First Do No Harm: Responding to Canada’s Prescription Drug Crisis

Ottawa, March 27, 2013 — The Canadian Centre on Substance Abuse (CCSA), in partnership with the National Advisory Council (NAC) on Prescription Drug Misuse, today released a comprehensive 10-year, pan-Canadian strategy, First Do No Harm: Responding to Canada’s Prescription Drug Crisis. The strategy highlights the action required to address the devastating harms associated with prescription drugs in Canada in the areas of prevention, education, treatment, monitoring and surveillance, and enforcement. Prescription drug use is everyone’s issue and touches the lives of Canadians across our country.

“Harms such as addiction, overdose and death associated with certain prescription drugs — opioids, sedatives and tranquilizers, and stimulants — are a leading public health and safety concern in Canada that has now reached crisis proportions,” stated Michel Perron, Chief Executive Officer, CCSA and NAC Co-Chair.

The number of opioid-related deaths is increasing, emergency room visits are on the rise and there are increased demands for treatment. Canada now ranks as the world’s second largest per capita consumer of prescription opioids, with the United States ranked as number one (International Narcotics Control Board, 2013). Canada‘s rate of use increased by 203% between 2000 and 2010, an increase steeper than in the United States (International Narcotics Control Board).

When prescribed and used appropriately, opioids, sedatives, tranquilizers and stimulants have therapeutic benefits for people experiencing pain or those with certain illnesses. The NAC is working towards a Canada that allows for the benefits while minimizing the harms associated with prescription drugs.

Many people dependent on these drugs might have initiated their use through prescribed therapy. Others use these drugs entirely for non-medical purposes. The human impact of addiction, withdrawal, overdose and death is devastating. Harms can result in road crashes, accidental overdoses and suicide, and are borne by individuals, families, communities, as well as by health care, social services, public safety services and society at large.

“The Government of Canada recognizes that the abuse of prescription drugs is a serious health and safety issue that is having a devastating effect on individuals, families and communities across Canada,” said the Honourable Leona Aglukkaq, Minister of Health. “As this report makes clear: prescription drug abuse is an issue that governments, professional associations and other stakeholders all have a responsibility to help address. Our Government is committed to doing its part and will review the recommendations put forward by the CCSA.”

There is currently no information on the costs of prescription drug misuse and harms in Canada. Recent research from the U.S. estimates the annual cost of the non-medical use of prescription opioids to be more than $50 billion, with lost productivity and crime accounting for 94% of this amount (Hansen et al., 2011). To effectively address the issue, it is imperative that the direct and indirect costs of prescription drug misuse and harms be quantified, both across the Canadian healthcare system and within society.

First Do No Harm: Responding to Canada’s Prescription Drug Crisis is a national strategy to address prescription drugs that have legal status and therapeutic uses, but also a high potential for harms. Developed by the CCSA, in collaboration with NAC, this national initiative has brought together the best minds devoted to all aspects of prescription drugs, including a variety of health practitioners (physicians, pharmacists, nurses, dentists and coroners), patient and family organizations, First Nations representatives, enforcement officials, regulators, industry leaders and researchers. Specific attention is devoted to First Nations, rural and geographically isolated communities to highlight their unique needs.

Strategy Recommendations

The recommendations were developed around five streams of action: Prevention, Education, Treatment, Monitoring and Surveillance, and Enforcement. In addition to the five streams, three other areas cut across all streams and are important to this work: legislation and regulations, research, and evaluation and performance measurement.* The recommendations aim to:

