Health Committee on Nov. 7th, 2024

[Dr. Charlotte Moore Hepburn]

I think that we so gravely failed children and youth when novel, non-combustible nicotine products first entered the market. There was an entire generation of children who had never touched a traditional cigarette and who are now grappling with [Technical difficulty—Editor] nicotine addiction, and they did it on our watch. We cannot let that happen again.

Nicotine pouches are a novel nicotine delivery system. We do not yet understand the full physiological consequences over and above how devastating and powerful nicotine addiction can be to young people. We know that it not only affects cardiovascular health and pulmonary health, but there are long-term mental and physical health consequences that we have yet to understand. There are also the consequences associated with potential accidental or intentional overdose.

They're enormously risky, and we cannot again fail our children by not regulating them appropriately.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

I want to come to you, Mr. Thuna.

You spoke about enforcement. You said that regulations are important—I appreciate that, as a business owner, you want those regulations—but you said that there needs to be enforcement, that without enforcement they mean nothing. As I understand, that's precisely what Vanessa's Law does. It actually gives the power to recall a product in case it's not meeting the regulation.

Is it not precisely doing what you're suggesting should happen? There are regulations in place, and there's an enforcement mechanism. If we pass Bill C-368, that enforcement mechanism then is gone.

[Joel Thuna]

That's not exactly what I'm saying. What I'm saying is that Health Canada has been derelict for what I can safely say is my lifetime in enforcing the regulations with the tools they have.

I've been doing this for over 50 years. I can say that I have been a member of my family's company for 50 years. I haven't been inspected by Health Canada in 30 years. I'm in a compliant company. How on earth do you actually expect companies to be compliant if they're slightly less equipped than we are without Health Canada using the tools to help them become compliant and stay compliant?

I am actually inspected by four different agencies on a regular basis. Part of the reason we are so compliant with all four of those agencies is that I am regularly inspected. During those inspections, they find minor things that need to be adjusted, and they work with me to adjust them.

If you work on the premise that the companies are trying not to comply, then your solution.... If you're working on the premise that, as this House has heard multiple times, we are a compliant industry, then help us comply. Don't try to slap the living daylights out of us because you think we're not.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Thuna.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Thank you to all the witnesses for their informative testimony.

We move forward as we work in committee and study a bill. What I heard from all the witnesses, except perhaps Ms. Hepburn, is that, in its current state, the bill is unacceptable from the standpoint of health, specifically children's health, because of nicotine products. I've already announced that we will be moving an amendment to exclude nicotine products from Bill C‑368.

However, I heard an additional concern from Ms. Hepburn. I heard that you've been using natural health products and recommending them since long before Vanessa's Law was implemented, which was not that long ago.

Now, all of a sudden, you would have a problem recommending natural products. Why is that, knowing that the current regulations could wipe out several companies and have the unintended consequence of allowing foreign products entering the country to bypass regulations and inspections altogether?

[Dr. Charlotte Moore Hepburn]

I hope that I'm understanding your question. I'll try my best to answer it.

What I can speak to is the want for care providers, parents and patients to understand their products, the products they are buying and the products they are recommending, to be safe and effective. It has been quite a journey in the medical community to understand natural health products and the science that underscores their use. Understanding the basic pharmacokinetics and pharmacodynamics of natural health products has been a long time coming. It has only been more recently that we've had the scientific evidence base in pediatrics to quite commonly prescribe some natural health products, including things like melatonin in certain circumstances or probiotics in other circumstances.

What I can say is that it's important that we all [Technical Difficulty—Editor].

[Luc Thériault, Bloc, Montcalm, QC]

Yes, that was my understanding.

Even before the ministerial order, you were making those recommendations and using those products. Essentially, you trusted those products.

If we amended Bill C‑368 to maintain the minister's recall powers, would the bill be valid from your perspective?

What I'm trying to do is bring these different strands together to find commonalities. Vanessa's Law would not have been passed if there hadn't been issues with pharmaceutical products. You've been using those forever. There is no such thing as no risk. Pharmaceutical companies' products have many more side effects, which can be more serious and undesirable.

Why should an industry be considered on the same footing as pharmaceutical companies?

Would this amendment deal with this issue, in your opinion? The minister would retain recall powers, and we would make an amendment for nicotine products.

Would the parents you're talking about find that reassuring?

[Dr. Charlotte Moore Hepburn]

It's important that we all agree that any product that can have a therapeutic effect can have a therapeutic side effect.

