Thank you. Good afternoon, Mr. Chair and members of the committee.
My name is Michel Perron and I'm the chief executive officer of the Canadian Centre on Substance Abuse, or CCSA as I'll refer to it in my remarks.
I'll extend my congratulations to you, Mr. Lobb, on your appointment as chair of the committee. Thank you for having us here.
I am joined today by Paula Robeson, one of CCSA's knowledge brokers and the lead on the prescription drug abuse file.
For those of you who are not so familiar with CCSA, we were created by Parliament to bring government, the not-for-profits, and the private sector into alignment on substance abuse issues. As a result, we have a federally legislated mandate to provide national leadership in reducing alcohol and other drug-related harms, and we have been doing so since our creation 25 years ago in 1988.
We are largely funded by Health Canada to perform the role of bringing together these entities. I think we have demonstrated our capacity to do so in areas such as alcohol treatment, youth drug prevention, and many of the issues that are important to you individually, to your ridings, and to this committee. It is therefore appropriate and relevant that CCSA initiated the process that brings many of us here today.
I want to tell you about the strategy titled First Do No Harm: Responding to Canada's Prescription Drug Crisis, which the centre launched last March in collaboration with many partners, including Health Canada. This strategy represents a unique approach in Canada to respond to the country's prescription drug crisis, which is an understandable source of concern for the government, as evidenced by the latest Speech from the Throne and this committee meeting.
Why develop a strategy? I know it has been circulated. I suspect the committee has heard some facts about the magnitude of the prescription drug crisis in Canada. Allow me to add to that, if I might.
Canada is now the world's second-largest per capita consumer of prescription opioids behind the United States. In Ontario alone, the deaths related to prescription opioids doubled from 1991 to 2004, and the mortality rate is now more than double that of HIV.
More recent data show that of the 2,300 drug-related deaths in Ontario between 2006 and 2008, 60% were opioid-related. The number of drug-related deaths goes as high as 74% in Nova Scotia. These are smaller numbers but nonetheless a very significant proportion.
Prescription drug use is a growing problem among young Canadians. A 2001 survey of Ontario students in grades 7 to 12 revealed that 14% reported the non-medical use of pain relievers. Among these, 72% said they got it from home and 6% got it from their friends. The abuse of prescription drugs by young Ontario students ranks third behind binge drinking and cannabis use.
It's clear that prescription drug abuse touches us all and requires a comprehensive pan-Canadian approach to deal with the issue.
“First Do No Harm”, the strategy we will refer to today, was launched in March 2013 by the CCSA, along with then Minister of Health Leona Aglukkaq and over 20 partners who were participating in the development of this strategy. This 10-year pan-Canadian strategy lays out 58 recommendations to address the devastating harm associated with prescription opioids, stimulants, and sedatives, in the interest of improving the health and safety of Canadian communities across the country.
This strategy is the result of over a year of work by the National Advisory Council on Prescription Drug Misuse, which included health professionals, patients, families, members of first nations, law enforcement representatives, regulatory bodies, the pharmaceutical industry and researchers. The council was co-chaired by Alberta's Coalition on Prescription Drug Misuse.
whom I know you will be meeting with in the weeks to come.
Also involved were the Nova Scotia Department of Health and Wellness and the Canadian Centre on Substance Abuse.
The federal government was represented throughout that process by a number of departments, namely Health Canada, Public Safety Canada, the Department of National Defence, and Justice Canada.
CCSA brought together those with a clear stake in the problem to help develop the solution. It was apparent to all of us when we initiated this process a year and a bit ago that the status quo could not carry on and that we needed to find a new path forward.
Following the first meeting we convened, all stakeholders called upon CCSA to take the lead in developing the strategy, as we have in other areas.
In answer to the question being considered by this committee, that is, the role of the federal government, there is a very clear one in addressing this national problem, but I wish to underscore as well that this goes well beyond any one level of government and well beyond government alone. We have, however, taken the liberty of drawing out all of the recommendations from the First Do No Harm strategy that recommend the involvement of the federal government, for your particular attention. I'd note as well that Health Canada was identified as a co-lead, alongside the Canadian Centre on Substance Abuse, and other parties, whether regulatory, professional, or the like. A copy of this has been handed to the clerk of the committee.
The following are the main areas in need of the federal government's involvement: preventing the harms associated with prescription drugs for individuals, families and communities; ensuring that the system can provide the affected individuals with effective and timely treatment; controlling and monitoring prescription dispensing, as well as the associated consumption, abuse and harms, at provincial, territorial and national levels.
