Prescription Drug Misuse in Canada: Towards a National Response

1. Prescription Drug Misuse in Canada:Towards a National Response Barry V. King, OOM(Rtd) Chief of Police,Ontario Lead - Safe Communities Canada (Parachute) ,Chair, CCSA Board Alumnibarryking1@sympatico.ca

2. Purpose • Overview of the scope and prevalence of prescription drug misuse (PDM) in Canada • Highlight current national activities lead by CCSA in addressing PDM across Canada • Identify potential opportunities for collaborative action

3. About CCSA • Charitable, non-profit organization • Works at arm’s length from government • Volunteer board • Approximately 50 staff • National and international role CCSA’s mission Provide national leadership and advance solutions to address alcohol and other drug-related harm.

4. Prescription Drug Misuse in Canada In 1999, Oxycodone accounted for 1.39 deaths per million in Ontario. By 2004, it accounted for 7.17 deaths per million - (an increase of 416%) (Dhalla et al., 2009) • Past year non-medical use of prescription opioids by youth aged 12-18 ranks fourth (17.8%) after alcohol, cannabis and binge drinking (OSDUHS, 2009) • Recent years have seen Canada rank second in per capita consumption of prescription opioids (INCB, 2010)

5. Commonly abused prescription drugs • opioid pain relievers, (such as Fentanyl, Percodan®, Demerol®, Opana and OxyNEO®); • stimulants, (such as Ritalin®, Concerta®, Adderall®, and Dexedrine®); and • tranquillizers and sedatives, (such as benzodiazepine, Valium®, Ativan®, and Xanax®)

6. CCSA National PDM Strategy : A Pan–Canadian Response • Prescription drug misuse (PDM) presents unique challenges throughout the public health and safety system, as “licit” medications have now moved into “illicit” streams. • February 2012, CCSA hosted a national dialogue with 70+ multi-sectoral partners and stakeholders, as reducing PDM requires a comprehensive, multi-sectoral and interdisciplinary response. • Participants supported CCSA leading the development of a coordinated, national response on PDM , involving all those with regulatory, professional or policy accountabilities. • April 2012, saw the establishment of a National Advisory Council on Prescription Drug Misuse (NAC), comprised of key experts who met in June and will meet again September 2012.

7. Key Considerations • Efforts to reduce PDM associated harms such as overdose deaths and addictions, must be balanced with ensuring access to proper pain treatment. • PDM is very often characterized by comorbiditiessuch as pain, mental illness, and addiction. • Reducing PDM requires a comprehensive, multi-sectoral and interdisciplinary response.

8. Five Strategic Streams of Action Education: identify the educational needs and support mechanisms to be provided to health care providers in the areas of addiction, pain management, prescribing practices, co-morbidities, populations at risk and the utilization of harm reduction practices Prevention:focus on activities that promote the appropriate use of prescription drugs, prevent potential harms and look to ways of reducing the impact and effects of drugs in our communities Treatment : look to strengthen the capacities and support models of care provided by the treatment systems to respond to addictions and comorbidities resulting from the misuse of prescription medications Surveillance and Monitoring: identify and explore opportunities to develop a coordinated and systemic national prescription drug misuse surveillance system, leverage existing opportunities, includes linkages to prescription monitoring programs, and monitoring of overall key outcomes related to abuse and addiction of prescription medications Enforcement:work to understand and advocate for the tools and resources law enforcement needs to effectively prevent diversion, intervene, suppress and address criminal actions related to prescription drug misuse/abuse

10. National Advisory Council Structure

11. Moving Forward • CCSA’s NAC will first develop the national strategy , via the Expert Advisory Committees (EAC) on treatment, education, prevention, surveillance & monitoring and enforcement, each chaired by leading experts in those fields. • Once developed we will move into the implementation phase • In addition, legislation, regulation, research and policy considerations will be addressed within each component.

12. Considerations • Policy authority under the National Anti-Drug Strategy (NADS) is limited to Illicit drugs and does not include prescription drugs • The need for a clear PDM strategy is a critical anchor to balancing the need for appropriate access to pain treatment, while lessening the harms associated with prescription drug misuse • Many provincial and regional activities are in place and available to capitalize on • The Strategy needs to deal with the current exigent state of PDM and its impact, while also re-dressing actions to inform the future • There are pockets of surveillance, research data that can be leveraged for national application

13. International Collaborations • CCSA continues to consult and develop opportunities for collaboration with various international partners including: • Office of National Drug Control Policy (USA) • European Monitoring Centre on Drugs and Drug Abuse ( EU) and, • National Centre for Education and Training on Addiction @Flinders University (AUS) CCSA welcomes new partnerships with other international organizations on the issue of prescription drug misuse and finding solutions towards a balanced approach

14. For further collaboration/information, please contact: Deborah Cumming, MSW National Priority Advisor Canadian Centre On Substance Abuse dcumming@ccsa.ca (613) 235-4048. ext.234

15. P a r a c h u t e Thank You CCSA, one of our “Partners for a Safer and Healthier Country”