You are completely right. There is not a single drug that we would prescribe that has a traditional DIN, or drug identification number, that doesn't have a side effect profile.

We don't need to think about drugs as good or bad; we need to understand drugs as being right for the right patient at the right time for the right indication in the right dose. With that frame of mind, understanding that there can always be a therapeutic side effect if there's going to be a therapeutic effect, it's important that we have equipoise in our regulatory oversight over the products we recommend.

Recall powers are incredibly important. While extremely rare events are extremely rare, they are incredibly important when that adverse event affects someone you love.

[Luc Thériault, Bloc, Montcalm, QC]

So the answer to my question would be yes. You would be reassured if we made an amendment to retain the minister's recall powers, while ensuring an appropriate regime for natural health products in terms of fines, and so on.

That's what Bill C‑368 does. It makes it possible to remove natural health products from the pharmaceutical products environment, while creating strict guidelines to ensure the safe sale and consumption of these products. Natural product companies value their reputation.

I understand that the answer to my question is yes in terms of the amendments I intend to make.

[The Chair, Liberal, Sean Casey]

Mr. Thériault, do you want Ms. Moore Hepburn to answer?

[Luc Thériault, Bloc, Montcalm, QC]

Yes.

[The Chair, Liberal, Sean Casey]

Dr. Moore Hepburn, give a brief response, please.

[Dr. Charlotte Moore Hepburn]

The regulatory protections that have been put in place over many years, most recently through Vanessa's Law, have heartened providers and provided added confidence to patients and consumers in the strength and safety of the NHP product supply in Canada.

[The Chair, Liberal, Sean Casey]

Thank you.

Next is Mr. Julian, please, for six minutes.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you very much, Mr. Chair.

Thank you to the witnesses for being here.

Your testimony is valuable and important.

As Mr. Thériault just said, we believe it is very clear that amendments must be made with respect to nicotine products. I think we all get that.

Thank you for expressing your point of view on that.

I want to start off by stepping back a little.

My question is for Ms. Butson, Ms. Patel and Dr. Moore Hepburn. This came from what Ms. Butson talked about. I was really surprised by the fact that nicotine products were approved under natural health products regulations. It was surprising to me that Health Canada would allow this product to be distributed.

My first question for the three of you is this: To what extent were you or your organizations consulted before Health Canada, under the natural health products regulations, approved these products? What was the timeline and to what extent were you consulted?

Second, in terms of nicotine products and nicotine replacement products and pouches, I want to completely understand your concerns in terms of health impacts. Obviously, it's a gateway product, but what are the health ramifications of the products themselves, the nicotine pouches? What are the consequences of consuming those products, even if the individual doesn't move on to smoking?

We'll start with Ms. Patel.

[Foram Patel]

I'll start off with the health impacts of nicotine pouches, because that is the biggest concern here. Speaking from a cardiovascular perspective, nicotine by itself increases blood pressure, heart rate and cholesterol levels. These are important biomarkers that are concerning in the short term but over the long term can also create complications leading to increased risk of cardiovascular diseases down the line.

My colleagues have also noted the cognitive consequences of it, particularly on learning and attention. Especially when kids are in school, these are important functions for them.

By itself, using a nicotine pouch without graduating to other, higher-risk products like vaping and cigarettes would still be very harmful to young people's health, which is why these are very concerning products.

To answer your first question, we weren't much involved in the consultation process in deciding on the approval of these pouches, but hindsight is always 20/20. Now that we look back, we want to make sure that, going forward, kids are protected from nicotine pouches, because we've seen the grave concerns and the implications they have on children and youth.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you.

What are your thoughts, Ms. Butson?

[Sarah Butson]

With respect to the consultation process, similarly, the Canadian Lung Association wouldn't have been involved in those consultations. Part of it is because, under the natural health products regulations, these nicotine pouches, when they applied under those regulations, were under four milligrams of nicotine, which is what took them outside of the way we traditionally regulate nicotine or vaping products and allowed them to find that laneway under natural health products. We wouldn't typically consult there.

It is one of the best examples in my experience. From being made aware of this issue and raising awareness about it to government action and getting these products off the shelves, over the span of 10 months, it was an incredible effort and one that should be applauded.

With respect to the health impacts of nicotine pouches, of course, from a respiratory perspective, our primary concern is around exposure to nicotine early on. We know that the earlier young people are exposed to nicotine, the more likely they are to develop a longer-term dependence on nicotine. We're concerned about that leading to vaping use, which we know has respiratory harms, and, of course, tobacco use. I think some of my other colleagues have alluded to this. With vaping products, in some respects, we took a wait-and-see approach to determine what those health impacts were going to be, and that really did lead to a failure, so it's important that we don't wait and see. We have the evidence in our history to know that we need to keep these protective measures in place.

