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Editorial: Ontario's opioid plan has its pluses – but does little to ease pain

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There is much to applaud in the Ontario government’s new, “comprehensive” opioid strategy. But it still puts too much emphasis on only one side of the problem.

First, though, the pluses. The government has acknowledged that opioid-related overdoses and deaths are a serious problem. In 2014, 700 Ontarians are reported to have died from opioid overdoses, making it the third-highest cause of accidental deaths in the province, ahead of traffic accidents.

Ontario will also loosen its rules around the drug Suboxone, which can be used to treat opioid addictions and is more benign than Methadone, the current drug of choice. Both family doctors and nurse practitioners will soon be able to prescribe Suboxone; addicts won’t have to go to special methadone clinics.

Then there’s Naloxone, an antidote administered in the case of overdose. Under the new plan, it will be available free. The province also plans to give Naloxone “kits” to inmates at high risk of addiction on release from jail.

Finally, the government has recognized there is a flip side to this problem, and that it needs addressing. What is proposed, however, falls short.

The issue is what opioids are legitimately used for: pain control. Ontarians in severe and chronic pain need powerful drugs to manage it, and we can expect, as the population ages, that the need will grow. At one point, doctors were prescribing oxycodone, but a crackdown on it led many to turn to fentanyl, the potent narcotic whose abuse spurred the current crisis. Certainly, the evidence suggests doctors have been badly over-prescribing opioids (one researcher called them “mind-boggingly cavalier” in their attitudes toward prescribing fentanyl). Nevertheless, the patients still need drugs.

Yet the provincial plan proposes removing several high-strength opioid formulations from the Ontario Drug Benefit Formulary at the end of the year – less than three months from now. That’s not much time to come up with alternatives for Ontarians who struggle with debilitating suffering. Some experts fear the abrupt removal of such drug options will send more people to the black market. And that could accelerate the cycle of drug abuse and risk.

Ontario does say it will pump cash into 17 chronic pain clinics across the province, and offer physicians more training on pain management – which will help counter the tendency to over-prescribe. These are good initiatives, but won't be implemented quickly. Wait times to see pain specialists are already long. For people suffering, each day is agony.

The province has made a good start in dealing with addiction overdoses; it needs to work equally hard on behalf of pain sufferers who need appropriate drugs.

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