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Relapse: Facing Canada's Opioid Crisis

This is How Ontario Plans to Fight the Opioid Crisis

Measures include improving access to Suboxone, more chronic pain clinics and a new 'provincial overdose coordinator' to track deaths better
October 12, 2016, 7:59pm

Morphine photo via Flickr user Eric Norris

Ontario has announced a host of measures to try to crack down on the opioid crisis that has killed hundreds across the country this year, including improved access to Suboxone, a prescription drug used to treat opioid addiction.

"Suboxone is much safer than methadone, less addictive, and has fewer side effects," said Ontario Health Minister Eric Hoskins on Wednesday at a press conference at Toronto General Hospital.

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On Tuesday, Suboxone, which can relieve opioid withdrawal symptoms and has a lower risk of overdose than methadone, was changed from a "limited use" drug to a "general benefit" on the province's drug benefit formulary, making it a first-line treatment for opioid addiction.

Dr. Hakique Virani, an Edmonton-based preventative medicine and addiction medicine specialist, explained that while methadone is a "life-saving" medication, "it can be tough to work with" because it has a higher risk of toxicity when combined with other drugs.

"The other thing that challenges methadone treatment is the potency and toxicity of the current illicit opioid market, which doesn't appear to be as challenging to Suboxone, which is a partial opioid drug and binds to opioid receptors very tightly," he told VICE.

All doctors in the province are now required, when appropriate, to prescribe Suboxone over methadone, which only a few doctors can prescribe anyway, since they need special authorization from Health Canada.

The province will also be working with College of Nurses of Ontario to ensure nurses are trained in prescribing Suboxone, in hopes this will help those in rural and remote areas of the provinces, where nurses are primary care providers.

The change follows a similar move by British Columbia's government that enabled all doctors to prescribe Suboxone without an exemption.

"Our comprehensive approach to this crisis will not only help save lives, but will enhance the lives of families and whole communities," said Hoskins. "Given the urgency of this issue, taking action now will have a real impact on opioid addiction and overdose."

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Ontario has been under increasing pressure to come up with a strategy that responds to the wave of opioid deaths sweeping the nation. In particular, it's been heavily criticized for not having up to date data on the number of deaths. The latest figures are from 2014, when 700 people died from opioid-related causes—a 266-percent increase from 2002.

To that end, Hoskins has appointed Dr. David Williams, Ontario's Chief Medical Officer of Health, as the province's first ever Provincial Overdose Coordinator. He's been tasked with developing a new surveillance and reporting system of overdoses and overdose deaths in Ontario.

Hoskins explained that the government receives data from most hospitals whenever an opioid-related overdose is suspected, but that suspected opioid-related deaths are referred to the coroner, who must then investigate—a time-consuming process.

Williams has been tasked with improving "upon our access to and timeliness and comprehensiveness of the information with regards to overdose and deaths," said Hoskins. "We can and will do better."

"The headings appear to be the right ones," said Virani, pointing out, however, that the new strategy comes quite late in the game. "Now it's more challenging than it would've been had we dealt with it years ago, but today is better than tomorrow, and it's encouraging."

The province is also taking aim at "high-strength opioids" by no longer covering their cost. It is also investing $17 million annually to create or enhance 17 chronic pain clinics, expanding services for patients who suffer from lower back pain and training for primary care providers in treating chronic pain, and developing a patient guide to help prescription opioid users to understand associated risks.

The province recently made naloxone, an opioid overdose antidote, available free of charge to patients and their families at pharmacies and eligible organizations, and are looking to providing naloxone nasal spray to first responders. They'll also be handing naloxone kits out to at-risk inmates when they're released from provincial prisons.

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