Restricting opioid access in Ontario

Getting opioid painkillers in Ontario is more difficult now. The provincial government recently announced it will no longer pay for opioid prescriptions that equal 200 milligrams or more of morphine per day through publicly-funded prescription drug plans.

These programs serve senior citizens, those on social assistance, and people on disability pensions. The move is an attempt to counter the sharp increase in addiction to drugs like fentanyl, Oxycodone, and morphine.

In eastern Ontario, the Regional Opioid Intervention Service at the Royal Ottawa Mental Health Centre “The Royal,” cares for people addicted to opioids. A recent report in The Globe and Mail says there were over 17.5 million opioid prescriptions issued in Canada in 2010, and nearly 22 million in 2014. That huge jump can’t be accounted for by an increase in the number of people who actually needed painkillers for medical reasons. Another report said hospital visits related to opioid overdose and addiction have increased 72 percent in the past decade.

Liz Morgan (no relation to author) works at two facilities in Ottawa that assist people who are seriously economically disadvantaged, and many also have mental health issues. The two facilities do not work specifically with people addicted to prescription drugs, but some of the people who use their services do have substance abuse problems.

Morgan’s late mother was a drug addict for her entire adult life. Physically abused in her youth, she also had bipolar disorder that was not properly managed. Working as a nurse in a hospital, she would make false prescription requests for various drugs for her own use. As her addiction worsened, she was a regular patient at The Royal, often staying there for two or three months each time. This is a pattern of misuse that the Ontario plan seeks to disrupt.

But regarding Ontario’s decision to restrict opioid prescriptions to public insurance users, Morgan said, “They’re trying to tackle a problem they don’t understand.” According to her what really needs to be addressed are the reasons why opioid prescriptions are given in the first place. And under Ontario’s rules access is not similarly restricted for private insurance users. She is concerned that the tighter rules could make treatment for palliative patients in terrible pain unaffordable without insurance coverage.

Joyce Simpson of Listowel, a small town in southwestern Ontario, has the same concerns about access for palliative patients. She looked after an elderly relative who had several painful, chronic conditions for the last three years of her life and was on fentanyl. Joyce said the new restrictions in Ontario would have made it difficult for her family member to get her medication because she used the public insurance system. She owned a business with her late husband and did not have retirement benefits that provided private insurance.

Home care nurses visited to administer her fentanyl patches which were obtained from a local pharmacy. Joyce said her elderly relative most certainly became addicted to fentanyl during her three years of using it. However, due to her chronic pain and palliative state, there were no other options.

A study published since the government’s announcement shows most palliative patients will be unaffected by the restrictions. That, however does little to ease the concerns of individuals who will be affected, or for caregivers who want to ensure their loved ones can be kept in as much comfort as possible.

This is the challenge with controlling the epidemic of opioid addiction and overdose. Legal drugs that have a constructive medical purpose are being used for destructive reasons, and efforts to limit illegal access to them can have collateral damage among those whose need them for medical reasons.

 

Tags: canada, drug addiction, health care, Ontario