Supplementary Report of the New Democratic Party of Canada

The New DemocraticParty of Canada would like to acknowledge the House of Commons StandingCommittee on Health’s unanimous support for our motion to launch an emergencystudy into the opioid crisis in Canada.

The Committee’s studyis an important first step. It is clear, however, that the federal governmentmust now demonstrate leadership by working with the provinces and territoriesto implement a comprehensive national strategy on opioid addiction and overdoses.

Throughout the study,the Committee heard clear and consistent testimony on the scope and origins ofthis national public health crisis. In 2015, anestimated 2000 Canadians died from opioid overdoses and many provinces areseeing an alarmingly high number of fatalities in 2016.[1] Over the last two decades, more than 10,000 Canadians have diedfrom opioids and an untold number now suffer from addiction.[2]

Commendably, the Committee was able to work acrosspartisan lines to produce 38 recommendations in anticipation of the Minister ofHealth’s Opioid Summit on November 19, 2016. However, the New Democratic Partyis concerned that certain vital aspects of the evidence presented throughoutthe study were not adequately reflected in the Committee’s interim report, andseveral key recommendations have been omitted.

To that end, the NewDemocratic Party of Canada proposes the following supplementary recommendationsto the Committee’s report:

RECOMMENDATIONS

A. Disclosure of Financial Relationships

Accordingto Dr. Evan Wood, Professor of Medicine at the University of British Columbia,drug manufacturers have historically been able to exploit gaps in physicianknowledge and training relating to addiction medicine, which in turn has led tounsafe prescribing practices for opioids.[3]

Dr. DavidJuurlink, Head of Clinical Pharmacology and Toxicology at Toronto’s SunnybrookHealth Sciences Centre, outlined some of the drug industry’s problematic marketingtactics[4]:

They sent drug representatives to doctors' offices, but there was much more thanthat. Key opinion leaders in the field of pain all across North America gavetalks at CME events, continuing medical education events, at fancy restaurants.I went to them myself and I was told that not only should I use these drugs,but also that if I didn't use them, I was being ‘opiophobic’ and was deprivingmy patients of a proven therapy. The virtues of these drugs were extolled. Thecompanies made their way in some instances—including at my own medicalschool—into the curriculum where individuals in the pay of the companies thatmake these drugs taught medical students for years without disclosing theirconflicts and gave them overly rosy views of the utility of these drugs.

Canadian drug companies have recently announced a voluntary financial disclosure initiative.[5] However, under that initiative, participating companies will only report aggregate amounts given to medical education, rather than payments made to individual medical professionals.[6] Canada’s New Democrats therefore recommend:

RECOMMENDATION 1

That the Government of Canada work with medical regulatory bodies to develop legislation similar to the American ‘Physician Payments Sunshine Act,’ requiring pharmaceutical companies to disclose, as a legal requirement, all payments or transfers of value to medical professionals with respect to opioids.

B. High-Dose Prescription Opioids

According to Dr. Juurlink, “We did astudy in 2015 that made it very clear that people on high doses of opioids weremore likely to die from their medication than from almost anything else.”[7]

Moreover, a recent report fromthe Centre for Addiction and Mental Health (CAMH) suggests more prudent use ofhigh-dose opioid prescriptions.[8] The report endorsed the Government ofOntario’s plan to remove high-dose opioids from the Ontario Drug Benefitformulary, with exceptions for palliative care and support for patients whoneed to taper or switch medications.[9] Canada’s New Democrats thereforerecommend:

RECOMMENDATION 2

That Health Canada review the prescription criteria for the highest-potency opioids, such as fentanyl patches of up to 75 and 100 micrograms, OxyNEO® 80, and the highest formulations of Dilaudid®.

C. Shifting Jurisdiction and Authority to Indigenous Communities

Representing the Assemblyof First Nations, Ontario Regional ChiefIsadore Day informed the Committee that the “30,000-foot solution” toopioid overdose and addiction in Indigenous communities is based on shiftingjurisdiction on health because “jurisdiction means authority, and authoritymeans responsibility.”[10]

According to Chief Day, “For first nations, once we have a place in configuring oursolutions, and once we have that authority, we then start to put forward thereal costs of treatment and the real costs of prevention and we get results.Certainly, first nation jurisdiction on health is key.”[11] Canada’s New Democrats therefore recommend:

RECOMMENDATION 3

That the Government of Canada accelerate the shifting of jurisdiction and authority to Indigenous communities, willing and prepared to exercise same, for the programs, services, and responsibilities that are presently managed by Health Canada.

