Interventions in Committee
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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.
Suzy McDonald
View Suzy McDonald Profile
Suzy McDonald
2014-10-27 17:12
As Hilary mentioned earlier, the national anti-drug strategy is really built on three pillars. Those pillars are all designed to reduce or eliminate the negative impacts of illicit drug use and contribute to healthier and safer communities.
The health portfolio invests approximately $126 million a year to address addictions and illicit drug use in Canada. Since 2007 Health Canada has funded 139 projects to discourage illicit drug use among youth through the drug strategy community initiatives fund. Health Canada also provides $13.2 million annually to provincial and territorial governments and other key stakeholders to strengthen substance abuse treatment across Canada through the drug treatment funding program. As our minister noted, prescription drug abuse is now also being addressed through these funding programs.
Specifically with regard to prevention, the program provides approximately $9.6 million in contribution funding, and this supports a variety of recipients in delivering health promotion and prevention projects that facilitate the development of national, provincial, territorial, and local community-based solutions to drug use among youth aged 10 to 24, and promote public awareness of substance abuse issues.
More than 139,000 youth, 11,000 parents, and 2,000 work or schools have been reached through these programs. Projects have focused on capacity building: they've resulted in more than 13,000 youth and almost 5,000 teachers being trained on various topics, including peer leadership, facilitation, and life skills.
I'd note that an evaluation of that prevention program did note that the program increased awareness of healthy choices, increased perceived overall awareness of illicit drugs, increased awareness of potential problems that can affect people who use illicit drugs, decreased the likelihood of trying or regularly using marijuana, decreased the likelihood of trying or regularly using other illicit substances, and improved overall community engagement and capacity.
With regard to treatment, the program provided funding to 29 projects across Canada. I'd say that, for example, the introduction and increased reporting against national treatment indicators has provided consistent measures for treatment systems across the country for the first time. The production of evidence-based standards and guidelines has led to consistency and quality of treatment of care. Prior to the program, many PTs reported working in silos where collaboration with other sectors or regions was not a priority. Evidence shows that the program has helped to establish conditions necessary to support collaboration, including the development of a national knowledge exchange platform for all of these projects.
I can go on a little bit further in terms of first nations and Inuit health. We've invested $12.1 million to improve quality access to addiction services for first nations and Inuit. This funding has contributed to the reorienting of 36 treatment centres to more effectively meet community needs: services for women, youth, people with co-occurring mental health issues, and prescription drug abuse. It has contributed toward an increase in the number of treatment centres receiving accreditation: 82% of treatment centres were accredited in 2013, which was up from 68% in 2010. It has contributed toward an increase in addiction workers receiving training and becoming certified: 434 community-based addictions workers and treatment centre counsellors were certified in 2013, and this was up from 358 in 2010. Now 78% of all treatment centre counsellors are certified, up from 66% in 2011.
You can see the enormous impact these are having on prevention and treatment, both in first nations and other vulnerable communities, and particularly among our youth, parents of youth, schools, and teachers.
View Libby Davies Profile
We certainly look forward to seeing that information, because there's no question that when you analyze this issue, we're lagging far behind the drug safety measures in, for example, the U.S. and Europe.
I'd now like to ask you a second question concerning your recent decision to intervene and, in effect, ignore the experts in your own department who had given approval under the special access program for the SALOME trial in Vancouver. One of the things that really bothered me about this is that both you as minister and your office publicly said on a number of occasions that the SAP is for rare diseases or terminal illnesses. According to your own website, “...practitioners treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable.” Now, that's clearly within the realm of what the SALOME trial was about.
It was also very disturbing that you repeatedly referred to illicit drugs, when in actual fact, diacetylmorphine is actually a clinically produced medication. I'm aware that Health Canada, before coming to its decision under SAP, sought the advice of Michael Lester, an independent expert who has specialized in opiate dependence treatment for nearly 20 years. In fact, in a recent report in 2013 that he did for Health Canada, he called prescription heroin “a promising treatment of last resort” for this population, noting that there is no other next step for people who have failed multiple treatment attempts with methadone.
