I am pleased to rise, Mr. Speaker, especially after the two hon. members who spoke before me.
In my question to the Conservative member who is the sponsor of the bill, I raised some of the concerns I have with this bill. However, I will support it since the change to the regulations allows Health Canada to require drugs to be resistant to tampering and abuse. This is not mandatory, but Health Canada can opt for this requirement. It is not mandatory if the effectiveness of the drug is not proven or if there is a concern that it will drive up the cost too much. However, this bill gives Health Canada the option and that is why I will support it.
The bill introduced by my colleague seeks to respond to the problem of substance abuse, mainly fentanyl, a very powerful substance compared to other drugs in the same family. Other opioid analgesics have been on the market for a long time and are generally used more than fentanyl.
As many of my colleagues know, I was a nurse. In the vast majority of cases, when doctors prescribe drugs to people at home, they prescribe Dilaudid, which is hydromorphone, or morphine, which has been in use for a long time. Fentanyl is rarely prescribed to people living at home. It is mainly used right in the hospital and is rarely prescribed elsewhere. It is typically administered by injection in a hospital setting or by skin patch for patients with cancer or terminal illness.
Other opioids are used too. One of these is Demerol, or meperidine, which has been around for a long time, but is not used much because of its serious side effects. Another is oxycodone, which has also been associated with overdose and addiction, and codeine, a medium-strength opioid typically used to treat more moderate pain that is not severe enough for morphine.
Most of the people who are prescribed a drug go home with hydromorphone or morphine, generic versions of which are available for the reasonable price of about 40¢ to 50¢ per pill.
Long-acting tablets, on the other hand, can be much more expensive. For instance, tamper-resistant medication can easily cost between $10 and $20 per tablet. Forcing people to use these products could have a serious impact, given that they are much more costly. In addition, these products are often under patent protection, because the fact is, pharmaceutical companies work very hard to develop these drugs.
The most common form of tampering is crushing the drug in order to snort it or inject it. In most cases, patients with a legal prescription are not the ones doing these things, but rather people who steal the drug from patients they know. For instance, some people might raid their grandmother's medicine cabinet to see what they can get. Sadly, these people will steal from their friends and family.
Some measures could be introduced in terms of prescription practices, for instance, and the services offered by pharmacists. It could be a question of giving patients smaller amounts of medication. Perhaps they could be given a week's worth at a time, rather than a month. We need to find ways to ensure that smaller quantities of drugs are found in peoples' homes. This would also mean that patients would be less likely to be robbed.
We also need to educate patients about this phenomenon. They could be told not to keep their medication in plain view, for example, on the kitchen table where everyone can see it. We could try these kinds of measures.
As for skin patches, I have heard stories of people using syringes to pull out the liquid from inside fentanyl patches. It is extremely dangerous. With these kinds of practices, an overdose is almost guaranteed. That is another serious danger.
It is entirely appropriate to want drugs with tamper-resistant properties. My only fear is the higher cost for patients, especially when we are talking about terminally ill cancer patients. They should not find themselves in situations where they can no longer pay for their medications.
We could also work on doctors' prescribing habits. People could be prescribed drugs that are less likely to be stolen. For example, I believe that oxycodone should be used as a last resort when prescribing opioids. The use of this drug should be limited.
Clearly, there needs to be some soul searching if injectable drugs are being used at home, unless they are required for home palliative care, which usually does not last very long. We should perhaps limit as much as possible the use of pills at home. We could ensure that pharmacies only dispense small quantities to avoid having large quantities in people's homes and to prevent others from being tempted to take the medications after the patient's death.
We could also be more proactive when a patient dies. The pharmacy could request that the medication be returned so that it is not left in the home. That could prevent someone from searching and finding these drugs. There are several modest measures that we could put in place.
There are drugs, in pill form, that are available for a reasonable price and that limit problems. For example, there is long-acting morphine. Inside those capsules are tiny beads that are almost impossible to crush. Therefore, people cannot snort or try to inject them. This type of pill is sold at a fairly reasonable price compared to the tamper-resistant forms that can be used.
We can put several measures in place. I think that it would be worthwhile to move more and more toward tamper-resistant forms, particularly for molecules that are especially likely to be used by addicts and in cases where the molecules are already patented in their other form so to speak.
However, we must also not make it harder for patients to access medication. I think that my colleague's bill is balanced because it allows Health Canada to take action, but does not require it to do so. Health Canada would therefore have the freedom to determine whether the risks outweigh the benefits. It will have the flexibility to proceed if necessary. I believe that this approach is well balanced because it is cautious enough to provide some flexibility, which will ensure that patients are not deprived of treatment.
We must also give ourselves the means to act in the event that the benefits outweigh the risks.
I thank the House. I was pleased to be able to speak to this issue.