HESA Committee Report

Minority Report of the Liberal Party of Canada

Submitted by the Hon. Dr. Hedy Fry, P.C., M.P.
Federal Liberal Health Critic

The House of Commons Standing Committee on Health recently undertook a ten meeting study on the issue of the Federal Role in Addressing Prescription Drug Abuse. While the Liberal Party supports the majority of the content in the report, as well as the recommendations, we felt there were some critical points made by witnesses that were not reflected. They relate to the federal role in this ongoing crisis in Canada.

The federal government is the fifth largest provider of health care services in Canada. It has fiduciary responsibility for First Nations and Inuit Health, the Armed Forces and Veterans. The Committee heard that prescription drug abuse was a serious problem among these populations; in particular First Nations communities.

The main report notes that we heard witness testimony from the Assembly of First Nations (AFN) and the National Native Addictions Partnership Foundation (NNAPF).

In their presentations to the Committee both the AFN and the NNAPF stressed the need to ensure that any addictions program for First Nations be based on the Social Determinants of Health, which includes housing, education, poverty and income levels. They also noted that the most successful addictions treatment programs in First Nations communities were those that were culturally based and informed by an understanding of the history of colonialism and its effects on First Nations.

Recommendation 1: Health Canada work with First Nations and Inuit Community to implement a culturally based, comprehensive addiction treatment program that takes into account the social determinants of health and that these programs be implemented in partnership with the values, attitudes and aspirations of First Nations communities.

The Committee heard that while prescription drug abuse takes many forms and includes benzodiazepines as well as opioids, OxyContin is one of the most harmful and addictive opioids and the federal government should take particular actions to curb its use.

Dr. Navindra Persaud noted that Purdue Pharma admitted that is had provided misleading information to physicians about its abuse potential and highly-addictive properties. As a result, physicians began prescribing this drug to manage pain. It is estimated that 500 people died in Ontario alone each year due to opioid abuse. OxyContin is particularly prevalent in First Nations communities.

In 2012, the United States banned production of generic OxyContin in favour of the new abuse deterrent formulation known as OxyNeo. The United States Attorney General, Provincial Medical Officers of Health and Provincial Health Ministers have asked the federal government to do the same. Subsequently, Health Canada approved six generic pharmaceutical companies to produce generic OxyContin. Witnesses recommended that generic production of OxyContin be banned.

Recommendation 2: Health Canada immediately rescind the decision to allow the generic production of OxyContin in Canada to prevent further overdose deaths and addictions.

Recommendation 3: Health Canada remove generic OxyContin from the federal formulary for First Nations, Armed Forces and Veteran’s Affairs and replace it with tamper resistant OxyNeo.

The Committee also heard from witnesses that harm reduction must be a key component of any prescription drug abuse strategy. In 2007, harm reduction was removed as one of the four pillars of Canada’s Anti-Drug strategy. As noted by the Canadian Nurses Association, harm reduction is a public health approach that promotes safety while preventing death and disability, which has been shown to be an effective method of supporting individuals while engaged in active or decreasing drug use.

Though it was noted by many that “harm reduction” is now a politically controversial term, most of what the health care system does for patients is based on “harm reduction”. It does not only apply to supervised safe injection sites. One witness notes that when we treat diabetes patient and monitor blood sugar levels and diet – that is harm reduction. It is an effort to reduce harm to Canadians and prevent disability and premature death.

Recommendation 4: Health Canada reinstate “harm reduction” as a key pillar of Canada’s National Anti-Drug Strategy to promote safety and prevent disease, disability and premature and preventable death.

While the bulk of the remaining recommendations in the report were supportable, the Liberal Party is recommending more concrete action from the federal government in areas where it has fiduciary responsibility. Many recommendations call for the federal government to work with provinces and territories. While this is laudable, there are certain areas where the federal government must take action itself.

Recommendation 5: Health Canada conduct an assessment of alternative pain management programs with multidisciplinary teams in rural and remote areas, particularly in First Nations communities, in order to ensure all Canadians have access to a comprehensive pain management system, including physiotherapy, occupational therapy, psychology, biofeedback and acupuncture.