A UNIVERSAL DRUG PLAN IS NEEDED! My name is Roch Longueepee, I am here today on behalf of Community Advocates Network (C.A.N.).

I will also be speaking briefly as the CEO of Restoring Dignity which sits as a board member with Community Advocates Network. Community Advocates Network is a coalition of social agencies from all across Nova Scotia who are concerned with the issues of poverty in Canada. Restoring Dignity is an international organization which works with people who, as children were abused in institutions. As part of our mandate we also work on the issues of poverty in Canada. I have been asked to share with you the central concerns that Community Advocates Network has respecting pharmaceutical drug coverage and why we believe there is a need in Canada for a universal drug plan for all Canadians. Community Advocates Network believes that if we are ever to achieve a universal drug plan for all Canadians that we must ensure that such a plan is a sustainable one so that future generations will not have to endure the plight that many face today with drug coverage. We have identified the following key areas which we feel should also speak towards an accountable and sustainable pharmacare plan: 1. Bringing together all existing programs. Our group identified that there are government funded and non government funded programs assisting marginalized individuals and families such as the Canadian Lung Association and other similar type agencies. The vital services these groups provide to our communities should be complemented within the framework of a universal drug plan. 2. Looking at the problems of existing programs such as the diabetes support program and the plenary program. We need to examine the failures and successes of programs like these to ensure we are building on success rather than failures. Programs like these are inadequate and give too many restrictions. We need to assess these programs and remove restrictions which would deny Canadians access to the assistance they need. 3. Looking at the problems of existing drug insurance policies. Our group believes that we need to examine the problems MSI, Blue Cross, and other medical insurances have in order to avoid any future problems with a national pharmacare plan. 4. Looking at all the costs and benefits of having one universal program. Drug companies are purchasing ingredients for producing drugs at minimal cost and charging excessive prices to consumers. The mark-up is in the neighbourhood of 6,000 times that of actual costs. This is even happening with generic drugs now. If we are to have a universal plan, these costs will have to be controlled or the universal drug plan will inevitably fail. Sustainability is the key to the success of a universal drug plan.

5. Existing MSI policies Concerns have been raised about MSI making decisions on what drugs they will cover for patients. People are being denied drugs which they need even after medical experts have given authorization and reason for MSI to cover certain medications. The experts at MSI are not medical doctors, but Pharmacists. This is a practice which must stop. Pharmacists have no authority over medical experts as to what drugs patients should or should not have. 6. Needed education materials. Our group sees a need for patients to be educated on what medical services are available to them and what their rights are when receiving services. Doctors also need to be better educated on persons with special needs, IE disabilities blindness, deafness, patients suffering from mental health disorders and past trauma. 7. The education of various authorities. Our group identified there are problems between government and emergency services not working in an informed collaborative manner to ensure patient rights are respected and not abused. Subsequently, this also raises concerns about safety protocols for emergency service providers. 8. The role of different groups such as doctors and guardians. Patients who are dependant on their family members/guardians to administer medications are vulnerable. We believe it is vital that physicians are aware of any problems which may arise, such as abuse to patients by their family members and guardians, and that caregivers are educated on medication dosages, etc .. 9. Making a new system patient and user friendly. Bureaucracy has proven to be a barrier to accessing services. In todays health care system, too many people have to sift through tons of policies and paperwork to access much needed services. Many people are forced to turn to advocates for help. 10. Access issues, especially for rural communities such as the cost of travel for care including prescription drugs. Our rural communities face serious problems. We are concerned with senior citizens, disabled persons and people who do not have a source of reliable transportation to access drugs and medical equipment. Most pharmacies are situated in urban centres. 11. The importance of mandatory assessment of drug needs on at least an annual basis. Our group identified problems with physicians who were issuing prescriptions to patients who were being over medicated and being hospitalized as a result. Some patients also develop addictions to prescription and off the shelf drugs. 12. Patient safety concerns, such as cap safety. For example, persons with disabilities or seniors suffering from severe arthritis, muscular problems, blindness, etc, are often unable to open medications due to safety caps used on medications. 13. Proper labelling and identifiers for specific drugs for persons with disabilities using multiple drugs. Our committee has identified persons such as blind or visually impaired persons who have ongoing problems with identifying and therefore managing their drug intake. Of course, this alone

