Ontario's opioid problem bigger than public thinks, says researcher

The gravity of Ontario's problem with opioid addiction, and the toll it takes on thousands of people every year, is not fully understood by the public, says the lead author of a new report on opioid use and its adverse effects in the province.

“I'm still not convinced the gravity of the situation has trickled down to the general public,” said Tara Gomes, a principal investigator with the Ontario Drug Policy Research Network. “I think there's this inherent assumption with prescription drugs that they are safe because they are prescribed by a physician.” 
In the report Gomes and her colleagues found there were 638 opioid-related deaths in Ontario in 2013, or approximately one death for every 20,000 Ontarians. Nearly 13 per cent of those deaths involved suicide.

According to the Office of the Chief Coroner of Ontario 108 people in Greater Sudbury died from prescription opioid toxicity between 2008 and 2014.
In addition to opioid-related deaths, the Ontario Drug Policy Research Network's report also tracked opioid-related emergency department visits in Ontario. 
There were 3,200 such visits across the province in 2014, with about half of those patients being admitted into hospital.

The highest rates of opioid-related emergency department visits and hospitalizations were in Northern and Western Ontario. In particular, the North East LHIN area, which includes Greater Sudbury, had the highest number of opioid-related hospital admissions and emergency department visits (2.4 admissions and 4.4 ED visits per 10,000 residents) in 2014 and the second highest rate of deaths in 2013 (one death per 10,000 residents), rates approximately double the provincial average.

Health Sciences North has told Sudbury.com the hospital's emergency department saw 65 visits due to opioid poisoning, or overdose, in a two-year period from September 2014 to September 2016.

But Gomes said the real number of hospital admissions due to opioid overdoses could actually be higher, because hospitals don't always specify the type of drug a patient was using after an overdose. Those cases are not counted toward the total tally.

Gomes said her research points to the need to a targeted approach to combat opioid addiction in Ontario. 

Regions where the problem is more severe, such as Northern Ontario, should receive more attention and funding for treatment programs. 
“The findings in this report really speak to the fact that the programs and services that are really going to work in Ontario cannot be uniform across the province,” Gomes said.

Earlier this year the provincial government announced it will stop paying for higher-strength opioids through the Ontario Drug Benefit program in January 2017.
Higher doses of morphine, hydromorphone, and fentanyl will no longer be covered through the plan starting next year.

And more recently, Toronto's Centre for Addiction and Mental Health has lobbied the federal government to launch a review of all prescription painkillers available across Canada and to pull high-dose opioid medications off the market.

Gomes said she supports the recommendation, although the role high-dose opioids play for palliative care patients would require more analysis and evaluation.

But Gomes said it's possible for palliative care patients to receive more frequent low-dose treatments to manage their pain. 

She said the government should also limit how many high-strength opioids palliative patients can be prescribed at one time.

When a palliative care patients die they often leave behind hundreds of high-strength opioids in their medicine cabinets that can sometimes make their way into the community.