PACC Committee Report

RECOMMENDATION 20

That Health Canada implement a centralized analysis of drug use similar to that found in the provinces in order to identify misuse, abuse, and multiple use on a real-time basis.

Obtaining the consent of individuals to share information would satisfy concerns over privacy and allow interventions to resume. As Mrs. Stonechild indicated, “it would do wonders. It would be a fantastic thing if it happened.” However, the Committee has reservations about the viability of this approach. In particular, the Committee is not convinced that those who abuse prescription drugs will consent to having information on their drug use shared with health care providers. Dr. Kendall and Mr. Joubert both agreed that individuals addicted to prescription drugs would not consent. As Mr. Joubert told the Committee, “it’s not the drug abuser, the person who’s addicted to the drugs that will provide you with any information.” Dr. Kendall testified that “many patients who are seeking drugs for improper purposes actively conceal their previous drug use.” Yet if abusers withheld consent, the purpose for enrolment would be defeated.

The Department did not share this concern. Mr. Potter stated that NIHB recipients would give their consent “because it will be essential for being reimbursed … people will register in order to receive payment.” However, under the current arrangement, pharmacists ― not clients ― submit claims to a private-sector claims processor for reimbursement. At another point, Mr. Potter suggested that families would have to fill in registration forms providing consent “to continue their benefits.” Dr. Cooney mentioned another approach to obtaining consent. He told the Committee “for a drug abuser who may not want to sign, there is an option to give them an emergency supply for four days, after which they get cut off.” These approaches, however, are bound to raise other complex issues of a legal and ethical nature not given to easy or timely resolution.

It thus remains uncertain what the Department intends to do ― or can do ― if consent is withheld. And indeed Mr. Potter testified that Health Canada has not formulated a policy that will guide its actions if this happens. Such planning should have taken place while the Department was reviewing its options. Now that the choice has been made and the Department anticipates establishing a consent regime shortly, Health Canada should immediately develop a policy specifying what it will do if consent is not given. In particular, clients of the NIHB Program deserve to know, in advance, what consequences await them in the event that they do not consent. The Committee therefore recommends:

RECOMMENDATION 21

That Health Canada develop a policy to guide its response in cases where it is unable to obtain the consent of recipients of Non-Insured Health Benefits to share information on use of pharmaceuticals with health care professionals and make that policy known prior to the implementation of a client consent arrangement under the Non-Insured Health Benefits Program.

Departmental witnesses did not explain why consent was preferable to providing a legislative basis for the program. However, Mr. Potter did state that “legislation is a better guide than policy” in terms of supporting the Department in its delivery of the NIHB program. In later testimony, Dr. Cooney told the Committee “If we had a legislated plan, then we wouldn’t need enrolment … It is not legislated so we do need some type of consent.” In contrast, Mr. Potter testified earlier that the “best advice … at the moment is … that we would need consent, even if we had legislation.” Given the lack of clarity surrounding this issue as well as potential problems associated with the consent option, further review of the legislative option would be appropriate. The Committee therefore recommends:

RECOMMENDATION 22

That Health Canada review the option of obtaining specific enabling legislation for the Non-Insured Health Benefits program that would, among other things, permit sharing information about client drug prescription patterns among health care professionals, and report the conclusions of that review to the Committee by 31 March 2002.

At its last hearing, the Committee learned that the Department is now exploring other ways to share information among health care providers without getting directly involved. Dr. Cooney informed the Committee that a number of provinces have introduced a triplicate prescription plan. Under this plan, physicians prescribing a controlled substance or narcotic are required to use a prescription in triplicate form. One copy goes to the dispensing pharmacist and another goes to the provincial college of physicians and surgeons. The college can use this information to monitor the prescribing patterns of physicians. Also, according to Dr. Cooney, provincial legislation mandates pharmacists to provide information, including patients’ names, on prescription drug dispensing to colleges of physicians and surgeons. Dr. Cooney testified that Health Canada is about to

go into a testing phase with the College of Physicians and Surgeons in Saskatchewan to ensure the technology in the pharmacy area comes up to speed and after that, the intent would be for the information to be shared between the providers and the regulatory bodies such that Health Canada won’t have to share personal, private information.

Dr. Cooney indicated that he expected to conclude an agreement with the College “within a matter of months.” 

The Committee finds that this is an interesting approach and one that Parliament needs to be informed of. The Committee therefore recommends:

RECOMMENDATION 23

That Health Canada include, in its report on plans and priorities for 2002‑2003, a detailed description of the project it is testing with the College of Physicians and Surgeons of Saskatchewan to facilitate the sharing of information between pharmacists and the College under the Non-Insured Health Benefits Program. This description should include: a discussion of the nature of the information being shared; time lines for project implementation; and the human, financial, and technological resources devoted by the Department to this project.

RECOMMENDATION 24

That Health Canada discuss the progress of the project being tested with the College of Physicians and Surgeons of Saskatchewan, including the outcomes achieved, in its performance report for the period ending 31 March 2002.

As described to the Committee, this project will make information on the prescribing patterns of physicians available to the College so that it can intervene in cases of suspected inappropriate behaviour. Although this is useful, it does nothing to equip individual physicians with information they could use when making prescribing decisions. As Dr. Kendall testified, doctors “might not even prescribe, in fact, if they had accurate information about drug utilization history.” The Committee therefore recommends:

RECOMMENDATION 25

That Health Canada explore ways of facilitating the sharing of information between individual pharmacists and physicians providing services under the Non-Insured Health Benefits program and report its conclusions to the Committee by 31 March 2002.