McMaster pain guru lauds new provincial opioid strategy

The province is making the right moves to fight an opioid crisis that threatens to envelop some of Ontario’s most vulnerable, according to a leading McMaster University doctor and professor.
The powerful opioid painkiller fentanyl has become a real danger in Ontario in recent years. (CBC)

The province is making the right moves to fight an opioid crisis that threatens to envelop some of Ontario's most vulnerable, according to a leading McMaster University doctor and professor.

Ontario announced its "first comprehensive opioid strategy" yesterday, which includes measures aimed at modernizing prescribing and dispensing of both opioids and the drugs used to treat addiction and overdose.

As opioid overdose deaths mount in Hamilton and across Ontario, it's a positive step, said Dr. Norm Buckley, professor and chair in the Department of Anaesthesia at McMaster's Michael G DeGroote School of Medicine.

"Ontario really has taken a step towards understanding the complexities of the problem," Buckley said.

The measures include expanding access to Suboxone, which helps treat opioid addiction by stopping cravings and preventing withdrawal symptoms. The drug is considered safer than methadone, with fewer side effects and "significantly less" risk of fatal overdose, according to information from the Ministry of Health and Long-Term Care.

Buckley says methadone's half-life (as in when the concentration of a drug in the body decreases by half) can last anywhere from 14 to 40 hours — which "leads to quite a bit of unpredictability" in treatment. Suboxone, he says, is more predictable.

"It seems as though it is a safer drug to use."

There are some 50,000 Ontarians currently receiving methadone treatment, said Health Minister Eric Hoskins during Wednesday's announcement, adding that there are likely scores of others in need of the drug who can't access it because they live in a rural area under-served by addiction services.

Former opioid addict Nicole and Debbie Bang, the manager of St. Joseph’s Healthcare Womankind addiction service, explain prescription painkiller addiction. 3:57

Making Suboxone more widely available, meaning it can be prescribed by primary-care providers such as family physicians and nurse practitioners, is part of a more "holistic" approach to tackling opioid addiction and overdose, Hoskins said.

Something about the approach needed to change, as opioid deaths continue to rise. In 2005, 18 people died of opioid toxicity in Hamilton. That number peaked at 34 in 2011, and continues to stay high at 31 in 2014.

In 2014, more than 700 people died in Ontario from opioid-related causes, a 266 per cent increase since 2002, according to the ministry.

The province is also pledging $17 million to enhance or create 17 chronic pain clinics across the province.

Other measures include:

  • Developing "evidence-based standards" for health-care providers on prescribing opioids, to be released by 2017-18, to prevent unnecessary dispensing and over-prescribing of painkillers.
  • De-listing high-strength formulations of long-acting opioids from the Ontario Drug Benefit Formulary, starting Jan. 1. These include 200 mg tablets of morphine; 24 mg and 30 mg capsules of hydromorphone; 75 mcg/hr and 100mcg/hr fentanyl patches; and 50 mg meperidine tablets.
  • Bringing in stricter controls for fentanyl patches, which took effect on Oct. 1, that require patients to turn in used patches to their pharmacist before more can be dispensed.
  • Expanding access to the overdose medication naloxone, which will be made available free of charge through pharmacies and "eligible organizations" to prevent overdose.