Health Committee on Nov. 7th, 2024

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 138 of the House of Commons Standing Committee on Health.

In accordance with our routine motion, I'm informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

Pursuant to the order of reference of May 29, 2024, the committee will resume its study of Bill C-368, an act to amend the Food and Drugs Act regarding natural health products.

I'd like to welcome our panel of witnesses.

Today we have Joel Thuna, general manager, Pure-lē Canada. Representing the Canadian Lung Association is Sarah Butson, CEO. She's appearing virtually. From the Heart and Stroke Foundation of Canada, we have Foram Patel, policy analyst. From the Hospital for Sick Children, also appearing by video conference, we have Dr. Charlotte Moore Hepburn, medical director of the child health policy accelerator, and associate professor at the department of pediatrics, University of Toronto.

Thanks to all witnesses for being here today. You will have up to five minutes for an opening statement, followed by rounds of questions from the parliamentarians here.

We're going to begin with Mr. Thuna.

You have the floor, sir.

[Joel Thuna, General Manager, Pure-lē Canada, As an Individual]

Thank you for inviting me here today.

My name is Joel Thuna. I'm a fourth-generation master herbalist and the general manager of Pure-lē Canada, my family's small business. We directly employ 10 people in our building, and we indirectly help employ many more Canadians through our distributors, brokers, farmers and supplier network, which is in every province. For 135 years, my family has manufactured what are now called NHPs in Canada. We are a compliant company with over 500 product licences.

In my 50 years in the industry, I have seen the landscape change time and again. I testified before this very committee 26 years ago regarding the inappropriateness of Canada's regulations that treated NHPs as drugs. This committee consulted with Canadians and issued a report, “Natural Health Products: A New Vision”. In 1999, the Liberal government's Minister of Health, Allan Rock, announced that the report and all of its recommendations had been accepted by this House.

The report's guiding principles included the following:

...NHPs are different in nature from and must not be treated strictly as either food or pharmaceutical products....

NHP regulations must not unduly restrict access by consumers....

NHP regulations must not place inappropriate cost on industry, consumers and government....

Information regarding decisions and the regulatory system must be readily available to NHP stakeholders.

As an industry, we had high hopes that the resulting legislation and regulations would, once and for all, be appropriate to NHPs. The NHPD was set up. Through wide consultation, Canada achieved the enviable. We had laws and regulations that protected consumers and gave them access to the products they wanted, all with industry buy-in. Businesses were licensed and products required pre-market licensing. Repeatedly, we heard that Canada had regulations that were the envy of the world.

Over the past four years, multiple laws and regulations have been introduced without meaningful consultation or proper economic impact assessment. This patchwork system is causing me and my colleagues to question the viability of Canada's NHP sector. I was asked to estimate the cost to my small business. We estimated the first-year cost to exceed $500,000, with annual costs exceeding $300,000. These days, no small family business can survive with these additional costs.

Classifying NHPs as drugs is inappropriate. One complication of this is putting NHPs under Vanessa's Law. This is using a jackhammer to swat a fruit fly. Existing measures, such as inspection, stop-sale, seizure and licence suspension, are rarely used. Regulation without enforcement is meaningless. Health Canada has the power to suspend licences, if required. Industry is happy to consult on appropriate regulations for recall.

New requirements for drug labelling are to come into force. These regulations do not provide any new information to consumers, but rather make the packages confusing and increase costs that are going to be passed on to consumers. Additionally, these regulations will reduce the likelihood of package recycling, needlessly increasing our industry's carbon footprint.

Foreign actors see that the easiest and cheapest route for Canadians is through the personal use importation framework. A significant portion of Canadians now buy product not captured under Health Canada regulations, exposing themselves to unacceptable risks. In the past, I have questioned Health Canada: If a product is potentially harmful, how is it potentially harmful only when manufactured in Canada but not when imported? The big sticking point I have is that Canadian companies are investing to be compliant yet losing a lot of money and jobs. Canadians who buy NHPs outside Canada are bringing in a combination of products they can't get here and products they can. They do this to reduce their shipping costs. This is destroying Canada's retailers. Do you understand the depth of the problem? There are foreign companies with warehouses in Canada for their non-licensed products, so customers can get fast, no-border-issues shipments. This means no tax revenue and no Health Canada oversight.

