Interventions in Committee
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Sony Perron
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Sony Perron
2015-06-01 15:39
I would like to thank the committee chair and the rest of the committee members for the invitation to appear here today.
I, and other officials at Health Canada, have reviewed the Auditor General's 2015 Report, and we have paid a great deal of attention to his recommendations. We take the findings seriously and are addressing each of them through an action plan. This plan will continue to be refined and defined in collaboration with first nations. Indeed, as you know, we work in cooperation with first nations. This plan can therefore only be completed with an additional commitment by our first nations partners.
The health care system serving first nations is highly complex. Provincial health systems do not directly extend to first nations reserves. To support first nations, Health Canada provides the delivery of a range of effective, sustainable and culturally appropriate programs and services. We work with first nations to increase their control of health services and collaborate with provinces to increase access and promote system integration.
We also support programs that address first nations health priorities in the areas of mental health, chronic disease, maternal and child health, and health benefits providing coverage for prescription drugs, dental care, vision care, mental crisis intervention, and medical supplies and equipment.
Most of the community-based programs have been transferred in varying degrees to over 400 first nation communities. This number does not include British Columbia, where in 2013 Health Canada transferred its role in the design, management, and delivery of first nations health programming in British Columbia to the new First Nations Health Authority.
Health Canada provides funding to first nations to deliver clinical care in 27 remote and isolated communities, again, outside British Columbia. In an additional 53 remote and isolated first nation communities, Health Canada continues to deliver clinical care. The delivery model varies based on the specifics of each province and geographic conditions. The clinical care teams are located in nursing stations, along with community health workers delivering other programs.
Because of the importance of these services, it is imperative that Health Canada ensure that remote communities have access to clinical and client care, that nursing stations are staffed with registered nurses, and that nurses work in a safe environment, have access to physicians to support them, and have access to tools.
Registered nurses and nurse practitioners are predominantly the first point of contact in isolated communities and are highly educated and qualified individuals. To ensure that our nurses are prepared for the unique demands of working in remote stations, a mandatory training requirement has been defined and is now part of the national education policy.
I can report that we currently have an 88% compliance rate on Health Canada's nursing education model for controlled substances in first nations health facilities, while advanced cardiac life support is at 63%, trauma support is at 59%, pediatric advanced life support is at 64%, and immunization is at 61%. The overall compliance rate is at 46% as of the end of April 2015. We still have work to do, and we are doing it while ensuring that we have resources in place to backfill these important positions while incumbents are in training.
Health Canada is committed to ensuring that nurses working in remote first nations communities meet established public service requirements on top of these workers' already robust credentials.
Remote and isolated practice environments sometimes require nurses to respond immediately to life-threatening or emergency situations. Nurses therefore need appropriate mechanisms to perform these important duties.
Clinical practice guidelines assist nurses to address clinical care situations and provide instruction on whether and when consultation with a physician or a nurse practitioner is required. There are arrangements in place for all nursing stations to access physicians when physicians are not located in the community. We also continue to collaborate on region-specific solutions with provinces to advance access to health services and with regulatory bodies to support nurses practising within their scope of practice.
A key challenge is the need for more nurses. Health Canada has implemented a nurse recruitment and retention strategy, which involves a number of initiatives: a nursing recruitment marketing plan, a nursing development program, a student outreach program, and an onboarding program.
Since its February launch, we have received over 500 nursing applications, with 200 of these moving to the next level of screening. As well, the strategy aims to increase the number of nurse practitioners, which will provide greater stability in the clinical teams, assist in meeting training objectives, and enhance the level of services available at the community level.
Nurses and other community health professionals require facilities to conduct their work. Currently, we invest approximately $30 million annually for repairs, renovation, and construction of health facilities, plus an additional $44 million for maintenance and operations. The nursing stations are owned by first nations communities, and we collaborate with them to support their operation.
We work with first nations communities to ensure buildings are inspected and deficiencies are addressed. In response to the audit, we are implementing a more robust tracking system to capture this work. We will also enhance our process in order to use facility condition reports as a tool to better plan maintenance and renovation work with the owners.
In addition, to ensure new nursing stations are built to code, we have updated our requirements for attestations and have communicated the change to facility management staff. The audit rightly noted that the requirements, such as the station as defined currently, did not provide the necessary level of assurance.
Another area reported on was the management of medical transportation; medical transportation that provides coverage to support access to insured health services. Health Canada spends over $300 million on medical transportation per year, and approximately 60% of that is in remote and isolated communities. The main reasons for transportation are emergencies, at 24%, hospital services, at 10%, appointments with general practitioners, at 7%, and dental services, at 5%.