Other aspects include ensuring that law enforcement has the tools it needs to prevent diversion and trafficking in prescription drugs and related criminal sanctions; reviewing federal and provincial and territorial legislation and regulations that govern all areas of our current prescription drug system; and finally, leading and contributing to enhanced research and knowledge exchange about the nature and extent of the prescription drug abuse problem in Canada.
On a separate but related note, I was very happy—delighted would be a better word, and perhaps even more—that the federal-provincial-territorial ministers of health recently turned their attention to this very piece of work, the First Do No Harm strategy, and committed to working in the areas of prescription monitoring programs and surveillance and prescriber education—again key recommendations that found their way into the strategy. That's to say that, along with the intentions and the actions of the federal, provincial, and territorial governments, there are many other activities already under way that are responding to the recommendations identified. We underscore that it's vital as we move forward that all of these efforts be coordinated in a strategic and comprehensive manner to avoid any duplication and to maximize the investments being made.
By the way, since the launch, eight months ago, of the strategy titled First Do No Harm: Responding to Canada's Prescription Drug Crisis, the centre has created two implementation teams whose mandate is to ensure that each of the 58 recommendations is carried out.
To put it bluntly, if I may, we are moving forward and we have a plan. We have a plan for Canada, and we have the right people at the table to realize the vision laid out in First Do No Harm and we are now working together to obtain the resources to make it happen.
Mr. Chair, while the committee should rightfully consider the role of the federal government in addressing prescription drug abuse, I would argue that the committee should also consider the role of CCSA, an agency created by an act of Parliament and responsible to Parliament, as part of that response.
To provide greater clarity to the members of the committee, I have brought copies of the relevant sections of the CCSA Act to show the purpose and scope of our intent and how that might be helpful in this regard. By definition, we have a legislated responsibility not only to have initiated the process of First Do No Harm, but also to see it through to completion.
Beyond this, it's imperative that the hard work and dedication of the great number of organizations that participated in the development of the strategy and committed to staying with it toward its implementation not be squandered. The fact that we have 58 consensus recommendations means that we have at the table—and prepared to engage in the process—all of the key organizations responsible for not only identifying the problems but also resolving them. That is more than only talk and goodwill; it's about putting real dollars, real investments, real professional practice, as well as their commitment, on the table for us, in a truly pan-Canadian approach to dealing with the issue.
Distinguished members of the committee, the strategy First Do No Harm: Responding to Canada's Prescription Drug Crisis is putting forward a strong call for action. It is proposing detailed solutions that encourage all of us to find a remedy to the problem of prescription drug abuse in Canada.
I am very happy that you'll be hearing from others who collaborated on the development of First Do No Harm, including Ada Giudice-Tompson, whose son died of an unintended drug overdose, and Dr. Susan Ulan of the Coalition on Prescription Drug Misuse, among others, who participated in First Do No Harm. I am sure you will hear a consistent message from them about what needs to happen now. Indeed, part of our role is to attenuate the noise on this issue and help you focus, as decision-makers, on the signal, and First Do No Harm is the signal.
To conclude, Mr. Chair, we urge special attention by this committee to three areas. The first is to prioritize the key functions that the federal government can engage in to address prescription drug abuse, consistent with the recommendations laid out in First Do No Harm. I would add CCSA to that as well.
The second is to underscore your committee's support for the structure and process going forward under First Do No Harm, which, again, is a true pan-Canadian strategy to address this issue.
Finally, the third is to commit to examining adequate resourcing for the strategy to move forward, including the role CCSA is expected to play in it now and in the future.
I want to thank the committee for its interest in this issue, which is of vital importance for the health and safety of Canadians.
I am very happy to take your questions at this time.
Thank you very much, Chairperson.
Thank you, Mr. Perron, and Ms. Robeson, for coming today. You've provided a lot of information.
The first question I'd like to ask—well, it's maybe not appropriate to you—is that I do find it a bit curious that we have this First Do No Harm strategy. I guess it was rolled out just in March of this year, so it's very new. It does beg the question why we're actually studying it, because it does appear that we actually do have a strategy.
Now, you've laid out some areas where we can maybe assist, but it begs the question why we're actually studying this. Nevertheless, I do have some questions.