poses some very serious safety issues such as overdoses or accidental mixing of wrong medications. 14. Freedom of information and protection of privacy. This includes the role and sharing of patient information when assessing drug and treatment programs. Hospitals and physicians need to be able to access patient information in the event of serious medical issues. Doctors are not coping complete patient files when patients are transferring to a new clinic. Records are often in disorder. Such deficient practices hinder new physicians from reviewing pertinent patient history. Without the knowledge of patient history physicians are treating presenting diagnosis rather than addressing the ailment of the patients health. Such practices also contribute to rising costs of pharmaceutical drugs. 15. One aliment per visit policy as a means for some doctors to maximize their billing for patients. Once again physicians are examining only presenting diagnosis, without taking the time to identify the underlying health issues patients are suffering from. This is also an abuse of the Medicare system which must end. o 16. Public participation in decision about how a new program should work and how well it is working once in place. Our group feels that Canadians have not been engaged in deciding how pharmacare programs are designed and delivered to them. We feel that the government needs to allot sufficient time to allow groups and individuals Canadians to review and respond to new programs initiatives. PREVENTION: The Homeless: Our homeless suffer from a great burden of disease and illness; a circumstance which has multiple causes. Our homeless face huge barriers to accessing preventative or treatment services. Many homeless members have high rates of infectious diseases and psychiatric diseases, health consequences of addictions, respiratory, violence and accidents. Below is a chart from an October 2007 article published in the Parkhurst Exchange entitled Caring for the Homeless offers some disturbing statistics on the homeless population:

Nutritional needs as a preventative measure; Research tells us that people who live in poverty cannot afford to eat well, no matter how carefully they choose and prepare food. From Healthy Eating Nova Scotia, March 2005 In September, 2007, a report on the nutritional needs of those living in poverty entitled Income Assistance and Nutrition: Are You Getting What You Need? was published. The information below provides disturbing realities about the state of those living in poverty and the health concerns that the inability to afford nutritional foods can lead to serious health problems.

What does Income Assistance cover?

In Nova Scotia, the personal allowance for an individual on Income Assistance is $190 per month. This money is intended to cover all non-shelter expenses such as clothing, haircuts, household products, bus tickets, emergency expenses, hygiene products, phone bills, and FOOD.

Are Income Assistance rates sufficient to meet basic needs plus nutritional needs? No!! The Nova Scotia Nutrition Council did a food costing study that found that income
assistance recipients in Nova Scotia barely meet their basic cost of living on this amount, much less meet their nutritional needs. The report found that these inadequate allowances are causing people to buy foods that are less nutritious but more filling in order to ward off hunger.

Does this patients health require one or more of the following diets?
* Modified fat diet (low fat, low * High fibre or high residue diet * Restricted sodium diet (low salt) * Oral nutritional supplements (Ensure, Boost, Pediasure, etc.) * Polycose (calorie supplement) * Diet addressing a Failure to Thrive (individual assessment by a dietitian is recommended) cholesterol, hyperlipoproteinemias)

In addition, does this patient have any of the following medical conditions or dietary needs?
* Chronic Fatigue/Fibromyalgia diet * Cystic Fibrosis (please specify any required supplements!!) * Diabetic diet (please specify the daily caloric need of the patient!!) * Dialysis type diet * Gluten free diet (Celiac disease) * Modified fat diet (low fat, low * High fibre or high residue diet 5

Does this patients health require one or more of the following diets?
cholesterol, hyperlipoproteinemias)

* Restricted sodium diet (low salt) * Oral nutritional supplements (Ensure, Boost, Pediasure, etc.) * Polycose (calorie supplement) * Diet addressing a Failure to Thrive (individual assessment by a dietitian is recommended)

