Canadian Pain Task Force Terms of Reference
It is estimated that 6 million Canadians (or 19% of the population) are currently suffering from chronic painFootnote 1. Some Canadian populations (e.g., women, older Canadians, veterans, Indigenous populations) are disproportionally affected by chronic pain. Chronic pain has significant impacts on individuals' well-being, and often prevents patients from undertaking everyday functions.
Chronic pain is also a significant burden on the Canadian economy, with an estimated $6 billion per year in direct health care costs, and $37 billion per year in productivity costs related to job loss and sick daysFootnote 2. Evidence also indicates that treatment for chronic pain is fragmented and sometimes difficult to access for many CanadiansFootnote 3. Pharmacological interventions also continue to be, in many instances, the only option available to healthcare providers to help patients manage their pain. This has contributed to significant increases in the level of prescription opioids being dispensed across Canada over the past 20 yearsFootnote 4.
Pain is linked closely to the current opioid crisis. For instance, data recently published in British Columbia indicated that 46% of individuals who died from an illegal drug-related overdose in the province had sought assistance from health services for pain-related issuesFootnote 5. A study performed in 2018 also indicated that 52% of opioid-related hospitalizations in Manitoba and Ontario, and 34% in British Columbia occurred in people with an active opioid prescriptionFootnote 6.
At the ministerial roundtable on chronic pain and the Opioid Symposium in September 2018, Health Canada heard about the impact of the opioid crisis on the chronic pain community. Some people with chronic pain have indicated experiencing increased stigma as a result of the attitudes and beliefs around opioid use in the context of the crisis. They also reported inconsistencies in treatment services, with some individuals finding it more difficult to access opioids to manage their pain. This is particularly problematic as some individuals may find ways to self-manage their condition (e.g., by using illegal opioids) given the lack of treatment options that may currently be available to them. Health Canada also heard about the importance of better national coordination in order to increase knowledge of best practices on pain-related issues and increase the efficiency and consistency of actions to improve health outcomes of Canadians living with chronic pain.
The purpose of the Canadian Pain Task Force is to assess how chronic pain is currently managed across Canada to identify gaps and priority areas for actions. The Task Force will consult with stakeholders across Canada, including the chronic pain community (i.e., pain specialists, pain research experts, chronic pain patients), federal, provincial and territorial governments, the medical community and Indigenous populations to inform its work. It will also disseminate its findings related to best practices for chronic pain management and prevention to these stakeholders.
1.1 The Task Force's mandate is to:
- Assess how chronic pain is currently addressed in Canada.
- Conduct national consultations and review available evidence to identify best and leading practices, potential areas for improvement, and elements of an improved approach to chronic pain management and prevention in Canada.
- Provide recommendations on priority actions to ensure people with pain are recognized and supported and that pain is understood, prevented, and effectively treated across Canada
1.2 The Task Force will submit three reports to Health Canada over the course of its mandate:
- A report assessing the current state of how chronic pain is managed across Canada (by June 2019).
- A report identifying best and leading practices, potential areas for improvement, and elements of an improved approach to chronic pain management (by June 2020).
- A report recommending priority actions to ensure people with pain are recognized and supported and that pain is understood, prevented, and effectively treated across Canada (by March 2021).
1.3 In carrying out its mandate, the Task Force will be mindful of federal and provincial/territorial jurisdictions and authorities, as well as the importance of promoting the principles of cultural safety and humility.
1.4 The Task Force will provide Health Canada with advice regarding evidence and best practices for the prevention and management of chronic pain. Health Canada has the responsibility and sole authority to make decisions resulting from the evidence generated by the work of the Task Force.
1.5 The Task Force will be established for a three-year period, with a mandate to be terminated in December 2021. Health Canada may consider renewing the mandate of the Task Force and revising its membership at the end of its mandate.
2.0 Reporting Structure/Governance
2.1 The Task Force operates under the Health Canada Policy on External Advisory Bodies. All elements of this policy apply to this Task Force.
