'Major' fixes for Ontario’s addiction battle

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[People carry a coffin during Overdose Awareness Day in the Downtown Eastside of Vancouver, B.C. THE CANADIAN PRESS/Darryl Dyck]

Ontario is unleashing an arsenal in its fight against opioid addiction, the province’s ministry of health and long-term care announced Wednesday.

Among the changes, Suboxone will be rolled out as a first-line treatment for addictions as an alternative to methadone.

In an emailed statement, addiction specialist Dr. Evan Wood called the increased Suboxone use an “evidence-based decision.”

“Suboxone is safer than alternative medications and is much more flexible and safer for take-home dosing than methadone,” said Dr. Wood, the interim director of the British Columbia Centre on Substance Use.

“(It) will contribute to major improvements in addiction care in Ontario,” he added.

Opioid-related overdoses and deaths have increased considerably in several parts of the country over the past two years, particularly in British Columbia, Alberta, Saskatchewan, and Ontario.

It is difficult to know just how many deaths are related to opioid overdose across the country because there is no national database tracking them, and reporting guidelines vary across provinces and territories.

There is also no accounting of national numbers on emergency-room visits due to opioid overdose.

The province also announced:

  • Expanded services for pain treatment, including 17 new chronic pain clinics

  • The appointment of Dr. David Williams as the province’s first provincial overdose co-ordinator

  • A new province-wide system for reporting opioid-related overdoses

  • Plans to make overdose antidote Naloxone available free of charge for patients and families, as well as outfitting first responders with the nasal-spray formulation

By the numbers

1,019 - The number of Canadian drug poisoning deaths involving fentanyl, between 2009 and 2014. More than 50 per cent were in the last two years alone.

980% - The increase in fentanyl-related deaths in Alberta from 2012 to 2016.

$93 million - The amount public drug programs spent on anti-addiction medication 2014, up from $57.3-million in 2011.

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[OxyContin pills. AP Photo/Toby Talbot]

Timeline of Canada’s ongoing opioid crisis

February 2012: Ontario announces it will delist oxycodone from its provincial drug formularies, a move intended to curb abuse but that some experts advised against.

June 2013: Experts first advise of the appearance of fentanyl and fentanyl analogues in the illegal marketplace.

February 2014: Counterfeit oxycodone tablets containing fentanyl are becoming increasingly available.

February 2015: Deaths involving illicit fentanyl begin to increase in British Columbia, Alberta, and Saskatchewan.

October 2015: B.C. adds Suboxone to its provincial drug formulary as a regular benefit, making it a first-line treatment for opioid addiction.

March 7, 2016: Health Minister Jane Philpott receives a letter from her American counterparts urging Canada to put forward a federal response to combat opioid use.

March 15, 2016: The Centers for Disease Control and Prevention in the U.S. release new prescribing guidelines for opioids, including a recommendation for the use of non-opioid alternatives for pain management.

March 22, 2016: Health Canada announces that it is removing prescription-only status for Naloxone.

March 31, 2016: The United States announces new black-box warning labels for immediate-release opioids, as part of measures to combat what the U.S. Food and Drug Administration referred to as “an epidemic of addiction.”

April 14, 2016: B.C. declares a public health emergency because of the dramatic increase in overdose deaths, including those related to fentanyl. The province is the first to do so.

May 2016: The Canadian Border Services Agency begins tracking fentanyl seizures at the border. The drug was seized 32 times at various points of entry between May and late September, Vice News reported.

June 1, 2016: B.C.’s college of physicians becomes the first in the country to release guidelines for the prescription of opioid painkillers. The guidelines are based on those introduced in the U.S. earlier in the year.

June 17, 2016: Minister Philpott refers to the fact that more people in Alberta and B.C. currently die from opioid abuse than automobile accidents as a “public health crisis” in a speech.

July 6, 2016: Health Canada announces the approval of the non-prescription nasal-spray formulation of Naloxone, called NARCAN.

July 24, 2016: Ontario becomes the first province to delist high-dose opioids from its public drug plan, in an effort to curb abuse.

Sept. 28, 2016: B.C. announces $10 million in funding for education and research to combat opioid abuse, including funding for the B.C. Centre on Substance Abuse.

Oct. 7, 2016: Carfentanil, a synthetic opioid thought to be up to 100 times more toxic than fentanyl, is confirmed in two overdose deaths in Alberta.

Oct. 12, 2016: Ontario unveils its new plan to prevent opioid addiction and overdose, including listing Suboxone as a first-line treatment.

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