In the midst of rampant opioid abuse and addiction across Canada, Ontario's health ministry has announced that its public drug plan will no longer pay for certain potent opioid prescriptions, including high-dose fentanyl patches — making it the first province in the country to do so.
"As you know, the inappropriate use, abuse, and diversion of prescription narcotics has emerged as a significant public health and safety issue in Canada and other jurisdictions around the world," states a bulletin to physicians and drug companies on the website for Ontario Health Insurance Plan (OHIP) news alerts last week.
As of next January, all prescription opioids containing more than 200 mg of morphine (or its equivalent) per day will no longer be covered by the Ontario Drug Benefit plan. This plan covers the cost of thousands of prescription drugs for eligible people from Ontario, including those on social assistance, and people over 65 years of age. Unlike the US, healthcare in Canada is governed at a provincial and territorial level.
The move to strike high-potency opioids from the public drug benefit plan is the latest attempt by Ontario to get a grip on opioid-related overdoses and overdose deaths, which have skyrocketed in recent years. Overprescription of opioids by doctors across North America has been linked to the opioid addiction epidemic — and this new attempt to curb abuse is being watched closely in the United States as it fights its own battle.
A recent investigation by the Globe and Mail found that Ontario has the highest per capita rate of prescription painkiller use in Canada, and that doctors wrote more than 8 million prescriptions for opioids in 2015. Ontario has a population of about 13 million people.
Ontario's health ministry has been routinely slammed by medical and addictions experts for not reacting quickly and efficiently enough to the problem, especially compared to other provinces such as British Columbia, which recently declared a state of emergency over the opioid crisis. Earlier this year, the provincial coroner released its most recent data from 2014 that showed that fentanyl is currently the leading cause of opioid-related deaths in the province, killing 663 people that year. Since then, hundreds more people across the country have died from opioid-related overdoses.
However, it's unclear just how effective funding cuts on these prescriptions will be, as many private drug insurers could still cover them, or people could pay for them out of pocket. Also, the illicit opioid supply chain does not often involve prescription drugs diverted from doctors' offices. Much of Canada's black market synthetic opioid supply comes from fake drug labs in China.
"The delisting of higher dose opioid formulations by itself may have little effect on health and safety given the plethora of opioid formulations available for prescribers," Michael Parkinson, co-ordinator at the Waterloo Region Crime Prevention Council, wrote to VICE News in an email. "History demonstrates the fluidity of drug markets — both regulated and black market to adapt to isolated supply-side interventions, often with deadly consequences."
What's more, the new funding ban could negatively impact sick patients, such as those with advanced stages of cancer, who do use these painkillers as they were originally intended, said Doctor Mark Neuman, a professor at the University of Pennsylvania's department of anesthesiology and critical care. Neuman and other researchers at the university recently found that doctors in the US are prescribing unprecedented rates of opioid painkillers to patients undergoing common surgeries.
"Outright refusals to pay could limit abuse, but will make it harder for people who are using these drugs for their intended purposes to get ahold of them," Neuman said. He explained that many drugs involved in opioid and fentanyl overdose deaths are not coming from the typical prescription route.
"There's still a lot to be learned in terms of where the source of the problem is," Neuman said. "But I think that how those make their way from the prescription pad into the epidemic still needs to be worked out."
However, he said medical experts would do well to monitor the success of Ontario's plan, and that public insurers in the US such as Medicare and Medicaid could implement something similar since they have the ability to decide what to cover.
He pointed to the state of Massachusetts, which implemented a significant opioid law this March that places limits on opioid prescriptions, with some exemptions for people who suffer from chronic pain. It was the first law of its kind in the US to limit new opioid users prescriptions to seven days.
Follow Rachel Browne on Twitter: @rp_browne