US embassy cable - 05OTTAWA1989

UNCLAS SECTION 01 OF 02 OTTAWA 001989 
 
SIPDIS 
 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: ETRD, ECON, SOCI, CA, Health 
SUBJECT: HEALTH MINISTER ANNOUNCES STRATEGY ON CROSS-BORDER 
DRUG TRADE 
 
REF: OTTAWA 0525 (CANADA SEEKS REGULATORY 
     PRESCRIPTION FOR INTERNET PHARMACIES) 
 
1.  (U) Summary:  Health Minister Dosanjh announced that the 
GOC will take three steps to address the cross-border drug 
trade:  1) create a drug supply monitoring network, including 
input from both public and private stakeholders, to determine 
whether there are drug shortages or threats to the Canadian 
drug supply; 2) seek legal authority to ban bulk exports in 
the event of a drug shortage or "when it is necessary to 
protect the health of Canadians;" and 3) require an 
established doctor-patient relationship for prescriptions. 
Pharmaceutical industry associations are hailing this as a 
good first step, while internet pharmacies are already up in 
arms at the new attack on what Dosanjh deems the "unethical 
conduct" of doctors' cosigning prescriptions.  Dosanjh says 
that it was never his intention to kill the internet pharmacy 
industry and that he is sure that the industry "will adapt." 
End summary. 
 
Drug Supply Monitoring Network: More than anecdotal evidence 
------------------------------ 
 
2.  (SBU) Following months of hints and speculation, Health 
Minister Dosanjh received Cabinet go-ahead to announce  three 
new initiatives to stem the flow of prescription drugs from 
Canada to the United States.  The first initiative is the 
establishment of a drug supply monitoring network, to be 
housed in Health Canada, which will work with the provinces, 
territories and other stakeholders to provide Health Canada 
with more comprehensive drug supply data.  This initiative 
should not require any legislative changes, and thus will be 
the easiest for Health Canada to implement.  (Note:  An 
industry contact suggests that Health Canada may encounter 
resistance to monitoring at anything beyond a wholesale level 
because of the commercial confidentiality involved.) In 
declaring a threat to Canada's drug supply from cross-border 
trade, Health Canada has frequently run into the difficulty 
that there is limited empirical evidence of any drug 
shortages.  The formation of a drug supply monitoring network 
will give Minister Dosanjh evidence beyond anecdotal accounts 
from pharmacist associations and patients groups to support 
his contention that the cross-border drug trade poses a 
threat to Canada's drug supply. 
 
Bulk Export Bans "if and when necessary" 
---------------------------------------- 
3.  (SBU) Second, the GOC also intends to introduce 
legislation to amend the Food and Drug Act to allow Health 
Canada to ban bulk exports in the event of anticipated or 
actual drug shortages (note: GOC is reacting to possible U.S. 
legislation allowing bulk inports of drugs from Canada). 
Despite questioning, Minister Dosanjh did not make it clear 
whether the GOC intends to impose bans as soon as legislation 
is passed or act only when there is a threat of shortage of 
"prescription or other needed" medication.  A pharmaceutical 
company representative called this portion of the 
announcement "ambiguous", and Minister Dosanjh further 
muddied the waters by at first saying that the GOC would 
"possibly introduce legislation" and then, under questioning, 
saying that the GOC will definitely introduce legislation. 
(Note: Local stakeholders inform us that the insistence on 
modifying language rather than an outright ban may have come 
from resistance at the cabinet level, possibly prompted by 
the fact that an outright ban could block legitimate domestic 
drugs produced for export to foreign markets.) 
 
Unethical Conduct:  Thou shalt not...kill the internet 
pharmacy industry? 
------------------ 
 
4.  (U) Finally, in keeping with his previous insistence that 
prescription cosigning is "unethical" (ref Ottawa 0525), 
Minster Dosanjh intends to propose measures to "strengthen 
existing federal regulations under the Food and Drugs 
Act...to require an established patient-practitioner 
relationship."  This initiative prompted the most intense 
questioning at the press conference, including repeated 
questions at to whether the requirement of an established 
patient-practitioner relationship would "kill the (internet 
pharmacy) industry."  Minister Dosanjh stated that he 
"...never intended to kill the industry" and said that he was 
"sure the industry would adapt."  When pressed to clarify 
what is meant by an established patient-practitioner 
relationship, Dosanjh answered "A doctor-patient relationship 
means a doctor-patient relationship" and explained that he 
expected foot traffic by Americans traveling to buy drugs in 
Canada to continue and that he would work to ensure that 
Canadian snow-birds would still have access to drugs from 
Canada.  Representatives of the internet pharmacy industry 
say that actions against cosigning would have a major impact 
on their industry. 
 
Visit Canada's Classified Web Site at 
http://www.state.sgov.gov/p/wha/ottawa 
 
WILKINS