Remarks for the Honourable Jane Philpott, Minister of Health

National Opioid Conference & Summit

Ottawa, ON
Nov 18, 2016

AS DELIVERED

Thank you very much, Adair. And welcome everyone. I am very happy that you are all here today. This is a very important day for us.

And I want to also say hello to the web folks. We apparently have people all over the world who are joining today by webcast.
 
I want to thank my co-host Minister Eric Hoskins for agreeing to help in the coordination of this very important day and for hosting it. And of course I want to also thank the folks at the Canadian Centre for Substance Abuse who have done the largest part of the work for organizing today’s conference. But every one of you here today represents a huge amount of work, a tremendous commitment to this very serious challenge that we’re facing together, so I want to thank every one of you for what you have done in getting here today, for the reasons why you’re attending and for what you intend to do as we go forward from this.
 
I think it’s important to start with remembering the individuals, the reasons for whom we are here today. And I wanted to start, therefore, with a story, a story of a young man named Jordan. The story of Jordan is told on the Health Canada website if you want more details about Jordan.
 
When he was in his early 20s, this young man was a lively, active, engaged citizen working in the construction industry, and unfortunately, hurt his back at one time while lifting wood, and went to his physician and was prescribed an opiate. Opiates became the focus for his life, unfortunately, after that, for a variety of reasons, and eventually, when he was not able to get enough medication from his doctor, he went looking for them on the street.
 
You can probably imagine where it went from there. Eventually, his parents, after some real challenges, got him into a detox program that seemed to be successful for a while, but he went back to taking drugs—opioids and others—and unfortunately, because of a combination of drugs—three of which were prescribed to him—he took a combination of medications that was lethal, and at the age of 25, he died.
 
Jordan’s mother is here with us today. Leslie McBain. She is here with an organization called Moms Stop the Harm. And I suspect that there are many others of you in the room who have personal stories of a friend, a loved one, a family member who has suffered from addiction or in fact some of you know those who have lost their lives to the challenge of opioids. I want to recognize all of those who are here and tell you that you are the reason why we need to be here today, for the sake of those who are currently facing the challenges of opioids and for those who might be at risk in the future.
 
We in Canada are facing a public health crisis. It is a crisis of increasing numbers in terms of overdoses and deaths associated with the use of opioids. We see this more severely in certain parts of the country, and certainly our colleagues in British Columbia have talked a great deal about this and had a large delegation here yesterday and continuing through the weekend. Alberta is also facing increasing challenges, but there is no part of this country that is entirely immune. The number of deaths in certain parts of the country now are more than those caused by motor vehicle accidents.
 
Canada has the world’s second highest per capita consumption of prescription opioids, but I think it’s important to realize that this is not a simple story about prescription medication. It’s not a simple story about addiction. It’s not a simple story about illicit drugs.

In fact, as I think about it, I’m reminded of that parable of the elephant in the dark room where people come and approach the elephant from different angles, and one has a grip on the tail and another grasps the trunk, and another grasps one of the large legs of the elephant and seems to think that they have a pretty good understanding of it, all the while not realizing that the problem is so much bigger than they can realize from their perspective. And until someone comes in with a light to the room to expose the scope of the challenge, it can be very easy to get distracted by looking at one particular piece of the puzzle, no matter how large it is.
 
Jordan’s story tells us that the opioid crisis is a public health challenge that can affect any one of us. It affects all communities, all age groups, all socioeconomic groups. Each of us are vulnerable; a construction worker who gets a prescription for back pain; a teenager who attends a party and takes a pill.
 
I want to note before I go any further that we need to be careful that we remember that, properly used, opioids have a role in the health care system. They help people in serious pain, including people receiving palliative care. We need to balance the risks with the benefits and make sure that there are appropriate safeguards in place. We need a comprehensive, pan-Canadian approach.
 
When I lived in West Africa, I learned a lot of Hausa proverbs, and one of them that is fitting for today is: “One stroke cannot fell a tree.” We’re not going to solve this today. We’re not going to solve it in a single stroke. This is going to take repetitive work, and it’s going to take work on the part of every one of us here.

When it comes to the where opioids are coming from, there are at least two streams that we have to be talking about. One is, of course, prescription use, and we know that opioid dispensing levels in this country are high—the second highest in the world—and those dispensing levels are strongly associated with harm. We know that people can transition from prescription use to problematic use and sometimes drug seeking – seeking drugs illicitly. I know that there will be others today who will talk about illicit opioids or drugs that are diverted for illicit purposes. We will also talk of course today about the emergency of fentanyl as a major factor.
 
For each of these paths, we must strengthen prevention and look for safer routes to stop the excessive uses of opioids. We must address so many other factors. What is the role of industry in this? What is the role of educators and regulatory bodies? Who are the partners that need to be at these tables today? And I’m pleased that we have partners here from our colleagues with Justice and Public Safety. And of course today we also need to talk about the social determinants of the opioid crisis.
 
Today is not about blame. Today is not about seeing who is at fault and who is not doing enough. Today is about making sure we all do our part. Today is making sure that we have people with lived experience, people who use drugs and have in the past that can educate us. Today is about making sure we listen to those who are the prescribers and understand their perspective, and all stakeholders need to be involved.
 
At the federal government level, we have indicated that we think that there are four core principles that need to be involved. One is that our response needs to be evidence based. Second, that it needs to be comprehensive, and all of the resources available need to be considered. Third, it must be collaborative, involving all levels of government, private agencies, social society and communities. And fourth, it needs to be compassionate. The opioid crisis is a public health crisis. It is not about criminal activity. It is not about moral failing.
 
