Prescription heroin for addicts among the options in proposed Toronto overdose plan

With opioid deaths steadily rising, Toronto Public Health is calling for wider distribution of life-saving naloxone kits — and wants to explore providing prescription heroin as a treatment option for opioid addicts.

Those are among the recommendations of TPH's just-released Overdose Action Plan, which is heading to the Toronto Board of Health on March 20.

"We know the way we're dealing with illegal drugs right now is not working," said Dr. Barbara Yaffe, Toronto's Acting Medical Officer of Health. "So we need to look at the public health approach to this — this is a health issue."

Overdose deaths reported in Toronto have gone up by 73 per cent over the past decade, and preliminary TPH data shows 135 deaths were tied to opioids in 2015 alone — far more than either alcohol or cocaine.

Accidental deaths in Toronto caused by most frequently lethal drug types, either alone or in toxic combinations with other drugs

Yaffe said opioids like heroin and fentanyl have an "increasing role" in the city's accidental deaths.

Fentanyl is a powerful synthetic opioid commonly prescribed as pain medication, which is now being increasingly found in street drugs across Canada. According to the U.S. National Institute on Drug Abuse, fentanyl is between 50 and 80 times more powerful than morphine.

The drug is just one factor in a widespread opioid crisis which is "spreading like a cancer" across Canada, Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, previously told CBC.

TPH hopes for wider naloxone access

Rising deaths are a key reason why TPH hopes to push the Ministry of Health and Long-Term Care to provide free naloxone to community service providers like housing programs, shelter providers, and drop-in services.

Right now, potentially life-saving naloxone — a medication used to block the effects of opioids, particularly if someone has an overdose — is only available to selected public health units and community health centres, Yaffe said.

Naloxone kits are also carried by all paramedics in the city.

"But they're not available, for example, in housing services, shelters, even convenience stores, coffee shops," she added. "This is where overdoses tend to happen."

And due to the time-sensitive nature of the medication, she says exploring ways to get it to those spots is crucial to reducing deaths.

Heroin, hydromorphone for addicts being explored

Yaffe said TPH is also exploring the possibility of having prescription heroin or hydromorphone available through a special access program for the rare circumstances where other opioid substitution therapies — such as methadone — don't work.

"There have been studies that have shown, particularly in Vancouver, that in those rare cases these drugs have worked effectively in allowing the person to have a less chaotic life — and eventually connect them with treatment and get their life back in order," Yaffe said.

According to the plan, TPH will "explore the feasibility of providing injectable diacetylmorphine (prescription heroin) and/or hydromorphone as opioid substitution treatment options through the Methadone Works program, and according to federal requirements."

Right now, TPH and 46 community agencies provide harm-reduction supplies at more than 80 service locations across the city.

There were nearly 140,000 client visits to these programs last year, according to preliminary TPH data, and more than two million needles were distributed along with other sterile injection supplies.

Community input shaped final plan

Community input on a draft version of the TPH plan was gathered online, and through sessions held in downtown Toronto, North York, Etobicoke and Scarborough involving 160 people.

There are no "direct financial implications for 2017" arising from the report, according to TPH.

"A funding request for additional resources to support this work will be included in the TPH 2018 Operating Budget Request for consideration as part of the City's 2018 Budget process," reads a release from Yaffe.

Earlier this month, Premier Kathleen Wynne announced Ontario will soon call a meeting of mayors from both large and small communities across the province as it looks for ways to tackle a growing opioid crisis.

Wynne made the announcement Monday after meeting with Ottawa Mayor Jim Watson, and said the province is prepared to fund that city's $2.5-million opioid plan.