I noticed that Nova Scotia is one of the provinces. In fact, it's the only province that's involved. I'm curious about that because I don't know if you remember, Mr. Perron, but when the Special Committee on the Non-Medical Use of Drugs did its report in 2001 or 2002, what I remember from that study across Canada was that in Atlantic Canada in particular, there was much higher misuse of and addiction to prescription drugs than elsewhere in Canada. I just wondered if you could give us any sense of this across the country. I know that in B.C. it was more around so-called illegal drugs, whereas in Atlantic Canada it was legal prescription drugs. Is that still the case? Is there a great variation across the country? That's one question.
The second question I have is this. I'm very interested to know if you will be investigating something, and I've been looking through the strategy here very quickly as you were speaking, to see where it is, if anywhere, and I haven't found it yet. I thought maybe it would be under monitoring and surveillance—that we would actually set up some sort of national system regarding the way pharmacies and dispensaries are operating to prevent people shopping around and getting double, triple, whatever, prescriptions. Is that part of the plan too? And if so, where would that happen?
And thirdly, I noticed that Health Canada is the lead on a lot of these things, which of course would naturally be so. I wonder if you could tell us if Health Canada has committed any funds to actually implementing this strategy at this point.
Thank you for the comment.
I have a couple of points. One is that we learned as we entered into this discussion that there's a tremendous amount of mobility among markets, in people who want to use drugs. That's part of the reason for having effective prevention in the first place, of course, but also reaching out to those who are in difficulty when they are dependent.
Here in Ottawa, the issue is not so much OxyContin, but fentanyl. We've seen that if you push down on one drug, another will emerge.
The point is that we need to have a very comprehensive and holistic appreciation for how we wish to deal with this issue, and how we want to have a coherent strategy across the nation that involves all levels of government, the not-for-profit and private sectors, and that involves some of the other elements I referred to.
On Krokodil, I should mention that we are part of a novel psychoactive-substance network, because a lot of these new drugs are emerging, and that will always be the case. There's a new chemist born every year, so that will just carry on.
On novel psychoactive substances, we have an alert system, if you wish, that CCSA works with in the regions. We have asked specifically about the issue of Krokodil. There have not been any known reports of it, just yet, in Canada, if I'm not mistaken. That was the latest information we received.
That said, I will look into this element, because one of our challenges is to have the right kind of quality of information. I think Dr. Fry made the point and that we need to act on it. But at the end of the day, I understand the point you made in terms of—
If I could step back a little bit, I think the point was made—I perhaps introduced the issue earlier—about alcohol and treatment. In Canada we have what's called the national framework for action, which is meant to be a national, pan-Canadian blueprint for how we can deal with alcohol and other drugs. Part of that identified thirteen national priorities, eight of which CCSA is leading on. One of those strategies is around prescription drug misuse. But as we cut into the prescription drug misuse strategy and identify prevention activities that we wish to undertake, the issue for us is what is good prevention.
You can then change the channel to recent work that was funded by the government under its national anti-drug strategy, whereby we have come up with Canada's first national youth drug prevention standards for schools, families, and communities.
In other words, if you are in Estevan, Saskatchewan and want to do a prevention program in your school, the standards allow you to have the confidence that the programs are consistent with what good evidence is telling you is the right kind of prevention, so that it's not only time spent with youth, but time well spent.
The point with CCSA is that we try to knit together a variety of these elements, whether they be alcohol, youth, campus, and stimulants, as was raised earlier, or prevention standards to support the prevention element that we've identified here in terms of the practice with the provinces. This is part of that connecting-the-dot element that we will bring.
The issue of cannabis certainly is one that preoccupies us quite significantly, not only in terms of prevalence of use by young people and the changing components of cannabis with the molecular change between tetrahydocannabinol—the active ingredient that makes you high, if you wish—and CBD, another molecule, which would attenuate some of the psychoactive effects of cannabis.... The point is that cannabis is very present in Canada. We are concerned about its impact on the developing brain.
There are various proof points that we can know much more about, and we plan to bring them forward. The federal government has in fact recently supported CCSA to advance knowledge around this area: around prevention, around the competencies for people who will do prevention, and focusing on cannabis and sport as an element to help with prevention. This is recent funding that we've received from Health Canada, in particular around the national anti-drug strategy.
The last point I'd make is that it will be interesting as this committee goes forward, as a health committee looking at prescription drugs, that one thing we really never discuss in earnest is what happens about medical marijuana and where it fits into this scheme at some point. This is something we will have to look at on a go-forward basis. It's a 10-year strategy. Clearly, as the ground shifts with respect to how that substance is being made available medically, we will have to look at this.