In addition, does this patient have any of the following medical conditions or dietary needs?
* Chronic Fatigue/Fibromyalgia diet * Cystic Fibrosis (please specify any required supplements!!) * Diabetic diet (please specify the daily caloric need of the patient!!) * Dialysis type diet * Gluten free diet (Celiac disease) I would now like to switch hats and draw your attention to an issue which my primary organization has, respecting the medicating of children. Restoring Dignity continues to see serious problems with children in the public schools system and in particular children under the care of child welfare authorities. In Ontario, a July 12, 2007 The Epoch Times article reported that; Documents recently obtained by the Globe and Mail under Ontario's Freedom of Information Act revealed that in a random sample of five Ontario children's aid societies, 47 percent of the children were prescribed psychotropics last year for a range of mental health diagnoses, including depression and attention deficit hyperactivity disorder (ADHD). The Globe article reported that this number is more than triple the rate of drug prescriptions for psychiatric problems among children in the general population. Furthermore, it said last year prescriptions for antidepressants, including Ritalin, which is widely prescribed to children to treat ADHD, rose more than 47 percent to 1.87 million, according to Montreal-based pharmaceutical information company IMS Canada. In addition, prescriptions for a new generation of antipsychotic drugs increasingly being used on children almost doubled, rising to 8.7 million. Source:
http://en.epochtimes.com/news/7-7-12/57563.html

There was a story of a nine year old boy who was sent to a group home where they had assessed him with behavioural issues and began medicating him to control his behaviour. The boy then began showing side effects from the drugs and the system responded by giving him more diagnoses and hence, more drugs. His grandparents intervened and took the care providers to court. Had the grandparents of this little boy not intervened, he would have died. After his story was covered on a CBC documentary, it spurred on a provincial inquiry. CBC was then inundated with letters from concerned parents and viewers. CBC would later do a sequel, as other news centres would, on the issue of mislabelling children with behavioural problems and using anti-psychotic drugs to treat them. You can view his story on CBCs website here: http://www.cbc.ca/national/news/normal/ Sadly, the testing standards for medications being used on children are only tested for adults, not children. A November 11, 2003 article entitled Drug policies make kids 'sentinel canaries published by the Canadian Press, evidences this. "If you look at the adverse-drug-reaction literature, kids have been the sentinel canary for a lot of bad things in drug theory for quite some time. And I would argue that's not the best segment of society who should be serving that function," he said. Traditionally new drugs are tested first in animals, then in adult humans. Once they are licensed for use, however, doctors can and do prescribe them to children -- but without the benefit of clinical data to show if they will be effective or what the appropriate dosage should be. Source: (http://restoringdignitycampaign.blogspot.com/2007/02/drug-policies-make-kids-sentinel.html ) also see (http://www.cbc.ca/news/story/2003/11/11/children_drugs031111.html ) For adults off label drug usage is fast becoming a high risk factor in treating patients. Off label drug usage is the practice of prescribing drugs in patients for treatment other than what health agencies like health Canada has approved it for. This is being fuelled by for profit drug companies seeking to market their product, in order to increase their profits at the risk of public safety. The pharmaceutical drug companies are doing a good job in convincing physicians to continue this practice, despite the fact that it goes against the very principles which the medical profession is founded upon. And I quote from the Hippocratic Oath: I swear by Apollo the Physician and Asclepius (Es-clep-ius) and Hygieia ( Who Jay AA) and Panaceia (Panac-ceia) and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief These are the very principles which the medical system is built upon. Yet, we find ourselves here today struggling to find ways to help countless Canadians trying to care for their families and loved ones who are sick or dying. Attempting to define the boundaries where for profit interests can no longer place Canadians at risk. Setting boundaries where pharmaceutical drug companies will no longer take healthcare hostage nor corrupt the medical field all in the name of profit. The ingredients to make most drugs are a minimal cost to drug companies as it does production. Yet the prices for these drugs are beyond the means of most Canadians and their families. This is not the Canadian way. Is this the way we should be forced to make decisions on who should live and who should die? A universal program is the only way to eliminate these problems, but we must do so with a sustainable outlook for present and future generations of Canadians. We must do this to aide the preservation of, not just ourselves but of our children. We must do this so that the suffering and death of those lives already claimed in this tragic state of affairs are not wasted to the pages of Canadian history. That the words shared in this room today, and the choices of government made by the results of these words, reflect the needs and voices of all Canadians.