Speaking Notes for the Honourable Jane Philpott, Minister of Health - 2nd Charting the Future of Drug Policy in Canada Conference

Statement

Toronto, ON
June 17, 2016

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Hello everyone, and thank you Richard for that very warm welcome.

It's great to see a number of familiar faces in the room.

I had the pleasure of seeing a number of you, including Richard and Don MacPherson, at the U.N. General Assembly in New York City earlier this year.

I am delighted to join all of you here in Toronto to talk about the future of drug policy in Canada.

Before we do so, it's worth spending a little bit of time reflecting on where we have been.

I don't have to tell you about the four pillars approach to drug policy - many of you in the room are experts on the approach. I know Don, for one, has written a number of important papers on the topic.

Suffice to say, the four pillars--prevention, treatment, enforcement and harm reduction--have underpinned successful approaches to Canada's national strategy on drugs for the better part of three decades.

A decade ago, harm reduction was removed from Canada's strategy, as was any focus on the problematic use of licit or legal substances.

Many of you may be expecting me to speak today about our government's plans for the legalization of marijuana. You know that we have committed to legalizing and tightly controlling access to marijuana, for instance.

We believe that we need to keep marijuana out of the hands of children, and the profits out of the pockets of criminals.

You also know that, rather than fighting to close Insite, we've renewed its exemption for another four years. And we have also granted an exemption to the Dr. Peter Centre to operate as a supervised consumption site, also in Vancouver.

We have received another application for an exemption to operate similar sites, and Health Canada will rigorously review all applications without undue delay.

Our government is also supporting MP Ron McKinnon's private member's bill - the Good Samaritan Drug Overdose Act. This Bill would grant immunity from minor drug possession charges for any individual calling 9‑1-1 to help someone who has overdosed.

But today, I want to talk to you about drugs that are very much legal.

As many of you know, the last decade has seen a steep rise in troubling statistics related to the use of many prescription drugs, particularly opioids.

It's become very clear that while we were all focusing on drug dealers on the streets, we forgot about the harm that can be done by the legal products in bathroom cabinets across the country.

We acknowledge that many families are struggling with the impact of addiction to legal substances, and too many have lost a friend or family member to an overdose.

In B.C. and Alberta today, we are seeing more people die from opioid abuse than from automobile accidents.

This is nothing short of a public health crisis, and we need to do more.

This Government has already begun. We are taking an approach that is different from that of the previous government. Our approach is comprehensive, collaborative, compassionate, and evidence-based.

We have already made naloxone more easily available, by removing the requirement for a prescription, in order to help more Canadians survive opioid overdoses.

Today, I am happy to tell you that I have also asked Health Canada to undertake an expedited review of a naloxone nasal spray, a more user-friendly version that could be available before the end of the year.

I plan on working with my colleagues across Canada to address the current crisis with respect to opioids. Much of what needs to be done will lie in the hands of provincial and local governments, law enforcement or medical professionals.

As federal Minister of Health, I believe I need to lead, not just follow.

In fact, I believe there are five key areas where the Government of Canada can provide leadership on the opioid crisis:

First, we will ensure Canadians have better information about opioid risks.

It is only common sense that drug information should be as clear and accurate as possible, especially when that drug has serious risks associated with it.

That's why we will proceed with regulatory changes to require all opioids in Canada to have standard warning stickers and patient information sheets that clearly describe addiction and overdose risks.

In addition, we need to do a better job of informing the Canadian families about opioids. We need to move beyond fear-mongering and look to international best practices in educating our kids about smart choices.

If we look at the evidence in other countries, educating very young children and helping them to build resilience, decision-making and coping skills can improve drug misuse outcomes.

Second, we need to do more to support better prescribing of opioids.

It's fine to support patients with information, but we need to remember that prescribers need to be supported too.

In the past, we have tended to see drug prescribing as squarely a "practice of medicine" issue.

But I am concerned that despite federal changes in labelling, despite more and better education and guidelines, we continue to have prescribing rates that are far too high.

Of course, people with a genuine need for pain management should have appropriate access. But we also need to help doctors watch for problematic opioid use.

