Evidence of meeting #26 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A video is available from Parliament.
Liberal
Dr. Sadaf Faisal Interim Vice-President, Public and Professional Affairs, Canadian Pharmacists Association
Good afternoon, Madam Chair and honourable members of the committee. On behalf of the Canadian Pharmacists Association, I'm pleased to be here today to talk about the important issue of pharmaceutical sovereignty and how we can strengthen Canada's drug supply chain.
CPhA represents more than 40,000 pharmacists across Canada. Pharmacists are among the most accessible health professionals in the country and are often the final point of contact before medications reach the patient. As such, pharmacists see first-hand the impact that drug shortages and supply disruptions have on Canadians.
In late 2022, Canada faced a crisis as shelves sat empty of children's fever medications. Parents were forced to ration doses, travel long distances or improvise care at home. For many, a routine illness became a moment of real concern.
Drug shortages are becoming increasingly common. Each year, more than 2,000 shortages are reported in Canada, with somewhere between 1,500 and 2,000 active shortages at any given time. Pharmacists are on the front lines of managing these shortages. Our research shows that pharmacists can spend up to 20% of their day managing drug shortages—time that would otherwise be spent providing care to Canadians.
In the past few years, we have seen the number of drug shortages increase as the COVID-19 pandemic and geopolitical changes have resulted in significant disruptions to global supply chains, revealing weaknesses in Canada's manufacturing capacity. At the same time, new policies under the Trump administration, including most favoured nation policies and the threat of tariffs on pharmaceutical products, threaten to impact drug pricing in Canada and around the world.
Pharmaceutical sovereignty does not mean complete domestic self-sufficiency. Rather, it means building a resilient, diversified and reliable supply chain that reduces overreliance on a limited number of global sources. Before we can invest more into Canada's pharmaceutical manufacturing industry, we need to understand where Canada sources its drugs and raw material from.
Canada relies almost exclusively on imports for active pharmaceutical ingredients. Most of them are imported from India, followed by China, Mexico, Italy and Spain. Only 2% of APIs are manufactured in Canada. The U.S. is Canada's top trading partner for pharmaceuticals, representing 31% of Canada's imports. Around 50% of Canada's pharmaceutical imports originate from the European Union countries.
From a pharmacy perspective, six key priorities stand out.
First, Canada must strengthen domestic pharmaceutical manufacturing. There is a clear opportunity to reduce reliance on both imported drugs and raw materials. To support this shift, the federal government should strengthen relationships with diverse trading partners to ensure reliable access to APIs, while also providing targeted investment and incentives for companies to manufacture in Canada. These incentives could include expedited regulatory review processes for drugs made with Canadian-sourced ingredients and reduced review fees for domestically produced products.
Second, Canada should establish and maintain a list of medications at high risk of shortage. This action would support federal, provincial and territorial governments in planning and maintaining appropriate reserves, ensuring preparedness and continuity of care.
Third, there is a need to invest in tools, data collection and technologies to strengthen drug shortage monitoring and response. Improved data systems would enable earlier detection of supply disruptions and more effective coordination across jurisdictions.
Fourth, Canada must examine procurement practices that prioritize lowest cost over supply resilience. More balanced procurement models that value reliability, redundancy and supply security will be critical to prevent further shortages.
Fifth, we need a coordinated pan-Canadian approach, which is essential to ensure alignment across federal, provincial and territorial governments in managing supply risks and responding to shortages.
Finally, an inconsistent scope of practice across jurisdictions limits pharmacists' ability to respond to drug shortages in a timely and effective way. Enabling pharmacists to practise to the full extent of their training, including adapting prescriptions and performing therapeutic substitutions independently, would improve continuity of care and ensure more timely access to treatment for patients.
Pharmaceutical sovereignty is ultimately about ensuring Canadians have reliable, timely and equitable access to medications. Achieving this will require a balanced approach that strengthens domestic capacity, diversifies global supply, reforms procurement practices and improves coordination across jurisdictions.
Pharmacists play a critical role in managing shortages and ensuring continuity of care and must be supported to practise to the full extent of their training. CPhA looks forward to working with government and other partners to strengthen Canada's drug supply and ensure pharmacists can continue supporting patients across the country.
Thank you for the opportunity to appear today. I welcome any questions.
Liberal
The Chair Liberal Hedy Fry
Thank you, Dr. Faisal.
We now go to the question-and-answer period. In the first round, each questioner has six minutes, but this includes the question and the answer. I will try to be very tight in sticking to that timeline.
We'll begin with Mr. Bailey for the Conservatives for six minutes, please.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you, Madam Chair.
I'd like to thank the witnesses, and I'd like to take a special moment to thank Dr. Judson for five decades of service.
Thank you.
