30/10/2017 History Prevalence/Impact Stigma 1 30/10/2017 Yearly - - PDF document

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 History  Prevalence/Impact  Stigma

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Number of Deaths

550

Yearly Number of Opioid Toxicity Deaths in Ontario by Drug, 2002-2014

500 450 400 350 300 250 200 150 100

Codeine Fentanyl Heroin Hydromorpho ne Methadone Morphine Oxycodone Total Deaths

50 2002 2004 2006 2008 2010 2012 2014

Year Figure 4:The total number of deaths with which a drug was associated and the total number of unique individual opioid toxicity deaths annually in Ontario from 2002 to 2014. Some deaths can be attributed to multi-drug toxicity, therefore a single decedent may have more than one opioid contributing to death.

Source: Office of the Chief Coroner,

 50-80 times stronger than Morphine.  Dec 6, 2016 - Carfentanyl detected for the first

time in Ontario

 Black market pills and powder  Uncertain dosage  Lethal at very small doses

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Not for Public Circulation: MDSCNO Only

Volkow, Frieden, et al. (2014). Medication-assisted therapies- Tackling the opioid-overdose epidemic. N Engl J Med ; 370:2063-2066

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Source ce: : Office ce of the Chief Coroner of Ontario and the Ontario Ministr try of Transpo porta tati tion

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 Approximately 80% of males in correctional

custody within Canada have used drugs in the 12 months prior to incarceration

(Harm Reduction International)  Individuals who are released from institutions

who have addiction or substance misuse issues are often at greater risk of death due to overdose, particularly within the first two weeks.

 The Public/Community  Policy

• Federal
• Provincial

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 Hospital EDs  CHCs  Physicians  Health Units  Community groups  Police Services  Addiction Clinics  Researchers  Community Agencies  Bereaved parents  Pharmacists  Municipal Drug Strategies  Toxicologists, Coroners  MPs and MPPs  Community Centers  Media  Etc. etc

 Municipal Drug Strategy Coordinators Network

• f Ontario

 Association of Local Public Health Agencies of

Ontario

 Boards of Health  Emergency Nurses Association  Canadian Medical Association  Ontario Medical Association  Etc. etc.

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 Canada is the largest per

capita consumer of prescription opioids in the world

 Ontario has the highest rate

• f opioid prescription, and
• verdose deaths have been

steadily increasing.

 Opioid Agonist therapy

such as Suboxone or Methadone remains limited, especially in rural communities.

Policy Begins:

“Extraordinary real alitie ities s requir ire extr trao aordinar inary y measu asures.

• s. We are in a

crisis.

• isis. But

t in this is crisis, isis, we will ll not t merely ly be spectators”.

Federal Minister Of Health Jane Philpott

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Ontario Ministry of Health and Long- Term Care

27

TRANSFORMING ADDICTIONS TREATMENT, & REDUCE OVERDOSES & FATALITIES

• On October 12, 2016, Dr. Eric Hoskins, Minister of Health and

Long-Term Care announced the government’s plan to address the rise in opioid addiction and overdose by improvi ving acces ess to quality addiction n servi vices and interdisciplina nary y pain n mana nagement nt teams.

• Moderni

nizing ng pain n mana nagement practices and preventing opioid addiction and overdose is part of the government's plan to build a better Ontario through its Patients First: Action Plan for Health Care. .

MODERNIZ IZIN ING OPIOID OID PRESCRIB IBIN ING AND MONIT ITOR ORIN ING IMPR PROV OVIN ING THE TREATMENT OF PAIN ENHAN ANCIN ING ADDIC ICTION ION SUPPO PORTS & HARM REDUCTIO ION

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• 1. MODERNIZING OPIOID PRESCRIBING AND MONITORING

WORK TO DATE:

Ontario’s First-Ever Provincial

al Overdose Coordinato ator

• Dr. David Williams, Ontario's Chief Medical Officer of Health was designated Ontario's

first-ever Provincial Overdose Coordinator.

Province-wide expans

ansion of the Fentan tanyl yl Patch for Patch Progr gram am Beginning October 1, 2016, stricter controls on the prescribing and dispensing of fentanyl patches took effect. Patients are now required to return used fentanyl patches to their pharmacy before more patches can be dispensed.

Delist

t High gh-Str trength th Opioids Beginning January 1, 2017, high- strength formulations of long-acting opioids will be delisted from the Ontario Drug Benefit Formulary. The government is currently working with health care providers, including palliative care clinicians, to ensure that Ontario patients can continue to access appropriate pain treatment. OPPOR ORTUNITY: Y: Foste ter experti tise in prescribing g best practi tices through educati ation, training g and improving g access to data; a; enhanc anced provincial al surveillanc ance and monitoring syste tems.

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• 1. MODERNIZING OPIOID PRESCRIBING AND MONITORING

WOR ORK CURREN ENTLY UNDER ERWAY:

• Overdose Monito

toring Launch a new overdose surveillan ance and reporti ting g syste tem to support the Provincial Overdose Coordinator.

• Quality

ty Standar ards Develop evidence-bas ased qual ality ty standar ards for health care providers

• n appropriate opioid prescribing, led by Health Quality Ontario and health sector

partners.

• Appropriate

te Prescribing ng Develop new, evidence-based training modules and academic programs in conjunction with educational institutions that will provide modernize zed training g to all health th care providers who prescribe or dispense opioids.

• Practi

tice Reports ts Provide reports ts through Health Quality Ontario to physicians that show how their opioid prescribing compares to that of their peers and to best practices.