The program provides coverage for transportation to the nearest appropriate professional or facility that takes place when the needed service is not locally available. Our goal is to provide timely coverage for medical transportation to avoid an undue burden for clients and health care professionals. Decisions are based on a national program framework and are made with a solid understanding of the health services available and the transportation options at the regional level.
In response to the audit observations, the program has already modified and disseminated guidelines to resolve discrepancies observed between our practices and the medical transportation framework in terms of the level of documentation required.
Regarding the transportation of children who are not registered, Health Canada has a long practice of allowing coverage for a child up to one year of age to be covered for medical transportation under the registration number of their parents. Health Canada will continue its efforts with partners to inform parents and make available registration material in nursing stations and health centres.
Health Canada and the Assembly of First Nations are undertaking a joint review of the non-insured health benefits program, of which medical transportation is a component, and I am pleased to report that the work is well under way. It will identify strengths, weaknesses, including inefficiencies in administration, and recommendations for action.
Given that the geographic location, the size of the community, and the need to ensure cultural safety influence the range of programs and services funded or provided by Health Canada, comparing one community to the other is not always possible or the best approach. Community health planning, investing in the integration of services with provincial systems, and the development of community programs and capacity have proven to be more effective and more responsive to community needs over time.
As indicated earlier, Health Canada funds a number of community programs aimed at addressing specific needs and working as a complement to the clinical and client care program. These programs are funded to support community health needs and mostly managed by the communities themselves. In response to the audit, we will improve our support to community health planning to enhance integration of the community-based programs and clinical services where these services are delivered by Health Canada. We will also engage with the communities to review the current service delivery model and clinical care resource allocations.
The last area I would like to discuss is coordination among health system jurisdictions.
We work closely with partners to build health service delivery models that take into account community needs.
We have made significant progress with health service integration over the last 10 years. We see examples in various regions where there are more physicians' visits, provincial services are being extended on reserve, and there are more collaborative arrangements between community health services and regional health authorities. Co-management and trilateral tables exist in most regions to formally engage with provincial and first nations partners to advance common practices and resolve systemic issues. We will formally engage these tables in order to make progress on the important issues raised in the report.
Health Canada will continue to collaborate with our partners to develop and implement other models of first nations-led health systems across the country, as we have celebrated in B.C. We have presented an overview of our action plan, which requires further engagement and collaboration with first nation partners. We believe the next update will be more comprehensive as it will benefit from our partners' input.
In closing, we are working on a number of actions in response to the audit, and we will continue to do so.
I would note that I am accompanied today by three senior officials from Health Canada's first nations and Inuit health branch: Valerie Gideon, assistant deputy minister, regional operations; Robin Buckland, executive director, office of primary health care; and Scott Doidge, acting director general, non-insured health benefits.
We would be pleased to answer your questions. Thank you.
Robin Buckland
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Robin Buckland
2015-06-01 16:04
Thanks, Sony.
I am a registered nurse, and I have been for the last 27 years. To become a registered nurse, you have to complete a nursing program. In the vast majority of the country, it's at the baccalaureate level; you have to have a degree in nursing. In Quebec, the entry to practise is actually a diploma, so you can obtain a nursing diploma from the CEGEP in Quebec. Basically, through nursing school, you obtain the core competencies that are required to function as a registered nurse.
Generally speaking, nurses come out of nursing school and they are generalists. They're able to practise in a wide variety of areas.
In remote and isolated locations, there are additional competencies that are required. As the report indicated, they are often the only provider in the community and they are the first point of contact for the patient. They need to be able to respond to what comes in the door. If it's an emergency, a trauma, they need to have the competencies to deal with it. That is why Health Canada has identified advanced cardiac life support, pediatric life support, trauma, and the other courses you'd see listed as our five courses. Those are the key competencies that RNs will require to meet the needs of the community, in addition to so much more.
Valerie Gideon
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Valerie Gideon
2015-06-01 16:27
Very quickly, we have a trilateral table in Ontario with the Ontario Ministry of Health and Long-Term Care. We also have a specific northern table that the northern first nations have asked for, and in that table, which has just started this year, we do anticipate that we're going to be talking quite a bit about clinical and client care and medical transportation and engaging them in terms of our follow-up actions on that plan.
In Manitoba, we've had a committee for several years that was at a more junior officials level. We've now bumped it up to an assistant deputy minister level, with the Province of Manitoba, the Grand Chief of the Assembly of Manitoba Chiefs, and me. As well, we will be using that table to engage first nations in Manitoba with respect to our actions on this report to ensure that we're also monitoring progress and partnership of first nations.
