Access to New Medications

This paper was approved by the Executive Committee of the Canadian Psychiatric Association Board of Directors on May 30, 1998. /

The Canadian Psychiatric Association (CPA) is gravely concerned that short-sighted policies are placing uneven restrictions on access to a new generation of antipsychotic, antidepressive, and other medications. These restrictions impede physicians' ability to exercise their best judgement in making optimum, evidence-based, clinical decisions on the best treatment for those suffering from mental illnesses. Moreover, these restrictions diminish the positive outcomes and potential improvements, experienced often for the first time, in the lives of those suffering from the most debilitating of mental illnesses, such as schizophrenia and depression.

As key mental health care providers, Canadian psychiatrists and physicians are trained to exercise their best clinical judgement when assisting patients suffering from mental illnesses such as depression, schizophrenia, alcoholism, and others through careful diagnosis, assessment, treatment, and rehabilitation to regain healthy functioning and productivity. This continuum involves many modalities of which one important component is the ability to prescribe the most appropriate medication.

Medications to treat clinical depression and the psychotic symptoms of schizophrenia have been available for more than 40 years, with some, particularly in schizophrenia, being useful as well in treating negative symptoms such as lack of motivation and apathy. While older medications continue to be used successfully, newer medications with improved efficacy and side effect profiles have helped to relieve more of the suffering caused by certain mental illnesses, especially those symptoms not responsive to, or adequately relieved by, earlier medications.

Appropriate intervention at an early stage of mental illness is critical for the patient. Evidence suggests that early diagnosis and effective drug treatment during the first episode of schizophrenia, supported by appropriate psychosocial interventions, have a positive impact on the future course of the disease. The required cycling of patients through older medications before the newer medications can be tried, as is the case in some jurisdictions, can impede effective early treatment. A lower incidence of side effects of the newer medications helps to increase adherence to treatment and lessen the frequency of psychotic episodes. For people with clinical depression, early diagnosis and treatment with a combination of pharmacology and psychotherapy also lead to better outcomes. For these reasons, new medications for schizophrenia and depression, with vastly improved side effect profiles, are increasingly considered the treatment of choice.

Canadian psychiatrists observe with deep concern, however, the increasingly erratic pattern of inclusion and rejection of these newer medications on provincial drug formularies, a disturbing trend that exacerbates interprovincial disparities and the varied access to treatments across the country. While CPA encourages cost-effective approaches to treatment, many short-term policies aimed at controlling drug costs do not take into account the social and long-term impact of mental illness. Furthermore, the most disturbing aspect found in these short-term analyses of cost-benefit is the apparent tendency for viewing the relief of suffering for people with mental illness as a lower priority than treatment regimes for those suffering from other diseases.

When one in 5 Canadians will become ill with a mental disorder at some time during their life, it is evident that mental illness and its stigma touches all Canadians either directly, or through someone they know. One in 4 women and one in 10 men can expect to develop depression, with persistent emotional and physical symptoms that engender a paralyzing sense of apathy and hopelessness. Schizophrenia, a brain disorder characterised by a chronic course of different symptom complexes, affects one out of every 100 Canadians and their families. The impact of these and other mental disorders on people's lives represents an enormous loss to society and a great cost to the social and public health care systems.

The debilitating and often invisible nature of mental illness means many citizens do not ask for, and often do not receive, priority attention or support, though these diseases are serious and sometimes terminal health conditions. Suicide is one of the leading causes of death among people between the ages of 15 to 24, and many doctors now believe that depression is the illness underlying most suicides in Canada. Tragically, it is the outcome for as many as 10 percent of those suffering from schizophrenia.

In response to these facts, it is essential that a full choice of medications be available to enable treating physicians in every province, to advise on the best clinical treatment for each individual patient. This is the only way to ensure that physicians can exercise their highest clinical judgement in the best interests of the patient and the public.

While recognizing the complex factors involved in providing optimal care for mental illnesses, the CPA urges all publicly supported provincial drug plan formularies to provide timely and unrestricted access to new antipsychotic, antidepressive, and other psychiatric medications that are approved by the federal Health Protection Branch.

In the interest of all mental health patients and their physicians, the CPA requests transparency and harmonization of these policies and is prepared to participate in any process to achieve optimal access to modern care and treatment for Canadians with a mental illness.