It's all very interesting, and I think the whole idea of how we got there is a very important question. But I want to remind everyone that this is not new, it's simply the global media that makes it new.
Back in the Victorian era, opium—from which “opiate” and “opioid” come—was taken by every good little Victorian lady. She had tincture of opium and she took it all the time. Opium was then a legal drug. Then it became illegal because of trade wars with China. So it isn't new, but what it points to is the fact that it's ongoing.
What we now know today, which we didn't know then, is that addiction is a chronic disease and it comes from lack of dopamine in the brain, which doesn't give you the right triggers to stop you from being addicted. This is why some people drink a lot of alcohol and don't become an alcoholic and others do become alcoholics. We've seen that happen. As teenagers we all went around trying to get drunk because we thought it was cool, then most of us went on to drink responsibly. But some of our friends, we know, never could stop. We now know that it's a chronic brain disease and that we need to deal with that.
You've all made a really good point about prescribing practices. Physicians—on the contrary, Mr. Lizon—don't know very much about addiction. We've only known a lot about addiction in the last 15 years. So you would give something, hoping you could take the person off it. If they happened to be the wrong person with the dopamine problem, they would stay on it and wouldn't be able to get off it.
I will tell you a story, because I think it's important and because I know I'm allowed to make comments as well as ask questions. Recently, a friend of mine had a baby and left the hospital. She had a C-section. She was fine, she got up, she walked out of there, great! For two days she was in the hospital. She was given OxyContin to help her with pain at home. I said to her, “You've been given what? Just tear up the prescription and throw it away”. That was a ridiculous thing to do. If you have pain, take Tylenol Extra Strength. But this is what we see. This is happening over and over, and then we have a problem.
There is a problem I want to bring to your attention. You questioned the problem, which I think is very valid, about the role of advertising. We know a lot of kids who take Ecstasy, etc. After awhile the amount of serotonin in their brain lowers and they become depressed after a good night on Ecstasy. So they go into their parents' medicine cabinet and take out an antidepressant and they get hooked on that, because that antidepressant raises the level of serotonin and they get to behave normally. So here is an illicit drug feeding the abuse of a prescription drug, which is a real problem. Advertising—all these names you see advertised on television about antidepressants—feeds that understanding of what drugs do what for you, for people who need to abuse them.
I do think the role of advertising of drugs, especially narcotics and opiates and barbiturates and antidepressants, all of those, is a really important thing for which this committee should think about making some kind of recommendation. Advertising really opens up this information for a lot of young people about what the drug can do for them. They open their parents' closet, their parents have it in their medicine cabinet, and boom, the young person takes it. I think it's a really important piece.
It's really not only about criminal activity, it's about what you talked about earlier on about education. I think we have to look at the advertising component of this. I think it's completely unnecessary and dangerous.
What do you think?
Some hon. members: Oh, oh!
Hon. Hedy Fry: I did ask a question.
I get the 30 seconds now, right?
Voices: Oh, oh!
Mr. Michel Perron: You made a lot of points there, Dr. Fry.
First on the point of advertising, it is a recommendation, but perhaps a bit different from what you might have conceptualized. It's advertising to physicians; it's how in fact the drug companies are advertising and marketing to physicians. Now, practices have changed drastically over the years, but this is an area that we have identified specifically under the prevention rubric:
Conduct an independent review of the evidence and make recommendations as appropriate on the link between promotion (e.g., advertising, marketing to clinicians) and the harms associated with prescription drugs.
To bring it back to your earlier point, this entire work fits into the broader context of how people may use drugs or not. What we do know is that a significant portion of Canadians got here because they happened to have their teeth extracted, or they happened to break an arm, or what have you. That is not to point a finger at any particular profession, other than to say that people have unwittingly become dependent on a drug, at times very powerful, from which an exit strategy is difficult to attain.
Everybody is agreed that this cannot continue and therefore we need to change the dial on it.
If I may underscore, Mr. Chair and members, in First Do No Harm a lot of the heavy lifting around who should be doing what has been articulated in what we hope is a very clear manner in this report. You can use this by going to the individuals listed and saying, “You sat there, you were part of this process. Have you agreed and will you commit to supporting these, and what will you do?” I say so because there have already been those suspicions.
This is about having a true national approach that will have to evolve over time in the context of broader challenges around youth and cannabis and the like. I don't mean to stump here, but the point is that we think this is worthy of the attention of not only the federal government and this committee, but also of others.