Prescription drug abuse strategy targets governments, health practitioners

OTTAWA – Canada has a new national strategy to tackle an escalating prescription drug abuse crisis — but whether a tangled web of governments, regulators, health professionals and police will be able to effectively implement it remains an open question.

“This is a very complex process,” federal Health Minister Leona Aglukkaq said Wednesday as she announced the details of the new 10-year plan for tackling a problem that’s ravaging families, communities and First Nations.

“It involves many partners. It requires many individuals, a number of organizations, to be at the table to be dealing with this issue of prescription drug abuse.”

The strategy is a 10-year blueprint that would, among other things, overhaul legislation so that doctors and pharmacists no longer prescribe painkillers indiscriminately, and addicts are able to get appropriate and timely help.

It takes aim at opioids, stimulants and sedatives at a time when addiction centres, remote communities and health-care workers are increasingly overwhelmed with abuse cases.

Canada is the world’s second largest per capita consumer of prescription opioids, after the United States, and use increased 203 per cent between 2000 and 2010. But at the same time, Canada has a hodge-podge of rules, information campaigns and treatments that have not adequately dealt with the problem.

“This strategy addresses prescription drugs that are legal and have therapeutic uses, but also have a high potential for harm,” states the document, entitled “First Do No Harm: Responding to Canada’s Prescription Drug Crisis.”

It urges governments and regulators to set up a pan-Canadian surveillance system that tracks patterns of prescription drug abuse down to the regional level.

It also recommends that the provinces establish prescription monitoring programs within the next two years by engaging with regulators to clamp down on high-risk prescribing and dispensing practices. That way, health-care professionals should be able to tell who is taking what, and why.

“Existing activities to monitor the harms associated with prescription drugs in Canada are fragmented,” the report states.

“The data sources that do exist in Canada, such as coroner reports, poison centre records, (health) data, losses and thefts data, post-market surveillance related to adverse events data, medication incidents and law enforcement records, are not part of any comprehensive national initiative.”

But in order for that part of the strategy to work, governments need to review and reconcile the web of laws that affect prescription drugs, the report warns.

“Federal, provincial and territorial privacy law, which is not harmonized across jurisdictions, is a significant challenge not unique to the monitoring and surveillance stream. Legislation limits how and why personal data are collected and stored. Limited understanding of this legislation impacts how these data are used and shared.”

The plan would also see increased resources for policing, so that law enforcement can raise awareness and promote the safe storage of properly used drugs, instead of just dealing with the fallout from abuse.

The strategy also recommends major improvements to the sharing of information about prevention and abuse, as well as better access for addicts to treatment — especially in remote First Nations where some communities have reported that the overwhelming majority of adults are addicted.

One by one at Wednesday’s news conference, the key contributors to the report vowed to push for its implementation. The Canadian Centre on Substance Abuse committed to driving the process, and to an annual report that would allow the public to monitor progress.

“Everybody here is committed to seeing this through. There’s no sense in going through the entire development process of a strategy if we’re just going to leave it on a shelf,” said the centre’s chief executive, Michel Perron.

“They’re committed for the long haul.”

But at least one expert was skeptical about the strategy’s potential to lead to material change.

Benedikt Fischer, professor of health sciences at Simon Fraser University in Burnaby, B.C., sees many small ideas included in the strategy, but little in terms of vision, and plenty of potential for jurisdictional problems.

“The question is, what is the big vision and the focus here, and I’m not sure I really see this,” Fischer said.

“The one part I’m missing is a clear perspective on what, on a population level, is driving our extraordinarily high levels of prescription opioid consumption in this country.”

The prevalence of the drugs is the source of the abuse, dependence and death that is plaguing so many communities, he added.

“What we should be doing here is population-level prevention and I’m not sure there is a vision and strategy to do that.”

While data as to the exact extent of prescription drug abuse is spotty, the report makes it clear that the problem is on the rise.

A survey of youth smokers in 2010-11 found that 8.2 per cent of Canadians in grades 6 to 12 reported using prescription and over-the-counter drugs in the previous year to get high.

In Ontario, 18.6 per cent of people seeking addiction treatment in 2010-11 were struggling with prescription drugs, compared with just 10.6 per cent in 2005-2006.

Or, as Fischer said: “This is big.”