  • Prevent prescription drug-related harms to individuals, families and communities;
  • Educate and empower the public and promote healthy and safe communities;
  • Promote appropriate prescribing and dispensing practices among healthcare practitioners;
  • Increase timely, equitable access to a range of effective treatment options throughout the continuum of pain and addictions treatment;
  • Identify effective, evidence-informed practices and policies and build upon them;
  • Develop a standardized pan-Canadian surveillance system to improve our understanding of the nature and extent of the harms associated with prescription drugs in Canada;
  • Establish prescription monitoring programs in each province and territory to share information about prescribing and dispensing practices across disciplines and jurisdictions on a timely basis and take timely action;
  • Ensure that law enforcement has adequate tools, training and resources to address the diversion of prescription drugs;
  • Engage industry, governments, regulatory bodies and others with a stake in the issue to join forces, commit to specific recommendations, leverage existing resources and strengthen system capacity to address the issue;
  • Develop or clarify legislation and regulations to reduce barriers to effective treatment and prevent harms;
  • Conduct research to address knowledge gaps and promote strategies to deal with this important issue;
  • Engage industry in concrete, responsible actions that promote patient safety, improved patient outcomes and risk mitigation; and
  • Provide a contextual lens to First Nations, geographically remote, isolated and rural populations.

What Canadians Can Do Right Away

What can Canadians do immediately to help? First, be aware that it isn’t only illicit drugs that can be harmful. Ask questions of doctors, dentists, specialists and pharmacists. If chronic pain is the issue, people can inquire about their prescriptions and what other therapies and treatments are available.

Become better informed about the medications you’re taking. Know that even though they are legal and might have been prescribed, these medications have the potential of causing serious harm. You and your healthcare provider need to weigh the risks and potential benefits to decide what is best for you.

Do not share your medications. Most Canadians don’t understand the risks of sharing prescription drugs to help out friends or family members who have acute or chronic pain or anxiety. Many prescription drugs that are harmful and misused come from the medicine cabinets of friends and families, so proper storage and disposal of prescription drugs can effectively reduce misuse and diversion.

“The success of this strategy is rooted in its comprehensive approach—stakeholders from the health, education and enforcement jurisdictions will implement the recommendations from all five action streams,” advised Carolyn Davison, NAC Co-chair and Director, Addiction Services, Nova Scotia Department of Health and Wellness. “This includes the work required by communities to address the safe storage and disposal of medications, as well as increasing access to opioid dependence treatment for Canadians in need of assistance.”

Moving Forward—What Canadians Can Expect Will Be Different Because of the Strategy

The strategy now moves to implementation and evaluation, drawing on the proven cross-sector, multi-jurisdiction collaboration that delivered this document. Work has already begun. The NAC is aligning the work of all those involved with mutually reinforcing activities. For example, the Canadian Association of Chiefs of Police has held National Take Back Days to reduce the volume of these drugs available for diversion. In the future, Canadians might see greater involvement of public health and local pharmacies to increase awareness of the importance of safe storage and disposal and to evaluate these efforts. Prescription Monitoring Programs already exist in some provinces. The NAC will learn from these initiatives and support other jurisdictions to implement effective programs.

The NAC will continue to lead the work of the strategy and oversee the implementation of its recommendations. An annual progress report on progress outlining achievements and expected outcomes will ensure that stakeholders are kept informed on developments. CCSA, in collaboration with NAC, is committed to working with leading experts in the field to implement this plan of action to reduce the number of Canadians experiencing harms associated with prescription drugs.

“Our goal is to get the right medication to the right people for the right reasons. This complex issue has a very human face,” concluded Dr. Susan Ulan, NAC Co-chair, and Co-chair of the Coalition on Prescription Drug Misuse with the College of Physicians and Surgeons of Alberta. “All Canadians — individuals and all the organizations that continue to work together to reduce the harms associated with prescription drug misuse — will draw from the strategy recommendations presented today. Together, we will have a collective impact by addressing areas that touch on this issue such as research, evaluation, prevention, education, treatment, law enforcement, regulation and legislation.”

Documents Available

The webcast for the national news conference will be archived.

About the Canadian Centre on Substance Abuse

The Canadian Centre on Substance Abuse changes lives by bringing people and knowledge together to reduce the harm of alcohol and other drugs on society. We partner with public, private and non-governmental organizations to improve the health and safety of Canadians.

Media Contact: Suzanne Stoltz, Communications Advisor, CCSA, Tel.: 613-235-4048 ext. 240 Email:, Twitter: #StratRxCan

This post is also available in: French