No silver bullet solution for opioid crisis

There is no silver bullet to solve the opioid crisis in Ontario, but Niagara is rolling up its sleeves to make a difference, says Niagara Region’s public health department.

On Tuesday, the regional public works committee heard solutions to the crisis have to involve a multijurisdictional approach that tackles several issues at once.

“We have considered public education and awareness, access to services, pharmacists and physicians, and harm reduction,” said Vanessa Levay, the manager of chronic disease injury prevention at public health, in an interview after the committee meeting.

Leavy provided the committee with an update on the opioid crisis, presenting a memo on the latest recommendations from the federal government. The memo said the federal approach includes a “four pillar drug strategy of prevention, treatment harm reduction and enforcement.” The federal report said Ottawa is trying to raise public awareness, improve access to anti-overdose medications and improve how doctors prescribe opioids.

Leavy said at the local level, working groups are being formed to create action plans on several fronts.

She said Niagara has an Opioid Overdose Prevention and Communication Network composed of several community agencies. She said the network, co-chaired by the public health department and Positive Living Niagara, is building the working groups.

The public health department has been working on opioid problems for years, she said, including a successful initiative to reduce youth access to prescription opioids in the home.

“We have been doing this work for a long time. The difference now is the potency of the drugs,” Leavy said referring to fentanyl, the frighteningly powerful opioid responsible for overdoses across Canada.

Fentanyl is exacerbating the already acute opioid addiction crisis in the province. According to Ontario coroner’s office data, there were 174 oxycodone-related deaths in 2010, a number that declined to 109 by 2015. When all opioid-related deaths are counted, the coroner said the drugs killed 543 people in 2015.

According to Niagara Regional Police, officers responded to 12 fentanyl overdoses in 2016, up from two in 2012. They responded to 12 fentanyl overdose deaths in 2016, up from four the previous year.

Leavy said strategies to combat the crisis have to involve an examination of street-level dealing and legitimate opioid prescribing by doctors.

A report released last month by Health Quality Ontario - an arm of the provincial government showed that Niagara has one of the highest rates of opioid prescribing. The report said the NiagaraHamilton-Haldimand-Brant Local Health Integration Network has the fourth highest rate of opioid prescriptions in Ontario.

The data said around 25 per cent of those prescriptions are filled for short-term pain relief after an injury or surgery, and the patient never uses the drug again.

The rest are prescriptions for longer term use, including those for people with chronic pain or at the end of life. The report does not differentiate the reasons patients are taking opioids or their demographics.

Dr. Brian Kerely, of the Niagara North Family Health Team said, it’s unclear why the LHIN would have a higher level of opioid prescribing than other, sometimes larger communities in Ontario.

“We don’t have good data yet to be able to determine that,” he said.

Kerley said Niagara has an older, generally sicker demographic than many other communities, which could mean more people are suffering from chronic pain.

He said some patients who are prescribed opioids are at risk of becoming addicted to them, and physicians have to examine how and to whom they give the powerful painkillers.

However, he said forming new prescribing guidelines will require a nuanced thinking.

“For instance, are we to screen patients for possible risk factors? There are already have patients who are wary of taking opioids because they worry about addiction,” Kerley said. “So if you do that kind of screening, you might scare away patients who actually should take an opioid.”

Kerely said many of his patients are older,and at the end of life, are generally at a very low risk of developing an opioid addiction.

“Now if you are talking about someone who is 18 and has other possible risk factors, then I would be open to doing some kind of screening process,” Kerely said.