Christine Moore

[Criminal Code, October 24th, 2017]

Mr. Speaker, what I am saying is that the experts do not agree when it comes to serum level limits. It is extremely difficult to prove that a specific dose will cause a person to be impaired.

In other scientific tests, in the case of cognitive tests, for example, if you ask a person to perform a task that he or she cannot do, you can prove scientifically that the person is not fit to drive. It might be simpler for the government and the police to use these types of tests to prove that a person is unable to drive, because there would be a direct link between the task and the person’s ability to drive. Let us say that a person is required to have certain reflexes. If we test the person’s reflexes and determine that they are too slow, we are making a direct link between substance use and reflexes that are slow enough to raise questions about the person’s ability to drive. It is also much easier to prove in court than obtaining a blood test.

Also, you may have to wait an hour or two before you can do a blood test in some rural regions. As an emergency nurse, I am resuscitating someone, so my priority is not to do a blood test to determine a patient’s serum THC level. My priority is to save a life.

When we administer a standardized test, we do it right away and we get the proof we need. It is far more difficult to challenge, because we have a video of the person failing to perform physical tasks that show that he or she is unable to drive.

[Criminal Code, October 24th, 2017]

Mr. Speaker, I am pleased to rise to speak to this important bill, which deals with impaired driving. Impaired driving is a major problem on our roads and a very serious issue that we must consider.

That is why the NDP chose to support Bill C-46 at second reading, even though we still have some unanswered questions. Personally, I must admit that I have not yet decided what my final vote will be after report stage and third reading.

Second reading is often the step where members decide whether the underlying principle of the bill is important. This bill deals with impaired driving. It seeks to do more to prevent impaired driving and to go after those who choose to drive while under the influence. There is no doubt that the underlying principle of this bill is important. At third reading and report stage, members must determine whether the bill really supports that principle. Right now, I have my doubts, and I will explain why by talking about the medical concept of drug tolerance.

For instance, when one drinks alcohol, one's body becomes habituated, but it does not develop a tolerance. We cannot say, for example, that if someone does not drink alcohol and then starts drinking every day, he will be able to drink 40 times more without any effect because he is habituated.

Alcohol does not produce a tolerance effect; the same dose will always have the same effect. For example, we can expect someone who drinks three beers to present certain symptoms, and we can expect someone who drinks five or six alcoholic beverages to display other symptoms. The clinical picture is pretty clear. There can be small variations from one person to the next, but they are minor.

Some drugs, however, can produce a tolerance effect. This means that the body becomes habituated and that larger and larger doses are needed to produce the same effect. Morphine and fentanyl patches are good examples of these types of drugs. A cancer patient will be given a certain dose, a fentanyl patch, and this should relieve the symptoms. However, as the illness progresses and the patient takes the drug over a longer period of time, the body becomes habituated and the patient needs larger and larger doses to obtain the same relief.

A test was conducted on a cancer patient. He was given fentanyl patches until he felt relief. If he was still in pain, he was given a larger dose. Eventually, he was able to tolerate 140 fentanyl patches. I can assure the House that if anyone here were given a dose that size, he or she would die on the spot. That is an example of the tolerance effect.

That is why it is difficult to establish a dose of medication or any other substance that produces a tolerance effect because the results change depending on the person, the dose, the time and the causes. It is extremely difficult to establish dosage limits to determine at what point a person will be impaired or at what point it would be dangerous to increase the dose, because the tolerance effect changes for the patient during treatment.

Marijuana appears to have somewhat of a tolerance effect, which means that its effect will be completely different depending on the person.

So, even if you set serum level limits, a person who took a legal dose may be completely unaffected, while another person who took the same dose may be totally dysfunctional and impaired. Some people could take a quarter of the legal dose and be extremely dangerous on the road. So, if we set an arbitrary limit, we might not be able to convict drivers who did not exceed the legal dose but who are still impaired and in no condition to drive. We also risk convicting drivers who are not impaired because their body has developed a tolerance.

By establishing a serum level limit, I think this bill will cause problems with cases that go to court. I spoke with a few defence attorneys, and they told me that no scientific studies have been able to establish a specific dose that can determine whether a person is impaired.