Those are just two examples that are more relevant to this audit, but there are many more across the country. We also have national partnership agreements with the Assembly of First Nations and the Inuit Tapiriit Kanatami, which we signed this year.
Sony Perron
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Sony Perron
2015-05-12 15:38
Thank you, Mr. Chair, for the opportunity to provide an overview of the programs and services supported by Health Canada in the area of mental health and wellness for first nations and the Inuit.
Health Canada recognizes that addressing mental health and addictions issues are important health priorities for First Nations and Inuit. Consequently, the department is investing more than $300 million this year on a suite of mental wellness programs and services.
Programming includes mental health promotion, addictions and suicide prevention, other crisis response services, treatment and after-care services, and supports to eligible former students of Indian residential schools and their families.
Health Canada is working with partners so that efforts to support individuals, families and communities around mental health care are coordinated and include family support, employment and training, education and social services.
Building on best practices, we know that efforts to support individuals, families and communities should be culturally safe and community-driven. We can find lasting solutions only if we work together with our partners, including First Nations and Inuit organizations and, most importantly, the communities themselves.
Mental health promotion and suicide prevention research emphasizes the need for comprehensive and multi-layered interventions across a continuum of wellness. Interventions at each of the individual, family, and community, and federal, provincial, and territorial levels have been found to be most effective.
We have worked with the Assembly of First Nations and mental wellness leaders to develop the first nations mental wellness continuum framework. Through this process, communities were engaged and brought their ideas to the table.
From these discussions, culture emerged as a foundational component. Community innovation, partnerships across government, collaboration and coordination across sectors, and linkages between programs and services were also identified as being crucial for moving forward.
This framework has been ratified by the Assembly of First Nations' chiefs of assembly and was released by the AFN in January 2015. We are now working with the Inuit Tapiriit Kanatami to develop a mental wellness continuum for the Inuit.
Health Canada is a partner in implementing the first nations mental wellness continuum framework, which calls for integrated models of service delivery that focus on community strengths and indigenous knowledge.
Moving forward, we will look at ways to strengthen the federal mental wellness programming with our partners to meet community-specific needs, such as moving away from siloed program approaches toward more coordinated and effective approaches, and through closer integration between federal, provincial, and territorial programs.
We are also supporting mental wellness teams, which provide specialized treatment to a group of First Nations communities facing mental health issues. These teams seek to increase access to a range of mental wellness services including outreach, assessment, treatment, counselling, case management, referral and aftercare.
Through the National Aboriginal Youth Suicide Prevention Strategy we support screening for depression in schools; education and training for front-line workers to reduce stigma and increase community awareness; referral and intervention training; crisis services; follow-up and support for at-risk youth; and cultural and traditional activities to promote protective factors and to reduce risk factors.
Since 2008, we have supported a range of services to former students of Indian residential school and their families so they may safely address emotional health and wellness issues related to the disclosure of childhood abuse. For example, in 2013-14 alone, Health Canada supported approximately 630,000 emotional and cultural support services to former students and their families, and 47,000 professional mental health counselling sessions.
On February 20, 2015, Minister Ambrose announced an investment to prevent, detect, and combat family violence and child abuse. Health Canada's investment will support enhanced access to mental health counselling for first nations victims of violence who are in contact with shelters, and will support the improvement of services to first nations and Inuit victims of violence so that services are better coordinated, more trauma informed, and culturally appropriate.
Thank you for your attention. I am pleased to take your questions afterward.
View Rona Ambrose Profile
Thank you very much, Mr. Chair, and thank you to the committee. I want to thank all of you for the work you do on the health committee. I know many of you are passionate about the issues of health, and I thank you for your commitment to that.
I'm joined by Simon Kennedy, Health Canada's new deputy minister; Krista Outhwaite, our newly appointed president of the Public Health Agency of Canada; and Dr. Gregory Taylor, whom you've met before, Canada's chief public health officer. I know he'll be here for the second half. You might want to ask him about his trip to Guinea and Sierra Leone to visit our troops and others who are working on the front dealing with Ebola. I'm sure he'll have some great things to share with you.
Michel Perron is here on behalf of the Canadian Institutes of Health Research. He's also new. Last time I know you met Dr. Alain Beaudet.
We also have Dr. Bruce Archibald, who's the president of the Canadian Food Inspection Agency. I think you've met Bruce as well.
