Question Period Note: Who is responsible for delivering Prescribed Alternative projects?

N/A

• Provincially regulated health professionals are responsible for prescribing medications based on a patient’s medical needs, safety considerations, available medical guidelines, and applicable provincial and territorial rules and regulations.
• Prescription drugs used in prescribed alternative projects are largely funded from provincial drug formularies and are bound by provincial regulation of the practice of medicine.
• Health Canada is providing time-limited funding to a number of pilot projects for costs such as hiring nurses, and funding the provision of wrap-around supports such as mental health and housing services. Currently 22 active projects are serving approximately 3,116 clients in 3 provinces (BC, ON, NB).
o Health Canada is seeing some positive early results from PA pilot projects, including evidence of declines in emergency department visits and hospital admissions, and reduced all cause and overdose-related mortality.
o PA program providers and clients are also reporting outcomes such as reduced overdoses, reduced illegal drug use, and reduced engagement in criminal activities such as petty crime. We are closely studying all new research as it emerges.
• Health Canada also supports research and evaluation activities, including funding a long-term, arms-length evaluation of prescribed alternatives pilot projects.
• As these projects are a health care service under provincial and territorial jurisdiction, Health Canada does not approve the operation of these sites.
If pressed on studies showing increasing rates of prescribing of drugs commonly used in prescribed alternative programs:
• We are aware of data showing increasing rates of prescribing hydromorphone, including one recent study out of Quebec.
• While we have data on the number of prescriptions, it does not tell us what the exact medical purpose of these prescriptions are.
• The most common use for these drugs in Canada is for the treatment of moderate to severe forms of pain.
• They are prescribed to millions of Canadians each year for this purpose. Prescribed alternatives programs in Canada are very small by comparison.
o 4.69 million individuals in Canada used opioids in 2022. By comparison, federally funded prescribed alternatives projects currently support 3,250 clients.
• Its important for us to better understand prescribing data. We are closely monitoring all relevant research and data to help inform our approach to the overdose crisis, and also ensure that pain patients continue to receive the supports they need.
If pressed on diversion
• Diversion is illegal, and something we take very seriously.
• Sadly, this is not a new phenomenon.
• Examples of diversion can include patients sharing or selling their own prescriptions, thefts from pharmacies, pilferage in healthcare settings and prescription forgeries.
• Governments, health care professionals and law enforcement share the responsibility of reducing the risk of diversion and to take action when it occurs.
• We are monitoring the situation closely, and taking action to help prevent diversion from federally funded-prescribed alternatives pilot projects.
• The RCMP says there is no evidence to suggest the widespread diversion of drugs from prescribed alternatives.
If pressed on diversion risk in Health Canada-funded projects
• Health Canada has worked with federally-funded prescribed alternatives pilot projects to strengthen their operational protocols to help reduce diversion risk. Projects are also required to report regularly to Health Canada.
• Projects have implemented a number of practices to help reduce diversion risk, including:
 Patient screening
 Efforts to better match drugs to patient tolerance
 Risk-based protocols for assessing patient eligibly for take-home dosing
 Patient monitoring
 Actions to address instances of diversion, which can include:
• switching to observed dosing;
• transfer into a different support services; or
• removal from program.
• In January, Health Canada hosted an expert roundtable on assessing, measuring and mitigating diversion risk related to these services.
• Officials also convened federally-funded projects in February to review their protocols, share the latest evidence and ensure they are implementing promising practices
• In addition, we continue to support the evaluation of projects, to inform our actions moving forward.
• These actions are important to mitigate risks. At the same time, I recognize we will need to continue to closely monitor these projects and analyse the evidence to inform our way forward and any further adjustments that may be needed.
If pressed on evidence
• Prescribed alternatives projects are being studied by a number of researchers across Canada.
• Some promising early outcomes include evidence of reduced overdose mortality and hospitalizations, as well as client and provider reports of reduced illegal drug use, improved access to health and social services, and reduced engagement in criminal activity.
• We are also aware of some concerns, such as diversion, and we take these reports seriously.
• We recognize that there are differing views among experts.
o I met with, and received letters from, physicians, researchers and practitioners calling for changes to prescribed alternatives programs, as well as those calling for increased support.
• We are working with federally-funded pilot projects so that they are implementing strong diversion mitigation practices and reporting on these regularly to Health Canada.
• We will continue to evaluate all available and emerging evidence, and listen and engage with experts with various views, to learn from current experiences and inform this practice moving forward.

N/a

N/a