Thank you very much for the invitation and the experience. It's my first time to stand in front of one of your committees.
First of all, I support all the statements that have been made. I was thinking as I was listening to my colleagues here that there's actually a fair amount of consensus around what we're talking about, as in the issues and so forth, and I'm thinking if there's so much consensus, how come we're still having so much difficulty delivering the services we need?
To put things in perspective, I've been in the field for 48 years—too long—as an addiction physician and an addiction psychiatrist, and I want to put this in perspective: when we talk about drugs, we should never forget about alcohol and tobacco first, followed by the other drugs.
I think we all agree that the problem we are facing is a bio/psycho/social/spiritual problem. I think there is a lot of agreement on that. Certainly among the physicians who specialize in the field, this a common agreement. This is not a matter of having one or the other. It's all together. This is the package.
I couldn't help but also think that probably 10 years ago I would have been here talking about methamphetamines. Before that, I would have been talking about stimulants. Before that, I would have been talking about heroin. The field has a way of bringing us continuous crises, one after the other after the other.
I would assume that one of the reasons that we're meeting here is that at this point in time hundreds of our patients in western Canada are dying from the fentanyl crisis as well as the overdoses from prescription drugs. I like to tell people that unfortunately we should also plan for the next crisis, and we already have it. The next crisis is not fentanyl. The next crisis is carfentanil, which is 100 times more potent than fentanyl. What else is coming up?
What is the major difference occurring right now? The major difference is that in the past our addictive drugs came from plants. This is now a thing of the past. Our major drugs will now come from labs. Therefore, the frequency, the potency, and all those qualities are going to change much more rapidly than they used to before. That, I think, is a new phenomenon that we should be careful of.
I'm a strong believer that a crisis is also an opportunity, and when I look at what has been happening over the last while, I just want to point out some topics that I think may give us some hope.
The crisis at the moment has three components to it.
Number one is the component of overdoses. This is what makes people die. Hundreds of people have died. In terms of lethality, it's probably been many years since I've seen such an amount of people dying so fast. They're not all addicted; they could be my son or my daughter going to a rock concert and taking those blue pills. Sometimes they don't even know what they're taking. Before you know it, respiratory depression occurs, it's an emergency, and you're lucky if you only pass out. These are not addicts. These are experimenters. In terms of overdoses, what we are now providing more and more across the population naloxone injections. I want to congratulate Health Canada. It's not very often that I congratulate Health Canada, so let's congratulate Health Canada when it's due. Naloxone spray is a tool that we didn't have two years ago and is now available to the population for opioids.
The second issue we have is a major issue around what to do with chronic pain. We have more and more older people. We have an aging population and we have all kinds of disabilities, all kinds of things. As a physician, I was the recipient of lectures that were given to us in the 1980s and how we were opio-phobic. Physicians were afraid to prescribe opioids, and it was “what's going on, we're not treating chronic pain properly, we don't know what we're doing”, and opioids would be the solution. As usual, the pendulum swung from A to B, and now we have this epidemic going on with prescriptions.
There are two things. First of all, there's a major effort going on at the moment with educating the physicians. It takes some time to reverse the pendulum, but I think there are some signs that the pendulum will reverse. The other thing is that the treatment of chronic pain is not only about opioids, about giving someone OxyContin. The treatment of chronic pain is a comprehensive program involving a number of alternative methods, one of which is opioids.
By the way, opioids are now increasingly coming up as being not that effective, in fact, in the treatment of chronic pain. The nature of the medication is such that when you use it, it will make you dependent after three to six months.
The third component, then, is addiction—and I agree with my colleagues—but it's not the only one. In addiction at the moment there are new methods of delivery going on. One of the things that has been a problem for us is the non-compliance from people. People are given medication and don't take it. The same thing applies, actually, to schizophrenic patients, so learning from schizophrenia, increasingly the medication that will be provided would be in an injectable form.
We see a number of medications in the United States that are not yet here in Canada. I really would like the committee to make a recommendation about that. There's a medication called Vivitrol. Some of the medications are implants. In the future, there are probably going to be vaccines. A number of future things are coming up. For some reason, we seem to be delaying its introduction in Canada, and I would recommend that we do something about that.
Unfortunately, as the methods of delivery of our medication change, so does the method of delivery of drugs. One of the things that is being singled out at the moment is the famous electronic cigarette. The cartridge for the electronic cigarette, which was supposed to be no problem and all that kind of stuff, can actually be used for a number of things, including the delivery of opiates, including the delivery of your favourite drug and including a number of things. We are really worried about that as, again, a new method of delivery.
In thanking the committee, I will say to please put the crisis in perspective. There are a number of components to it, and think there are some possibilities. I wouldn't talk about solutions, because humanity has experienced addiction since its beginning, but certainly, to reduce the harms of the present day with them is a possibility. It is opening up opportunities too.
Thank you.