New report gives troubling new perspective on Ontario’s opioid crisis

Posted on April 21, 2017 in Health Delivery System – Opinion/Editorials – A new report on the latest trends in opioid deaths in Ontario says fatalities have skyrocketed at the same time opioid prescribing has increased dramatically.
April 20, 2017.    Editorial

A new report on the evolution of Ontario’s opioid problem over the past 25 years provides troubling, but useful, new perspective on a growing public health crisis.

In 2015, a stunning 734 people in this province, or roughly two a day, died of opioid-related causes, according to a report by researchers with the Ontario Drug Policy Research Network, St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES).

That number is almost four times higher than the tally of opioid-related deaths in 1991, the first year of the study. The problem is now so bad that, for instance, in 2014, far more Ontarians died using opioids than in motor vehicle collisions. Many of these deaths, almost 60 per cent, affect a fairly young population – those between the ages of 15 and 44.

How did we get here and how do we work to help push down these disturbing numbers?

A big part of the problem is over-prescription. Opioids, drugs such as codeine, oxycodone, fentanyl and hydromorphone, are typically prescribed to treat pain. The report notes that the rate of opioid prescribing has increased “dramatically” in the last two decades.

Tara Gomes, a scientist at ICES and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, and one of the principal investigators on the study, says recent data from the province shows that in the fiscal year 2012 there were 7.4 million opioids dispensed through prescriptions. By 2014, that number had risen to 9 million.

Treating pain is tricky for doctors. It’s hard to know which drug is most effective for which individual.

Some researchers say that in the past two decades medical schools have, with input from pharmaceutical companies, focused on the use of opioids, suggesting they are safe and effective for treating chronic pain. But too often patients develop a tolerance to the drugs, don’t get the same pain relief when they use them over a long period of time, and become addicted, with sometimes-fatal consequences.

Last month, both British Columbia and Alberta adopted guidelines to curb the overprescribing of opioids in those provinces. Ontario ought to follow their lead.

The report also makes clear that the province must do more to help those already addicted and to prepare for and try to prevent an epidemic of overdoses.

Those who are dying accidently run the gamut from the middle class to street-involved individuals who may be using drugs like heroin laced with an opioid like fentanyl.

Training on how to administer the opioid antidote naloxone is being given to front-line city staff at agencies such as the TTC, and it seems quite reasonable that the availability of naloxone kits should be expanded to other parts of the province.

After much political wrangling, Toronto is finally getting three safe injection sites, and one is set for Ottawa, but the report makes clear that opioid-related deaths are becoming increasingly prevalent throughout the province. The government should move quickly to open more of these life-saving sites

This new report is just the latest indication that Ontario is in the midst of a deepening opioid crisis. The government should use every tool at its disposal to get ahead of – and if possible prevent – the sort of devastating overdose epidemic we are seeing elsewhere in the country.

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