We in the federal government have introduced a five-point action plan. It includes: making sure Canadians are better informed about the risks of opioids; second, that we support better prescribing practices; third, that we reduce easy access to unnecessary opioids; fourth, that we support better treatment options; and fifth, that we improve the national evidence base that we use for policy decisions. I do not believe that that is an exhaustive list, so our plan is evergreen and will continue to be updated, and we look forward to your input on that. We want you to think about what’s missing and what other roles the federal government needs to play.

Much of our work at the federal level will include some of the downstream factors, and I personally get confused about upstream/downstream, but I think I’m finally figuring it out. And the best way that I can understand which is which is to think about a river flowing down from a mountain. And a lot of the work that we’re going to talk about today is going to be about what happens in that big pool of water at the bottom of the mountain where the streams have flowed down. And sometimes, we feel like we’re lifeguards around that deep pool of water. We’re trying to save people who have somehow slipped in at some level along the way and are now drowning in the pool. But as I don’t need to tell you there’s also a lot of work that needs to be done to prevent people from falling into the stream further upstream. There also needs to be talk about whether we need to put up warning fences upstream, whether or not we need to provide life jackets, whether or not maybe it’s smarter to provide swimming lessons or build a fence. The federal government, like you, needs to work at all of those points. To address the crisis, though, I want you to know that we will be there at the level of the deep pool trying to help those who – who need the rescue in their most critical state. And in that sense, I’m pleased that we have been able to make progress.
 
Many of you know that we were able some months ago to move the use of naloxone from prescription to non-prescription status. One of my happiest days so far in government was when we got to decide to do that. We were able to expedite access to nasal naloxone that has been imported from the United States until we can have a regular supply here. And I’m pleased that we were also able to expedite the approval of nasal naloxone, which should be available from a Canadian source.
 
We also were involved, as some of you know, in adjusting the federal regulations to allow access to pharmaceutical grade diacetylmorphine in order to treat people with severe addiction.
 
We were able to provide an exemption to the Dr. Peter AIDS Centre for a supervised consumption site and to provide a four-year exemption to Insite to continue its excellent work. We’ve been working with groups across Canada that wish to operate supervised consumption sites, those who are applying and working with provincial and municipal health authorities in that regard. I wanted to spend just a few more minutes on that topic because I know that many of you have concerns in this area, and it will be addressed today.
 
Many of you have called for repeal of the Respect for Communities Act and have also asked that there be amendments, so that the Act doesn’t present undue barriers and delays in establishing properly managed supervised consumption sites. The previous legislation, as you know, has widely been perceived to introduce unreasonable barriers, and I share the concerns that have been expressed. I think it’s not unknown to this group that I am a strong proponent, a strong advocate for supervised consumption sites in communities that want and need them. I know that they work. They save lives. They prevent infection. They provide safe access to health care. Thank you for your work in this area.
 
It’s become increasingly clear that legislative changes will be required to better support communities that want access to these sites. We will need to continue to have a robust process to review applications, and the key to their success will be that they must be properly managed, established and well maintained. It will be critical to remember the importance of communities in supporting these facilities. And so you can look forward to much more about that in the weeks to come.
 
There’s much more to do downstream, though, particularly in the area of access to treatment, which I increasingly hear is one of the biggest challenges that we face. There’s a tremendous need to address stigma and discrimination, and we must emphasize that people with addiction need to be treated with dignity and respect, the way we treat anyone else who is suffering from a health concern.
 
Let me talk just for a couple of moments about upstream actions. As you know, complex challenges like this require complex solutions, including those upstream. On the health care side, we must provide better access to mental health and addictions care. We have to find optional approaches to pain management, and I hope that will be discussed today. There’s much to do in the area of prescriber education. Our government intends to do work on supporting strong labelling. And there’s much to be done in the area of public safety to prevent diversion, to address illicit flow of opioids. There’s work to be done around the scheduling of precursors, addressing pill presses, work at the border, which I know that my colleagues in Public Safety are working on.
 
But I wanted to mention as well that I think we need to be talking about the social and economic conditions that result in sometimes unhealthy choices and adverse health outcomes. The social determinants of health, people’s access to education, to jobs, to appropriate housing and accessible social services are part of the drivers of the crisis we’re facing today. We need to give Canadians the best chance to thrive. We need to build resilience and protective factors in individuals and communities.
 
And I want to finally acknowledge so many other jurisdictions who are here today, who are participating, and the tremendous action that’s been taken on the part of multiple provinces and territories. I’m so pleased that there are municipal leaders here who have an essential role in this, many grass root organizations, first responders who play some of the most important roles in saving lives. I’m happy that there are medical regulators here, that there are educators. Thank you all for your commitment and your leadership. Thank you for accepting the personal toll that this often takes on those who are most deeply involved.
 
We will have a summit tomorrow to build on the actions and the discussions that have taken place today. There are so many of you that are going to have a broad range of expertise that will help to define the problems and define the solutions. I’m a pragmatist at heart, and people are dying. The work that we do today and tomorrow must produce practical actions and measurable milestones. There is no single policy, no single decision and no single participant that is going to solve this, and it’s not going to happen overnight, but we have to get the work done.
 
Many of you, I know, have been involved in similar kinds of social challenges. I often think about the work that I’ve been involved in in the area of HIV in the world. And one of the best books that I ever read about taking on the challenge of HIV was a wonderful book by a woman named Helen Epstein called The Invisible Cure. And she talks in that book about where people got it right and where societies and countries did well in the fight against HIV.
 
She talks about something called collective efficacy: the power that happens when people come together, when they recognize that there is in their midst a common threat and that they will make progress against that threat when they combine their efforts. She says that collective efficacy is present everywhere, that there is a spirit of collective action and mutual aid. It’s a spirit that’s impossible to measure and quantify, but it’s rooted in a deep sense of compassion and a reality of our common humanity.
 
Let’s go forward in a spirit of collective efficacy. Thank you for joining me in this.