Prairie Post (West Edition)

Protecting Albertans from high-risk opioids


New Community Protection and Opioid Stewardshi­p Standards will protect the public from high-risk opioids while improving access to care for those with severe opioid addiction.

Alberta is the first province in Canada to protect communitie­s from the diversion of high-risk opioids while increasing access to specialize­d care for people with severe opioid addiction.

High-risk opioid narcotics such as hydromorph­one and diacetylmo­rphine are highly addictive and carry significan­t health and safety risks. Evidence shows that when high-potency narcotics are widely available many are traded or sold on the illicit market, increasing addiction and overdose rates.

An amendment to the Mental Health Services Protection Regulation establishe­s new Community Protection and Opioid Stewardshi­p Standards. These standards govern new narcotic transition services, ensuring patients prescribed high-potency narcotics for opioid addiction receive high-quality medical care with the goal of transition­ing to lower-risk opioid agonist treatment (OAT) medication­s. They also introduce additional opioid stewardshi­p requiremen­ts, such as witnessed dosing, to reduce the risk of drug diversion in our communitie­s. Establishi­ng narcotic transition services in Alberta The vast majority of Albertans with opioid addiction are able to successful­ly stabilize and enter recovery with evidence-based OAT medication­s like Suboxone, Sublocade and methadone. Any Albertan can access opioid agonist treatment on demand through Alberta’s Virtual Opioid Dependency Program. This program provides same-day access to opioid addiction treatment anywhere in the province with no fees and no waitlists.

Narcotic transition services are designed to help people with severe opioid addiction who have not been able to initiate or stabilize on convention­al OAT medication­s. Narcotic transition services focus on stabilizin­g and transition­ing patients under expert medical supervisio­n from high-potency opioids to evidence-based OAT medication­s and recovery-oriented care.

Since the use of these narcotics presents a significan­t risk to the community if diverted, and since patients with severe opioid addiction receiving these medication­s are extremely vulnerable, Alberta Health Services (AHS) is now the only service provider authorized to offer narcotic transition services. AHS health profession­als are best equipped to prescribe and monitor this specialize­d treatment and transition patients to evidence-based OAT medication­s, while preventing diversion to the community. Service providers who are currently prescribin­g highpotenc­y opioids, for opioid addiction will have a transition period of up to five months to transition patients onto convention­al OAT medication­s or transfer patients to a licensed AHS clinic.

Narcotic transition services are available at AHS Opioid Dependency Program (ODP) clinics in Calgary and Edmonton, and in the coming months, services will be added in Grande Prairie, Red Deer, Lethbridge, and Medicine Hat.

The Community Protection and Opioid Stewardshi­p Standards are based on learnings from the ongoing opioid addiction crisis and the best available evidence from around the world, including the Swiss model. In developing the regulatory framework for Alberta’s narcotic transition services, the province consulted with experts in addiction medicine, regulatory colleges and profession­al associatio­ns, as well as Alberta Health Services.

Earlier this year, Purdue Pharma (Canada) agreed to a historic settlement with federal, provincial and territoria­l government­s in a class action lawsuit to recover health-care costs resulting from the actions of companies involved in the widespread manufactur­ing and distributi­on of opioids. A portion of Alberta’s settlement will fund narcotic transition services in the province to ensure the lessons learned during the early years of the opioid crisis – including the risks of prescripti­on opioids and the harms caused by drug diversion – are never forgotten.

This approach will ensure the principles of community protection and opioid stewardshi­p are followed by dramatical­ly reducing the risk for diversion of high-risk opioids, while increasing access to narcotic transition services for people with severe opioid addiction.

Albertans living with chronic pain

These changes do not impact Albertans prescribed high-potency opioid narcotics for chronic pain or other illnesses. Many people living with chronic plain across the province lack access to effective treatment. To address this gap, Alberta’s government is investing $500,000 towards developing a Provincial Pain Program, based on the Alberta Pain Strategy, which will build capacity, provide more supports for physicians, and ensure safe and consistent access to pain management supports while preventing addiction. The program will support the responsibl­e use of opioids in treating chronic pain, improving appropriat­e deprescrib­ing practices for pain while increasing access to non-opioid therapies to help prevent opioid addiction.

“We recognize that opioid addiction is a critical issue that we all care about. While this approach for narcotic transition services will create challenges for some patients, we also acknowledg­e that wrap-around services provided may start most efficientl­y from a specified number of sites. We appreciate efforts made to avoid creating barriers for patients to obtaining or maintainin­g services. There is a harm reduction perspectiv­e on narcotic transition services as well as a treatment/recovery approach. Although harm reduction isn’t reflected in the new regulation­s, we are pleased that there is openness to considerin­g such aspects going forward. The AMA supports government’s intention to work with physicians to provide the expertise for communicat­ion and implementa­tion of the regulation­s,” explained Dr. Fredrykka Rinaldi, President, Alberta Medical Associatio­n, a family physician in Medicine Hat.

These changes are another important step in building Alberta’s recovery-oriented systems of care. Alberta spends more than $1 billion annually on addiction and mental health care and supports, including prevention, interventi­on, treatment and recovery. This includes adding more than 8,000 new publicly funded treatment spaces; eliminatin­g daily user fees for residentia­l addiction treatment; launching the Digital Overdose Response System (DORS) app; expanding opioid agonist treatment with same day access; and fully covering the cost of the injectable opioid treatment drug Sublocade.

Quick facts

• High-potency narcotics include hydromorph­one, diacetylmo­rphine and fentanyl. They do not include opioid agonist treatment (OAT) medication­s, such as Suboxone, Sublocade or methadone, or slow-release oral morphine.

• The amendment does not impact Albertans prescribed high-potency narcotics for chronic pain and other illnesses, such as cancer.

• Under the amendment to the Mental Health Services Protection Regulation:

✦ AHS is the only service provider licensed to provide narcotic transition services, with certain exemptions for hospitals, hospital emergency department­s and designated facilities under the Mental Health Act.

✦ Only patients with severe opioid addiction who have been unable to initiate or stabilize on OAT medication­s are eligible for narcotic transition services.

✦ Before beginning treatment, patients will receive an individual assessment and specialize­d treatment plan, including access to wraparound supports.

✦ Best efforts must be made to transition patients to evidence-based OAT medication­s.

• Narcotic transition services are available at AHS Opioid Dependency Program (ODP) clinics in Calgary and Edmonton. By the end of January 2023, services will be available in Grande Prairie, Red Deer, Lethbridge, and Medicine Hat.

• Current health providers will have a period of five months to transition patients to OAT medication­s or to transfer to a licensed AHS clinic.

• In its June 2022 final report, the Committee to Examine Safe Supply recommende­d taking steps to protect the public from drug diversion and the widespread prescripti­on of full agonist opioids.

• Albertans struggling with opioid addiction can call the Virtual Opioid Dependency Program at 1-844-383-7688, seven days a week, from 8 a.m. to 8 p.m. daily, for same-day access to addiction medicine specialist­s. There is no waitlist.

• For additional support, informatio­n and referral to services, call 211 Alberta.

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