• Narcoti

tics Monito toring g Syste tem (NMS) ) Make NMS data readily available to health care providers, including physicians and pharmacists so they have access to up-to to-date ate dispensed medicati ation informati ation for their patients when making decisions concerning

• pioid prescribing.
• Patient

t Educati ation Improve access to important medicati ation informati ation, including a patient guide, for all patients prescribed opioids to help them better understand the associated risks.

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• 2. IMPROVING THE TREATMENT OF PAIN

WORK TO DATE: E:

Investi

ting g in the Chroni nic Pain n Netwo twork Invest t $17 million annual ally y in multi-disciplinary care teams, including 17 Chronic Pain Clinics across Ontario, to ensure that patients receive timely and appropriate care to help them manage chronic pain.

OPPO PORTUNIT UNITY: Y: Moder erniz nize e chronic ic pain n services ices and better er connect nnect patien ients s with h high h qualit lity treatmen ent.

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• 3. ENHANCING ADDICTION SUPPORTS AND HARM REDUCTION

Expanded

ed Acces ess s to Naloxone Naloxone, an antidote for opioid overdose is now available free of charge for patients and families through pharmacies and eligible organizations.

Expand Acces

ess s to Suboxone Suboxone, an effective treatment used to relieve opioid withdrawal symptoms that has a lower risk of overdose than methadone and reduces drug cravings, as of October 11, 2016, is available as a Gener neral l Benef nefit it on the e Ontario io Drug ug Benef nefit it Formu mula lary. OPPORTUN UNIT ITY: Improve addiction n services to better support patient nts with opioid addiction, n, and prevent nt injur ury y and death related to overdose.

On-site Services:

• Physician care
• Urine Screens – Lab Testing
• Pharmacy
• Carries

 Wrap around supports  Groups and 1:1 to debunk myths and stigma  Engage families

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• 3. ENHANCING ADDICTION SUPPORTS AND HARM REDUCTION

.

WORK CURRENTLY LY UNDERWAY: AY:

• Naloxone Kits for At-Risk Inmate

ates: Work with the Ministry of Community Safety and Correctional Services to begin providing naloxone kits free of charge to at-risk inmates at the time of their release from provincial correctional institutions.

• Intr

tranas anasal al Naloxone Explore providing naloxone in nasal al spray ay form to first responders.

• Nurse Practi

titi tioner Scope of Practi tice Continue working with the College of Nurses of Ontario to enable Nurse Practi titi tioner prescribing g of Suboxone, improving access to a methadone alternative for patients struggling with opioid addiction, particularly for those in rural and remote areas.

• Indige

genous Mental tal Heal alth th and Addicti tions Initi tiati atives Continue to work with Indigenous partners to identify community mental health and addictions priorities and ensure that cultur turally y appropriate te investm tments ts are made both th on- and off-reserve to improve mental health and addictions issues in Indigenous communities.

• Harm Reducti

tion Work with experts and municipal leaders to develop an evidence- based harm reduction framework, which could include expandi anding g needle exchang ange programs and supervised injecti tion services which have been demonstrated to save lives and reduce costs within the health care system.

• Health

th Care Delivery and Primar ary y Care Inte tegr grati ation Enhance inte tegr grati ation of comprehensive primar ary y care, mental tal health th and Suboxone/m /meth thad adone treatm tment t to better support patients with opioid addiction. .

 Abstinence Conflict

• Myths of Naloxone

 Overdose Prevention  Risk of Staff Exposure  Organizational Liability  Patients First Legislation  2015/16 RAAMs/RAACs opened in 7 sites

across Ontario:

 This model is evidence based – resulting in

significant reduction in repeat substance use ED visits. Most clinics have already expanded their hours of service

 Major portion of Ministry of Health funding

rolled out for Opioid Crisis last week.

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 https://www.facebook.com/lloyd.longfield/vi

deos/1983216678619459/

 Brief assessment of substance use concerns  Review of treatment options, including

both harm reduction and abstinence options

 Outpatient tapering of patients on high

dose opiates or benzodiazepines

 Brief individual counselling and withdrawal

support

 Medication assisted treatment for alcohol,

• pioid and benzodiazepine use disorders

 Education on overdose prevention and use

• f naloxone

 On-site peer support  Referral to longer-term treatment programs

and/or community services for ongoing care

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Federal Minister of Health (Jane Philpott) and the Federal Minister of Public Safety (Ralph Goodale) announced that a series of legislative changes will be introduced in order to make it easier for safe-injection sites to open within Canada. Bill l C-37 37 – An Act to Amend end the e Controlle lled Drugs gs and Subst stances nces Act and to Make Amend ndments ts to Othe her Acts ts  Amendments to five acts  Fewer barriers to opening safe consumption sites  Ability for agents to inspect and seize packages under 30 grams  Temporary Accelerated Scheduling of NPS. The bill would allow the Minister of Health to be granted powers to quickly schedule and control a new substance  Temporary scheduling would last up to two years and possession

• f a temporarily scheduled substance would not be an offence

Announcement of provincial funding of three ee safe e consu nsump mptio ion sites es

In order for safe-injection sites to be opened, Provinces and municipalities will be required to meet five (5) criteria:

 Demonstration of the need for such a site;  Demonstration of consultation conducted with the local

community;

 Presentation of evidence as to whether the intended site will

impact crime in the community;

 Assurance that the requisite regulatory systems and

framework are in place; and

 Sites will need to prove that appropriate resources have been

allocated.

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What is clear from the Policy surrounding the Opioid Crisis is that funding opportunities will not flow through corrections (provincially or federally at this time) Opportunities flow from health funding, provincial and federal Community Correction Agencies that have multi- funding (health funding) are most favorable situated