30/10/2017 History Prevalence/Impact Stigma 1 30/10/2017 Yearly - PDF document

30/10/2017  History  Prevalence/Impact  Stigma 1

30/10/2017 Yearly Number of Opioid Toxicity Deaths in Ontario by Drug , 2002 - 2014 550 500 450 400 Number of Deaths 350 Codeine Fentanyl 300 Heroin 250 Hydromorpho ne Methadone 200 Morphine 150 Oxycodone 100 Total Deaths 50 0 2002 2004 2006 2008 2010 2012 2014 Year Figure 4:The total number of deaths with which a drug was associated and the total number of unique individual opioid toxicity deaths annually in Ontario from 2002 to 2014. Some deaths can be attributed to multi-drug toxicity, therefore a single decedent may have more than one opioid contributing to death. Source: Office of the Chief Coroner,  50-80 times stronger than Morphine.  Dec 6, 2016 - Carfentanyl detected for the first time in Ontario  Black market pills and powder  Uncertain dosage  Lethal at very small doses 2

30/10/2017 Not for Public Circulation: MDSCNO Only Volkow, Frieden, et al. (2014). Medication-assisted therapies- Tackling the opioid-overdose epidemic. N Engl J Med ; 370:2063-2066 3

30/10/2017 Source ce: : Office ce of the Chief Coroner of Ontario and the Ontario Ministr try of Transpo porta tati tion 4

30/10/2017  Approximately 80% of males in correctional custody within Canada have used drugs in the 12 months prior to incarceration (Harm Reduction International)  Individuals who are released from institutions who have addiction or substance misuse issues are often at greater risk of death due to overdose, particularly within the first two weeks.  The Public/Community  Policy ◦ Federal ◦ Provincial 5

30/10/2017  Hospital EDs  Bereaved parents  CHCs  Pharmacists  Physicians  Municipal Drug Strategies  Health Units  Toxicologists, Coroners  Community groups  MPs and MPPs  Police Services  Community Centers  Addiction Clinics  Media  Researchers  Etc. etc  Community Agencies  Municipal Drug Strategy Coordinators Network of Ontario  Association of Local Public Health Agencies of Ontario  Boards of Health  Emergency Nurses Association  Canadian Medical Association  Ontario Medical Association  Etc. etc. 6

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30/10/2017  Canada is the largest per capita consumer of prescription opioids in the world  Ontario has the highest rate of opioid prescription, and overdose deaths have been steadily increasing.  Opioid Agonist therapy such as Suboxone or Methadone remains limited, especially in rural communities. Policy Begins: “Extraordinary real alitie ities s requir ire extr trao aordinar inary y measu asures. s. We are in a crisis. isis. But t in this is crisis, isis, we will ll not t merely ly be spectators”. Federal Minister Of Health Jane Philpott 8

30/10/2017 Ontario Ministry of Health and Long- Term Care TRANSFORMING ADDICTIONS TREATMENT, & REDUCE OVERDOSES & FATALITIES • On October 12, 2016, Dr. Eric Hoskins, Minister of Health and Long- Term Care announced the government’s plan to address the rise in opioid addiction and overdose by improvi ving acces ess to quality addiction n servi vices and interdisciplina nary y pain n mana nagement nt teams. • Moderni nizing ng pain n mana nagement practices and preventing opioid addiction and overdose is part of the government's plan to build a better Ontario through its Patients First: Action Plan for Health Care . . MODERNIZ IZIN ING OPIOID OID PRESCRIB IBIN ING AND MONIT ITOR ORIN ING IMPR PROV OVIN ING THE TREATMENT OF PAIN ENHAN ANCIN ING ADDIC ICTION ION SUPPO PORTS & HARM REDUCTIO ION 27 9

30/10/2017 1. MODERNIZING OPIOID PRESCRIBING AND MONITORING OPPOR ORTUNITY: Y: Foste ter experti tise in prescribing g best practi tices through educati ation, training g and improving g access to data; a; enhanc anced provincial al surveillanc ance and monitoring syste tems. WORK TO DATE:  Ontario’s First-Ever Provincial al Overdose Coordinato ator Dr. David Williams, Ontario's Chief Medical Officer of Health was designated Ontario's first-ever Provincial Overdose Coordinator.  Province-wide expans ansion of the Fentan tanyl yl Patch for Patch Progr gram am Beginning October 1, 2016, stricter controls on the prescribing and dispensing of fentanyl patches took effect. Patients are now required to return used fentanyl patches to their pharmacy before more patches can be dispensed.  Delist t High gh-Str trength th Opioids Beginning January 1, 2017, high- strength formulations of long-acting opioids will be delisted from the Ontario Drug Benefit Formulary. The government is currently working with health care providers, including palliative care clinicians, to ensure that Ontario patients can continue to access appropriate pain treatment. 28 1. MODERNIZING OPIOID PRESCRIBING AND MONITORING WOR ORK CURREN ENTLY UNDER ERWAY: • Overdose Monito toring Launch a new overdose surveillan ance and reporti ting g syste tem to support the Provincial Overdose Coordinator. • Quality ty Standar ards Develop evidence-bas ased qual ality ty standar ards for health care providers on appropriate opioid prescribing, led by Health Quality Ontario and health sector partners. • Appropriate te Prescribing ng Develop new, evidence-based training modules and academic programs in conjunction with educational institutions that will provide modernize zed training g to all health th care providers who prescribe or dispense opioids. • Practi tice Reports ts Provide reports ts through Health Quality Ontario to physicians that show how their opioid prescribing compares to that of their peers and to best practices. • Narcoti tics Monito toring g Syste tem (NMS) ) Make NMS data readily available to health care providers, including physicians and pharmacists so they have access to up-to to-date ate dispensed medicati ation informati ation for their patients when making decisions concerning opioid prescribing. • Patient t Educati ation Improve access to important medicati ation informati ation, including a patient guide, for all patients prescribed opioids to help them better understand the associated risks. 29 2. IMPROVING THE TREATMENT OF PAIN OPPO PORTUNIT UNITY: Y: Moder erniz nize e chronic ic pain n services ices and better er connect nnect patien ients s with h high h qualit lity treatmen ent. WORK TO DATE: E:  Investi ting g in the Chroni nic Pain n Netwo twork Invest t $17 million annual ally y in multi-disciplinary care teams, including 17 Chronic Pain Clinics across Ontario, to ensure that patients receive timely and appropriate care to help them manage chronic pain. 30 10

30/10/2017 3. ENHANCING ADDICTION SUPPORTS AND HARM REDUCTION OPPORTUN UNIT ITY: Improve addiction n services to better support patient nts with opioid addiction, n, and prevent nt injur ury y and death related to overdose.  Expanded ed Acces ess s to Naloxone Naloxone, an antidote for opioid overdose is now available free of charge for patients and families through pharmacies and eligible organizations.  Expand Acces ess s to Suboxone Suboxone, an effective treatment used to relieve opioid withdrawal symptoms that has a lower risk of overdose than methadone and reduces drug cravings, as of October 11, 2016, is available as a Gener neral l Benef nefit it on the e Ontario io Drug ug Benef nefit it Formu mula lary. 31 On-site Services: ◦ Physician care ◦ Urine Screens – Lab Testing ◦ Pharmacy ◦ Carries  Wrap around supports  Groups and 1:1 to debunk myths and stigma  Engage families 11