QUEEN’S PARK—The Ontario government announced a new opioid strategy, touted as its first comprehensive strategy to prevent opioid addiction and overdose. According to a government press release, this new strategy is attempting to meet those goals through “the enhancement of data collection, modernizing prescribing and dispensing practices and connection patients with high quality addiction services.” Local health practitioners are giving the new strategy mixed reviews.
“In my opinion it is a good thing that the government is identifying the high number of deaths and emergency room visits,” said Dr. Cooper, chief of staff at the Manitoulin Health Centre and a general practitioner with the Northeastern Manitoulin Family Health Team in Little Current. “It is looking at harm reduction. It doesn’t address the question of getting people off of the drugs—but that is not its goal. It is hoped that will happen, but it isn’t the central goal.”
Dr. Cooper said that the addition of suboxone to the arsenal of the battle against the debilitating effects of opioid addictions by making it more readily prescribed is a good thing, but that it is significantly more expensive. “You are looking at around three dollars a dose for suboxone and methadone is pennies, but a lot of the cost is in dispensing fees, so there isn’t that much difference in cost to the government,” he noted. “It is a safer drug and the efficacy is about the same.” Efficacy in this regard is actually measured in the reduction of deaths by overdose and visits to the emergency rooms of local hospitals. When suboxone is used to treat opioid addiction, the risk of a fatal overdose is significantly less than with methadone.
“I am delighted that the government has announced 17 new chronic pain clinics,” he added, but there is a significant caveat to that delight. “Where are they going to be located?” queried Dr. Cooper. “I don’t expect they will be located in small rural or Northern communities. It probably won’t help those smaller communities.” Many small rural communities, including First Nations have epidemic proportions of opioid addictions running rampant.
It is a concern shared by Algoma-Manitoulin MPP Mike Mantha. “With 17 pain clinics coming to the entire province I’m very concerned that this will leave Northern Ontario without access,” he said.
As for the rest of the strategy, Mr. Mantha also had concerns. “I know of people who need this medication (opioids) to function and this will not help them,” he said. “It will only accomplish two things: one is cause financial hardship for those who can’t afford the medication pushing them to the black market and two, causing further health concerns as to the uncertainty of the quality, effectiveness and dosage of the product. We do have an opioid problem but denying the care to the most vulnerable who suffer with incredible pains isn’t the answer. Let’s make sure supports are in place for those suffering and have pain clinics available to all who need them.”
“Lots of rural people get started on opioids when they are trying to deal with chronic pain,” Dr. Cooper noted. “I don’t think we do a great job on the issue of chronic pain management.”
If the new strategy contains a significant outreach component that will stretch into rural and remote communities, that would be a major step forward for those areas, he suggested. “I would like to see opioid addiction services integrated into primary care.” Right now those services are largely separate and that tends to single out and marginalize those seeking help.
“I am also a little bit concerned about the training component,” said Dr. Cooper. He noted that there is currently a great deal of training and information available. “It seems like every third email I get in my office is from an organization offering training. There are a lot of resources (currently), so it is not a lack of effort. But you can know how, but the question is ‘are you applying that knowledge in an appropriate manner?’,” he said.
Dr. Cooper pointed out that while he can prescribe chemotherapy medication, “I wouldn’t want to be the one prescribing chemotherapy drugs. It has to be considered carefully by someone trained in that field to safely prescribe and monitor the drugs.”
There are three pillars of approach to a strategy that Dr. Cooper said he believes need emphasis. “People with addictive personalities should not be prescribed opioids; we should be managing chronic pain better, there has not been nearly enough research into managing chronic pain; and a huge part of opioid addiction is taking place in shattered communities, opioid addiction is a reflection of underlying issues.”
As a society our approach to addictions tends to only deal with the symptoms of deeper social issues, noted Dr. Cooper. While there are issues that spring from more advantaged parts of society as well, and some of that will be unavoidable, the underlying social issues that provide the most fertile breeding ground for addictions need to be addressed. “Although we tend to hear a lot about it in First Nations communities, the issue is not at all limited to those communities,” he pointed out. “There is a common vein running through those communities that are being most impacted and it tends to be those communities that are socially and economically marginalized.”
Ontario’s strategy to prevent addiction and overdose includes: designating Dr. David Williams, Ontario’s Chief Medical Officer of Health, as Ontario’s first-ever Provincial Overdose Coordinator to launch a new surveillance and reporting system to better respond to opioid overdoses in a timely manner and inform how best to direct care; developing evidence-based standards for health care providers on appropriate opioid prescribing that will be released by end of 2017-18 to help prevent the unnecessary dispensing and over-prescribing of pain killers; delisting high-strength formulations of long-acting opioids from the Ontario Drug Benefit Formulary starting January 1, 2017 to help prevent addiction and support appropriate prescribing; investing $17 million annually in Ontario’s Chronic Pain Network to create or enhance 17 chronic pain clinics across the province, ensuring that patients receive timely and appropriate care; expanding access to naloxone overdose medication, available free of charge for patients and their families through pharmacies and eligible organizations to prevent overdose deaths; and increasing access to Suboxone addiction treatment and improving patient outcomes and integration of care for those using this treatment.
Beginning October 1 stricter controls on the prescribing and dispensing of fentanyl patches took effect and patients are now required to return used fentanyl patches to their pharmacy before more patches can be dispensed.
According to the Ministry of Health, Ontario’s opioid strategy was informed by the recommendations of the Methadone Treatment and Services Advisory Committee, which was established by the province to advise on strengthening Ontario’s methadone treatment and related services. The Methadone Treatment and Services Advisory Committee is comprised of addiction experts, experienced clinicians and patient advocates from across Ontario.
In addition, Dr. Eric Hoskins, Minister of Health and Long-Term Care, and Dr. Williams have written to all health care providers in Ontario outlining the strategy and enlisting their support to help prevent and reduce opioid addiction and overdose and the government will “continue to seek input on the strategy and identify additional areas for consideration.”
Underlying the new strategy are some startling facts. In 2014, over 700 people died in Ontario from opioid-related causes, almost two per day, and that represents a 266 percent increase in overdose deaths since 2002.
During the fall of 2016, public consultations will be held with families, caregivers, academics and health care providers, people with lived experience, among others, to seek input on the strategy and to identify additional important considerations. You can send your comments to: opioidactionplan@ontario.ca.
