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.
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
I'd like to see that in our communities.
Thank you.
Liberal
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
Thank you, Madam Chair.
I would like to start, Dr. Tadrous, by saying that I was really impressed with how you emphasize data-driven, evidence-based approaches to drug policy, as well as with your ideas for a framework in terms of prioritizing where we put our efforts when it comes to Canadian pharmaceutical sovereignty.
I'm wondering if you are aware of some of the changes Health Canada is making to the clinical trial process. We have heard in this committee, not only in this study but in previous studies, that at the present time many researchers find that clinical trials take way too long and that they're perhaps not as useful as they should be. Have you had any involvement in Health Canada's developing a more streamlined approach to clinical trials?
Associate Professor, University of Toronto, As an Individual
Some of my work relates to the growing field of real-world evidence. The idea is to use and leverage existing data routinely collected from health care visits and other data that can be drawn from the real world. That's been seen as an opportunity to bolster the ability to rapidly allow trials to exist and do studies.
One issue we're facing in drug development today is that a lot of the drugs coming to market are rare drugs that treat rare diseases, such as rare cancers. They are really innovative things, but the problem is they don't have a lot of people, so it becomes challenging to do these clinical trials in the robust way we've been used to and Health Canada has been used to.
What we're seeing from a lot of regulators around the world, such as the FDA, the EMA and Health Canada, which all work together to develop guidance and international standards, is that we need to bolster how we can do those clinical trials to allow ready access to do that. One space in which we're able to do that and unleash the data capacity of Canada is real-world evidence.
We haven't met that promise yet. Something many of us are trying to work towards is how we tap into the data that's part of our amazing health care systems in Canada—which do require some improvement—as a power for Canada, making it more involved in these global studies. This means we could get earlier access to treatments, study Canadians in these studies who might not always be included and then get access to medications earlier.
I want to make one comment that has to do with some of the comments that came before. When you're thinking about sovereignty, it's really important to consider that there are two pathways for conversations around branded, novel and new treatments and generic drugs. Clinical trials and those pieces are really important to get us new, novel treatments, but some of the things around essential medicines and capacity involve generic drugs as well. Both are important for sovereignty.
Liberal
Helena Jaczek Liberal Markham—Stouffville, ON
Thank you so much.
Dr. Faisal, to pick up on what Dr. Tadrous just said, you talked about developing a list of essential medications, and I was wondering how you might see this happening.
Actually, there was an attempt at this. Dr. Eric Hoskins, former Ontario minister of health, was charged by the Trudeau government—I think in 2015 or so—with coming up with such a list.
Could you elaborate on how you see that we might do this?
Interim Vice-President, Public and Professional Affairs, Canadian Pharmacists Association
We have been discussing this for some time now.
We can't manufacture every drug. There are a lot of drugs, so we need to pick the ones that are really essential.
There could be two approaches. We can look at the drugs that are essential in the sense that there are no alternative treatments available for them if they ran out due to a shortage. For example, right now we are seeing an oncology medication for which there is no alternative treatment available, so this would be considered something that needs to be on the essential or critical drug list.
Then there are certain drugs that people use for chronic disease management and that they have been on for a long time. It is not easy for a physician or a prescriber to switch them from one medication to another. We need to pick and choose the ones that can give us the opportunity to cover most Canadians. We can also look at the usage of the drugs, so the drugs that have been very heavily used in Canada are ones that should be included on the list as well.
Liberal
The Chair Liberal Hedy Fry
Thank you very much.
I'll go to Monsieur Blanchette-Joncas for two and a half minutes, please.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Thank you, Madam Chair.
My next question is for Dr. Judson.
In light of the opioid crisis, does our dependence on imports place patients directly at risk?
Addictionist, As an Individual
It depends on what medicines you're referring to.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
In general, could our lack of the drugs needed to treat people's problems and illnesses adversely affect their health or make it impossible to treat them?
Addictionist, As an Individual
I'm not aware of it interfering with the management of people who are addicted. The drugs used primarily for management of addiction, particularly opioid addiction—methadone and Suboxone—are readily available in Canada. As for where they're manufactured, I cannot answer.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Thank you.
Does Canada currently have the capacity to secure the supply of drugs and treat people suffering from addiction in the event of a crisis?
Addictionist, As an Individual
As far as I'm aware, they do have the ability to secure them. In fact, in my 40 years of prescribing methadone, I was never aware of any pharmacy running short of such medication.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
Thank you.
As far as you know, does Canada have a strategic stockpile or minimum production capacity to handle a crisis, for example?
Addictionist, As an Individual
I'm not aware of that. I can't answer the question.
Bloc
Maxime Blanchette-Joncas Bloc Rimouski—La Matapédia, QC
In terms of sovereignty, again, should we be doing or implementing things to ensure as much stability as possible, particularly when it comes to the opioid crisis?
Addictionist, As an Individual
The best way to manage the opioid crisis is to reduce the amount of addictive drugs prescribed to addicted people. It's the same thing as offering alcoholics free alcohol.
Bloc
Liberal
The Chair Liberal Hedy Fry
Thank you very much.
We'll now go to Mr. Mazier for five minutes, please.
Conservative
Dan Mazier Conservative Riding Mountain, MB
Thank you, Chair.
Dr. Judson, Health Canada gave $4.5 million to an organization called MySafe Society, and the money was used to operate vending machines that dispensed opioids to people struggling with addiction. As a physician, what is your assessment of the federal government's directly funding opioid vending machines as a health and addictions strategy?
Liberal
The Chair Liberal Hedy Fry
I would like to comment quickly. Let us be careful. This is not a study on addictions. Let's stick with the order of the day, which is a study of pharmaceutical sovereignty. Again, I ask members to exercise caution.
Thank you.
Conservative
Dan Mazier Conservative Riding Mountain, MB
On that, Chair, one of the previous witnesses here today talked about sovereignty, and there are two streams: new treatment and traditional treatment. This is directly talking about sovereignty and how we deal with addictions in Canada. This is what we're getting at, but thank you for the clarification.
Addictionist, As an Individual
Effectively, supplying vending machines from which patients could access their daily doses or several daily doses of opioid replacement therapy didn't last very long, as far as I know, because those people were coming in the night, smashing the machines and accessing the drugs. I think they didn't get very far. I think it was a waste of money. Again, it would have been much better to be investing the money in treatment.
It's this obsession with harm reduction. Harm reduction has been very effective in reducing the spread of HIV and hepatitis C, but it has ignored the need for what is the basis of recovery. The healthiest people in the process of recovering from drugs and alcohol are found in fellowship meetings such as Alcoholics Anonymous and Narcotics Anonymous, which are not religious—they're spiritual—and those people do not take any drugs at all. Recovery is possible without prescribing addictive substances.
Conservative
Dan Mazier Conservative Riding Mountain, MB
Thank you.
Dr. Judson, there's growing evidence that drugs obtained through safe supply programs are being diverted from patients onto the street and into the hands of young Canadians. Is diversion a problem with safe supply? What are the consequences when this happens?
Liberal
The Chair Liberal Hedy Fry
I would again ask Mr. Mazier to be careful with his questions.
Thank you.