Opioids

Opioids are natural or synthetic substances typically used to reduce pain in clinical settings, often producing a euphoric sensation. While many opioids share a similar chemical structure, their potency varies greatly. For instance, fentanyl is a powerful opioid that is 50-100 times more potent than morphine and has been implicated in a rising number of deaths across Canada. In fact, the opioid crisis has more recently been defined by drug contamination with illicitly manufactured versions of fentanyl and fentanyl analogues, and fentanyl was shown to be present in 68% of opioid-related deaths in Ontario in 2017, compared to 45% in 2016.

While opioids can be an effective part of pain management for some medically supervised patients, opioid-related harms, such as addiction and overdoses, present a significant challenge for public health. The country is experiencing a public health crisis, and we are certainly seeing the effects both locally and provincially when it comes to the increasing harms associated with both prescription and non-prescription opioid use. Specifically, we have seen a sharp increase in hospital and emergency room visits, as well as an increase in opioid-related overdose and overdose deaths. The Public Health Agency of Canada recently released a report estimating that approximately 4,000 Canadians lost their lives due to opioid-related overdoses in 2017, a 30% increase since 2016. In Ontario specifically, there were 1125 reported opioid-related deaths in 2017. The opioid crisis is also having a significant impact on the healthcare system in Ontario as there were 7,658 emergency department visits related to opioid overdoses from January to December 2017, compared with 4,453 during the same time period in 2016 (a 72% increase). The former Canadian Minister of Health Jane Philpott claimed,

“The death toll is worse than any other infectious epidemic in Canada, including the peak of AIDS deaths,
since the Spanish flu that took the lives of 50,000 people a century ago“.

While the increasing harms related to opioid use have been attributed to a tainted drug supply of fentanyl and fentanyl analogues, there are many more factors contributing to the opioid crisis. When we look at our prescribing rates in North America, Canada and the United States have the highest rates of prescription opioid use in the world. “Ontario’s dispensing levels per capita are five times higher than those in the United Kingdom and four times higher than those in Germany – even though between Canada and those countries there is ‘no tangible evidence for correspondingly different pain care needs or outcomes’”. Health Quality Ontario estimated that roughly 1 in 7 Ontarians filled an opioid prescription in 2015/2016. CAMH also reports that in addition to Ontario’s high prescribing rates, there is a lack of investment in alternative pain management approaches and pain management training in Canada.

On August 29, 2017, Dr. Eric Hoskins, former Minister of Health and Long Term Care, announced the government’s plan to provide support to those affected by the opioid crisis, including additional funding improvements to pain management and opioid prescribing. This announcement supported the Ministry’s comprehensive strategy to prevent opioid dependence and overdose through the following three pillars:

Modernizing opioid prescribing and monitoring
Improving the treatment of pain
Enhancing addiction supports and harm reduction

Part of this funding was made available to the Central East Local Health Integration Network (LHIN), which enabled the development of an Opioid Strategy, and allowed for:

The establishment of Rapid Access Addiction Medicine (RAAM) clinics
Enhancements to withdrawal management services
Enhancements to outreach and harm reduction services (including better access to naloxone, and improved reporting tools for opioid-related events)

Action on the abovementioned objectives requires a collaborative approach. While some facets of the Opioid Strategy will require enhancements in funding, “[many] of the recommendations can be implemented and/or sustained without new funds and are based on a shared commitment toward improved processes, targeted education, upstream prevention and intervention, and a dedication toward improving service quality for better outcomes”.

For more information about the Central East LHIN’s Opioid Strategy, click here.
Click here to view the Prescription Opioid Policy Framework developed by Centre for Addition and Mental Health.

1 CAMH. (2016). Prescription Opioid Policy Framework. Retrieved from https://www.camh.ca/-/media/files/pdfs—public-policy-submissions/camhopioidpolicyframework-pdf.pdf

2 Special Advisory Committee on the Epidemic of Opioid Overdoses. (2018). National report: Apparent opioid-related deaths in Canada. Ottawa: Public Health Agency of Canada [web-based report]. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-june-2018.html

3 Opioid Strategy Action Group. (2018). Central East Local Health Integration Network Opioid Strategy. Retrieved from www.centraleastlhin.on.ca/page.aspx?id=789975175EB04B2C9B61960B7104C9F1

4 Special Advisory Committee on the Epidemic of Opioid Overdoses. (2018). National report: Apparent opioid-related deaths in Canada. Ottawa: Public Health Agency of Canada [web-based report]. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-june-2018.html

5 Ministry of Health and Long-Term Care. (2018). Ontario Moving Quickly to Expand Life-Saving Overdose Prevention Programs: Latest Data Shows Opioid-Related Deaths Continue to Increase. Retrieved from https://news.ontario.ca/mohltc/en/2018/03/ontario-moving-quickly-to-expand-life-saving-overdose-prevention-programs.html

6 Tierney, A. (May 15, 2012). Canada’s Health Minister Says Opioid Crisis Deaths Have Surpassed AIDS Epidemic. Vice. Retrieved from https://www.vice.com/en_ca/article/kb4x7y/canadas-health-minister-says-opioid-crisis-deaths-have-surpassed-aids-epidemic

7 CAMH. (2016). Prescription Opioid Policy Framework. Retrieved from https://www.camh.ca/-/media/files/pdfs—public-policy-submissions/camhopioidpolicyframework-pdf.pdf

8 Health Quality Ontario. (2017). 9 Million Prescriptions: What we know about the growing use of prescription opioids in Ontario. Toronto: Queen’s Printer for Ontario.

9 CAMH. (2016). Prescription Opioid Policy Framework. Retrieved from https://www.camh.ca/-/media/files/pdfs—public-policy-submissions/camhopioidpolicyframework-pdf.pdf

10 Opioid Strategy Action Group. (2018). Central East Local Health Integration Network Opioid Strategy. Retrieved from www.centraleastlhin.on.ca/page.aspx?id=789975175EB04B2C9B61960B7104C9F1