Ontario launches ‘comprehensive’ opioid strategy aimed at curbing growing addiction, overdose problem

Ontario is launching its “first comprehensive opioid strategy” aimed at curbing a growing addiction and overdose problem that is plaguing not only the province, but the rest of the country.

Health Minister Eric Hoskins announced numerous measures Wednesday aimed at modernizing prescribing and dispensing of both opioids and the drugs used to treat addiction and overdose.

The measures are aimed at curbing “opioid misuse,” which Hoskins said is the third-leading cause of accidental death in Ontario.

“They are absolutely critical measures at a time when we are facing a public-health crisis across the country,” Hoskins told a news conference on Wednesday morning.

The measures include expanding access to Suboxone, which helps treat opioid addiction by stopping cravings and preventing withdrawal symptoms. The drug is considered safer than methadone, with fewer side effects and “significantly less” risk of fatal overdose, according to information from the Ministry of Health and Long-Term Care.

The province has just added the drug to its Drug Benefit Formulary. A document from the ministry shows that Suboxone in 2 mg and 8 mg strengths has been changed from “limited use” to “general benefit” on the formulary.

That change came into effect on Tuesday.

There are some 50,000 Ontarians currently receiving methadone treatment, Hoskins said, adding that there are likely scores of others in need of the drug who can’t access it because they live in a rural area under-served by addiction services. Making Suboxone more widely available, meaning it can be prescribed by primary-care providers such as family physicians and nurse practitioners, is part of a more “holistic” approach to tackling opioid addiction and overdose, Hoskins said.

The move follows a decision by the Liberal government in British Columbia to make Suboxone more accessible to deal with that province’s opioid addiction and overdose problem. All B.C. doctors can now prescribe Suboxone and will no longer be required to have an exemption.

• B.C. College of Physicians and Surgeons lifts ‘outdated’ restriction Suboxone to help overdose crisis

The new measures announced by Hoskins also include the appointment of Dr. David Williams, Ontario’s chief medical officer of health, as the province’s first-ever provincial overdose co-ordinator. The new position is aimed at developing a new surveillance and reporting system to gather data on overdoses and inform decisions about patient care.

Hoskins said the province does collect data on the number and cause of overdose deaths, but doesn’t always get that information in a timely manner, particularly if the patient doesn’t arrive at an emergency room. Williams added the province hasn’t identified “hot zones” yet, in terms of where addiction or overdose incidences are concentrated.

‘A growing urgent issue’

The province is also pledging $17 million to enhance or create 17 chronic pain clinics across the province.

Other measures include:

• Developing “evidence-based standards” for health-care providers on prescribing opioids, to be released by 2017-18, to prevent unnecessary dispensing and over-prescribing of painkillers.
• De-listing high-strength formulations of long-acting opioids from the Ontario Drug Benefit Formulary, starting Jan. 1.
• Bringing in stricter controls for fentanyl patches, which took effect on Oct. 1, that require patients to turn in used patches to their pharmacist before more can be dispensed.
• Expanding access to the overdose medication naloxone, which will be made available free of charge through pharmacies and “eligible organizations” to prevent overdose.

“I believe that this comprehensive strategy will propel us to the front of jurisdictions not just in Canada but worldwide in responding holistically and effectively to this growing opioid crisis,” Hoskins said.

In 2014, more than 700 people died in Ontario from opioid-related causes, a 266 per cent increase since 2002, according to the ministry.

Last month, new data from Ontario’s chief coroner showed that fentanyl was the number one cause of opioid-related deaths in Ontario in 2015 for the second straight year. Across the province, the powerful narcotic killed a record 162 people on its own and 36 when combined with alcohol, the numbers revealed. Over a five-year period, deaths from fentanyl alone nearly doubled in Ontario, up from 86 in 2010.

• Record number of Ontario fentanyl deaths in 2015, new data from chief coroner’s office shows

“Despite our best efforts, we know there is a growing urgent issue here in Ontario and across North America that we need to come to grips with,” Hoskins said. “And that is the increasing number of people who are becoming addicted to prescription opioids.”

Fentanyl deaths in Canada have been characterized as a country-wide “disaster.” In British Columbia, nearly 500 people have died of fentanyl overdoses between January and August of this year. 

In Ontario, police and community groups have raised alarm bells that a fentanyl crisis could be looming as synthetic versions of the drug appear across the province as they have elsewhere in Canada and the U.S.

• Fentanyl crisis coming to Ontario, police and community groups warn