The Ontario government and the College of Physicians and Surgeons have nothing against four dozen recommendations resulting from an inquest into a pair of overdose deaths – but they have no intention of acting on them any time soon.
The suggestions from a five-member jury came out last week following more than a month of testimony into the 2008 deaths of Dustin King and Donna Bertrand. The two died within days of each other in Ms. Bertrand's Brockville, Ont., apartment. Each had ingested fatal amounts of prescription drugs.
The 48 recommendations seek to change the way prescription opioids such as OxyContin are prescribed, policed and monitored. They'd halve the maximum potency of pills that are legal and require doctors doling them out to have special education beforehand, register patients getting the painkillers and call the police if they suspect their patients are breaking the law.
"I would characterize it as the most important drug safety problem we face today," said Dave Juurlink, a doctor at Toronto's Sunnybrook Health Sciences Centre and a member of the province's Committee to Evaluate Drugs. "I don't know what it is about this particular problem that has allowed it to escape the scrutiny that so many other drug-related problems have attracted."
The province is already working on a narcotics strategy, notes Assistant Deputy Health Minister Diane McArthur – and has been since late last year. But even the most preliminary step – an electronic database for monitoring who's getting which pills – can't roll out until the required regulations go through. There's no estimate on when that will happen, although the ministry has said it will likely be in the coming months.
Once that happens, "we'd like to look at all those recommendations to see where we can adjust and build into our strategies to make them stronger," Ms. McArthur said. "We're really sort of trying to lay some of the foundational groundwork. So once we have more targeted [prescribing] information, really ramp that up."
In the meantime, doctors facing a crisis in prescription-drug addiction are frustrated at what they see as inertia. The number of people dying in Ontario annually from opioids is equal to the number of drivers being killed each year in motor vehicle accidents.
The Committee to Evaluate Drugs is a group of experts advising the province on drug-related issues. Dr. Juurlink and fellow committee member Irfan Dhalla, who testified at the Brockville inquest last month, said Tuesday that the province should be moving faster to implement the recommendations.
"Every month we wait," Dr. Dhalla said, "another 30 or 40 people die."
College of Physicians and Surgeons spokeswoman Jill Hefley said that the 48 recommendations are similar to a 2010 report on the crisis the college conducted itself, and that it's in the midst of implementing those. Last year's report says doctors should get better prescribing education, but doesn't suggest making it mandatory.
"The jury went beyond what the college had recommended," said Deputy Chief Coroner Bert Lauwers – and he argued that's a good thing. "The recommendations are tremendous. … If they're implemented, they'll go a long way to preventing opioid overdose deaths in the future."