you think it's prudent not to set aside emergency funds to deal with the opioid emergency over the years ahead? Is that a prudent way to budget?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Thank you for the opportunity to clarify the significant investments that are in budget 2017 related to the opioid crisis. You and I were both involved in the very important policy forum that took place over the last couple of days here in Ottawa to discuss this. There's no question that this is a crisis of unprecedented proportions, requiring all of our efforts to be able to address the realities that you've eloquently described in terms of the number of people who are dying.

In the time that remains, what I can say to you is yes, we provided that $16 million of emergency funding directly to those provinces that are facing the crisis in the most severe ways, but in fact there are significant new investments. The Canadian drugs and substances strategy has ongoing funding in the budget. We did not take anything away that was previously there, and it had been allocated to the level of $570 million over the next five years just for that strategy alone. We were able to bring a 20% increase to that, bringing the total investments in the Canadian drugs and substances strategy an additional more than $100 million to be able to amplify that.

I also need to make sure that you know that this is a problem that has widespread implications and requires a comprehensive response, and that's why we did things like the $5-billion investment in mental health. You know the links between mental health and the opioid overdose crisis. You also know that investments in things like housing—$11 billion to our national housing strategy—will go a long way. This is not a crisis that's going to be fixed overnight, and it requires all those social determinants of health to make sure people have access to employment, that they have access to safe housing, and that we get good health care.

I will work with you. This is not a political or a partisan issue. This is one of the most serious public health crises that we have faced in this country; we are determined to turn it around, and I look forward to working with the committee.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Minister.

I agree with all that, but the question was on emergency funding. The budget line is there. I'm just surprised the government hasn't allocated any to emergency. We could have a flare-up on this crisis next week, and the fact that there's no emergency funding budget for it is an omission.

I want to move to pharmacare and pharmaceuticals. Your mandate letter tasked you to improve access to necessary prescription medicines, and it went on to talk about looking to join in bulk buying to reduce the cost that Canadian governments pay for these drugs. You well know that one in five Canadians reports not taking medicine because they can't afford it. It has been estimated that 20% of Canadians—seven and a half million Canadians—do not have stable access to medicine they need when they need it.

So my question is this. I know you're only 18 months into your mandate, but that's a year and a half. Has access to prescription medications improved for Canadians since you have taken office?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Thank you. I know I probably don't have very much time.

I first of all want to thank the committee for your work on the pharmacare study. I'm very much looking forward to the results of that. I know the interests of you and others around the table in the matter of making sure Canadians get access to care.

What I can tell you for sure is that there has been progress made in ensuring that prescription medications are more affordable and therefore accessible, and appropriately prescribed. One of the things I can point to is the bulk purchasing plan, which we joined with the provinces and territories. That is on track to save something in the order of $700 million or $800 million a year now, bringing down the prices of those drugs and therefore bringing down the cost to the public.

I look forward to giving you more information about how we're bringing down the cost of medication overall and working with provinces and territories around things like a national formulary. These are all absolutely essential steps in making sure that prescription medications are available to Canadians.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we have Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much, Mr. Chair, and thank you very much for the leadership you've been providing for a very important file for all Canadians. It's great to have you as our Minister of Health.

My first question is around the opioid crisis that we've been dealing with, and fentanyl. It is wonderful in Bill C-37 to see a return to evidence-based harm reduction approaches to this crisis, which is a big change from what we had in place before. So with Bill C-37 coming forward, can you tell the committee, are we seeing easier access to safe consumption sites, and are we starting to see prescription changes in naloxone availability? Are you sensing a turn here?

[Jane Philpott, Liberal, Markham—Stouffville, ON]

The circumstances are a sobering reality, and Mr. Davies has highlighted some of what's actually happening. I think we are seeing good progress

However, this is a crisis that has been bubbling up for some time. To manage people's expectations, while I would like to be able to say it's going to turn around immediately, we have to realize that it's taken years to get to where we are and it's going to take some time to turn this around. I am pleased with the progress that's been made.

You asked specifically around Bill C-37, and I once again want to reiterate my thanks to this committee for your expeditious work on that. You had already studied the matter and were able to move it through. We look forward to the passage of that bill, and I hope it will be very soon. I met with the Senate committee last week, and they are still taking hearings, but I hope we will see that moved through very quickly.

