OTTAWA - An expert on a national drug panel believes the Ontario government may reduce access to fentanyl through dosing limits and by removing the drug from the list of those available under the provincial drug plan.
Fentanyl is a manmade opioid that is up to 100 times more powerful than morphine and comes in patch form in doses up to 100 micrograms. The patch is meant to slowly deliver the drug to patients dealing with chronic pain over a period of 48 to 72 hours.
Fentanyl has caused addiction and death when people smoke the gel inside the patch, which delivers the patch’s full dose in a few breaths. The Manotick community has seen the drug misused locally and one young man died in 2012 after smoking the drug. A string of home break-ins was also linked to fentanyl abusers who needed money to buy the drug.
Dr. Meldon Kahan, medical director of the Women’s College Hospital in Toronto, is a member of a national group that released First Do No Harm: Responding to Canada’s Prescription Drug Crisis. The report, released on March 27 in Ottawa, lays out a 10-year national strategy to reduce the harms caused by prescription drug abuse.
In response to questions about Fentanyl abuse in south Ottawa, federal Health Minister Leona Aglukkaq refused to say if a prescription drug could be removed from the market as a result of the expert committee’s work.
“It’s a complex process,” Aglukkaq said of the panel’s ongoing research and future recommendations, adding that ensuring patients have access to drugs they need is important.
Kahan called fentanyl “convenient but dangerous,” and suggested an outright federal ban on fentanyl might not be needed. He offered some hope that Ontario will unilaterally address the abuse of the drug in this province.
“Maybe the 100-microgram (fentanyl) patch is not the safest option,” Kahan said during the press conference as the First Do No Harm report was released. “It may not simply be a matter of Health Canada banning a particular product.”
Following the press conference, Kahan said he believes Ontario’s Health Ministry is reviewing the dose limits on fentanyl, which could see the amount of drug per patch reduced. That could reduce the amount of the drug redirected to people who misuse fentanyl.
More importantly, Kahan said Ontario could remove coverage of fentanyl from the provincial drug plan. That would mean doctors could still prescribe the drug, but patients whose drugs are paid for by the province would have to pay for fentanyl out of their own wallets. That could prompt many legitimate fentanyl users to request their doctor to prescribe painkillers in other forms, reducing the amount available for misuse.
“It’s up to the (provincial) Ministry (of Health) to rethink these very carefully,” Kahan said of fentanyl’s dosage and financial coverage.
Earlier, Kahan said Ontario has seen a big jump in the number of people seeking treatment for opiate addiction.
“We’ve seen an increase in substance abuse in Ontario, with treatment for opiates doubling between 2004 and 2009,” he said, adding that treatment resources haven’t kept up with demand. “People are dying.”
The co-chairs of the National Advisory Council on Prescription Drug Misuse said all Canadians have a part to play in reducing the misuse of drugs, starting in the nation’s bathrooms. Carolyn Davison of Nova Scotia’s health department said the medicine cabinets of friends and family are the source of many drugs that end up being abused.
First Do No Harm includes 58 recommendations and more are expected as the panel continues its work. In the short term, Canadians can expect to see more public education about safe storage of prescription drugs.
Michel Perron is CEO of the Canadian Centre on Substance Abuse, which partnered with the NAC to produce First Do No Harm.
“Canadians have an increasing appetite for these drugs,” he said of opiates, adding that it remains important to get drugs to those who need them. “But the situation cannot carry on as it is. First Do No Harm is a roadmap to change and a clear signal of where we need to go and how to get there.”
NAC co-chair Dr. Susan Ulan of the College of Physicians and Surgeons of Alberta said First Do No Harm has clear objectives.
“Our goal is to get the right medication to the right people for the right reasons,” Ulan said.
The complete report is available online at www.ccsa.ca.