Mr. Chair, I'd like to start by sharing an update on some of the key issues that we've been working on recently. I'll begin by talking about Canada's health care system, the pressures it's facing, and the opportunities for improvement through innovation. I will then highlight some recent activities on priority issues such as family violence and the safety of drugs in food.
According to the Canadian Institute for Health Information, Canada spent around $215 billion on health care just in 2014. Provinces and territories, which are responsible for the delivery of health care to Canadians, are working very hard to ensure their systems continue to meet the needs of Canadians, but with an aging population, chronic disease, and economic uncertainty, the job of financing and delivering quality care is not getting easier.
Our government continues to be a strong partner for the provinces and territories when it comes to record transfer dollars. Since 2006, federal health transfers have increased by almost 70% and are on track to increase from $34 billion this year to more than $40 billion annually by the end of the decade—an all-time high.
This ongoing federal investment in healthcare is providing provinces and territories with the financial predictability and flexibility they need to respond to the priorities and pressures within their jurisdictions.
In addition of course, federal support for health research through the CIHR as well as targeted investments in areas such as mental health, cancer prevention, and patient safety are helping to improve the accessibility and quality of health care for Canadians.
But to build on the record transfers and the targeted investments I just mentioned, we're also taking a number of other measures to improve the health of Canadians and reduce pressure on the health care system. To date we've leveraged over $27 million in private sector investments to advance healthy living partnerships. I'm very pleased with the momentum we've seen across Canada.
Last year we launched the play exchange, in collaboration with Canadian Tire, LIFT Philanthropy Partners, and the CBC, to find the best ideas that would encourage Canadians to live healthier and active lives. We announced the winning idea in January: the Canadian Cancer Society of Quebec and their idea called “trottibus”, which is a walking school bus. This is an innovative program that gives elementary schoolchildren a safe and fun way to get to school while being active. Trottibus is going to receive $1 million in funding from the federal government to launch their great idea across the country.
Other social innovation projects are encouraging all children to get active early in life so that we can make some real headway in terms of preventing chronic diseases, obesity, and other health issues. We're also supporting health care innovation through investments from the Canadian Institutes of Health Research. In fact our government now is the single-largest contributor to health research in Canada, investing roughly $1 billion every year.
Since its launch in 2011, the strategy for patient-oriented research has been working to bring improvements from the latest research straight to the bedsides of patients. I was pleased to see that budget 2015 provided additional funds so that we can build on this success, including an important partnership with the Canadian Foundation for Healthcare Improvement.
Canadians benefit from a health system that provides access to high-quality care and supports good health outcomes, but we can't afford to be complacent in the face of an aging society, changing technology, and new economic and fiscal realities. That is why we have been committed to supporting innovation that improves the quality and affordability of health care.
As you know, the advisory panel on health care innovation that I launched last June has spent the last 10 months exploring the top areas of innovation in Canada and abroad with the goal of identifying how the federal government can support those ideas that hold the greatest promise. The panel has now met with more than 500 individuals including patients, families, business leaders, economists, and researchers. As we speak, the panel is busy analyzing what they've heard, and I look forward to receiving their final report in June.
I'd also like to talk about another issue. It's one that does not receive the attention that it deserves as a pressing public health concern, and that's family violence. Family violence has undeniable impacts on the health of the women, children, and even men, who are victimized. There are also very significant impacts on our health care and justice systems.
Family violence can lead to chronic pain and disease, substance abuse, depression, anxiety, self-harm, and many other serious and lifelong afflictions for its victims. That's why this past winter I was pleased to announce a federal investment of $100 million over 10 years to help address family violence and support the health of victims of violence. This investment will support health professionals and community organizations in improving the physical and mental health of victims of violence, and help stop intergenerational cycles of violence.
In addition to our efforts to address family violence and support innovation to improve the sustainability of the health care system, we have made significant progress on a number of key drug safety issues. Canadians want and deserve to depend on and trust the care they receive. To that end, I'd like to thank the committee for its thoughtful study of our government's signature patient safety legislation, Vanessa's Law. Building on the consultations that we held with Canadians prior to its introduction, this committee's careful review of Vanessa's Law, including the helpful amendments that were brought forward by MP Young, served to strengthen the bill and will improve the transparency that Canadians expect.
Vanessa's Law, as you know, introduces the most significant improvements to drug safety in Canada in more than 50 years. It allows me, as minister, to recall unsafe drugs and to impose tough new penalties, including jail time and fines up to $5 million per day, instead of what is the current $5,000 a day. It also compels drug companies to do further testing and revise labels in plain language to clearly reflect health risk information, including updates for health warnings for children. It will also enhance surveillance by requiring mandatory adverse drug reaction reporting by health care institutions, and requires new transparency for Health Canada's regulatory decisions about drug approvals.