A few weeks ago, I was able to announce three new supervised consumption sites in Montreal that were working under the previous legislation, but it had taken them 18 months in the application process to get to that point. We now have another 11 sites in the queue. If we can get that bill through quickly, that really changes the landscape in terms of what it requires, not only for those who are in the queue but for others who will come after them. We hope to be able to announce new sites in the future.

Also, I want to once again remind the committee that while access to supervised consumption sites in communities that want and need them will be effective in saving lives and reducing suffering associated with substance use, this is one of a whole range of measures. We always need to keep our eye on the comprehensive response to this crisis.

[John Oliver, Liberal, Oakville, ON]

We heard testimony from one of the witnesses—because we did our study on this and released our 38 recommendations—about the importance of distinguishing treatment and addiction treatment. It's often lumped under mental health, and too often the funds for addiction end up in general mental health pools. There was a very strong appeal from a couple of physicians to make sure that we address addictions and have good treatment centres available across Canada.

One of the biggest barriers right now, when people identify themselves as ready to look for treatment, is whether we can get them quickly into centres.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

I'm very pleased you raised that matter.

[John Oliver, Liberal, Oakville, ON]

I know it's provincial.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Well, it is provincial, but I think there are ways that we can signal our support to encourage expanded access to treatment for people with problematic substance use. There's no question that the matters of mental health and addiction are very closely related, and it makes sense to talk about them together. You're right, though, that the fact that we link those together because they have interrelated themes can mean that sometimes resources don't get to addictions or problematic substance use in the way that they should.

One of the things I am certainly trying to do is to indicate that we need to do far better in this country on treatment, both the mental health support treatment and social support treatment that people need, but also on the medical support for people with problematic substance use, including access to medication-assisted therapies, opioid substitution therapies, for example.

There are ways we can do it, including, I'm thinking, in terms of working with our partners in research who are helping us to look at expanded access to treatment. There are ways within our federal leadership that we can try to move that along and make sure there's better access, which there certainly is a big challenge on right now.

[John Oliver, Liberal, Oakville, ON]

Thank you.

In the estimates, there is an increase of about 30% for first nations and Inuit primary health care.

I'm wondering if you can share any recent success stories in this area. I heard there were some changes in the maternal accompaniment plan. Are there any other things like that? I know there are a lot of challenges but that you're making progress.

[Jane Philpott, Liberal, Markham—Stouffville, ON]

Again, that's a great question, because sometimes I think we don't do a good enough job talking about the good-news stories of things that have happened.

There was money in the budget last year, as you may recall, around health infrastructure on reserve. There were some good-news stories. I had the opportunity to go out to Cross Lake in Manitoba and talk to them about being able to support an expansion of the nursing station there, which they were ecstatic about. It was long overdue.

You asked about other things within the broad range of health services. I would like to take this opportunity to highlight one. You referred to prenatal issues. I have become increasingly aware of the importance of wellness at the time of birth. This goes for all Canadians, but in particular there are real challenges for indigenous Canadians. Many of them live in very remote communities and are forced to leave their communities to give birth, with essentially lifelong implications for the mothers and the children. There are two things in the budget that I am beside myself with happiness over. Number one, we were able to change the policy on prenatal escorts. Some of these young women are teenagers who have to leave their communities and give birth in a faraway city. Unless they had a medical reason for it, they couldn't bring someone with them. As they have to leave five weeks before the baby is due and stay for a number of weeks after, this was not a healthy policy. We were able to change that. Now every woman who has to leave her community to give birth is able to bring an escort with her. It's incredibly good news.

The chair is looking at me because my time is about to run out. But the other thing you need to know is that one of our longer-term goals is to be able to restore the cries of birth to remote communities in Canada—to use the words of a first nations leader—and find ways that we can expand midwifery and expand access to allow people to give birth in their homes, in their lands, surrounded by their families.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to our five-minute rounds, starting with Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Minister and staff, for being here today.

Minister, as you are likely well aware, there are hundreds if not thousands of Canadians suffering daily from Lyme disease. We know that many are more likely to have been misdiagnosed or are not getting the treatment they need. We've had conferences. We've had experts provide their opinions and recommendations. We've had public consultations. The Lyme disease community believes that enough talking has happened and now action needs to take place. We know that action is not possible without adequate funding.

Minister, can you tell us how much funding over and above previous funding has been allocated to implement a Lyme disease action plan?