2.2 The Task Force reports to the Associate Assistant Deputy Minister of the Controlled Substances and Cannabis Branch (CSCB) at Health Canada.
2.3 A delegated official within CSCB will act as the Executive Secretary to the Task Force, and serves as an ex-officio member on the Task Force.
2.4 The Director of the Task Force Secretariat in CSCB oversees the activities of and provides support to the Task Force, as appropriate.
3.0 Membership and Nomination Process
3.1 Members of the Task Force are recruited through a targeted nomination process. The goal of this process is to ensure that together, members of the Task Force have a range of knowledge, experience, and expertise and reflect a variety of perspectives. Health Canada promotes diversity and inclusiveness in Task Force membership.
3.2 Following a review of nominees, members of the Task Force are appointed by the Associate Assistant Deputy Minister of CSCB. They are appointed at pleasure, and appointments may be ended without cause or consultation.
3.3 In considering whom to appoint, the Associate Assistant Deputy Minister of CSCB may consult:
- staff at Health Canada;
- other federal departments and agencies;
- Provincial and territorial health authorities;
- external organizations, associations, academic, research-based institutions, or experts; and
- the public
3.4 Members are appointed by the Associate Assistant Deputy Minister of CSCB for a three year term, terminating on December 31, 2021. Membership will be reviewed on an ongoing basis by Health Canada to ensure a range of expertise, experience, and perspectives on the Task Force.
4.0 Membership Considerations
4.1 The Task Force will be comprised of 8 members.
4.2 Together, members of the Task Force will reflect a range of perspectives and expertise, including those of patients, pain researchers, and experts providing health services to Canadians suffering from chronic pain.
4.3 To preserve the independence of the federal government as a decision maker, a federal employee can neither chair nor be a member of the Task Force, and cannot participate in the formulation of the Task Force's advice to Health Canada.
5.0 Conduct and Disclosure of Affiliations of Interest
5.1 Members of the Task Force are expected to interact in an unbiased, professional, respectful, and fair way with the Co-Chairs, other Task Force members, the Secretariat, government officials, stakeholders, and the public. They may not use their position on the Task Force for private gain or for the gain of any other person, company, or organization.
5.2 To be considered for appointment, potential members of the Task Force are required to complete and return an Affiliations and Interests Declaration Form.
5.3 In keeping with the Privacy Act, a completed Affiliations and Interests Declaration Form is considered confidential. Health Canada will not make public any information in the form without the member's permission. However, as a condition of membership, members will allow Health Canada to publish, on its website and in print, a Summary of Expertise, Experience, and Affiliations and Interests, based on the completed declaration form.
5.4 In addition to publishing the summary, Health Canada or the Co-Chairs will ask members to make a verbal statement of their relevant affiliations and interests at the beginning of the first Task Force meeting. Members will be asked to provide verbal statements on new relevant affiliations and interests at the beginning of meetings, as needed.
5.5 Members must update their declaration in writing whenever their situation changes. Health Canada will review declarations before making appointments and on an annual basis.
6.1 To support their ability to provide well-informed advice to Health Canada, members of the Task Force may receive confidential information. Everyone must sign a Confidentiality Agreement before participating in the Task Force as a member, presenter, or observer.
6.2 The Confidentiality Agreement prohibits the disclosure of any confidential information received through participation in the Task Force, including information received orally or in writing, through email correspondence, telephone calls, print materials, meeting discussions, etc. Reports of the Task Force are also considered confidential information until its release by Health Canada.
6.3 Health Canada will mark information according to the level to which it is protected under the Policy on Government Security.
6.4 The Co-Chairs will ensure that everyone participating in meetings, telephone discussions, email exchanges, or in another form of communication has received clear instructions on the confidentiality of the proceedings.
7.0 Security clearance
7.1 All members are required to attain an appropriate security clearance. This may require the member to submit fingerprints to the RCMP. Health Canada provides the required forms to candidates for appointment.