To ensure the new transparency powers are providing the kind of information that Canadian families and researchers are looking for, we've also just launched further consultations asking about the types of information that are most useful to improve drug safety. Beyond the improvements in Vanessa's Law, we're making great progress and increasing transparency through Health Canada's regulatory transparency and openness framework. In addition to posting summaries of drug safety reviews that patients and medical professionals can use to make informed decisions, we are now also publishing more detailed inspection information on companies and facilities that make drugs. This includes inspection dates, licence status, types of risks observed, and measures that are taken by Health Canada. Patients can also check Health Canada's clinical trials database to determine if a trial they are interested in has met regulatory requirements.
Another priority of mine is tackling the issue of drug abuse and addiction in Canada. There's no question that addiction to dangerous drugs has a devastating and widespread impact on Canadian families and communities. In line with recommendations from this committee, I am pleased that the marketing campaign launched last fall by Health Canada is helping parents talk with their teenagers about the dangers of smoking marijuana and prescription drug abuse. The campaign addresses both of those things, because too many of our young people are abusing drugs that are meant to heal them.
Our government also recognizes that those struggling with drug addictions need help to recover a drug-free life. From a federal perspective, of course, we provide assistance for prevention and treatment projects under our national anti-drug strategy. We've now committed over $44 million to expand the strategy to include prescription drug abuse and are continuing to work with the provinces to improve drug treatment.
I've now met and will continue to meet with physicians, pharmacists, first nations, law enforcement, addictions specialists, medical experts, and of course parents to discuss how we can collectively tackle prescription drug abuse.
Finally, our government continues to make very real investments to strengthen our food safety system. As only the latest example, I recently announced a five-year investment of more than $30 million in the CFIA's new food safety information network. Through this modern network, food safety experts will be better connected, and laboratories will be able to share urgently needed surveillance information and food safety data, using a secure web platform. This will put us in an even better position to protect Canadians from food safety risk by improving our ability to actually anticipate, detect, and then effectively deal with food safety issues. This investment will continue to build on the record levels of funding we've already provided, as well as the improved powers such as tougher penalties, enhanced controls on E. coli, new meat labelling requirements, and improved inspection oversight.
In conclusion, those are just some of the priorities that will be supported through the funding our government has allocated to the Health portfolio. This year's main estimates, notably, include investments for first nations health, for our ongoing contribution to the international response to the Ebola outbreak in West Africa, and the key research and food safety investments that I have already mentioned.
I'll leave it at that. If committee members have any questions, my officials and I would be very pleased to answer them. Thank you.
View Wladyslaw Lizon Profile
Well, maybe quickly, on another topic, what progress can you report following the last implementation of the health agreement with the First Nations Health Authority in B.C.?
George Da Pont
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George Da Pont
2014-11-20 12:29
Again, I would say that really is a landmark tripartite agreement that has seen the responsibility for design and delivery of programs and services that previously came from Health Canada now being turned over to a newly created First Nations Health Authority. That authority has gotten off, we think, to a very good start.
One of the early things we notice is that now they have developed stronger relationships with the province, so with regional medical delivery mechanisms, and are taking a more integrated approach. They now have the ability, really, to redesign programs, get better integration and consistency with the province, and hopefully, get much better outcomes for first nations people in B.C.
Obviously, it's only been a year that it's been in place—
View Dany Morin Profile
Okay, then. Thank you for the answer.
Here is my next question. Canada's first nations and Inuit face significant barriers when accessing dental care, and they experience much higher rates of dental disease, but we have heard of significant concerns with the rules and requirements of the program responsible for ensuring their dental care, the non-insured health benefits program. These rules can cause delays in treatment and increases in transportation costs and can deter follow-up treatment. All of these effects have direct impacts upon patients' health.
Can you confirm that you plan to have a joint review for the non-insured health benefits program to ensure that it is meeting its goals and is meeting the needs of first nations and Inuit people in Canada?
George Da Pont
View George Da Pont Profile
George Da Pont
2014-05-15 9:02
Perhaps I can add a few comments on timing.
AFN is in the process of finalizing its own internal views on the review. I understand they will do it over the summer, and then we would be in a position to start the process after that.
Robert Ianiro
View Robert Ianiro Profile
Robert Ianiro
2013-11-06 15:31
Thank you, Madam Chair, for the opportunity to appear before the Standing Committee on Health to speak to this important issue.
