Effective Canadian policy to reduce harms from prescription opioids: learning from past failures

published on November 7, 2016 by Benedikt Fischer PhD, Jürgen Rehm PhD, Mark Tyndall MD ScD, in CMAJ

The use of prescription opioids to treat pain has increased over the past two decades in Canada, but it has led to a major public health crisis. Since 2000, the number of cases of opioid-related misuse, addiction disorders and admissions to hospitals or treatment programs continues to grow. Deaths from opioid overdoses have also risen.

Several authorities have launched interventions, mostly since 2010, but most have been ad hoc, reactive and limited in scope. These interventions have failed to effectively address the root causes of the opioid crisis. This crisis is only get- ting worse, and Canada urgently needs to implement effective measures aiming at and addressing the underlying drivers of the opioid epidemic.

A growing crisis

National surveillance data have been spotty and inconsistent, but data from population surveys showed that, by 2010, more than 1 in 20 adults — and as many as one in six adolescents — were using prescription opioids for nonmedical purposes.1 In addition, prescription opioids have become highly available and popular drugs on the street, which have also disproportionately affected indigenous and other vulnerable populations. Mis- use has become highly prevalent on many reserves in Northern Ontario and elsewhere.

Demand for opioid-related addiction treatment has soared. In Ontario, for example, annual admissions to publicly funded (nonpharmaco-therapy) treatment for opioid-related problems doubled between 2004 and 2013, from 8799 to 18 232.3,4 Enrolments in opioid pharmacotherapy also rapidly increased. Based on updated numbers, there were more than 50 000 individuals enrolled in methadone treatment in Ontario by 2015, and similar proportional trends were seen in British Columbia.

Deaths from opioid-related poisonings have increased too. The annual number of opioid-related deaths in Ontario, most involving young people, rose from 127 in 1991 to 680 in 2014, which is a greater than fivefold increase. Data for overdose deaths from other provinces indicate similar levels and increases.9,10 In 2015, an estimated 2000 Canadians — about 1200 in BC, Alberta and Ontario alone — died from opioid-related poisonings. Initial numbers for 2016 are higher again, and more deaths are being attributed to clandestinely produced fentanyl and other opioid products.

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Effective Canadian policy to reduce harms from prescription opioids: learning from past failures

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