Federal Health Minister Jane Philpott is pledging to use every tool at the disposal of the federal government to address Canada's epidemic of opioid abuse.
"This is a national public health crisis," Dr. Philpott told reporters on Friday. "It is an emergency. It's absolutely essential that we put all tools on the table to address it."
Dr. Philpott spoke to reporters during a national conference on opioids. The toll opioid addiction and abuse is taking on families, the health-care system and communities came into sharp relief during the session.
"It's a national crisis," said Ontario Health Minister Eric Hoskins, who is co-hosting the two-day conference with Dr. Philpott. "During the course of this conference today, probably six or seven Canadians will die. And that will happen tomorrow and the day after tomorrow."
The conference is the first time the federal government has brought together policy makers and medical experts to come up with strategies to address the crisis. An investigation by The Globe and Mail found that Ottawa and the provinces have failed to take adequate steps to address the roots of the problem: the over-prescribing of prescription painkillers.
The practice dates back two decades, to when doctors began prescribing opioids to relieve moderate to severe pain as pharmaceutical companies promoted their benefits. In 2015, doctors wrote one prescription for every two Canadians, according to figures compiled for The Globe by IMS Brogan, which tracks pharmaceutical sales. The death toll has escalated since last year, with the advent of a thriving black market for bootleg fentanyl, a drug 100 times more powerful than morphine.
David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre, asked during his keynote address why the Public Health Agency of Canada has not been "all over" the crisis.
The agency was created after the SARS crisis in 2003, when 44 people died in an outbreak of the disease across Canada. "That many people die every week from opioid overdoses," Dr. Juurlink said.
An inquiry into the SARS outbreak led by Justice Archie Campbell said it was fundamental that, in public-health emergencies, the chief medical officer of health should have "operational independence from government in respect of public-health decisions."
New Democrat health critic Don Davies called on the federal government on Friday to declare a national public health emergency. Dr. Philpott said she would consider taking such a step only if doing so would enhance her ability to respond to the crisis.
Greg Taylor, Canada's Chief Public Health Officer, said such powers would be enacted only as a last resort if the provinces need Ottawa's help. "At this point in time, it doesn't seem to be needed," Dr. Taylor said in an interview.
In Ontario – the country's biggest per capita user of prescription opioids – just under 700 people died of overdoses last year. In British Columbia, 622 people died in the first 10 months of this year, and another 338 died in Alberta between January and September.
"The death rate that we're seeing is just a tiny fraction of the untreated addiction that we're seeing," said Keith Ahamad, a family and addiction medicine specialist at Providence Health Care in British Columbia. At St. Paul's Hospital in downtown Vancouver, he said, 6.8 per cent of all visits to the emergency department last year were due to opioid overdoses.
Karen Mazurek of the College of Physicians and Surgeons of Alberta highlighted the lack of surveillance data in Canada to monitor the problem. The colleges, she said, have a tradition of reacting to issues. To address the opioid crisis, the colleges must be pro-active, but they need data on physicians' prescribing practices. In Alberta, more than 3,000 doctors prescribe more than the equivalent of 200 milligrams of morphine a day – four times the dose recently recommended by the Centers for Disease Control and Prevention in the United States.
Mae Katt, a nurse practitioner in Thunder Bay, Ont., told the conference that remote communities in the north have been quietly suffering from the opioid crisis for years. At a high school in Thunder Bay, she said, 63 of the 150 students were addicted to opioids in 2010. Much of that addiction was linked to trauma over the high rate of suicides in many of their communities.
"We realized quickly that their grief was really predominant and they were using the drugs to soothe that," Ms. Katt said.