[Peter Julian, NDP, New Westminster—Burnaby, BC]

Thank you.

Dr. Moore Hepburn, I have the same question for you.

[Dr. Charlotte Moore Hepburn]

I'm not sure I have much more to add over and above what the last two witnesses said. From a consultation perspective, I'm unaware that there was any pediatric input in the approval process. That would certainly not be customary when it comes to the approval of a natural health product.

I would say that when these products came to market, they were positioned as nicotine replacement therapy, a therapeutic product to help people wean themselves off nicotine. We have seen that before. That was exactly how vaping products were introduced.

I agree that we cannot wait and see. We have to learn from our grave mistakes and ensure that nicotine replacement therapy products don't accidentally or unintentionally addict a new generation of children.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Moore Hepburn and Mr. Julian.

Dr. Ellis, you have five minutes, please.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thanks very much, Chair.

I find it fascinating that we have an incompetent Minister of Health, who allowed a new nicotine-containing product to be licensed for sale in this country and now we have three out of four “activist” witnesses, I'll call them, who are clearly not concerned about a $13-billion industry that's being dismantled by the incompetent minister, but only about their niche idea. Again, if they were involved in the early decision-making, shame on them.

I also find it fascinating that Mr. Naqvi talks about nicotine pouches, but he thinks it's okay to give eight milligrams of Dilaudid to kids for free, sponsored by his government.

That being said, this does affect the definition of what a therapeutic product is, which then leads down the cascading road of Mr. Thuna—the only person here from the actual industry—whose business will be decimated by the over-regulation of an industry. We have heard multiple testimonies that say these products are overwhelmingly safe.

Again, I'll hearken back to Dr. Sharma's testimony many months ago, when the original legislation was introduced in an omnibus bill. She tried to tell this committee that these products were incredibly dangerous, and refused to provide any proof.

We heard other testimony the last time we were here about how terrible Deloitte was and how their report, which was commissioned by CHFA, could not even be trusted.

Here again, we have single-entity witnesses—one who's clearly partisan, having recently worked for a minister of the Liberal government—trying to get rid of this legislation. This is shameful.

That being said, Mr. Thuna, tell us a bit about the industry. It's a $13-billion industry. My understanding is that it's mostly small businesses like your own, and many of those small businesses are run by women as well. What will happen to all these businesses?

[Joel Thuna]

What I can tell you is that we are classified as a small business, and yet we're still larger than most businesses in our industry. Most businesses in our industry employ, from my experience, three or fewer people. A lot of them are passionate people who get into the business because of personal requirements or family requirements. Many of them are led by women; I would say, from my knowledge, if it's not 50%, it's pretty darn close. A high percentage of them are run by minorities, and many also by new immigrants.

As I said earlier, we as an industry try to comply. Overwhelmingly we try to. I can't tell you the number of times I have had conversations with companies where they've asked me, “How do you comply with this part of the regulation? How do you comply with this? What do you do?” It's an industry where, not universally but frequently, we actually have conversations with competitors on how to do things better. It's friendly competition. That's the easiest way to say it. One of my best friends, for example, is one of my biggest competitors. We regularly talk about how to comply. It's one of our discussions.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

That's great testimony with respect to the camaraderie and the desire to comply with regulations. I think you mentioned previously that if there are deficiencies at Health Canada, obviously you'll understand what those deficiencies are and will work towards correcting them—and correct them, not just work towards correcting them.

Of course, the issue with the demise of the natural health products industry in Canada is really related to online sales. As we heard in the House of Commons today, the dastardly carbon tax is also driving businesses south of the border. I mean, businesses from Canada will go either south of the border or elsewhere in the world. Of course, online sales are of absolutely unregulated products. Is that not true?

[Joel Thuna]

You can get almost anything online, be it safe, legal or otherwise, when it comes to natural health products—or, for that matter, almost any product. We see it regularly. I do many store visits as part of my job, and I can't tell you the number of times I've gone into stores and had people hand me a packet and ask, “Can you do something like this? Can you make me this? Can you do this? Where did this come from?” I would say that well over 90% of the time, they are products that are not legally available in Canada. My only conclusion is that they came from an online retailer, and a consumer brought them in saying, “I want more of these.”