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Canada continues fight against growing opioid epidemic on several fronts

Concerns over increasing opioid abuse across Canada continue to mount as headlines on overdoses and deaths become more frequent and the availability of dangerous opioid formulations like fentanyl and cardenafil grows on city streets from coast to coast.

National numbers are hard to come by because of different reporting regulations but there is a consensus that opioid overdoses and deaths are increasing steadily across the country. The situation has reached a crisis level in B.C., where overdose deaths were up 80 per cent in 2016 compared to just one year earlier. And in Alberta, the rate of opioid-related hospital visits in 2014-15 was 57 per cent higher than in Ontario, according to a report released in November 2016.

More recently, Toronto and Montreal have started planning for safe-injection clinics in order to get ahead of an expected increase in opioid abuse. And earlier this month, Toronto’s health authorities asked for an extra $300,000 from the city for resources to prevent overdoses.

Federal Health Minister Jane Philpott has called the ongoing opioid epidemic Canada’s greatest current public health crisis. Here are the latest updates in Canada’s fight against rising opioid overdoses and deaths.

The federal government is considering new opioid labelling

Including cigarette-style labels on every package of prescription opioids is one of several unprecedented measures the Canadian government is considering to curb overdoses, Philpott told Reuters in a news report published Monday.

Health Canada will publish a proposal for the warning stickers, which could state that opioid painkillers can lead to addiction or overdose, in February, Reuters reported. The stickers would also be put before a focus group and be subject to public comment. Philpott did not provide a guideline of when they may be in use.

In August 2016 the U.S. Food and Drug Administration announced new “black box” labelling for opioids that warn about serious health risks associated with the medications. The warning is the strongest available type for approved prescription drugs in the U.S.

Prescription rules could be revised

A month after the guidelines on warning stickers are released a government advisory panel will consider revising the official labeling for how opioids should be prescribed, Reuters also reported Monday.

Canadian physicians are currently allowed to prescribe opioids off label, for uses beyond those on the official drug labelling based on a patient’s individual needs.

In March 2016 the United States Centres for Disease Control and Prevention released revised guidelines cautioning against the use of long-acting opioids for chronic pain, recommending that initial doses for prescriptions be low, and advising physicians to discontinue the use of opioids as soon as possible.

New legislation may be coming

Two bills could soon become part of the government’s arsenal to reduce opioid overdoses and addictions. Put forward by Philpott, Bill C-37 would amend the Controlled Drugs and Substances Act to replace the 26 criteria currently in place for a safe-injection site to be considered with five criteria aimed at allowing more safe-injection sites to open.

And Bill C-224, a private member’s bill introduced by Liberal Ron McKinnon, would amend the Controlled Drugs and Substances Act to exempt a person who seeks help for someone experiencing a drug overdose from facing charges for possession. Such a bill has been endorsed by the Canadian Medical Association, and more than 30 U.S. states now have similar laws.

A fight is brewing between B.C. and Ottawa

On Friday, two B.C. Tory MPs released a joint statement calling for Philpott to declare a national public health crisis due to rising overdose deaths. A week earlier the province’s health minister made a similar call, the same day that the B.C. coroner announced that illicit drug overdoses–overwhelmingly suspected to be opioid overdoses–had killed 914 people in the province in 2016, up from 510 the previous year.

The criticism of the federal strategy has also come from the government’s own party. Liberal Vancouver Centre MP Hedy Fry told the Vancouver Sun on January 8 that she believed an unintentional regional bias is affecting the speed of action from her own government on the opioid crisis.

“I think that it is that the whole country isn’t suffering from the same problem — it’s B.C. and Alberta,” Fry said. “It’s now starting in Ontario, and I would suggest to you that once it gets bad in Ontario, we will notice action being taken.” B.C. declared its own public health emergency due to opioid overdoses in April 2016.

Philpott has maintained so far that declaring a federal state of emergency would override provincial rights to deal with opioid overdoses on their own terms, and should only be undertaken as a last resort.