Ontario and the federal government are rushing to close policy gaps that medical experts say have contributed to the deadly toll wrought by opioid addiction and the rise of bootleg fentanyl across the country.
On Wednesday, both governments launched massive expansions in free access to naloxone, a cheap, life-saving antidote to opioid overdoses. Ontario Health Minister Eric Hoskins announced that his province – the country's largest per capita consumer of prescription opioids – would join B.C. and Alberta in dispensing free naloxone to anyone through community pharmacies, no prescription needed. The federal government, meanwhile, added naloxone to the list of drugs covered under the Non-Insured Health Benefits, the national pharmaceutical program for aboriginals, a group that has faced disproportionate numbers of opioid-related deaths in some regions. Both Ontario and Ottawa have faced criticism that their response to the crisis has been slow.
Taken together, the new initiatives add a much-needed sense of urgency to tackling the opioid crisis, medical experts say, and address the fact that a potentially life-saving drug is reaching a small minority of people in the country's largest province and in aboriginal communities. The changes follow a Globe and Mail investigation that found Ontario, like the other provinces and Ottawa, is not taking adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids or monitor the addiction crisis that has ensued.
"I don't want anyone to think that extending naloxone coverage is the magic wand that's going to obliterate the opioid crisis," said Michael Parkinson, a community engagement co-ordinator with the Waterloo Region Crime Prevention Council and one of the country's leading voices on the scale of the opioid problem. "It's just one key tool in the toolbox."
The full scale of the public-health crisis isn't fully known. There is no national storehouse for up-to-date statistics on opioid-related deaths, only a patchwork of provincial figures. In Ontario, opioid overdoses killed 663 people in 2014, 173 linked to fentanyl, a powerful painkiller that has become a lucrative source of income for organized crime. In 2015, Alberta and British Columbia recorded 418 overdose deaths related to fentanyl, a 10-fold increase over the previous three years.
The new Ontario program is expected to cost $2-million, with naloxone kits appearing in pharmacies within two weeks.
Up until recently, the ministry had delayed a rollout of free non-prescription naloxone in pharmacies until the Ontario College of Pharmacists completed a slow drug reclassification process, scheduled for early July. But ministry officials were spurred to action last week, when Alberta announced it would circumvent the reclassification process with a ministerial order to provide immediate naloxone access through pharmacies.
"My understanding is we're modelling it similar to Alberta in how it's being distributed to pharmacies," said Joshua McLarnon, a spokesman for Mr. Hoskins. "We realized it was not something we could wait on."
The Ontario announcement came hours after a Globe and Mail story highlighted the tardiness of Ontario's response when compared with its western counterparts.
In a notice on Wednesday, Health Canada said it is adding naloxone to the list of drugs covered under its health-benefits program for people living in First Nations and Inuit communities, many of whom are struggling to access the antidote. An official at Health Canada said the move is designed to "improve access to treatment for opioid overdose," according to a copy of the notice obtained by The Globe and Mail.
"The upside here is tremendous, both in terms of protecting First Nations people from the risk of overdose but also in terms of creating equity for First Nations and access to necessary medical treatment," said Hakique Virani, a public-health and addiction-medicine specialist in Edmonton.
Dr. Virani said he is pleased Ontario has joined British Columbia and Alberta in making naloxone available without a prescription. "We would like to see the rest of Canada come on board," he said.