Across Canada, the tragic spike in opioid-related deaths has brought to national attention the large and complex issue of drug use and misuse. As fentanyl-related overdoses are gripping the country, there is a connected, but separate crisis of doctor-prescribed opioids being increasingly used on a regular, long-term basis.
Many drugs prescribed to seniors have either not been adequately studied for this age group or have not been formally approved for the conditions they are being prescribed to treat. They are sometimes prescribed without any evidence they are safe and effective for them, and in some cases, even when they are known to present a possible risk (antipsychotics prescribed to older patients with dementia, for example).
When the topic of health care and pharmaceutical drugs comes up, the discussion usually turns sooner or later to the high prices we pay. At the upcoming meeting of the Council of the Federation in Yukon, the Canadian health care system will certainly be on the agenda. But a national pharmacare plan would do more harm than good.
It's natural for any industry to undergo changes, but few industries have experienced as many rapid changes as the pharmaceutical and health care ones. To remain relevant among these digitally wired consumers, big pharmaceutical companies have adjusted, making visible efforts to grab the audience's attention through web and mobile presence.
A 65-year-old man notices he's feeling more tired lately. He's gaining weight and losing muscle. He can't get as many erections, and generally feels foggy and unwell. His family doctor takes some blood tests and rules out thyroid problems, high cholesterol and blood sugar issues. The only finding is low testosterone -- but that's a normal part of aging, right?
Using non-beneficial medications or failing to offer comfort medications to chronically ill patients is potentially harmful, time-consuming and simply bad medical care. Unnecessary or unwarranted medical interventions, including medications, are also costly to the healthcare system. It's time to embrace new ways of thinking.
Today, doctors' offices are inundated with people who have been harmed more than helped by these drugs. Thousands more are dead. And yet the marketing continues, with pain specialists and advocacy groups opposing moves to curtail opioid prescription, their efforts financed by the very companies that make these drugs.
For the past three years World AIDS Day on December 1st has been themed, "Getting to zero," which means zero new HIV Infections, zero discrimination and zero AIDS-related deaths. Even with these promising new developments however, we cannot underestimate the challenges ahead in responding the AIDS epidemic. More than 71 thousand Canadians were estimated to be living with HIV in 2011 and there were 3,175 new HIV infections. Worldwide, there are a staggering 36 million people living with AIDS.
The glaring gaps in drug coverage for Canadian children are made stranger by the economic dimensions of the issue. Children's health care represents a drop in the ocean of health care budgets -- extending universal drug coverage to children would constitute a small fraction of total pharmaceutical spending.
The overwhelming majority of these incredibly common infections are caused by viruses -- that is, they will not respond to antibiotics -- so I don't routinely offer antibiotic treatments. When patients hear they won't be getting an antibiotic many become surprised and often upset. I then spend time counselling them about why antibiotics are, in most cases, the wrong treatment choice.
A new study in the Canadian Medical Association Journal with health economist Steve Morgan as lead author argues a national universal care drug program would not result in substantial tax increases. It seems the time is ripe to finally complete our universal system of public healthcare coverage by adding a national public drug plan. If anything, these cautions should serve as guideposts to make sure a new national drug plan is not only effective but also designed in a fiscally sustainable manner.
The federal government plays a vital role in pharmaceutical drug regulation. We have many reasons to be proud of the systems for drug safety already in place in Canada. Yet there's room for significant improvement. Canadians deserve safe, effective, accessible and reliable pharmaceutical drugs when they need them. The only way to do this is through perpetually improved systems framed by transparency and openness.
In a public healthcare system, too often system failures end up as fodder for Question Period battles rather than impetus for learning. When investments have been made in new models of health service funding and delivery that don't work out, it can be difficult to proclaim failure as a means to move toward success.
Employers want their drug plans to be as competitive as those offered by other employers. So what happens when the norm is to cover all new drugs at any cost, even if the drugs do not provide additional therapeutic value? Well, the end result is that everyone buys "generous" plans instead of increasing employee compensation. Everyone we spoke with agrees about the need to educate employees and employers alike. And in fact, everyone agrees (even insurers) that exorbitant drug costs are a big issue for Canadians.