My name is Robert Ianiro, and I am the director general of the Controlled Substances and Tobacco Directorate in the Healthy Environments and Consumer Safety Branch of Health Canada.
I am with several of my colleagues, all of whom are responsible for programs that collectively support the government's ongoing efforts to protect Canadians against the risks associated with prescription drugs.
Dr. John Patrick Stewart is the senior medical director in the Health Products and Food Branch and is able to speak to Health Canada's role in establishing and maintaining prescription drug accessibility while decreasing the risk of abuse associated with certain drugs.
I am also joined by Ms. Debra Gillis and Ms. Sandra Bruce, both directors general from the First Nations and Inuit Health Branch, who are able to speak to the range of activities under way to protect and promote the health of first nations and Inuit.
As committee members will be aware from various media reports and other sources, prescription drug abuse is a public health and safety issue in many areas across the country. It has been marked by increases in rates of consumption and, in many cases, addiction and death due to overdose. While there is little national-level data on prescription drug abuse presently available in Canada, there is growing evidence of the nature and scope of the problem.
You have probably heard media reports about OxyContin and fentanyl. These drugs are potent opioids frequently used for the relief of moderate to severe pain. According to the International Narcotics Control Board, Canada is currently the world's second largest consumer of opioids per capita, second only to the United States.
Opioid pain relievers have been used for the treatment of cancer pain and in palliative care settings for many years. However, in the 1990s, these drugs started to be marketed for treatment of chronic non-cancer pain, like back pain and arthritis. OxyContin quickly emerged as one of the top prescribed opioids for pain management. Unfortunately, OxyContin became very popular for non-medical use due to the euphoric high that users obtain by crushing and injecting this drug. Shortly thereafter, communities began reporting public health concerns related to the abuse of OxyContin, as well as public safety concerns related to its diversion from legal sources to the illicit market.
There is growing evidence that prescription drugs have become popular among youth, and that they increasingly represent a path to addiction for both youth and adults.
There is growing evidence that prescription drugs have become popular among youth, and that they increasingly represent a path to addiction for both youth and adults. According to the most recent Youth Smoking Survey, prescription drugs are now the third most commonly used group of substances among Canadian youth, after alcohol and marijuana.
Several overarching factors contribute to the growth of this problem.
While Canadians understand the dangers involved with illicit drug use, there is not the same understanding of the harms related to prescription drugs. Prescription drugs are commonly perceived as safe. This misconception directly affects consumer practices on use, storage, and disposal of prescription medications.
The second factor relates to inappropriate prescribing practices. Prescribers, including those from the College of Physicians and Surgeons of Ontario, have acknowledged that their lack of knowledge and training for pain management has contributed to the growth of the problem. According to a Canadian study conducted in 2009 on curricula in health professional education, veterinary students receive five times the training on this subject than medical students.
As a result, some Canadians leave their physicians' offices with prescriptions for inappropriate or excessive quantities of powerful medications without proper information about these drugs, and without the appropriate follow-up from their healthcare team.
As a consequence, the demand for treatment for opioid dependence has increased in many jurisdictions. In Ontario, admissions to publicly funded substance abuse centres rose by 129% between 2004 and 2011.
Finally, lack of awareness of safe storage and disposal practices is an important driver. There is evidence that the home represents a common point of access to medications for abuse for many Canadians. Many unused and expired medications remain in unlocked medicine cabinets, making them vulnerable to diversion and abuse.
For example, the results from the 2011 Ontario student drug use and health survey indicated that 67% of youth in Ontario who reported misusing prescription drugs obtained them from within the home as a result of a prescription from a family member.
Effectively combatting prescription drug abuse requires a coordinated and comprehensive response across a broad range of sectors.
Federal, provincial and territorial governments share responsibility for addressing prescription drug abuse. The provinces and the territories are responsible for the delivery of health care services, which includes providing treatment services, and through regulatory colleges and licensing bodies for establishing training requirements and practice standards for health professionals.
This point is reinforced in the recent national prescription drug abuse strategy developed by the Canadian Centre on Substance Abuse, called First Do No Harm.
Provinces and territories have expressed willingness to collaborate with Health Canada to address the issue. Early opportunities for collaboration to support better collection and sharing of information, and improve prescribing practices, were recently endorsed by federal, provincial and territorial ministers of health this past October.
Health Canada's role in preventing prescription drug abuse supports that of the provinces and the territories. This is realized through our role as a regulator under the Food and Drugs Act and the Controlled Drugs and Substances Act, and as a service provider for first nations and Inuit.