8.0 Indemnification, Travel and Expenses
8.1 All members of the Task Force serve on a volunteer basis. Health Canada undertakes to provide its volunteer Task Force members with protection against civil liability provided the volunteer member acts in good faith, within the scope of their volunteer duties; and does not act against the interests of the Crown.
8.2 Members of the Task Force will be reimbursed for expenses incurred on approved travel for the Task Force, such as trip costs and accommodation, according to the Treasury Board's Directive on Travel, Hospitality, Conference and Event Expenditures.
8.3 The travel and accommodation expenses of individuals participating in approved task force activities will be arranged and reimbursed according to the National Joint Council Travel Directive.
8.4 The Secretariat will make travel and accommodation arrangements for members of the Task Force. Members who make their own travel arrangements may do so only after the travel has been approved. Authorized travel expenses will be reimbursed in accordance with the limits and provisions in the National Joint Council Travel Directive.
9.0 Resignation and Membership Changes
9.1 It is preferable for a member to provide 14 days' notice of the intent to resign. The resignation letter must be in writing and be addressed to the Associate Assistant Deputy Minister of CSCB and the Co-Chairs of the Task Force. The letter should state the effective date of the resignation.
9.2 Health Canada may end a member's appointment by writing to the member and providing the effective date of the termination of appointment. Appointments may end for a variety of reasons, including, but not limited to:
- The advisory body's mandate has changed, thus requiring a different membership.
- A member who fails to act according to the terms of reference.
- A member who breaks the confidentiality agreement.
- A member's repeated failure to participate in Task Force activities.
10.0 Roles and responsibilities
10.1 Task Force Members
10.1.1 Members of the Task Force have a responsibility to Health Canada and, by extension, to Canadians, to give their best advice to Health Canada. To do so, they must consider all input received that is related to the mandate of the Task Force.
10.1.2 Other responsibilities include:
- Becoming familiar with key documents and issues relevant to their mandate, through the review of written documents being prepared in advance of meetings.
- Participating in briefings and meetings in advance of engagement activities.
- Actively participating in Task Force meetings and discussions, which may include in-person meetings, webinars, email exchanges, conference calls, and videoconferencing.
- Actively participating in engagement activities related to the Task Force's mandate, which may include roundtables across Canada.
- Applying their expertise and experience, and considering all input received when identifying areas of improvement and providing advice to Health Canada.
- Actively contributing to the development of reports being drafted as part of the Task Force's mandate.
- Notifying the Secretariat and the Co-Chairs of any changes in their affiliations and interests related to the Task Force's mandate during their tenure.
- Directing any media inquiries to the Secretariat and the Co-Chairs.
10.2.1 The Task Force will be led by two Co-Chairs – one representing the health provider community and the other representing the perspectives of patient communities and those impacted by chronic pain. The Co-Chairs of the Task Force have additional responsibilities, including:
- Chairing meetings of the Task Force.
- Ensuring that discussions of the Task Force remain in line with its mandate.
- Ensuring that all Task Force members act in a respectful manner towards another, and that all members have an opportunity to communicate.
- Ensuring that an appropriate number of Task Force members, and where necessary specific members, participate in each engagement event or meeting.
- Indicating when information and discussions are considered confidential and clarifying expectations regarding this protected information.
- Seeking consensus amongst members of the Task Force, and if there is not agreement, ensuring that the diversity of opinion is noted in the meeting records and reports.
- Providing interim updates to the Associate Assistant Deputy Minister of CSCB, as required.
- Presenting the Task Force's reports to the Associate Assistant Deputy Minister of CSCB.
- Serving as the media spokesperson for the Task Force.
- Supporting, in any other way, the fulfillment of the Task Force's mandate.
10.3.1 The Secretariat of the Task Force is housed in the CSCB at Health Canada. The Secretariat is the administrative liaison between members of the Task Force and federal departments and agencies.
