Health committee  Good morning. Thanks for the opportunity to present. By way of introduction, I'm a physician. I specialize in internal medicine and pharmacology. I'm not a specialist in addiction. I'm not somebody with extensive public health training, but I do a fair bit of research in the fie

Health committee  Not quite. We published a paper a few years ago that simply looked at all of the deaths that occurred in Ontario and at the deaths that involved opioids, and we broke those up into age ranges. I think the key finding there, other than the fact that deaths involving opioids have s

Health committee  —that's the segment of the population where one in eight young people died of an opioid and, collectively, all of the person years of life lost was about one-thirteenth that of all cancers combined.

Health committee  I said in my comments and I can't emphasize it enough that I really think Health Canada needs to revisit its grounds for the indications for using these drugs. If you find yourself in a hole, then the first thing you have to do is stop digging. Unless we stop prescribing these d

Health committee  In Ontario, it has roughly doubled over the last four years. In Alberta, I think fentanyl-related deaths have gone up about 5,000% over the span three or four years. That's no longer the prescription stuff; it's the illicit stuff that's coming into Canada from China, and being pr

Health committee  I think some of them have. I'd have to direct you back to the CCSA itself for the status of the various recommendations. I guess my point in making that comment earlier was that of those 58 recommendations, by definition some of them are more important than others. I have one i

Health committee  What kinds of prescriptions should be implemented for physicians? You'll get very different—

Health committee  Restrictions?

Health committee  Are you asking what restrictions I would advise?

Health committee  I think there are certainly different constructs, but from the prescribing perspective, I think as a physician I am conditioned to want to help my patient. I see pain all the time, and I'm scared of the other drugs, and I've become comfortable with opioids because of what we've b

Health committee  Education should focus on the fact that the goals of a drug are to impart more benefit than harm, and opioids very frequently don't do that. They can be beneficial to some patients in the long term, but the higher the dose goes the less likely that will happen. That's why I think

Health committee  It's invaluable. People are always going to use drugs. Not everybody who has an addiction wants to keep using. Many of them want out, and they should be given the opportunity to get out. But it's simply a fact that people do not die in safe injection sites. I agree with Sean that

Health committee  Yes, I do. I think B.C. has already done that. In fact, the CDC in the U.S. introduced prescribing guidelines earlier this year, and I think B.C. has mandated their use. There is some danger in that, because those guidelines don't deal with the people on hundreds of milligrams

Health committee  I just want to correct that. I think you cited me as saying that these drugs shouldn't be prescribed. I didn't say that: they do have a role. I think abuse-deterrent formulations are a good thing generally. You can crush them, and you can chew them, and you can get a much highe

Health committee  [Inaudible--Editor] to stop that problem, but we can take lessons, again, from B.C., which in the mid-1990s began a program called PharmaNet. Almost overnight, every doctor, and every pharmacist had access to real-time data. If you got a prescription in Richmond and the following