Few palliative care patients at risk under Ontario’s new opioid policy: study

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Only a small number of palliative-care patients in Ontario will be affected by the province's plan to stop paying for high-dose opioid medications under its public drug programs, a new study shows.

Ontario will become the first province to cut off publicly funded access to all opioids that exceed the equivalent of 200 milligrams of morphine a day, as part of a measure aimed at combatting the widespread abuse of prescription painkillers.

Nine out of 10 people in Ontario who were prescribed high-dose opioids paid for by the province's public drug plans were not palliative-care patients, says the study done by the Ontario Drug Policy Research Network based at St. Michael's Hospital.

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The study, released Tuesday, looked at the 62,605 people in Ontario receiving palliative care and how physicians were treating their pain. Just over 40 per cent were prescribed opioids paid for by the province in a one-year period. Only 2.7 per cent of those patients received the high-dose formulations. "It is reassuring that the vast majority of palliative-care patients will not be impacted by this policy," said Tara Gomes, a principal researcher at the network.

She is also a scientist at the Li Ka Shing Knowledge Institute at St. Mike's.

Russell Goldman, director of the Temmy Latner Centre for Palliative Care at Toronto's Mount Sinai Hospital, said he would like to see the province set up a system that allows patients in need of the high-dose drugs to continue receiving them.

"Given the small number of patients that we are talking about," Dr. Goldman said in an interview, "there should be a way for us to ensure that people who need the meds receive access in a timely fashion."

His comments echoed other palliative-care doctors who have called on the provincial government not to cut off access to the high-dose opioids for patients who are nearing the end of their lives or suffering from cancer pain.

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The Ministry of Health has posted a notice on its website saying 24- and 30-milligram capsules of hydromorphone, transdermal patches that deliver 75 and 100 micrograms of fentanyl an hour, and morphine in 200-milligram tablets will be delisted from Ontario's drug formulary as of January.

The province's drug programs pay prescription costs for those aged 65 and older and those on social and disability assistance. Just over 40 per cent of prescription drugs are financed by the public sector, with the remainder paid for by private insurance plans or individuals paying out of pocket. Ontario's delisting of the high-dose opioids affects only those paid for by the public sector.

The study done by the network examined prescriptions for three long-acting opioids – hydromorphine, fentanyl and morphine – paid for by Ontario's drug plans over a one-year period beginning April 1, 2014. Over all, high-dose opioids accounted for just under 16 per cent of all long-acting painkillers prescribed during that year.

The study found that 13,695 people had received at least one provincially-funded prescription for high-dose opioids during the one-year period. However, only one in 10 of those high-dose opioid users was a palliative-care patient.

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Darren Cargill, section chair of palliative medicine at the Ontario Medical Association, said the figures cited in the study for the number of patients in palliative care highlight the fact that access to palliative care is poor in the province.

"It is odd logic indeed to claim that the number of patients requiring these meds for palliative care is low when we know the number of patients requiring palliative care in general is much greater than those currently being served," Dr. Cargill said.

The government needs to strike a balance, he said, between addressing the needs of palliative-care patients who require these pain medications to remain comfortable and the widespread abuse of prescription opioids.

The Ontario government is overhauling its drug plans against a backdrop of rising addiction rates and overdose deaths across Canada.

Tafflyn Welch, whose husband has bone marrow cancer, said she does not think a measure that "attack[s] everybody who needs the drugs … is the way to go."