To that end, prescription monitoring programs have been shown to be helpful tools in assisting regulatory bodies to understand the scope of over-prescribing, to influence prescriber behaviours, and to support best practices.

In the U.S., there has been relatively rapid progress in establishing PMPs in every state but one.  A recently published report seems to show they are having an impact - there has been a 30 percent reduction in the rate of prescribing opioids after these programs were introduced.

Overall, IMS Health indicates that there has been a 12 per cent decline in opioid prescriptions in the US since a peak in 2012.

We should be able to do just as well for Canadians.

That's why Budget 2016 provided $40 million to Canada Health Infoway to work with provinces and territories to develop an electronic prescribing system that could be useful in capturing prescribing data electronically. This would have the advantage of capturing all prescriptions issued by doctors, not just what was dispensed, where adopted.

In the absence of monitoring systems, we have the opportunity to direct Health Canada inspectors to obtain prescription reports from pharmacies and share them with provincial and territorial regulatory authorities.

This will allow provincial and territorial regulators to decide when to take appropriate action.

The third major area we need to address is reducing easy access to unnecessary opioids.

I know first-hand that doctors come under intense pressure from patients to prescribe opioids. In family medicine, this was one of the hardest things for residents to deal with, and an area where many feel inadequately prepared.

We need to help doctors think twice.

That's why I have asked Health Canada to consider adding additional contraindications to the product monograph for approved opioids. This could include, for example, indicating that opioids are not the best choice for the treatment of chronic pain.

Although almost all opioids require a prescription, medications with less than 8mg of codeine are still available over the counter. While a prescription may not be needed today, codeine can produce drug dependence and has the potential for being abused.  This practice must be stopped, and so I will also introduce regulatory changes that will propose requiring a prescription for low-dose codeine products.

I will also be proposing changes that would make Risk Management Plans mandatory for certain opioids. Right now, these types of plans, while valuable in protecting Canadians from high-risk products, are negotiated voluntarily between the drug company and Health Canada.

These changes would require a Risk Management Plan to be developed by drug companies for certain opioids. These plans could include, for example, the requirement for all prescribers to meet mandatory education requirements, before they are able to prescribe the drug.

But I urge the provincial regulatory authorities and the physician colleges to continue their discussions and to do so with the goal of mandatory education requirements for opioid prescribing.  This is the most concrete way that   Canadians can be assured that their physicians understand the particular risks with this class of drugs.

Fourth, we need to support improved treatment options for patients with addiction.

Everyone agrees that treatment for people addicted to drugs is incredibly important.

Building on our efforts to date, I believe we need to provide better and faster access to naloxone, especially in more convenient formats that can be used in the field by police and other first-responders.

That is why I am announcing today that Health Canada is prepared to consider removing regulatory barriers to allow provinces and territories, should they request it, to import bulk stocks of the naloxone nasal spray from the U.S., as an interim measure, until the completion of the expedited product review.

I have also asked Health Canada to commit to reviewing non-opioid pain relievers more quickly. While safety and efficacy must always remain paramount, we also need to increase access to other forms of pain relief, and move away from choosing opioids as our first option.

I have also asked the Canadian Agency for Drugs and Technologies in Health to conduct for a comparison of the safety and effectiveness of methadone and buprenorphine (or suboxone), so that multiple options are available to all provinces when considering treatment options.

And I have asked officials to look at whether the regulatory requirement for a doctor to have a special exemption to prescribe methadone still makes sense. We need to know if an exemption is truly needed to ensure patient safety, or if this represents an unnecessary barrier to treatment.

Fifth and finally, I am looking at ways to improve the evidence base, because policy decisions need to have a solid foundation. 

I have asked the Canadian Institutes for Health Research to bring together experts to help me decide what data can be collected now, and how we can improve Canadian evidence in this area.

And I will also be hosting a summit on opioid abuse this fall, where I will be inviting a small group of regulators and others whose actions are needed to combat this wide-reaching problem. The goal of this summit will be to identify a prioritized list of action items, and to establish clear timelines so that we can begin to move forward.

We are in a crisis.

But in this crisis, we will not merely be spectators.

We promise to be strong partners.

We have already taken many important steps - but we need to keep going.

I want to thank you for inviting me here today, and I offer you my best wishes for a very successful conference.

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