As the Deputy CEO of the Canadian Centre on Substance Abuse (CCSA), I am compelled to respond to Dr. David Juurlink’s article, “Doctors inadvertently turning patients into addicts.”
Compelled for two reasons. First, I am always grateful when the harms associated with prescription drugs such as opioids, stimulants, sedatives and tranquilizers are brought into the public forum. It is important for all Canadians to be aware of this issue, and to contribute to the ongoing dialogue. Second, while there are many points on which Dr. Juurlink and I agree, there are others related to CCSA and our work that require clarification.
I absolutely agree with Dr. Juurlink’s assertion that the harms
associated with prescription drugs – addiction, overdose and death – are
a public health and safety concern that has reached crisis proportions
in Canada. I also agree with many of his recommendations to address
these harms, including that doctors need enhanced education regarding
pain and its treatment; that we need a comprehensive national assessment
of the toll exacted by opioids; and that doctors and pharmacists should
be better equipped to monitor patients’ medication profiles.
In
fact, these recommendations are among the 58 that have been identified
as priorities for action in First Do No Harm: Responding to Canada's
Prescription Drug Crisis – a comprehensive 10-year, pan-Canadian
strategy released by CCSA in March 2013, in partnership with the
National Advisory Council on Prescription Drug Misuse.
However,
I’d like to clarify the role of the Canadian Centre on Substance Abuse
in the development and implementation of this Strategy.
At a
National Dialogue on Prescription Drug Misuse in February 2012, diverse
organizations with ownership in both the problem and finding solutions –
including Health Canada – came together to discuss this emerging
national concern. It was during this meeting that CCSA accepted a
request from meeting participants to take the lead in developing and
implementing a national strategy. However, the end product was very much
born of collective action for collective impact.
And, with
CCSA’s leadership, this collective commitment remains strong. The
“volunteers” that Dr. Juurlink references are representatives of
organizations that have a professional and/or mandated responsibility on
this issue. CCSA brought together these organizations, which represent
healthcare practitioners, regulators, patients and families, First
Nations, law enforcement, the pharmaceutical industry, researchers and
governments to develop and deliver on First Do No Harm. They all remain
at the table, as important members of the implementation teams that are
breathing life into the pages of First Do No Harm.
CCSA remains
the backbone organization to lead this initiative and coordinate the
work of the teams, who are bringing about real and positive change in
areas such as prevention, education, treatment, enforcement, legislation
and regulation, and monitoring and surveillance. In fact, their many
accomplishments were recently highlighted in the inaugural First Do No
Harm Annual Report.
In addition, federal, provincial and
territorial Health Ministers have all prioritized and begun developing a
national monitoring and surveillance system, which includes
prescription monitoring.
Regarding these accomplishments, there
is one final point on which I will agree with Dr. Juurlink. That is,
much of this work was achieved with limited funding. On this, I am
immensely proud of the work undertaken by CCSA staff and the many
committed individuals and organizations that join us to reduce the harms
associated with prescription drugs, while also giving important
consideration to their therapeutic uses.
This being said, CCSA
and our partners continue to pursue funding to support this significant
undertaking. Of particular note is Health Canada’s recent Call for
Proposals (under the Drug Strategy Community Initiatives Fund) to
improve the prescribing practices for prescription drugs that have a
high risk of abuse or addiction.
Just as importantly, we welcome
the involvement of professionals such as Dr. Juurlink, who is clearly
passionate about this issue and committed to reducing the harms
associated with prescription drug misuse and abuse.
In closing,
while action has been taken, there remains much more we can and must do.
CCSA looks forward to continuing its contributions alongside our many
committed partners to achieve greater collective impact. We invite
governments at all levels to join us. And I will be sending Dr. Juurlink
a personal invitation to join the work being done to promote the health
of individuals and families, and create safer communities across
Canada.
Rita Notarandrea
Deputy Chief Executive Officer
Canadian Centre on Substance Abuse
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