In my opinion, if we want to prove that a person is impaired, we might have to consider other avenues with respect to drugs such as marijuana that produce a tolerance effect. For example, we could use the same tests and tools police officers use to detect the presence of drugs. That is a good test. If we suspect that a person has used marijuana, we could administer the test and determine if we are correct.

In this case, the level does not matter. We would merely have to detect the presence of drugs, which we could prove, then we could administer standardized tests like the ones used for drunk drivers. For example, we could ask the person to walk a straight line or recite the alphabet backwards. There are a number of similar tests that we could use to prove that the person is impaired.

If we relied more heavily on these tests, which, incidentally, can be filmed using body cameras, we would be able to prove that a person is impaired because he or she does not have the cognitive or physical ability to perform certain tasks that a person who is not impaired could. This might be an option that would carry more weight in court.

That is why I question this bill, because it appears obvious that we cannot pass a bill without knowing whether the cases that make it to court will lead to accusations and convictions. There is no point in passing a law if we are going to get clobbered in court. We are in a situation where cannabis is legal and we do not have the tools we need to get convictions when someone is caught driving under the influence.

These questions are the reason I still do not know how I am going to vote in the end. We cannot ignore the fact that THC effects individuals differently. We must also consider the fact that people are already using marijuana for medicinal purposes and that regardless of whether or not legalization occurs, we still do not know how to determine whether a medicinal marijuana user is impaired. It is clear that blood levels are not a reliable measure. We need to consider other tools that would more effectively help determine if a person is impaired and would give crown prosecutors a better chance of getting convictions.

We have a lot of work to do to get a better grasp of this issue and I think we need to base our decisions on science, as with anything else. So far, the science is telling us that there is no blood test that can determine with 100% accuracy that a person is impaired by marijuana since there are too many interindividual variations. We have to find another way to determine whether a person is impaired.

[National Defence, October 23rd, 2017]

Mr. Speaker, today CBC/Radio-Canada reported that the sexual assault conviction rate is much lower in the military justice system than in civilian courts.

In addition, victims do not enjoy the same legal rights and protections. More often than not, the alleged offenders get a slap on the wrist and carry on working in the same place as their victims. The consequences are administrative, not criminal. It is not like in a civilian court.

Can the Liberals understand the impact on victims in the armed forces and provide them with better support?

[Petitions, October 6th, 2017]

Mr. Speaker, I wish to table a petition today that calls on the government to eliminate the federal tax, the GST, on essential baby products.

In my opinion, the GST has always been a tax that should apply only to non-essential luxuries. Diapers are essential for babies. No baby can go all day with a bare bottom, which is why it is completely unfair to parents to charge GST on diapers.

The petition also includes basic breastfeeding products. We need to encourage mothers to breastfeed given how beneficial it is for babies' health. By removing the federal tax on products needed for breastfeeding, such as breast pumps, the government would demonstrate its goodwill and encourage breastfeeding.

[Navigation Protection Act, October 6th, 2017]

moved for leave to introduce Bill C-366, An Act to amend the Navigation Protection Act (Abitibi and Témiscamingue regions).

Mr. Speaker, I am pleased to reintroduce this bill, which would address the cuts that the Conservatives made to the Navigable Waters Protection Act. These cuts left the majority of our waterways unprotected, even though they had been protected for years by one of this country's oldest acts.

Today, I am introducing a bill to protect the most important waterways in my region. There are around 50 of them. Some are watersheds, and others are part of the Algonquins' traditional canoe routes. Thousands of people used these waterways to reach previously unexplored lands. There is no doubt that these waterways are in need of protection.

I sincerely hope that these waterways will be protected again one day; they are so important to my region.

(Motions deemed adopted, bill read the first time and printed)

[Employment Insurance, October 6th, 2017]

Mr. Speaker, with winter approaching, seasonal workers in New Brunswick are feeling anxious because the Liberals abandoned their promise to deal with the spring gap. Workers and their families may find themselves without income for weeks in the very dead of winter. The Liberals are telling them to cross their fingers and hope the unemployment rate goes up so they will be eligible. What a boneheaded approach.

