In fight against opioids, Ontario set for long haul
Province commits additional $222M to battle addiction crisis
Ontario will spend an extra $222 million over three years to fight opioid addictions and overdoses, Health Minister Eric Hoskins announced Tuesday, with the single biggest chunk of the money going to long-term help for addicts. That tells us something about where the fight against the latest drug scourge is going.
If we can curb the overdoses and deaths that are at record levels now, if we can get past the crisis, cleaning up will be the work of a lifetime.
“Short-term solutions are not enough — we are committed to this journey for the long term,” said Dr. David Williams, Ontario’s top public-health doctor and the point man Hoskins has assigned to lead the province’s response to drug overdoses.
He and Hoskins made the announcement side by side at a Toronto hospital, St. Michael’s, that treats a lot of poor and troubled people on the east side of that city’s downtown.
The additional $70 million for support programs for chronic opioid users will be only a first payment. Helping people who will deal with opioid addictions forever is unglamorous and expensive. But for now, a crisis it is. New figures also given out Tuesday show that Ontario had 865 overdose deaths from opioids in 2016, up from about 728 in 2015.
The number has more than doubled since 2003. Visits to hospital emergency rooms for overdoses have risen even faster, suggesting that we got a bit better at treating them, but that more people are overdosing.
The money Hoskins promised also includes $7.6 million to improve addiction treatment in primary health care and $9 million for more front-line outreach workers.
Many people who work with drug addicts — if only to check on them from time to time and let them know someone cares — are volunteers and there aren’t enough. Another $15 million will go to train health-care workers on how to prescribe opioids more safely, hoping to prevent slides into addiction before they start.
Some of this announcement just puts dollar figures on things Hoskins and the government have already said they would do. It includes money for supervised injection sites, for instance, which Hoskins has previously promised to fund. There’ll be more money to give out naloxone, the drug that can reverse opioid overdoses temporarily, maybe long enough for paramedics to arrive.
Struggling to catch up to events has been the theme of our collective response to opioids. We’re always just sorting out what we’ll do about the last wave while the next one is swamping us.
Once, patients suffered needless pain and either lived diminished lives or self-medicated dangerously. We encouraged doctors to take pain more seriously and prescribe more generously. That made sense at the time. Especially since we were wrong about how addictive OxyContin pills were.
So patients got hooked on OxyContin and started upping their own dosages. The maker reformulated it so the pills couldn’t be crushed to inject or snort. Not enough. We de-listed it from provincial drug plans, so at least there’d be less of it around.
Now people are wringing out fentanyl patches and ... smoking them? We’ll, we’ll, uh, hold on, you say there’s powdered fentanyl in the heroin and in counterfeit pills that look real? Look, let’s — OK, carfentanil now? Even stronger, easier to transport and deadlier? Great.
This struggle has many parts. We won’t do the same things to prevent an addiction that starts with a painkiller prescription as we do to treat a heroin addiction or to reverse an overdose and buy someone another chance.
Plus the crisis is complex. We’ve seen what happens if we cut the supply of legitimate pharmaceuticals: some people avoid addictions; others who are already addicted step down the ladder into more dangerous habits. Simple solutions don’t just fail, they make things worse.
The Progressive Conservatives have a four-point plan for opioids that leader Patrick Brown put up again Tuesday.
They want a legal crackdown on pill-press machines that make counterfeit drugs look genuine, which is maybe not a bad idea, but also not a terribly important one given how well prohibiting the illegal drugs themselves has worked. (Tory MPP Michael Harris has been pushing a private member’s bill on this for a while.) Things go downhill from there.
The Tories want the Liberals to “re-direct 10 per cent of their whopping $57-million taxpayerfunded advertising budget to a provincewide opioid awareness campaign,” which is really a shot at the government’s advertising budget, not opioids.
They want weekly overdose data released publicly, which would be nice if the government had it. Gathering, scrutinizing and collating this information from hospitals, doctors, health units, paramedic services and coroners isn’t quick unless you’re OK with sloppy results.
And the Tories want “a ministerial task force to take urgent action,” which is what you call for when you’re out of ideas yourself.
The New Democrats want the government to declare opioids a public-health emergency, a move with little effect beyond symbolism. States of emergency give authorities power basically to commandeer property and restrict freedoms, like to fight a natural disaster. Against addictions and overdoses, these are not useful powers.
The Liberals have been slow, not as actively resistant to things such as supervised-injection sites as the federal Conservatives were, but not champions either.
They equivocated and temporized on this stuff as late as last summer. Ontario is still in a low gear and the Liberals are responsible. But they’re moving and that’s something.