Health committee  Good morning, Mr. Chair, members of the committee, staff, and witnesses. It is my privilege to assist you today, both as a physician and as a representative of the Office of the Chief Coroner for Ontario. The issue of prescription drug misuse, especially in regard to opiates,

Health committee  The coroner and all physicians have a choice of five manners or means of death: natural, accident, suicide, homicide, or undetermined.

Health committee  No, I don't think so. What we do in Ontario and in most provinces is in line with the World Health Organization. It allows us to implement a system that is transferable between jurisdictions. Although there is some movement on the definitions of each of the manners, overall I th

Health committee  Yes. It's not always possible to make the determination of someone's intent, but based upon the balance of probabilities, which is our standard of proof in most circumstances, we can. The data that's collected is not just the manner of death or means of death, but also the cause

Health committee  I think one of the issues, and I think both Mr. Bishop and the chief referenced this, is that there may not be a huge benefit in separating those groups because the risk applies to all those groups. I'd start by saying that. In answer to your question about what can be done at

Health committee  I'm not aware of a national model. I think most jurisdictions have difficulties with piecemeal-type collection systems. Within the country, I think Alberta and Nova Scotia lead us. Ontario is well behind, but has made an initiative and is starting to collect that information. The

Health committee  Correct.

Health committee  Correct. Yes.

Health committee  Yes. The number of deaths due to opioid toxicity exceeded the number of deaths of drivers in motor vehicle collisions in Ontario. It continues to do so significantly now.

Health committee  The first year we broke the 300 mark was 2008. We approached about 350 in 2008. The number of deaths of drivers in the province was well below the 300 mark, but since then the number of deaths due to opioids has increased. As I said, it's in excess of 500 now.

Health committee  Yes, I think the shortcomings are twofold. First of all, there's inadequate research evidence about the effectiveness of treatment of non-cancer pain, especially with opiates. That's an area that needs to be looked at in a more in-depth and scientific way. Second, you are abso

Health committee  I'll speak from my experience when I was practising, especially during the 1980s and 1990s when drugs like OxyContin were on the rise. We, being physicians, obviously don't get our information from TV commercials. We get it from advertisements in medical journals and also from

Health committee  No, I don't.

Health committee  I don't think it would add anything to our ability to investigate, to obtain that information, or to share that information over what we have. What it would do is it would make it very difficult for us to share information with other jurisdictions because of the addition of that

Health committee  No.