In the end, Canadians want what they have today: access to safe, well-made products. Bill C-368, along with extensive and meaningful stakeholder consultation prior to new regulation and law introduction, is a good starting point to bring Canada back to the guiding principles that are supposed to guide all legislation and regulations for NHPs.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thuna.

Next, on behalf of the Canadian Lung Association, we will go to the screen and hear from Ms. Butson.

Welcome to the committee. You have the floor.

[Sarah Butson, Chief Executive Officer, Canadian Lung Association]

Thank you very much.

Thank you to the committee for inviting me to speak here today. My name is Sarah Butson. I'm the CEO of the Canadian Lung Association.

Our organization has spent almost 125 years focused on helping Canadians breathe. We do this by funding research, leading advocacy and providing health information to Canadians. We have a long history in tobacco control, given its devastating impact on the health of our lungs. Still today, it remains a leading cause of preventable disease and death in Canada. In particular, it is a primary cause of lung disease.

With that context, I am pleased to speak to you today regarding Bill C-368, an act to amend the Food and Drugs Act. Our concerns with this private member's bill rest primarily with the potential unintended consequences should the bill be adopted in its current form, and its potential to undo important new restrictions put in place through a ministerial order called the “supplementary rules respecting nicotine replacement therapies order”. This order restricts the availability and appeal of some orally administered forms of nicotine replacement therapies, such as nicotine pouches. This keeps them out of the hands of children and youth.

We are appearing today to urge that if Bill C-368 is adopted, it be amended so that it would not impact nicotine products.

In the fall of 2023, Imperial Tobacco Canada announced that it had begun selling nicotine pouches under the brand Zonnic. Zonnic had been approved under the natural health products regulations. Soon, these products were available at local convenience stores, sold beside candy, with enticing flavours, packaging and promotion seemingly aimed at a younger generation. It also meant that there was no minimum age of purchase, marking the first time in modern history that a nicotine product owned by a tobacco company could be sold to minors.

CLA was among a group of concerned national health organizations that immediately urged the government to take action. Swift action was indeed taken. This demonstrated the commitment by decision-makers to protect young people from the influences of the tobacco industry. These products should never have been made available in the manner that they were. As an organization that has dedicated decades to protecting lung health, we were deeply concerned and outraged about the potential for this product to hook a new generation, which may lead to a lifelong battle with nicotine addiction.

The ministerial order that I mentioned above puts in place several important measures. It ensures that nicotine pouches are available for sale only behind the counter at pharmacies, and it limits the available flavours to only mint and menthol. We know that limiting access and reducing the appeal of products are policy measures that can have an impact on the likelihood that young people will use these products.

The order also places limits on advertising and promotions, with requirements of warnings and advising statements. Importantly, this order does not negatively impact other forms of nicotine replacement therapies that are currently available—we know that the over three million Canadians who currently smoke and may want to quit may need to access those supportive cessation aids—while at the same time it ensures that a new generation is not enticed.

The ministerial order righted a wrong that should never have occurred. We want to ensure that those protective measures stay in place. As a result, we would once again urge that, if adopted, Bill C-368 contain an amendment that it would not apply to nicotine products.

I thank you for your time and consideration. I would be happy to answer any questions.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Butson.

Next, representing the Heart and Stroke Foundation of Canada, we have Foram Patel.

Thank you very much for being with us. You have the floor.

[Foram Patel, Policy Analyst, Heart and Stroke Foundation of Canada]

Thank you, Mr. Chair and committee members.

The Heart and Stroke Foundation appreciates the opportunity to appear before this committee to discuss Bill C-368, an act to amend the Food and Drugs Act regarding natural health products.

Let me be clear. The Heart and Stroke Foundation is not against improved access to natural health products. I'm here today only to address the unintended consequence that this bill would have on the regulation of nicotine pouches and on other new and emerging nicotine products that could lure children and youth into nicotine addiction.