10.3.2 The Secretariat provides leadership and strategic advice in the management of the Task Force and works closely with the Co-Chairs, the Associate Assistant Deputy Minister of CSCB, and the Executive Secretary of the Task Force. The Secretariat is also a resource for members of the Task Force.
10.3.3 Additional responsibilities of the Secretariat include:
- Coordinating the appointment process of members.
- Coordinating the preparation of materials for Task Force members, observers, and others, and coordinating the timing of their distribution.
- Assisting with the work of the Task Force, as required.
- Providing administrative support to Task Force members.
- Supporting public access to information about the Task Force, as appropriate.
- Assisting the Co-Chairs in carrying out its responsibilities.
- Undertaking any tasks delegated to it by the Executive Secretary.
- Reporting to the Executive Secretary on the activities of the Task Force.
- Carrying out any additional duties as appropriate to support the activities of the Task Force.
10.4 Executive Secretary
10.4.1 The Executive Secretary of the Task Force makes decisions about the administration and operation of the Task Force. The Executive Secretary works closely with the Co-Chairs and Secretariat.
10.4.2 The Executive Secretary, or a delegate, reports back to the Task Force at the beginning of each meeting on progress and next steps.
10.5 Media and Communications
10.5.1 The Co-Chairs will act as the media spokespersons for the Task Force. In the event the Co-Chairs are unavailable to speak to the media, the Executive Secretary, in consultation with the Co-Chairs, will appoint a member to be the spokesperson to speak to the media on behalf of the Task Force.
10.5.2 A member may discuss the Task Force's work with the media or at conferences or other external events only with prior permission from the Executive Secretary.
10.5.3 All media requests related to the Task Force's statements or activities will be directed to Media Relations, Health Canada, who will coordinate responses with the Executive Secretary and the designated media spokesperson.
10.6 Intellectual Property
10.6.1 Intellectual property rights arising out of the work of the Task Force will rest in Health Canada.
11.0 External Input
11.1 An External Advisory Panel will be established to provide advice and information related to certain elements of the Task Force's mandate.
11.1.1 The External Advisory Panel operates according to the Health Canada Policy on External Advisory Bodies and these Terms of Reference.
11.1.2 Expertise reflected on the External Advisory Panel will cover issues related, but not limited to chronic pain management in vulnerable populations (e.g., Indigenous populations, veterans), the use of pharmacological, psychological and physical approaches for pain management, and innovative approaches to chronic pain management.
11.1.3 Members of the External Advisory Panel are recruited through a targeted nomination process as set out in Section 3.0. Following a review of nominees, individuals will be appointed by the Associate Assistant Deputy Minister of CSCB in consultation with members of the Task Force for a three year term.
11.1.4 To be considered for appointment, members of the External Advisory Panel will be required to complete and return an Affiliations and Interests Declaration Form. Members will also be required to sign a Confidentiality Agreement and attain an appropriate level of security clearance.
11.1.5 Members of the External Advisory Panel will be reimbursed for expenses incurred on approved travel associated with activities of the Task Force, such as trip costs and accommodation, according to the Treasury Board's Directive on Travel, Hospitality, Conference and Event Expenditures.
11.6 The Task Force may also decide to seek input from the general public for delivering on its mandate. The Executive Secretary, in consultation with the Co-Chairs and other members of the Task Force, will determine the process to be used to gather broader public input.
12.0 Management and Operations
12.1.1 Health Canada is committed to transparency as an operating principle. Transparency of the Task Force and the External Advisory Panel is served by:
- Ensuring that meeting schedules are predictable, where possible.
- Posting Task Force and External Advisory Panel materials on Health Canada's website, including, but not limited to, the terms of reference, the membership list and biographies, meeting agendas and highlights, and Task Force reports.
12.2 Meeting Agenda
12.2.1 The Executive Secretary, in consultation with the Co-Chairs and with input from the members, sets the meeting agenda, including identifying questions and issues for discussion. Members may be canvassed for relevant agenda items at least five weeks before regularly scheduled meetings.
