Beginning next year, the Ontario government will no longer pay for certain high-strength opiates (pain-killing drugs) under the Ontario Drug Benefit (ODB), a move which is leaving many wondering how palliative care patients and those with terminal illnesses will be affected.
In late July, the Ontario Ministry of Health announced that 200-milligram tablets of morphine, 24-milligram and 30-milligram capsules of hydromorphone, 75-microgram per hour and 100-microgram per hour patches of fentanyl, and 50-milligram tablets of meperidine were to be defunded by the ODB.
The ODB said this is part of a strategy to fight painkiller addiction. Opioid addiction in Ontario has been a problem that has been growing over the years. A 2014 study in Ontario showed that opioids are the leading cause of death in people between the ages of 25 to 34 and that one in every eight deaths among youths are opioid-related.
Additionally, the rates of opioid-related death have gone up by 242 per cent between 1991 and 2010. However, a study done by the United States’ Drug Enforcement Agency suggests that the increase in the deaths related to the high-strength opiate fentanyl, and presumably to other high-strength opiates, is in a large part due to illegal supplies from China and Mexico rather than prescription drugs.
Though there are many who are pleased with the actions which the Ontario government is taking to prevent drug abuse, there are those who feel that the government has overlooked the negative effects that this could have on the quality of life of those with medical illnesses.
Physician Darren Cargill, the Regional Lead at Cancer Care Ontario, said that the government acted too hastily and irresponsibly when it enacted this policy, and should have considered the unintended consequences. Cargill wrote in the Windsor Star: “palliative care patients rely on many of the medications removed from this formulary every day to manage their pain from cancer and other serious medical conditions.” He points out that “This move by the Ontario Liberal party once again highlights its lack of collaboration with healthcare providers and the ongoing lack of respect for process.”
A recent study from the Ontario Drug Policy Research Network (ODPRN) showed that only a minor amount of palliative-care patients will actually be affected by the new policy. The study showed that out of the 40 per cent of patients that were prescribed opiates in a one-year period, only 2.7 per cent were of the high-dose formulations that will be defunded. Tara Gomes, a principle researcher at the ODPRN, said that it is “reassuring that the vast majority of palliative-care patients will not be impacted by this policy.” Medical writer W. Gifford-Jones wrote in the Orillia Packet & Times that this statement was “foolish,” wondering, “isn’t there any empathy for others who will be impacted?”
Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, wrote in a blogpost entitled “Will Ontario’s new drug policy drive people to euthanasia?” He said, “whether or not the Ontario government’s new drug policy will deter drug addiction, it will also limit palliative and chronic care specialists from providing effective pain control and it may drive some people to seek death by lethal injection now that euthanasia has been legalized.”
Federal Health Minister Jane Philpott announced that this fall there will be a summit to address the important issues involving opioids and to develop strategies to deal with the problem of fatal drug overdoses.
Philpott is aware of the consequences of this policy, saying in an interview with The Canadian Press, “people need to have access to these effective medications where used appropriately but there is a tremendous risk potential. People do become addicted to them and people die.” Likewise, she is also aware of the complexity of this issue, saying, “it affects health care providers, it affects organizations that represent people who use drugs or have used drugs and their family members … we need research community on board, we need community associations on board.”