As it stands, the bill would exclude natural health products from the definition of therapeutic products. This change would be problematic because of its implications for the government's ability to regulate nicotine pouches and other nicotine replacement products, which are currently classified as natural health products. The Food and Drugs Act applies only to therapeutic products, so if natural health products are no longer classified as therapeutic products, there would be no act under which the government could regulate all these products. This is a gap that leaves our youth especially vulnerable.

In August 2024, Health Canada adopted the supplementary rules respecting nicotine replacement therapies order. It includes many provisions intended to keep nicotine pouches out of the hands of young people, such as requiring nicotine pouches to be sold in pharmacies only and to be placed behind the counter, banning flavour descriptors that can be appealing to youth and only allowing mint and menthol flavours, adding health warnings to the nicotine pouch packaging, and banning advertising, packaging and labelling that can be appealing to young people.

Prior to this, the unregulated sale of nicotine pouches such as Zonnic posed a danger to young people in Canada. As health advocates, we are long familiar with the methods of the tobacco industry and how it uses tactics to hook young people onto its products. First, it was cigarettes and chewing tobacco. Then it was vaping. Now it's nicotine pouches that risk addicting a whole new generation.

We know that nicotine is one of the most addictive substances on earth. It affects adolescent brain development, particularly the parts of the brain that control learning, attention, mood and impulse. We now have important measures in place to protect young people from these harmful products that research has shown to be potential gateways for future use of vaping and tobacco products. However, these measures are currently being threatened by Bill C-368.

To conclude, I urge the committee members to support an amendment to the bill that would address the concerns that have been raised by health groups, especially with regard to nicotine products. We urge you to keep in place the supplementary rules respecting nicotine replacement therapies order. No one was prepared for the aggressive marketing that the tobacco industry would use to target our teens, and now we have some of the highest teen vaping rates in the world. We can't repeat this mistake with nicotine pouches. Children and youth deserve to be protected from the predatory tactics of the tobacco industry, which is now trying to skirt the rules with nicotine pouches and other nicotine replacement products.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Patel.

Next, we're going to go back to the screen for Dr. Charlotte Moore Hepburn for The Hospital for Sick Children.

Welcome to the committee, Dr. Moore Hepburn. You have the floor.

[Dr. Charlotte Moore Hepburn, Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto]

Thank you so much.

Good afternoon, everyone, and thank you for the invitation to appear.

My name is Charlotte Moore Hepburn. For the last 18 years, I've practised pediatrics at the Hospital for Sick Children, which is Canada's largest children's hospital. I'm also proud to serve as the director of medical affairs for the SickKids child health policy accelerator, where our mission is to bridge the gap between medical evidence and public policy in order to optimize health outcomes for Canadian children and youth.

As it stands, we have serious concerns about Bill C-368. We feel this bill would significantly weaken the regulatory protections over natural health products in Canada, reducing the essential safety and quality standards that are currently in place. This would fundamentally compromise both provider trust and consumer trust in all NHPs.

Since I became a physician almost 20 years ago, our understanding of and appreciation for natural health products has substantially increased. The evidence base supporting the use of NHPs has expanded over time, as has an appreciation for the importance of identifying and reporting adverse events and drug-NHP interactions. As a pediatrician, knowing that NHPs are well regulated, I'm comfortable recommending NHPs to my patients when and where appropriate. We also now actively train medical students to make sure we ask all patients, without judgment, if they are using natural health products in parallel with the therapies that we prescribe.

Should NHPs fall outside of the definition of therapeutics under the Food and Drugs Act, and should those critical regulatory standards and safeguards no longer apply, my comfort and ability to recommend NHPs to my patients would have to change.

In addition, and importantly, Bill C-368 presents a serious and immediate risk to children's health, given the current regulatory status of synthetic nicotine as a natural health product. As pediatricians, my colleagues from across the country and I see first-hand the devastating impact of nicotine addiction in our patients. We care for seventh and eighth graders who started vaping even before entering middle school, who now require professional support in their efforts to quit. We care for young people in high school with disrupted sleep, decreased appetite and poor academic performance, all of which can be attributed to their nicotine addiction.

