Mr. Don Davies (Vancouver Kingsway, NDP)
Mr. Speaker, I rise today to speak to Bill C-307, an act to amend the Controlled Drugs and Substances Act (tamper resistance and abuse deterrence). This legislation proposes to allow the Minister of Health to implement regulations to restrict access to non-tamper-resistant controlled substances or classes of controlled substances. The bill also imposes an annual reporting requirement on the Minister of Health if no regulations are made “specifying controlled substances or classes of controlled substances that must have tamper-resistant properties or abuse-deterrent formulations”.
As we consider the bill, which is principally aimed at curbing prescription opioid abuse, it is important to remember how we arrived at the current overdose crisis, which has claimed an estimated 20,000 Canadian lives over the last 20 years.
For over two decades, opioids have been overused and over-prescribed by doctors for pain management and other causes, leading to many patients becoming dependent and addicted.
Canada has among the highest per capita volume of dispensed opioids in the world, totalling some 19.1 million in Canada in 2015 alone. That is up from 18.7 million the year before. This is about one opioid prescription written for every two Canadians last year.
Even though there are no credible peer-reviewed studies that demonstrate that opioids afford more benefit than harm for chronic pain, opioid use has been marketed beyond palliative care and cancer patients for regular use to people experiencing back pain and other common ailments.
Manufacturers, incorrectly, led prescribers to believe that addiction was a rare consequence of using prescription opioids long-term and that fewer than 1% of patients would become addicted. However, in reality, the addiction rate is estimated to be 10%, with 30% suffering from opioid use disorder.
In 2012, Purdue Pharma Canada, the manufacturer of the potent prescription opioid OxyContin, pulled OxyContin from the market and replaced it with OxyNEO, a tamper-resistant alternative that is difficult to powderize, snort, or inject. Purdue strongly supports changing legislative and regulatory regimes to mandate that over time the entire prescription opioid market be tamper-resistant.
Under the previous, Conservative government, Health Canada drafted regulations that would have compelled opioid manufacturers to make their oxycodone products, and eventually all opioids, tamper-resistant. However, the current Liberal government abandoned that plan in April 2016, on the basis that there is insufficient proof to back up claims that tamper-resistant formulations have positive policy benefits.
Health Canada concluded that requiring tamper resistance would not have the intended health and safety impact of reducing overall drug abuse. At the time, the Minister of Health told the Standing Committee on Health, “It would be wise if it worked, but the result is that the introduction of tamper-resistant products only serves to increase the use of other products on the market. You can't take a single approach to a drug.”
To be sure, independent expert opinion on tamper resistance ranges from the view that its application has very limited efficacy for addressing opioid abuse, to the view that tamper resistance is a counterproductive move aimed in part at extending the drug manufacturers' patent protections.
Testifying at the health committee's fall 2016 study of the opioid crisis, proposed by the New Democrats, Dr. Philip Emberley, director of professional affairs for the Canadian Pharmacists Association, said:
...we still see tamper-resistance as one solution, [but] not the only solution.... [T]here are some numbers out of the U.S. that say it has had some effect. However, we have to be very cautious of the unintended consequences, which may end up being even worse than what we were trying to prevent in the first place.
To understand these potential consequences, a U.S. study published in the academic journal JAMA Psychiatry looked at what happened in drug use patterns before and after tamper-resistant OxyContin came on the market. It found that abuse of OxyContin dropped significantly, from 45% to 26% of all users, but heroin use rose from 25% to 50% and effectively cancelled out any drop in OxyContin abuse. Many simply kept using OxyContin, and about one third of them found a way around the tamper-resistant formulation.
Another 43% were simply unable to crush the new, tamper-resistant pill, so they just swallowed it and got high anyway. Only 3% of those surveyed gave up the drug altogether when the new, tamper-resistant formulation came out.
Dr. Emberley's caution was reiterated at the health committee by one of Canada's leading drug safety experts, Dr. David Juurlink, who said this:
I think abuse-deterrent formulations are a good thing generally. You can crush them, and you can chew them, and you can get a much higher level in your blood than you would by taking them intact, but you can't powderize them, inject them, or snort them, but it is a mistake to think this is the way out of this problem. These products tend to materialize on the market as the patent on the original product expires, so a cynic might wonder if this is primarily a business decision.
The fact is that the primary route by which opioids are abused is oral. I know for a fact that physicians, when they hear about these abuse-deterrent formulations, think that these are somehow impervious to abuse. They are totally abusable. If you could snap your fingers and have them all be abuse deterred, great. It is not a major part of the solution to this problem, in my view.
At best, I could say that the impacts of tamper-resistant opioids are presently unclear. However, because New Democrats are unwilling to dismiss any potential tool to address the opioid crisis, we believe that this bill should be rigorously studied at the health committee, with extreme caution paid to the potential for unintended harm. Let me be clear. We will not hesitate to oppose this legislation if, based on the preponderance of evidence, we determine that tamper resistance is likely to be counterproductive.
Ultimately, New Democrats want a much more comprehensive response to the opioid crisis. Since last fall, our party has been calling on the federal government to declare opioid overdose a national public health emergency, because such a declaration would empower Canada's chief public health officer with the authority to open temporary clinics and supervised consumption sites on an emergency basis, and allocate emergency funding on the scale needed to comprehensively address the opioid crisis.
The Minister of Health has repeatedly dismissed our calls, on the basis that the federal government already has the ability to take these measures without an emergency declaration. However, here we are today, in April 2017, with no end in sight to the opioid crisis. The legislation to streamline supervised consumption site approvals remains stalled in the upper chamber, and budget 2017 fails to devote a single dollar in emergency funding to combat the crisis. Somewhat shockingly, budget 2017 also makes deep cuts to addictions treatment funding, when access to publicly funded programs is already appallingly insufficient across this country.
As the opioid crisis escalated in 2012, the Conservatives cut funding for addictions treatment by approximately 20%, allocating $150 million over five years. That is still $40 million more than the Liberals' entire allocation for the Canadian drugs and substances strategy just announced in the last budget. The Canadian drugs and substances strategy expands on the now defunct national anti-drug strategy's pillars of prevention, treatment, and enforcement to include harm reduction. In our view, that is a positive change, but it means a broader mandate with only 20% of the anti-drug strategy's funding.
With a federal reaction like this, one could be forgiven for believing that the opioid crisis is over. However, in my home city of Vancouver the crisis is getting worse by the day. Vancouver Fire and Rescue Services reported 162 overdose response calls for the week of March 20, a 56% increase from the previous week, when 104 calls were responded to. To date, in 2017, there have been 100 overdose deaths in Vancouver alone. There were 215 in all of 2016. If rates of overdose deaths continue at this pace, Vancouver could see nearly 400 deaths in 2017, double the number recorded in 2016.
In order to reverse this trend, the City of Vancouver is advocating for increased access to treatment-on-demand options. Apparently, this request has fallen on deaf ears at the federal level. Indeed, the Prime Minister seemed to acknowledge it last month when he visited Vancouver and pledged this: “It’s really important for all Canadians to consider that this is something we cannot continue to ignore, we cannot continue to stigmatize. We need to start addressing this as the real societal health problem it actually is.” However, as former U.S. Vice-President Joe Biden used to say, “Don’t tell me what you value. Show me your budget, and I’ll tell you what you value.”
Canadians do not need more empty words or broken promises from their federal government; they need real support to end the opioid crisis. I call on the Prime Minister to honour his word by taking emergency action to finally and fully address this immense human tragedy.
Subtopic: Controlled Drugs and Substances Act