I will take a few moments now to speak about Health Canada's role in ensuring the overall safety of drugs on the market, including safeguards that are in place to promote proper use. Under the Food and Drugs Act and its regulations, a new drug will be issued market authorization if, after a risk-based decision-making process, Health Canada determines that the drug demonstrates an acceptable level of safety, substantial efficacy, and high quality.
The regulations require that a manufacturer file a new drug submission with substantial data to support the safety, efficacy, and quality of the drug for its intended use.
Based on the information submitted, Health Canada scientists determine whether the data meet the current standards to support approval and whether a drug should only be available through a doctor's prescription.
Information on addiction and abuse potential is taken into consideration during the review process. If a drug has a significant risk of addiction and/or abuse, substantial data supporting the efficacy of the drug must be shown in a serious condition, such as severe pain, to justify the risks.
Additionally, through the approval of the final product monograph, information on the potential for addiction and abuse is communicated to health care providers and consumers. Physicians are advised to prescribe and handle such drugs with caution, assess patients for their clinical risks for abuse or addiction prior to prescribing the drug, and routinely monitor patients for signs of addiction and abuse.
The product monograph further contains information for the consumer about the dangers of a drug with addiction and abuse potential. Patients are advised to take the medication only as indicated by the treating physician, to tell their doctor if they have questions or concerns about addiction or abuse, and to keep the medication safe, and to never give it to anyone else as it may be abused and cause serious harm, including death.
Manufacturers may also be required to implement a specific risk management plan as a condition for approval. Such plans may include monitoring of events related to abuse and addiction once the drug is on the market, as well as education materials for health care professionals and patients.
Once a drug is on the market, Health Canada monitors its safety through surveillance of serious side effects reported within and outside Canada. As new information becomes available about side effects, the product monograph is updated to inform physicians and patients about the new safety information. The risk management plan can also be altered to address changes in risks, or a drug can be removed from the market if experience with the drug shows that its benefits no longer outweigh its risks.
Several drug classes, such as opioids, central nervous system stimulants and depressants, cannabinoids, and nicotine-like compounds are already well known to be potentially addicting and have abuse liability.
To this end, Health Canada put in place a guideline to assist manufacturers in conducting studies assessing whether a new drug produces acute effects such as euphoria, or drug-liking effects that could lead to addiction or abuse. Results of such studies are required to be included in drug submissions, and help guide benefit-risk assessments and decisions relating to drug approval, scheduling under the Controlled Drugs and Substances Act, prescribing information within the product monographs, information for the consumer, and risk management plans.
Through this work, Health Canada works to establish and maintain prescription drug accessibility, while decreasing the risk of abuse associated with certain drugs. Protecting the health of Canadians remains the primary concern. Public awareness among prescribers, dispensers and patients about the problems with drugs that are addictive or that could be abused promotes good medical practices, fosters dialogue, and more importantly, helps ensure patient access to effective medications while protecting them and others from the potential harms of these types of drugs.
I will now speak briefly to some of Health Canada's work to ensure that First Nations and Inuit have access to health services, including mental health and addictions programs, and to prevent prescription drug abuse in First Nations communities.
While there is limited data available, some first nations have reported significant challenges with the abuse of prescription drugs.
To respond to the serious problem of substance abuse, Health Canada invests approximately $92 million annually in addictions prevention and treatment programming. This investment includes funding to support a network of 55 treatment centres, as well as drug and alcohol prevention services in over 550 community-based prevention programs.
Of note, in 2013-14 Health Canada worked in close partnership with the Ministry of Health in Ontario as well as the Chiefs of Ontario, and invested $2 million to support first nations communities in Ontario where the problem of prescription drug abuse is most acute.
Health Canada's investments in addictions and treatment programs are part of a larger effort to provide first nations and Inuit with a comprehensive system of mental wellness services.
Health Canada also administers the non-insured health benefits program, NIHB. It provides coverage for a limited range of medically necessary goods and services, including prescription drugs, to eligible first nations and Inuit.
Over the last decade, the non-insured health benefits program has introduced a wide range of client safety measures to prevent and respond to potential misuses of prescription drugs to help ensure that First Nations and Inuit clients can get the medications they need without being put at risk.
Examples of these measures include sending automated real-time warning and rejection messages to pharmacies to alert them to situations of potential misuse when a client attempts to fill a prescription that requires a pharmacist's intervention before the claim can be processed. It also includes placing restrictions on the coverage of drugs of potential abuse, including those that present health risks or risk of diversion, and introducing dose limits that limit the amount of a particular drug that a client can receive per day.
