Ontario plans to set up a surveillance system to help monitor the number of people who overdose on opioids, open 17 chronic-pain clinics that will do more than just dispense prescriptions for painkillers, and treat patients struggling with addiction with a safer but more expensive pharmaceutical therapy.
The measures, announced on Wednesday, are part of Ontario's "first comprehensive opioid strategy" to curb a growing addiction and overdose problem, said Health Minister Eric Hoskins. An epidemic of overdose deaths not just in Ontario but across Canada began more than a decade ago and has accelerated in recent months with the arrival of bootleg fentanyl in the illicit drug market. In Ontario alone, more than 700 people died in 2015 from opioid overdoses, Dr. Hoskins said.
The measures, he said, are "absolutely critical" at a time when the country is facing a public-health crisis.
"No one asks to be addicted to painkillers and no one should have to die because of it," he said.
The strategy also include a long-term plan to address the roots of the epidemic: the overprescribing of a drug whose risks are substantial and benefits uncertain. A recent Globe and Mail investigation found that Ottawa and the provinces have failed to take adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids to treat chronic pain. In 2015, doctors wrote 53 opioid prescriptions for every 100 people in Canada, according to figures compiled for The Globe by IMS Brogan, which tracks pharmaceutical sales.
Ministry of Health officials will work with medical experts to develop new prescribing standards to curb the use of painkillers. However, the standards won't be finalized for another 18 months.
Dr. Hoskins has been under pressure to address a spike in overdoses. A letter signed by more than 200 physicians and public-health officials and addressed to the Health Minister and Premier Kathleen Wynne warned in April that Ontario is unprepared for an influx of illicit fentanyl. The group urged the government to expedite the creation of an emergency preparedness plan.
Ontario now has its first provincial overdose co-ordinator, Dr. Hoskins said on Wednesday. In his new role, Ontario's chief medical officer of health, David Williams will work with hospitals to set up a system that will require them to track the number of patients they treat in emergency departments for opioid overdoses. The province currently has no system that monitors, in real time, overdoses linked to prescription and illicit opioids.
Ontario also plans to invest $17-million a year into the new pain clinics to ensure that patients receive timely and appropriate care. The clinics will cover the entire spectrum of a patient' needs, from the earliest signs of chronic pain to those who develop an opioid addiction, Dr. Hoskins said. They will provide comprehensive care, including physiotherapy and counselling as well as prescription painkillers.
For those addicted to opioids, the province has added Suboxone to its drug formulary as a regular benefit, making it a first-line treatment for opioid addiction. The measure came into effect on Tuesday.
Methadone is the traditional treatment in Canada for patients hooked on opioids such as fentanyl and hydromorphone. But the provinces are under pressure to improve access to Suboxone, an alternative treatment that medical experts say is much safer than methadone and could dramatically reduce overdose deaths.
British Columbia was the first province to add Suboxone to its drug formulary as a regular benefit. Provincial drug plans pay only for medications listed on their formularies.
Dr. Meldon Kahan, medical director of the Substance Use Service program at Women's College Hospital and co-chair of a provincial task force that made the recommendations on expanding the use of Suboxone, said there are "serious deficiencies" in the current system for treating opioid addiction.
Only a few doctors have been able to prescribe methadone because they need authorization from Health Canada to administer it and must be associated with specialized clinics. Primary-care physicians, by comparison, can prescribe Suboxone.