Health Committee on April 11th, 2016

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Mr. Chair.

I want to thank the minister for being here. I want to clarify too, Minister, are you here for the full two hours today?

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

I do need to scoot out at some point. Unfortunately I'm not able to stay for the full two hours, partly because of the crisis in northern Ontario. I need to go to a media interview, but my team is going to stay around and I'm happy to come back.

[Colin Carrie, Conservative, Oshawa, ON]

If you can, stay for as long as you can because we would like to get through one round of questioning.

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

I will stay as long as I can until someone pulls me out of here.

[Colin Carrie, Conservative, Oshawa, ON]

We'll get right to it then.

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

Congratulations, by the way. Is it true that you are the new health critic for your team?

[Colin Carrie, Conservative, Oshawa, ON]

I am. Thank you very much for that.

When we were in government, minister, our number one priority was the health and safety of Canadians. I did look through your mandate letter, and it didn't state this. I just want to clarify; is that still your number one priority?

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

The health and safety of Canadians...?

[Colin Carrie, Conservative, Oshawa, ON]

Yes.

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

Absolutely.

[Colin Carrie, Conservative, Oshawa, ON]

We did notice that in January you authorized Canada's second safe injection site. I was wondering if you could comment. Is there any safe or healthy way to inject street heroine into your arm, something that could be laced with anything, that could be kerosene, as far as you know?

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

I'm very glad that you brought that up. As you know, I'm very much a supporter of supervised consumption sites. I am not only a medical doctor, but I have a degree in public health. I'm a person who really believes that people who find themselves in the position of having an addiction to illicit substances like heroin need to be treated from the perspective of a public health problem because it is a health problem. It's an addiction.

I was very pleased that we were able to allow an exemption for this site. The reason I think it's important is.... As you asked, is there a safe way to inject heroin or not? Let me tell you, there are certainly unsafe ways about it. There is a serious problem of addiction across this country, and particularly opioid addiction. Supervised consumption sites have been shown repeatedly—and this has been well documented—to save lives. I'll perhaps ask my public health colleagues to reiterate this.

There is nothing that is so devastating on this issue than when I talk to parents whose kids have found themselves addicted and who have accidentally overdosed on something like heroin. If we can find ways to save those lives, then I'm going to make sure that's possible. If we can find ways to prevent infection because it is absolutely unhealthy to inject yourself with a dirty needle that might have hepatitis C or HIV on the needle, that's definitely one thing that a supervised site can help with. This is a great way for people who have addiction to access health care services.

When I was at Insite, I was moved to tears when I saw the way that people who are on the street could come in and access care, where people didn't judge them, where people didn't stigmatize them, where people said, “If we can help you, we're here to help you. If you want to talk to one of our counsellors, you can. If you want to talk about getting into safer housing, we'll help you with that.”

[Colin Carrie, Conservative, Oshawa, ON]

I agree with that, Minister, but the question was, is there a safe and healthy way of injecting street heroin? As a doctor, you come from Markham—Stouffville, and I'm sure you've worked in the emergency department. If somebody came to you with an unknown substance in a vial and asked if you would supervise their injecting this into their body, would you do it?

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

It's perhaps a little provocative the way that—

[Colin Carrie, Conservative, Oshawa, ON]

No, that's okay. I'm curious to hear what you have to say.

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

I am here to make sure that Canadians have better access to healthier and safer lives. I think we need to be very cognizant of the fact that people do inject heroin. Yes, there are safer ways to do it and there are less safe ways to do it. Do I wish people didn't inject heroin? Of course I wish that people didn't have to, but they do. And if they're going to do it, I would like to make sure that it's done safely, that it will not kill them, that they will not be infected by what they're being given, and ideally, that they might be able to eventually learn how to taper off that and to manage their addiction.

This is an area where it's not perhaps entirely intuitive to every Canadian to understand that this is the best way to go, but I am fundamentally supportive of this. I believe it's really important for us, as a country, to make sure we address the very serious opioid and addiction crisis across this country.

[Colin Carrie, Conservative, Oshawa, ON]

I think most people would agree on that ,and you've been very clear about addressing the opioid crisis, which we found curious because I think it was just last week there was a regulatory process about tamper-resistant opioids. I think you're aware, Minister, Canadians take more of these drugs than anybody around the world. There was, let's just say, a way of moving forward for tamper-resistant opioids and you've backtracked on that. I would think that we should make all these opioids tamper resistant, whatever it is, for example, fentanyl.

When people are using Oxycontin, I think you're aware, if they can't get it, they go for heroin. We're looking at the health and safety of Canadians. The way you are moving forward, do you really think that's going to help improve the health and safety of Canadians?

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

I'm going to assume you want me particularly to address the issue of tamper-resistant medication. Again, sometimes these things aren't entirely intuitive. Your first gut reaction might be that if we can provide a tamper-resistant drug, then that should be what we should enforce. Having said that, sometimes you have to dig a little deeper into the evidence. One thing I'm pleased about is that we're able to provide a comprehensive approach to drug policy. That comprehensive approach includes a number of things like educating prescribers, the public, the health workforce. It also includes making sure that we minimize the harms to people.

But on the matter of tamper resistant, something very interesting happened. In 2012 the first products of tamper-resistant Oxycontin were introduced into the market. As a result of that most provincial drug policies, not all, but most provincial plans included only the tamper-resistant version. What ended up happening around the same time, and this has been well documented, was a rise in the illicit use of other substances, particularly fentanyl, which is now our number one problem in the country.

[Colin Carrie, Conservative, Oshawa, ON]

That was my point, though. If we do not want Canadians to take these drugs—we're the number one in the world—doesn't it make more sense to make all these drugs tamper resistant because it...?

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

I wish it were possible to have tamper resistance for which it was impossible to find other routes, but the reality—

[Colin Carrie, Conservative, Oshawa, ON]

But the diversion, because of these prescriptions being left, right, and centre to criminal elements, don't you think it would be wiser not to have that option?

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

It would be wise if it worked, but the result is that the introduction of tamper-resistant products only serves to increase the use of other products on the market. You can't take a single approach to a drug. As you may know, fentanyl is a product that is intended to be given transdermally and the way it's actually used in many cases—and other medical colleagues around the room can attest to this—is that it's often tampered with and injected in other ways or accessed in other ways.

Again, this is something on which I'm very pleased with the advice I've been given by my department. I'm absolutely convinced that we're on the right track.

I don't know whether anybody.... Do you want to respond to that? My deputy minister is a huge expert in these things-—

[Simon Kennedy]

I don't know about that.

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

—so I will pass it over to him.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Kennedy, no offence, but you'll be here in the next hour. The minister has to leave and I have another question about the Respect for Communities Act.