Ontario expands use of Suboxone as part of new provincial opioid strategy

Shavonne Bullock, a recovering heroin addict, holds a demonstration dose of the medication Suboxone during an appointment at the West Division Family Health Center in Chicago/ (AP Photo/ M. Spencer Green)

TORONTO -- Ontario will expand use of the drug Suboxone as an alternative to methadone to treat people addicted to opioids as part of a new provincial strategy to combat an increasing number of overdoses and deaths.

There are an estimated 50,000 addicts currently getting methadone treatment in Ontario, which saw 700 deaths from opioid overdoses in 2014. Opioid use has become the third leading cause of accidental death in Ontario, ahead of car accidents, said Health Minister Eric Hoskins.

He calls the situation a "public health crisis," and says family physicians, and eventually nurse practioners, will be able to prescribe Suboxone instead of referring addicts to methadone clinics.

"Providing Suboxone as a first line of treatment within a primary care environment, with that supportive care, is actually going to provide ... an astronomically better level of care for these individuals than is currently available at freestanding methadone clinics," Hoskins said at Toronto General Hospital.

Addiction specialist Dr. Medlon Kahan said having addicts treated by family doctors instead of at a clinic will ensure they get proper care for all of their issues.

"Suboxone can safely be prescribed by family physicians without a special licence or training, and this will greatly expand access to treatment for patients who urgently need it." said Kahan. "It can be prescribed in a variety of settings, in remote, rural regions, in hospitals, in prisons, withdrawal management centres and in shelters and emergency departments."

Hoskins also announced Ontario will make the antidote medication Naloxone available free of charge to treat overdoses, and will give Naloxone kits to "at risk" inmates as they are released from provincial jails.

"Naloxone is a life-saving antidote for opioid overdoses that actually reverses the effects of opioids on a person's body, and can save a person's life if they are overdosing," said Hoskins.

Ontario also named its chief medical officer of health, Dr. David Williams, as its first "provincial overdose co-ordinator," and announced a new narcotics monitoring system to let doctors know how much a patient has already been prescribed.

Opioid addictions are more common than most people realize, said Williams.

"Someone in this room or some family friend, or someone you know is involved with this," he said. "You may not be aware of it, but it is that widespread."

Ontario will also create a new surveillance and reporting system to monitor opioid overdoses, and a provincewide expansion of the "patch-for-patch" program for fentanyl prescriptions.

It will also spend $17 million a year to expand and operate 17 chronic pain clinics across the province and provide more training in chronic pain for physicians.

"We are taking bold action before this becomes an even worse public health crisis like it has in other parts of the world," said Hoskins.

"Ontario is far ahead of the rest of the country in terms of the per capita number of prescriptions for opioids, and there's no reasonable explanation for that."

Hoskins and federal Health Minister Jane Philpott will co-host a two-day summit on opioid addictions in Ottawa next month.

About half the people who have major surgery leave hospital with an opioid prescription, which Hoskins warns can lead to addiction, but many of the fatal overdoses involve illegal street versions of opioids such as fentanyl.

Police in Alberta and Manitoba recently arrested people with the drug carfentanil, an elephant tranquilizer about 100 times more toxic than fentanyl. Experts say a dose of carfentanil as small as a grain of sand is enough to kill someone.