Sadly, we've stabilized not only teenagers but also toddlers suffering from intentional or unintentional acute nicotine toxicity secondary to nicotine exposure. We failed our children so profoundly when the threat of novel nicotine delivery systems and other non-combustible nicotine-containing products first presented itself. As mentioned by others, Canada now sadly leads the world in terms of youth vaping rates.

With synthetic nicotine products like nicotine pouches now on the market regulated as NHPs, with this bill we could risk failing them again. There must be comprehensive regulatory protections in place ensuring that young people, people who have never smoked a traditional cigarette in their lifetime, never experience the harms associated with nicotine.

This bill would remove the government's current ability to keep synthetic nicotine pouches out of the hands of children, and, more broadly, it would make it more difficult for the government to regulate emerging health threats in a timely manner.

I would echo the comments from others who have testified before you. The challenges associated with the current NHP regulations, including the regulation of nicotine as an NHP, all merit robust public discussion. However, as witnesses last week pointed out, Bill C-368 doesn't solve those problems. It simply weakens our ability to ensure that NHPs are safe for use and fails the next generation of children in terms of protecting them against the well-known and well-defined harms associated with nicotine.

I'll close my remarks by asking the committee to consider the impact that this bill would have on children and their health. It's critically important that we preserve access to safe, well-regulated NHPs that serve children and families well, while at the same time restricting the sale of highly addictive substances like synthetic nicotine to our youth.

I look forward to further conversations and questions about how we can improve children's health together. Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Moore Hepburn.

We're now going to proceed with rounds of questions, beginning with the Conservatives for six minutes.

Mr. Moore, go ahead, please.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you, Mr. Chair.

Thank you to all of our witnesses who have appeared today. Thanks also for your suggestions about amendments. I appreciate your coming here with those.

Mr. Thuna, we had an appearance last week by the Minister of Health—a very animated appearance—and he made some fairly outrageous claims, one of which certainly does not reflect what I've been hearing. I would like your comments on it as someone who's very vested in this industry. He said that the new regulations on natural health products would only negatively impact “people who are negligent and wildly out of compliance.”

In your opinion, is this a true statement, or does the minister not accurately reflect the state of the natural health product industry in Canada?

[Joel Thuna]

What I will say is that I can echo what has been said before this committee: that our industry is, on the whole, widely compliant. We don't sit around and question how to avoid the requirements; we question how we can keep up and stay with them.

With regard to not having anything to worry about if you are compliant, we live in a free democracy, and in a free democracy, that's a false premise. It's akin to asking, “If you're not doing anything wrong, why should you have an issue with random stops and searches?” I have an issue with them. The reason I do is that I live in a free country that's supposed to be based on appropriate laws, appropriate regulations and appropriate enforcement. We respect the many Canadians who fought and died for our right to live free.

[Rob Moore, Conservative, Fundy Royal, NB]

Thank you.

I think you mentioned that you have 10 people employed at your location, and that's certainly reflective of what we're hearing and understanding about the industry in all corners of our many communities across the country. A lot of mom-and-pop shops and small businesses are impacted by these regulations.

Could you give some of your insights, from your perspective, on how Bill C-368 will help those shops and family-owned businesses like your own?

[Joel Thuna]

Bill C-368 will make it so that we have an environment similar to the environment we've been living under since the creation of the natural health products directorate. That is an environment where we know what is required of us. We know essentially what the goalposts are and we know how to meet these requirements. The problem is that once you start moving the goalposts and keep moving them, it's uncertain. With uncertainty, you're virtually creating a guarantee that companies that are trying to stay in compliance will not physically be able to.

We're a small company. We're actually larger than most of the companies in our industry on a number-for-number basis, but we're still a very small company. We're very proud of that. We do an awful lot with our small staff, and we're proud of that. The biggest challenge we have is keeping up and maintaining our high level of compliance, with the number of people we have.

