High-dose opi­oids cut in bid to re­duce ad­dic­tion

Death by over­dose

The Hamilton Spectator - - CANADA & WORLD - NI­COLE THOMP­SON

TORONTO — On­tario will be the first prov­ince to stop pay­ing for high doses of long-act­ing opi­oids as part of a push to re­duce the “grow­ing prob­lem” of ad­dic­tion to the painkillers in the prov­ince.

The Min­istry of Health said that in Jan­uary 2017, high doses of the painkillers will be re­moved from the On­tario Drug Ben­e­fit For­mu­lary, which cov­ers the cost of drugs for peo­ple who are 65 or older, live in a long-term care home, re­ceive so­cial as­sis­tance or have high drug costs rel­a­tive to their in­come.

It’s a de­ci­sion that Dr. David Ju­urlink, head of the divi­sion of clin­i­cal phar­ma­col­ogy and tox­i­col­ogy at Sun­ny­brook Health Sciences Cen­tre in Toronto, said is a “good move” on the govern­ment’s part be­cause it may dis­cour­age doc­tors from pre­scrib­ing un­nec­es­sar­ily high doses of the drugs.

“We’re start­ing to see doc­tors pre­scribe them some­what less reg­u­larly, but they are still used very, very often. And, I think, too often,” he said.

The af­fected drugs in­clude 200mil­ligram tablets of mor­phine, 24mil­ligram and 30-mil­ligram cap­sules of hy­dro­mor­phone and 75-mi­cro­gram per hour and 100-mi­cro­gram per hour patches of fen­tanyl. But the change doesn’t af­fect lower doses of the drugs, which the min­istry said can ac­tu­ally be more ef­fec­tive than high doses.

On­tario’s Health Min­is­ter said in a writ­ten state­ment that delist­ing the drugs is an “im­por­tant first step” in lim­it­ing high doses of opi­oids, which he noted are linked to over­dose deaths.

A re­cent study showed that On­tario pro­vin­cial in­mates are 12 times more likely than the gen­eral pub­lic to die of a drug over­dose within the first year fol­low­ing their re­lease from in­car­cer­a­tion, and 77 per cent of those deaths in­volved opi­oids.

Dr. Tara Gomes, who works at St. Michael’s Hos­pi­tal and is a prin­ci­pal re­searcher for the On­tario Drug Pol­icy Re­search Net­work, said that th­ese high doses of opi­oids can get peo­ple ad­dicted — and even cause an over­dose — with just one use.

Gomes was the lead au­thor of a 2014 study that found On­tario dis­pensed the most high-dose oxy­codone and fen­tanyl in the coun­try per capita be­tween 2006 and 2011. The study showed that across the coun­try, the rate of dis­pens­ing high-dose opi­oids rose 23 per cent over the same pe­riod.

Ju­urlink, who was also an au­thor on the study, said opi­oid ad­dic­tion reaches be­yond just On­tario and Canada. He said the over-pre­scrip­tion of high doses of the drugs is “a North Amer­i­can is­sue.”

Pre­scrib­ing high doses of the drugs is par­tic­u­larly prob­lem­atic be­cause drug ad­dicts and peo­ple look­ing to “make a buck” by sell­ing their pre­scrip­tions are more likely to look for higher con­cen­tra­tions, he said.

But he noted that there are some le­git­i­mate uses for high doses, like in end-of-life care.

“I’ve heard grum­blings (about the an­nounce­ment), mostly from the pal­lia­tive care com­mu­ni­ties,” he said. But he noted that doc­tors who need to pre­scribe a higher dose can in­struct their pa­tients to scale up the num­ber of pills they take.

And Gomes noted that the high dosages will still be avail­able in the prov­ince — they just won’t be re­funded to pa­tients un­der the On­tario Drug Ben­e­fit For­mu­lary, so pa­tients will have to pay out of pocket or use in­sur­ance to buy them.


Dr. David Ju­urlink, a drug safety re­searcher with Sun­ny­brook Hos­pi­tal, says the move is a good one.

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