To detect patterns of potential inappropriate prescribing and dispensing and other safety concerns, the NIHB program has a formal surveillance program called a prescription monitoring program, PMP.
Though the PMP was originally introduced in 2007 to focus on clients who have been double doctoring, it has since been expanded to address clients who are on high doses of one or more drugs of concern.
Clients whose drug utilization profiles indicate that they are at high risk of misusing certain drugs—opioids, stimulants, or benzodiazepines—are placed in the PMP. Clients listed in the PMP face restrictions in terms of the approval process for these drugs.
Since November 2012, the NIHB has been using the findings of the surveillance work to engage prescribers to gain insight into the reasons behind high doses of opioids and benzodiazepines, and work with them to impose restrictions, taper doses, and encourage the use of alternative non-opioid medications as appropriate.
Preliminary results of these initiatives indicate that the impact is positive. In the last 12 months the number of high-dose benzodiazepine clients has decreased by 36%, and the number of high-dose opioid clients has decreased by 7.5%.
Going forward, the non-insured health benefits program will continue to monitor the use of opioids and other drugs of concern. It will continue to adjust existing limits and introduce new restrictions and measures as appropriate.
NIHB will also continue to work closely with physicians, other prescribers, pharmacists, and other public drug plans in our efforts to ensure the safe use of prescription drugs among first nations and Inuit clients.
Madam Chair, I would like to close my remarks today by spending a few moments talking about the Controlled Drugs and Substances Act and Health Canada's role in the national anti-drug strategy.
The Controlled Drugs and Substances Act, or the CDSA, provides a legislative framework for the control of substances that can alter mental processes and that may cause harm to the health of an individual or to society when diverted to an illicit market or used illicitly. The CDSA has a dual purpose to protect public health and maintain public safety. It prohibits activities such as the production, sale and possession of substances such as opioids, unless authorized for legitimate medical, scientific or industrial purposes through regulations or exemptions. It includes offences and penalties that range from a fine to life imprisonment.
The CDSA has a number of regulations that are relevant to the discussion of prescription drug abuse. The regulations provide a framework to facilitate the use of prescription drugs for medical treatment.
Compliance and enforcement also form an important part of the drug control objectives of the CDSA. Health Canada is active across the regulated supply chain to verify compliance with the CDSA and its regulations.
For example, licensed dealers comply with regulations setting out reporting and record-keeping requirements, as well as security measures aimed at minimizing diversion. Pharmacists are required to maintain records of controlled substances purchased and are accountable for prescriptions dispensed.
As a final comment, I would like to highlight some of the lessons learned under the national anti-drug strategy, a strategy based on three key areas of action—prevention, treatment and enforcement—which I believe are informative in identifying actions to address prescription drug abuse.
Under this strategy, we have seen marked progress in discouraging youth from using illicit drugs and in supporting innovative treatment services for individuals addicted to illicit drugs.
For example, the government led a successful mass media campaign entitled “DrugsNot4Me” to raise awareness among youth and parents about the dangers of illicit drugs. This campaign saw impressive results. Youths are now more likely to say that they would refuse to take illegal drugs, and more parents engage their teens in discussions about the risks of taking drugs.
The government has also made significant progress, working in partnership with law enforcement, to prevent the production and diversion of illicit drugs.
The national anti-drug strategy and its successes provide a strong foundation upon which to support action to prevent prescription drug abuse. In light of the recent Speech from the Throne commitment to expand its scope, work is under way to assess how the prevention, treatment, and enforcement successes of the national anti-drug strategy can be applied to addressing this issue.
Thank you, Madam Chair.
Debra Gillis
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Debra Gillis
2013-11-06 16:18
Yes, I'd be pleased to answer that question, Madam Chair.
We have recently conducted a study within our NNADAP, the national native alcohol and drug abuse program, treatment centres to really look at the extent of prescription drug and polydrug use of people seeking treatment through these centres. We have found that about 30% of all people entering the treatment centres use opioids in addition to alcohol. Some could be using other types of illicit drugs as well. So it's about 30% of those.
Through the increased knowledge around prescription drugs and the increased evidence that there are actually possibilities of working with and treating prescription drug abuse as part of an overall treatment program, we are seeing an increase in the demand for prescription drug abuse treatment in the NNADAP treatment centres. We've had a very high success rate actually, Madam Chair.
In the research that we have done, we've found that 72% of the clients who entered those treatment programs with an opioid use problem left without an opioid use issue. They terminated the use. Of that small number of clients who didn't, almost 90% reduced the use.
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