A new peer-reviewed study examined the closure, Dr. Judson, of the Red Deer, Alberta, drug site using statistically significant health data. Are you familiar with this study, yes or no?
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you.
The study found that, after the site closed, opioid agonist therapy among former site users increased significantly and exceeded levels at the comparison site that remained open.
Does this data support your view that removing supervised consumption sites can increase the uptake of real treatment?
Addictionist, As an Individual
It's not easy to answer simply.
Opioid safe consumption sites have an advantage in preventing overdoses and give an opportunity for staff to engage with patients and hopefully encourage them to move down the continuum of care to get into treatment and to make some radical changes.
Unfortunately, the closure of some centres will inevitably, depending on where they're located, lead to the movement of patients from those centres to other areas in the town where they were previously located, so you've just moved safe consumption sites to perhaps an unsafe consumption area in the city. However, with regard to whether there are going to be fewer people seeking treatment, I think this particular study was conducted over a short period of time—maybe 26 weeks—and this is probably not long enough to see the long-term effects of a closure.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you.
Another thing to note in the Red Deer situation is that when the safe consumption site was removed, a nursing station was put in its place so that people were encouraged to go for treatment and not migrate to other sites.
I think you said that so-called safe supply keeps people locked in addiction. In your opinion, has the Liberal government's expansion of safe supply simply perpetuated addiction rather than treating it?
Addictionist, As an Individual
Well, safe supply was really pioneered in B.C. in about 2012. As I said in my opening remarks, the ideal treatment for opioid dependence or addiction is to use a long-acting opioid agonist—namely, methadone. However, it has its risks and has now really been replaced by Suboxone, which is much safer, particularly for less-experienced physicians to use, because there's less risk of overdose.
Latterly, safe supply has shifted from giving three injections of an opioid in the course of a day to the patients' being dispensed a day's supply of short-acting opioids to take by mouth. They take the first daily dose when the pharmacy opens at eight o'clock in the morning, and then they're given a bottle of hydromorphone, which is short-acting, to take home. They promptly sell it or divert it in some way in order to procure a stronger-acting opioid, such as fentanyl, and that's what's causing the harm.
I can see from my own work in London that in the clinic I used to work at—which employed 22 doctors and had 1,400 patients before the abundance of these safe supply clinics came about—we were containing the use of opioids. However, now the clinic is down to six doctors and 480 patients because the majority of the patients have migrated to an office at which they can get the short-acting opioids, which effectively encourages people to keep on using euphorigenic opioids. In other words, it's keeping them locked in their addiction.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you.
In the past, you've stated that these so-called safe supply clinics exist to make money, with patients selling their prescriptions to buy fentanyl. Has the safe supply model basically created a system that pays doctors to churn out pills and flood the street with diverted drugs?
Conservative
Burton Bailey Conservative Red Deer, AB
Given the emerging Alberta evidence and the real-world harms you and many others have observed, do you believe the Liberal government's safe supply policies have failed and should be replaced with a recovery-focused model like Alberta's?
Addictionist, As an Individual
I think their policies have been an unmitigated failure.
Conservative
Burton Bailey Conservative Red Deer, AB
Thank you.
Should the study that was conducted in Red Deer be expanded to cover more areas?
Addictionist, As an Individual
Yes. Then we'll truly know about the benefit of the safe supply and whether they are redundant or not.
Conservative
Burton Bailey Conservative Red Deer, AB
I'd like you to expand on the things you've heard or seen on the ground at these sites.
Addictionist, As an Individual
Many of the patients who have been stabilized on methadone or Suboxone for many years intimated, when they came to see me before I retired, that they found it a frightening experience to come down to what was once a safe haven and tread over patients who were accessing the safe supply clinics. They were encouraging some of my patients to purchase opioids that had just been dispensed at the pharmacy.
Liberal
The Chair Liberal Hedy Fry
Time is up.
I want to caution and ask members of this committee to consider their line of questioning. We're dealing with a study on pharmaceutical sovereignty, not addiction and mental health or how to treat addiction. Be careful about phrasing your questions so that we stay in order on the study we're doing today. Thank you.
We now have Ms. Chi for five minutes, please, for the Liberals.
Liberal
Liberal
Maggie Chi Liberal Don Valley North, ON
Thank you, Chair.
I'd like to thank all the witnesses who have come today to provide testimony and support us on this very crucial study.
My first question is for Dr. Tadrous online.
First of all, your testimony was excellent. I really found it informative and intriguing at the same time. You described how we're in an “era of abundance”. This struck a chord with me. Your approach, your proposed action plan, I find really reasonable.
I want to pick your brain and ask you to maybe help us expand on this framework. You outlined a more targeted approach to pharmaceutical sovereignty, focusing on critical supplies, higher-risk medicines and economic values in this country. What would this type of precision-based national resilience framework look like in practice? How should we decide which medicines fall into which category?