When will the Liberals do the right thing and keep their promise to deal with the spring gap once and for all?

[Hunting in Abitibi-Témiscamingue, October 6th, 2017]

Mr. Speaker, thousands of men and women are getting ready to head into the woods of Abitibi-Témiscamingue today for the opening of the hunting season. Moose hunting is a major industry in Abitibi-Témiscamingue, with some 24,000 permits issued annually. In many villages, life revolves around the hunting and fishing seasons. Last Saturday, I returned to Moffet for the hunter's mass, a more than 35-year-old tradition honouring nature, where the local church serves as a gathering place for hunters, not to mention the beavers and moose in attendance.

In addition, many children are getting ready for their first hunt. I hope they will be left with a favourable impression of this noble activity, which belongs to a tradition thousands of years old for the first peoples of this country. I would therefore like to take this opportunity to wish all hunters a safe and successful hunt and remind them that alcohol and firearms do not mix.

To all hunters, may your aim be straight and true, because, as the French proverb goes, you cannot sell the bear's skin until you kill the bear.

[Business of Supply, October 5th, 2017]

Madam Speaker, I thank my colleague for his question. I can say a few words about what I often see and what patients tell me.

Some of the patients I see in the emergency room or in intensive care tell me they cannot afford certain drugs, because even with insurance, they still need to cover 20% of the cost. I have heard patients admit to cutting their pills in half or taking their medication only every other day.

When a patient is prescribed a drug, they need to follow the dosage instructions. If patients do not take their medication as directed, not because they do not want to, but because they cannot afford to, they are not going to get better. Speaking as a health professional, we find it extremely difficult to deliver proper care to patients who are unable to follow their recommended course of treatment, not out of ignorance or a lack of understanding, but simply due to financial constraints.

[Business of Supply, October 5th, 2017]

Mr. Speaker, that is exactly what I do not understand.

All studies point to a universal pharmacare program. All the scientific evidence points to that, so I do not understand why they are not willing to get on board and support the bill. As a health professional, I can now prescribe certain drugs, such as birth control pills, because graduate nurses have made some strides in Quebec.

As a health professional, I learned to interview patients and choose the best drugs for them, but my choice is influenced by the fact that I may have to choose drugs that are covered, which is against professional standards. We want to make the best possible decisions for our patients, but we have to look at which drugs are covered. That means we are not making the best choice in terms of health; we are making the best choice in terms of what is covered and what the patient can afford. Sometimes the treatment we provide is less effective as a result.

[Business of Supply, October 5th, 2017]

Mr. Speaker, I am happy to speak today to the motion of my colleague, the member for Vancouver Kingsway, because this is something that is extremely important to understand. It is something that would allow us to do so much for the health of Canadians.

Listening to all the members who spoke before me, it was clear that none of them had any doubt that implementing universal pharmacare in Canada would save us millions of dollars. I do not want to dwell too much on this point because it is so obvious. All the studies show that there would be savings to be made. No one has ever said that it would cost us more than the current system. Since that has been laid out very clearly, I will not dwell on it any further.

Someone also mentioned the system in Quebec, the first one in Canada. Quebec's system was in some ways a response to a particular situation. We wanted to make sure that everyone would at least have access to pharmacare, but it is by no means a perfect system. Even the health minister knows that it is not perfect. That is why he is interested in having a truly universal system, and why he is open to discussions. We do not usually see a Quebec health minister who is interested in a national program. In this case, he is interested because he is aware of the potential cost savings and he knows that it could be more efficient than our current system.

I will try to clearly describe the limitations of the Quebec system. If an individual does not have access to insurance provided by an employer, he or she must take the government insurance. If this person does have access to a pharmacare plan provided by an employer, they are required to take it.

The problem is that some employers have substantially increased the price of pharmacare insurance for different reasons, and contracts are individually negotiated by the employers. Given that the employees of an employer in a sector with higher risks will use more prescription drugs, that employer's insurance premiums will be higher. Thus, people are forced to sign up for a pharmacare plan that is more expensive than the government's because it is the only one they can access. They are also required to take their employer's pharmacare plan even if they do not have the money for the premiums.