It is all very disturbing that this intervention was made at a political level, particularly in light of the information I've given you. So I guess my question is, why have you allowed politics to trump evidence-based medicine when the process was in place? Clearly, a decision was made based on expert evaluation, and as a result, because of your political intervention, I would say that people's lives are at risk and a very vulnerable population is left hanging out there with basically a political decision made by yourself. Maybe you can answer for that.
View Rona Ambrose Profile
First of all, in regard to the SALOME trial, these requests under the SAP are not, as you know, the SALOME trial. The SALOME trial is separate. That research is ongoing and was actually approved by our government.
In terms of the physicians who made this request, you should know that in the past when a request like this was made, it was denied. Under the special access program, as you know, Health Canada can approve emergency access to certain medicines for Canadians with rare diseases or terminal illnesses. The intent of that program was not—
View Hedy Fry Profile
Lib. (BC)
Thank you very much. Welcome, Minister.
There were some questions asked by my colleague Ms. Davies that I wanted to expand on.
The first one had to do with the SAP and the removal of the decision by the department to allow for diacetylmorphine to be used with certain patients, These patients are a very select group. They do not respond to methadone or to suboxone or to any of those other things, and they actually only seem to respond to heroin. This comes from the NAOMI trials and other trials, as well as SALOME.
Now, if these patients cannot get this, what they do is go back to heroin, which at the moment is only available on the street. So the question is, is withholding this heroin from them a good approach? It's a start to treatment and to getting them off and getting them on lower doses, which has been shown to work in Europe and in Australia and across the world for quite a long time now. This would help these people to get off the drug eventually and save their lives, because if they go back on the street, they're back to petty crime and to injections of heroin that can kill them.
This is a life-threatening problem. Can you quickly tell me about that? That's my first question.
I want to allow you to answer them all, so I'm just going to give them to you. The second one has to do with research on HIV. I think it's interesting to note that you're spending a great deal of money on research on HIV, but I wondered if you have met with and have decided that it is a good time to look at the highly active antiretroviral program going on in British Columbia, which has now been adopted by China, by Brazil, by the United Kingdom, and by France. With this program, people who are deemed to be HIV-positive are given a drug whose effect is that by the end of the first two doses they no longer create enough virus to infect others. It's known, therefore, as treatment as prevention. I know that the Canadian government has never paid any interest to this, which is kind of sad since we should be really proud of it. This is Banting and Best work that is being done. That's my second question.
My final question is this: you're taking on the food inspection agency, which I think is a good idea. I've always believed that it should be in one place and that PHAC should in fact be in charge of this. So I think it's fine, but I wondered, when you do so, are you going to look at some of the recommendations that came out of the report that the United States had asked that Canada do? This is about prevention strategies and oversight and technical training and better-trained inspectors and looking at research on preharvest ways of dealing with things. Are you going to look at how we get a faster way of getting the information to the public and collaborating with stakeholders? Those were four big areas that the recommendations addressed, and I wonder if you're going to address this when we get there, because this is a really severe problem. People could die. Fortunately, people only got sick, but people could die from E. coli or listeriosis or salmonella, any one of the things that we can find in foods. Now that it's turned over to Health Canada, we should be better able to deal with this in an appropriate and effective manner.
Can you tell me whether you are going to look at those recommendations or not?
View Rona Ambrose Profile
That's a lot of questions.
First, on the SAP program, I'll reiterate my view that the intent of the special access program is not to provide addictive drugs to those who are addicted. I will continue to focus on intervention, safe intervention, safe alternatives, treatments, and recovery for those who are addicted.
As for the HIV, you're right. We are a leader in HIV spending. We have spent half a billion dollars to address HIV/AIDS since 2006, and the Public Health Agency has done incredible work in that area. There's also the HIV vaccine initiative with Bill and Melinda Gates that we have funded.