D. Police Non-Attendance at 911 Calls for Overdoses

Lisa Lapointe, Chief Coroner, British Columbia Coroners Service, expressed the valueof adopting a policy of police not attending 911 calls for overdose situationswheresuch presence is not required.[12] Dr. Jane Buxton, epidemiologist and harm reduction lead at the B.C. Centrefor Disease Control, testified that approximately 82% of people inVancouver call 911 during overdose events, but that number falls to less than60% in regions outside Vancouver, primarily where the RCMP serves as the policeforce.[13] Dr. Buxton attributed this gap in large part to the Vancouver Police Department'spolicy of non-attendance at 911 calls for overdoses.[14] RCMP AssistantCommissioner, Todd G. Shean, told the Committee that, to his knowledge, the RCMP has notconsidered such a policy.[15] Canada’s New Democrats therefore recommend:

RECOMMENDATION 4

That the RCMP review its attendance at 911 calls for overdoses.

E. Illicit Drug Checking

Dr. Bonnie Henry informed the Committee of the B.C. Public Health Officer’s efforts to expand drug checking to give individuals the ability to verify that their illicit drugs do not contain potent opioids like fentanyl.[16] According to Dr. Henry, “It's a challenge still, because with the tests that are available for drug checking, we don't know the parameters. They're not designed for drugs. They're designed for urine testing. We don't have good drug checking capabilities yet, but we're working on it.”[17] Canada’s New Democrats therefore recommend:

RECOMMENDATION 5

That the Government of Canada provide funding for research into effective testing to detect the presence of fentanyl and other powerful opioids in illicit drugs.

F. Diplomatic Engagement

The Committee heard that the RCMPhas been building relationships with its law enforcement counterparts in Chinain an effort to strengthen collaboration to disrupt international drugtrafficking networks. According to RCMP Assistant Commissioner Todd G. Shean[18]:

InOctober 2015, the Chinese government completed regulatory amendmentscontrolling 116 new substances, including some fentanyl analogues, but thedrugs that made it to Canada are not controlled in China. In addition, there'sa disparity between what Canada and China consider a public health crisissimply based on population numbers. Fentanyl abuse has not been identified inChina. The Chinese government's focus is on other synthetic drugs of abuse likemethamphetamine and ketamine.

The Committee also heard that the RCMP’scounterparts in the United States have identified Mexico as their main sourceof illicit synthetic opioid distribution. However, Assistant Commissioner Sheannoted that the drugs that are entering Canada from China are also evident inthe United States.[19] Canada’s New Democrats thereforerecommend:

RECOMMENDATION 6

That theGovernment of Canada engage diplomatically with opioid-exporting countries withthe goal of stemming the flow of illicit opioids into Canada.

LIST OF RECOMMENDATIONS

RECOMMENDATION 1

That the Government of Canada work with medical regulatory bodiesto develop legislation similar to the American ‘Physician Payments SunshineAct,’ requiring pharmaceutical companies to disclose, as a legalrequirement, all payments or transfers of value to medical professionals withrespect to opioids.

RECOMMENDATION 2

That Health Canada review the prescription criteria for thehighest-potency opioids, such as fentanyl patches of up to 75 and 100micrograms, OxyNEO® 80, andthe highest formulations of Dilaudid®.

RECOMMENDATION 3

That the Government of Canada accelerate the shifting of jurisdiction and authority to Indigenous communities, willing and prepared to exercise same, for the programs, services, and responsibilities that are presently managed by Health Canada.

RECOMMENDATION 4

That the RCMP review its attendance at 911 calls for overdoses.

RECOMMENDATION 5

That the Government of Canada provide funding for research into effective testing to detect the presence of fentanyl and other powerful opioids in illicit drugs.

RECOMMENDATION 6

That the Government of Canada engage diplomatically withopioid-exporting countries with the goal of stemming the flow of illicitopioids into Canada.