12.3 Meeting Notice and Invitations
12.3.1 All meetings are scheduled at the call of the Executive Secretary or the Secretariat, in consultation with the Co-Chairs. Meetings may be limited to Task Force members only, Task Force and External Advisory Panel members only, or may be opened to presenters and observers by invitation.
12.3.2 The Secretariat sends out the invitations to attend a meeting.
12.3.3 Members generally receive the agenda and briefing material two weeks in advance and presentations two days before a meeting.
12.4 Frequency, Type, and Location of Meetings
12.4.1 Task Force meetings will be held every two months (by teleconference or in-person). External Advisory Panel members will meet with Task Force members on an approximately quarterly basis. Additional meetings, teleconferences, or roundtables may be held on an as-needed basis at the discretion of the Executive Secretary, in consultation with the Co-Chairs.
12.4.2 For teleconferences and other similar meetings, members must make every effort to ensure that a secure line is used and that no one else can listen to the proceedings unless the person has been previously approved by the Co-Chairs and Secretariat.
12.5.1 The Secretariat, or the Co-Chairs in consultation with the Executive Secretary, may allow individuals, organizations, or members of the general public to observe a meeting or part of a meeting. Observers may not provide input on agenda items or participate in the discussions, unless specifically invited to do so by the Co-Chairs.
12.5.2 As part of the opening remarks at a meeting of the Task Force, the Co-Chairs will:
- Identify, by name and organization, the people attending all or part of the meeting as observers.
- Confirm with the Secretariat that the observers have signed the Confidentiality Agreement and met the reliability checks standards, if required.
- State the requirements and expectations regarding confidential matters being discussed at the meeting.
- Clarify that observers may not participate in the discussions, either by speaking or by otherwise expressing their support for or disagreement with what is being said, unless specifically invited to do so by the Co-Chairs.
12.5.3 The Co-Chairs may ask observers who do not respect these rules to leave the meeting.
12.6 Invited Presenters
12.6.1 The Secretariat, or the Co-Chairs in consultation with the Executive Secretary, may invite individuals with particular expertise or experience to provide input on a specific topic or agenda item. Invited guests may participate in the discussions if the Co-Chairs specifically invite them to do so, but they do not participate in the development or revisions of reports.
12.7 Requirements for Presenters and Observers
12.7.1 Presenters and observers may be required to complete:
- Declaration of Affiliations and Interests Form
- Confidentiality Agreement
- Personnel Screening, Consent and Authorization Form
12.8 Deliberations and Report
12.8.1 The Task Force is encouraged to reach consensus in providing advice to Health Canada, whenever possible. When a consensus is not possible, the meeting record will reflect the diversity of opinions.
12.8.2 The Task Force must have quorum when providing advice to Health Canada. Quorum is two thirds of the members.
12.8.3 Minutes and/or records of proceedings will summarize the proceedings to effectively reflect the advice being offered. Remarks are not attributed to individuals in the minutes and/or records of proceedings.
12.8.4 Minutes and/or records of proceedings will be prepared by the Secretariat and circulated to members for review and confirmation.
12.8.5 Final minutes and/or records of proceedings and reports of the Task Force will be posted on Health Canada's website.
- Footnote 1
Statistics Canada. (March 2018) Prevalence of chronic pain among individuals with neurological conditions
- Footnote 2
Lynch. (2011) The need for a Canadian pain strategy
- Footnote 3
Peng et al. (2007) Challenges in accessing multidisciplinary pain treatment facilities in Canada
- Footnote 4
University of Wisconsin/WHO Collaborating Center. (2015) Opioid Consumption in Morphine Equivalence (ME) minus Methadone, mg per person in Canada
- Footnote 5
BC Ministry of Public Safety and Solicitor General (2018). Illicit Drug Overdose Deaths in BC – Findings of Coroners' Investigations
- Footnote 6
Gomes et al. (2018) Comparing the contribution of prescribed opioids to opioid-related hospitalizations across Canada: A multi-jurisdictional cross-sectional study
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