A group of physicians and public-health officials in Ontario is calling on the provincial government to implement emergency planning measures to address a spike in overdoses linked to illicit fentanyl.
Ontario is unprepared for an influx of illicit fentanyl and other toxic opioids, warns a letter signed by more than 200 physicians, medical officers of health, and addiction and harm-reduction organizations.
The letter, addressed to Premier Kathleen Wynne and Health Minister Eric Hoskins, says the toll from the opioid crisis in Ontario "is poised to rise sharply given the presence of non-pharmaceutical 'bootleg' opioids, specifically bootleg fentanyls in both powder and pill forms, in several Ontario communities."
The letter follows a Globe and Mail investigation that found that Ontario, like the other provinces and Ottawa, is not taking adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids to treat chronic pain. Illicit fentanyl, largely a product of organized crime, has its roots in Canada's abuse of prescription painkillers.
Amid an anticipated surge in opioid overdoses this year, the group is urging the government to expedite the creation of an emergency preparedness plan. Such a plan, says a copy of the letter obtained by The Globe, must include the establishment of real-time surveillance on the number of people overdosing on opioids, timely toxicology testing on drugs seized at a crime scene and broader distribution of the overdose antidote naloxone.
Rosana Salvaterra, medical officer of health for Peterborough, Ont., and lead author of the letter, said what's missing in Ontario is co-ordinated leadership and planning. "Our letter really is a cry for that," she said in an interview.
Dr. Hoskins was not available for comment on Wednesday. A spokesman referred to a previous statement, in which the Health Minister said the government "takes the issue of opioid drug abuse and misuse very seriously."
British Columbia declared a public-health emergency this month after a surge in drug-related overdoses and deaths. But the scourge of fentanyl has rapidly moved east. In Ontario, several communities have sounded the alarm in recent weeks about a spike in overdoses from street drugs that appear to have been laced with fentanyl.
Dr. Salvaterra said the Ontario government needs to get the rescue medication naloxone into the hands of everyone who is at risk of an overdose. The government's current naloxone program is limited largely to distributing the drug to public-health units and community organizations that manage needle-exchange programs.
The Ministry of Health has distributed 3,489 naloxone kits over the past 2 1/2 years, according to spokesman David Jensen. One in five of the kits has been used by someone who overdosed – the drug reverses the effects of an overdose within minutes.
In British Columbia, by comparison, Toward the Heart, the province's harm-reduction program and the biggest distributor of naloxone, handed out 7,418 kits between August, 2012, and April, 2016. British Columbia's population is roughly one-third the size of Ontario's.
Dr. Salvaterra is also calling on the Ontario government to pay for naloxone under its publicly funded drug program for seniors and residents on social assistance. A naloxone kit containing two doses typically retails for about $45 – a price barrier for many, she said.
Mr. Jensen confirmed that the Health Ministry would only consider listing naloxone on the Ontario Drug Benefit Formulary if it were to receive a request from a drug manufacturer.
"Are we going to allow the pharmaceutical industry to drive a provincial emergency response?" Dr. Salvaterra asked.
With a report from Andrea Woo in Vancouver