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Last May, Ontario’s Minister of Health, Dr. Eric Hoskins announced that Ontario would ensure pharmacies dispense Naloxone kits to anyone at risk of an opioid overdose. At last count, seven pharmacies in Peterborough City and County are participating in this attempt to prevent these tragedies from occurring in our communities. People using opioids, whether prescribed or obtained illicitly, or their families and friends, can now get a free rescue drug, Naloxone, to be used in the event of a witnessed overdose. These access points are in addition to the kits that have been available through public health, PARN and Fourcast.
But the rescue medication Naloxone, although critical (just like Epipens are critical to treat anaphylaxis) is not the solution to this opioid crisis that has emerged over the past two decades in Canada. So much more is needed. Canada has one of the highest opioid prescribing rates in the world: four to five times higher than countries like Germany or the UK. Peterborough has the honour of having the sixth highest rate of prescribed opioids in Ontario, where, in 2014-15 almost 2 million Ontarians received a prescription for a narcotic. Almost half of those addicted to opioids report that their introduction to the drug came by way of a prescription for pain for legitimate conditions like broken bones, arthritis or surgery. Although well intentioned, the proliferation of opioid prescribing for non-malignant and chronic pain that occurred in the 1990s, has had devastating consequences. So much so that now opioid deaths in Ontario hover at about 700 per year, and rival motor vehicle collision as a leading cause of accidental death in young adults. Now, one in eight deaths of young adults aged 25-34 are due to opioids.
Purdue Pharma introduced Oxycontin™ in 1996 and promoted it with what has been called the most aggressive marketing campaign ever undertaken for an opioid. It worked. Annual sales in the U.S. alone topped over $1 billion. In 2007, Purdue pled guilty to criminal charges that they misled government regulators, physicians and patients about the harms and dangers of the drug. The company was fined $600 million. In addition, three senior executives also pled guilty to misbranding and paid a total of $345 million in fines.
Fast forward to 2012, the year that Ontario delisted Oxycontin™ and replaced it with a more tamper proof version that can only be prescribed in special cases. Suboxone™, a pill that treats opioid addiction, has been made more readily available and there are online training courses for doctors who wish to prescribe it.
Federal actions that led to the enhanced availability of Naloxone, reduced the availability of lethal street drugs and removed barriers to the establishment of safe drug consumption sites are all helping to address the crisis. The commitment of Ontario to a comprehensive strategy that includes safe prescribing, better pain and addiction services, as well as enhanced harm reduction like free Naloxone kits for people at risk of overdoses is critical. Here in Peterborough, our medical and pharmacy providers are committed to taking action as well. We introduced a voluntary Fentanyl patch return program long before it was mandated by law. Our police have been champions for a local drug strategy that includes all four pillars of prevention, treatment, harm reduction and enforcement. Launching this month, our hospital will be one of the first to offer Naloxone kits in the Emergency Department to patients at risk of an opioid overdose and their friends and family. And now it will be up to all of us to reduce the stigma and shame associated with addictions.
It is easy to blame the person with an addiction – but blame will not help them get the help they need and muster the strength to turn their lives around. If one wishes to point fingers, one would need more than the ten fingers of both hands as the roots of this problem are multiple and deep. Let’s continue to make Peterborough proud with our open-mindedness, our compassion and our tenacity to work together to come up with local solutions.
By Dr. Rosana Salvaterra, Medical Officer of Health, Peterborough Public Health
