BEYOND THE LOCAL: a safe supply of prescribed opioids prevents future overdoses?

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The doctors of the Ontario are prescribing potent opiates to patients who might otherwise overdose and die from street supply – and ask other doctors to do the same.

They are part of the growing secure procurement movement, composed of prescribers and defenders of harm reduction in Canada who demand access to pharmaceutical opioids as an alternative to the illicit market that has been contaminated with fentanyl and carfentanil.

"We must be willing to get out of our comfort zone and out of the comfort zone of the medical facility and say that we have to keep people alive," said Dr. Andrea Sereda, family doctor at the London Intercommunity Health Center in Ontario.

For the past three years, Sereda has prescribed hydromorphone pills to take home to select patients who currently rely on the illicit market, most of whom are homeless and inject drugs. The effort, which she calls "the safest offer for emergency", started with three people and has since grown to 100.

Sereda says the results were positive. None of the patients has undergone a fatal overdose, half of them have found housing and have weekly contact with health professionals.

"It's not just a prescription for pills, but it's a relationship between me and the patient and the commitment to make things better," Sereda told Global News. "This implies that I take a risk and give them a prescription, but it also involves the patient who is committed to doing things that I advise on their health and that we work together."

A safer supply does not replace methadone or suboxone, Sereda said. It is an option for subset people for whom methadone and suboxone do not work and acts as a bridge for people who may not be ready for those treatments.

Hers is one of the few programs of its kind in Ontario and hopes to see more. Similar efforts include prescription injectable opioid programs in Vancouver for a subset of patients for whom opioid replacement therapies such as methadone and suboxone are ineffective. Last year, another Vancouver clinic he started prescribing hydromorphone tablets for patients who consume them locally with medical supervision.

Dr. Nanky Rai is one of the two doctors of the Last November, the Parkdale Queen West Community Health Center in Toronto began prescribing hydromorphone tablets for patients who rely on the illicit opiate market. He now prescribes about 10 patients and has seen an improvement in the quality of life.

Rai said it was encouraged to increase this type of prescription, in part because of the number of people who knew they were dying from opioid overdoses related to the supply of contaminated drugs.

"I had people who, literally, their urine is just all carfentanil," Rai said in an interview. "This is really what terrified me in action. Before that, I was doing it slowly building things up. If we don't take it, we will never be able to prescribe drugs for human consumption that could really compete and tackle what carfentanil is doing to people's bodies – for those who remain alive ".

Rai also stated that the focus on cutting opioid prescriptions as a solution to the overdose crisis has been detrimental to some. Not only has it cut people off from their prescriptions forced many patients to turn to the dangerous street supply, but it also has impacted those who need pain control for things like medical procedures, which now have more difficulty accessing them.

Rai said it does not see the time when its prescription program will be evaluated in the future. "We recognize that we are building as we go, "he said." But we can't wait to do more research to prevent people from dying. "

Addiction experts say that primary care providers have an important role to play towards governments that are slowing down or do not want to take some harm reduction measures. The supervised consumption sites sanctioned exist only in B.C., Alberta, Ontario and Quebec. And Alberta and Ontario have recently frozen or withdrawn funding for a number of sites.

But the overdose crisis has become even more urgent as mortality rates continue to rise throughout Canada. Overdose data nationwide published earlier this week from the federal government's show there were at least 4,460 opiate overdoses in Canada in 2018, up 10% from the previous year.

New figures released this week from the Ontario public health agency, 388 people in the province were found to have died from opiate overdoses last summer, slightly down from 414 deaths in the same period the previous year.

"If 11 people a day died for any other reason, whether it was lettuce or Ebola or viruses like SARS, I think we would be mobilizing in the community to do things differently to stop that epidemic, "he said. Sereda. "And I think that just because it's hitting a highly stigmatized group like drug addicts doesn't mean that doctors shouldn't come together for this collective action on this issue."

The federal government has express opening to secure procurement measures. In May, Health Minister Ginette Petitpas Taylor said he did approved injectable hydromorphone for the treatment of opioid dependence. However, it is not covered by the Ontario public drug plan, as it is part of the equivalent program in B.C.

A group of over 400 health workers and researchers was released on Thursday an open letter to the Ontario premier Doug Ford to add high-dose hydromorphone to the floor so that it can be prescribed economically. The letter also called for the implementation of programs that provide safer drugs.

A spokesman for the Ontario ministry of health told Global News in an e-mail that the province "takes the opioid crisis very seriously and is committed to helping people struggling with addiction to get the job done." ; help they need, when they need it ".

The province is also reviewing the federal injectable hydromorphone, but "no decision has been made regarding the support of the Ontario hydromorphone treatment".

The former liberal health minister Jane Philpott, that is currently an independent MP, was instrumental in implementing a series of federal measures to address the opioid crisis in Canada, such as easing restrictions on the opening of monitored consumer sites.

Although health care is under provincial jurisdiction, Philpott told Global News in an interview that the federal government may be a supporter of some harm reduction approaches.

"As the doctors and the entire system become more comfortable with the concept of security of supply," said Philpott, "one of the things the federal government has already done and can do even more is to make sure that the work done is well documented and well researched so that you can begin to understand how best practices are. "

– Global news

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