[Rob Moore, Conservative, Fundy Royal, NB]

We're very concerned about keeping as many businesses—small, medium and large—as possible in Canada. In today's day and age, businesses can move. What we've heard from industry in a survey that was done is that up to 20% of businesses would consider moving in the current context.

If Bill C-368 doesn't pass, what does the business case in Canada look like versus international competitors?

[Joel Thuna]

There's not much of a business case for Canada if this bill doesn't pass. If everything Health Canada and the government say they're going to put through goes through, there's not much of a case for staying in Canada.

To add to that, there is the aggressive nature with which American states are pursuing us. I, for one, have been approached by multiple states willing to give me the stars, the sun and the moon to move. They are willing to help in immeasurable ways economically to make it a no-brainer decision.

[Rob Moore, Conservative, Fundy Royal, NB]

Finally, you mentioned in your opening comments that the government's approach is “using a jackhammer to swat a fruit fly.” Can you elaborate a bit on that and what could be done rather than this approach?

[Joel Thuna]

As a member of the industry, I would be more than happy to sit down—and I know many of my colleagues would be as well—with the government to work out a realistic and appropriate recall measure and system for natural health products.

Having said that, before that even begins, the government, through Health Canada, should actually start using the tools it has. Having regulations without enforcement is like saying, “Nobody go over 60 kilometres an hour, but there will be no radar and no police officers. We're going to just hope and pray that you don't.” How many of us think that's actually going to happen?

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thuna.

Thank you, Mr. Moore.

Next, we'll go to Mr. Naqvi for six minutes, please.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

I want to thank all the witnesses for being here and for their testimony.

I also want to put on the record that we're dealing with Bill C-368 here. It deals with Vanessa's Law, which does not deal with the issue of cost recovery or labelling. I think the 20% number of businesses leaving was in relation to cost recovery and labelling.

Let me start with Dr. Moore Hepburn.

Thank you for your testimony. You said that you have serious concerns if this bill passes. You said it would undermine “provider trust and consumer trust”. I think that was your testimony.

In a brief that was submitted to the committee by the Canadian Medical Association, they took the position that “decisions regarding health care products, including NHPs, should be based on sound scientific evidence.” Do you agree with their evidence?

[Dr. Charlotte Moore Hepburn]

Absolutely. I can say that parents, patients and their care providers all need and want assurances that the products they would discuss and recommend are safe.

When you're talking about regulating all therapeutic products, we start on a foundation of solid scientific evidence. We build on that safety and quality, as well as regulatory oversight, to ensure that patients and consumers can be protected when need be.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

CMA also stated in its written brief, “Completely removing NHPs from the definition of therapeutic products would effectively eliminate oversight of this industry and expose Canadians to unnecessary risk.”

Do you agree with that statement?

[Dr. Charlotte Moore Hepburn]

I think it's important that we recognize how, over the last many years, the ability and the confidence of medical providers to discuss and recommend natural health products for the right patient at the right dose at the right time has significantly increased. I would be concerned that if we dial back on regulatory protections, a lot of that trust would be compromised.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

You also indicated that you feel strongly that Bill C-368 would undermine the ability of government to protect young people from a number of potential health threats.

Can you, for our benefit, elaborate further on the risks of passing Bill C-368 in its current form?

[Dr. Charlotte Moore Hepburn]

Most immediately, as the other witnesses have spoken to, the risk of synthetic nicotine is tremendous for Canadian children and youth.

I think all of our breath was taken away when Zonnic appeared on convenience store shelves. The idea of legally selling a product manufactured by the tobacco industry in a berry flavour to young children is truly breathtaking. Thanks to this government, with the collaboration of national health organizations, we were able to put into place protections to make sure that young children would not cause themselves undue harm as a result of these products.

Any move forward in the natural health product space must take into consideration the fact that nicotine replacement therapy and now novel nicotine-containing products like nicotine pouches are included in that regulatory oversight mechanism.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

I'm sure you were probably concerned that, as I heard from many conservative MPs, including Dr. Ellis, they are against the action the government is taking to keep nicotine pouches out of the hands of children.

Why do you think this action is so important to protect our children?