Take the example of an employee who starts working as an orderly in a private centre. At first, he may work one shift a week or every two weeks, depending on the staff schedule. He might work a relief shift or an on-call shift. He might work one week and perhaps earn $100. If the pharmacare premium is $60 a month, almost his entire salary will be used to pay for the insurance that he is required to take. Employer pharmacare plans do not take into account an employee's ability to pay. Most of the time, it is a fixed monthly rate, no matter the ability to pay. That is one of the significant limitations of the Quebec system, and the minister is well aware of it. It is not a perfect system. That is why he opened the door to universal pharmacare.

I would like to talk about all the savings we could achieve if we had universal pharmacare. Granted, they are not always easy to calculate, but they are still eye-opening. Since we have medicare, we often forget how much a hospital visit can cost. We forget that a stay in intensive care can cost in the tens of thousands, and that is just for a couple of days. Hospitalization is expensive. We tend to forget that because, at the end of the day, we do not see the bill. After we go to the hospital, none of us here ever see the bill that shows how much it would have cost if we did not have medicare. Since we are less aware of this, we do not realize just how much we could save if Canadians had equal access to drugs. One thing we noticed was that people who are not covered will often wait before consulting a doctor, because they do not have the money to pay for their medication. At the end of the day, when they do decide to consult, their condition has worsened to such a degree that they now require more advanced, and much more expensive, treatment.

The same is true when it comes to medication. When people are unable to pay for the medication they need, they do not take it and just hope that they will get better. Their health deteriorates, but they tell themselves they will be careful. They finally get to a point where their health is so bad that treatment ends up costing a lot more money than if we had just been able to provide them with the medication they needed in the first place.

It costs a lot less to provide prescription drugs to a person with heart problems than to care for someone who has had a heart attack and needs a triple bypass, stents, or some other form of surgery, and a hospital stay in intensive care.

This is not necessarily as easy to quantify as just calculating the cost of the drugs, as the parliamentary budget officer did, but it is possible. When people can take better care of their health, it can save money.

A universal pharmacare program would also save money when it comes to access to information and related health interventions. Since we do not have a universal pharmacare program right now, it is very difficult to learn about doctors' prescribing habits, to find out whether they are prescribing the right drugs or if they are prescribing too many drugs. It is impossible to look at the data.

A universal pharmacare program would provide access to data that would help us get a much more accurate picture of the health profile and make more effective interventions, for example in prevention. Doctors could be monitored and prevented from over-prescribing drugs. As things stand now, that data is not easy to get because it is stored in a number of private medical insurance programs. That is another aspect that is not quantifiable.

Many times, private firms are commissioned to conduct health studies in order to gauge what is happening in the area. However, a universal pharmacare program would provide access to that data much more easily, which would translate into more effective health care interventions.

It is not easy to implement such a program. Nevertheless, with the provinces amenable to the idea, the public would be better served with a universal pharmacare program. We could better monitor various health problems and do more for patients. We would avoid complications, and we could ensure that much less expensive generic drugs were prescribed instead of brand-name drugs.

This program will result in greater financial efficiency in patient care and public health. For that reason it is very important that we move forward on this file. We must create this program for all Canadians. It will also prevent the unfairness created when some medications are covered by a private pharmacare plan while others are not. For example, some public pharmacare plans only cover oral contraceptives even though there have been many changes in contraception and birth control, with products such as patches, contraceptive rings, and IUDs, which provide more effective contraception for women who have problems with the contraceptive pill.

People do not always make the best choices when it comes to their health, because pharmacare plans often do not provide choice, even though other methods of contraception exist and the monthly cost is about the same. People have to make choices based on what their pharmacare plan offers. Unfortunately, when a decision is not based on what is best for someone in a given situation, it is less likely that it will be effective or that the medication will be taken properly.

A universal pharmacare plan providing coverage for a broad range of medications will help health professionals. They would be able to choose a medication based on the needs of their patients, while helping them better manage their health.