I'm going to ask Krista to say a few words about that. But before I do, I would just touch on the healthy and safe food for Canadians framework. I think it was a very good public policy decision to bring CFIA under the Health portfolio. Already, we have interaction between CFIA and public health officers at the provincial level. So you hit the nail on the head. It's all about information-sharing and making sure that it's not just about agriculture but also about public health. We're seeing a great response from the provinces and territories. We recently launched another part of our FoodNet Canada set-up in Alberta. We now have them in B.C., Alberta, and Ontario, and we hope to have more. It is all about collaboration and information sharing. The sooner we can get that information to the public health officers from the inspectors, the better. That's exactly why we've done this. We see a great collaboration.
I'll ask Krista to speak.
View David Wilks Profile
Thanks, Chair.
Thanks to you and all your staff, Minister, for being here.
I'm going to carry on with the conversation that Ms. Fry and Ms. Davies had picked up on. You spoke in your opening remarks about healthy living and said further that protecting Canadians from harm is part of your mandate, as is ensuring that both licit and illicit drugs are dealt with in a manner that is responsible for all Canadians.
Recently, injection sites have been in the spotlight, and specifically how communities should have a say in their placement. As a former police officer, I think it's only fair that people have the right to say whether one is in their community or not. I wonder if you could comment from your perspective on the Respect for Communities Act and what it's trying to accomplish, and then, further to that, on the importance of treatment, recovery, and support.
View Rona Ambrose Profile
Sure, I'm happy to do that. I appreciate the question.
The legislation you're talking about with regard to supervised injection sites, the Respect for Communities Act, is being debated in the House right now. We introduced it last month.
This legislation will give law enforcement, municipal leaders, and local residents a voice, all of whom have asked for a voice before the permit is actually granted for a supervised drug injection site in the area.
This went to the Supreme Court, and in a 2011 Supreme Court ruling the justices were crystal clear. They ordered that I, or any health minister, must consider specific factors when reviewing applications that grant exemptions under our drug laws. In other words, we must look into specific factors before allowing a permit for a supervised drug injection site.
One of the five factors named in the ruling is expressions of community support or opposition. I do not, nor should I, ignore any of the factors named in the court's ruling. I think it makes good sense. I am required by the Supreme Court to consider community opinions in the process, and that information needs to be made available to me by the organization if it's seeking to build such a site.
I should say that there is no one now seeking to build such a site, but this bill also requires that these organizations submit the relevant scientific information demonstrating the effectiveness of illicit drug treatment at the proposed site as part of their application.
I think that all parties, or at least those with whom we have consulted, agree that this kind of information must be provided to decision-makers when assessing a permit of this kind. This information will be provided along with details about the resources of the proposed site and about how these resources will be used for drug treatment. Knowledge about the level of community support and the treatment options that are available will also help determine the merits of each application.
This is reasonable and it is also mandated by the Supreme Court, so that is what is in the bill. Those stakeholders who have been dealing with this issue for many years deserve a say in where these sites would be if we receive an application for them, so we are moving on this. The Supreme Court has ruled. We believe our communities deserve nothing less than to have a voice in that, and the Supreme Court has agreed.
I do encourage everyone to support the legislation and move it along.
Our government has invested quite a bit of money in drug treatment and recovery. I am of the belief that we spend a lot of time talking about a very small piece of the drug problem when we talk about supervised injection sites. There are literally hundreds of thousands, if not millions, of Canadians across the country who are either in recovery or suffering from addictions. A lot of them feel shame and they don't want to speak openly about their addictions and their need for recovery. We need to speak more about it because they need to feel comfortable about coming forward to seek help and intervention.
That is one of the messages that I bring, as the health minister in my tenure. We need to get people out of addiction, into recovery, and into the right kinds of treatment programs. Sometimes it takes years. Sometimes it takes multiple attempts. People talk about it not working, even after two tries. Sometimes it takes 15. As a police officer, you have seen this first-hand. Eventually, though, people can get up on their own two feet, recover, and lead a productive life.
The message is to not give up on people, any people, particularly those who are most vulnerable.
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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