A cheap, life-saving antidote to an affliction that kills more Ontarians than car crashes every year remains hard to obtain in the province despite mounting pressure from public-health officials and moves by other provinces to broaden its availability.
The drug naloxone is a safe and powerful remedy to opioid overdoses, a rising public-health crisis owing to a wave of bootleg fentanyl across the country that claims a life in Ontario every 14 hours, according to one estimate. The problem is even worse in Alberta and British Columbia, where provincial governments are countering the epidemic in part by shipping naloxone to community pharmacies for distribution free of charge to anyone, even those without a prescription.
But in Ontario, where the fentanyl scourge has emerged more recently, the government is taking a far slower path toward mass distribution of the antidote.
"At the moment, it's cheaper and easier to get opioids than naloxone in Ontario," said Michael Parkinson, who has researched the problem extensively as community engagement co-ordinator with the Waterloo Region Crime Prevention Council. "It's scandalous."
The contrast in provincial approaches became more stark last Wednesday, when Alberta announced it was using a ministerial order to make free naloxone available through 600 pharmacies without a prescription.
Health Canada cleared the way for just such a policy in March, expediting changes to its drug regulations that permitted provinces to dispense naloxone without a prescription as long as it was "for emergency use."
The Ontario College of Pharmacists has notified the provincial government that pharmacists here would embrace a model similar to Alberta's, but the discussions have gone nowhere.
"We have communicated with the Ministry [of Health and Long-Term Care] saying that if you want to deliver through pharmacies, we would work with that," College registrar Marshall Moleschi said. "We see no barriers to that. They haven't said no."
In the meantime, the College is working to address the problem on its own. It has launched a drug-reclassification process that would permit pharmacists to dispense naloxone without a prescription by early July. But the reclassification process is prolonged by design, a safeguard against the hasty introduction of unknown drugs.
So far, the province has shown little inclination to circumvent that reclassification process.
People dealing first-hand with the opioid crisis would like to see the same sense of urgency in Ontario as the Western provinces. "We've been anxious to get more naloxone in the hands of our outreach workers and right now we're waiting," said Dennis Long, executive director of Breakaway Addiction Services in Toronto. "This is the largest outbreak of overdose deaths we've seen in many years."
A spokesman for the Ministry of Health and Long-Term Care said it already sends naloxone kits to authorized organizations throughout the province, including public-health units that manage needle-exchange programs and ministry-funded hepatitis C teams. But according to Mr. Parkinson, the strict eligibility criteria has resulted in just 21 individual distributions points across Ontario.
"That number would be barely adequate to serve a city the size of Toronto, quite frankly," Mr. Long said. "And there are some real hot spots around the province. There is a real problem in Sudbury and Thunder Bay around opiates."
A single dose of naloxone is $1.50, proving the barriers to wider distribution stem more from bureaucratic entanglements than financial concern.
Last month, more than 200 physicians and public-health officials signed a letter imploring the province to better prepare for a spike in overdoses linked to bootleg fentanyl. Signatories called for real-time surveillance of opioid overdoes, timely toxicology testing of drugs seized at crime scenes and broader distribution of naloxone.