Opioid use and overdose have become a health emergency that affects all provinces and territories across Canada. A recent publication by the Canadian Institute for Health Information shows that the number of hospital admissions and emergency department visits due to opioid use is growing. The types of opioids that are commonly used include heroin, codeine, morphine, oxycodone, fentanyl, and others. Some medications are prescribed for pain relief but they are also addictive.

Statistics and Figures

The Public Health Agency of Canada - https://www.canada.ca/en/public-health.html released data, according to which in 2017 alone, some 4,000 people died from overdosing. Close to 30 percent of Canadians admit to having used opioids during the last five years. The problem is real and serious in light of the fact that during 2016/2017 there were 16 hospital admissions a day due to overdosing. The number of admissions increased by 19 percent compared to 2014/2015. In fact, admission rates increased by 53 percent over a 10-year period (from 2007 to 2017). This is an alarming increase which points to the fact that the opioid crisis needs a comprehensive approach.

 

Hospital admissions vary across the country but are higher in Western and Northern Canada. Opioid-related death rates are the highest in Alberta, British Columbia, the Northwest Territories, and Yukon. Western Canada has a higher death rate (10 deaths per 100,000) than the national average (8 deaths per 100,000). Saskatchewan, Nunavut, and New Brunswick have the lowest rates or 0 to 4.9 deaths per 100,000.

 

Chief public health officer Dr. Theresa Tam highlights the fact that some 2,800 people died from overdosing in 2016, and the number of opium deaths is higher than the number of deaths due to HIV during the 1990s epidemic.

Conferences, Commitments, and Initiatives

The federal government collaborated with the territorial and provincial authorities to develop a comprehensive plan to deal with the crisis. The Opioid Conference and Summit in 2016 brought together policymakers, regulatory bodies, national organizations, professional associations, and other key players. The Joint Statement of Action was developed to direct efforts in areas such as harm reduction, treatment, and prevention. The number of partners also increased from more than 30 to 54. A number of commitments and projects are in progress while others were completed. One commitment focused on educating patients about opioids and was jointly completed by Patients for Patient Safety in Canada, the Canadian Patient

Safety Institute, and the Institute for Safe Medication Practices Canada.

А number of initiatives took place as a result of collaboration between different partners, including social media and media activities, creation of knowledge dissemination products, and others. Other initiatives include teleconferences and webinars to encourage collaboration between key partners. A number of case studies were also produced, including studies with a focus on updating medical school competencies, tools for patient education, and improved strategies for pain management. Other case studies focus on surveillance and monitoring and e-prescribing solutions that enable healthcare professionals to send online prescriptions to pharmacies. A number of activities and events also took place, including panels, meetings, discussions, presentations, and sessions. More than 4,000 training sessions, webinars, and workshops were organized and multiple websites were launched. Training sessions were organized in 126 indigenous communities and Take-Home Naloxone kits were offered.

The Government Strategy

The federal government has developed and implemented the Drug and Substance Abuse Strategy to deal with the opioid crisis. The main pillars of the strategy are treatment, public health emergency response, prevention, harm reduction, evidence base, and enforcement. Supervised consumption sites have been created under the strategy. The main goals are to minimize the risk of disease transmission and to prevent overdosing. Supervised consumption sites offer a number of services such as housing, detoxification, management of withdrawal symptoms, counseling, and drug treatment. In addition, supervised consumption sites offer information about needle exchange and social welfare programs, community services, and mental health treatment. Patients are also offered information about primary health care, housing services, and rehabilitation.

Funding

The government also has an Emergency Treatment Fund to provide one-time financial assistance to the territorial and provincial governments to provide better quality services and treatment. Funding in the amount of $150 million is available.

 

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What is Methadone

Methadone is a type of opioid that is prescribed to patients who have developed opioid dependence. The main goals are detoxification, treatment of dependency, and pain relief.

Prescription

In Canada, it is prescribed by private healthcare practitioners and treatment centers. Methadone is safe and reliable to use when bought from a pharmacy and prescribed by a physician. The reason is that it is regulated by the government under the Narcotic Control Regulations and Controlled Drug Substances Act. And while only practitioners with exemption from Health Canada were previously allowed to administer methadone, this has changed in May 2018. At present, healthcare practitioners are allowed to sell, administer, and prescribe treatment to patients. This makes it easier for Canadians to get the treatment they need and can choose from different options. Pharmacies are also no longer required to confirm with Health Canada whether practitioners have obtained an exemption. This means that they are allowed to sell methadone and other controlled substances to individuals who present a dated and signed prescription or order.

How Does Methadone Help Solve the Opioid Crisis?

Statistics show that about 20 percent of persons with opioid dependence take methadone. A research study by the Canadian Research Initiative in Substance Abuse shows that the number of opioid poisonings and associated hospital admissions increased from 9 to 13 a day between 2008 and 2015. Such patients are not only at risk of overdosing but of disease transmission, including HIV and hepatitis C. Overdosing caused the death of some 3,000 persons who use opioids in 2016, and the number of death cases is growing. This is mainly due to illegal drug supply. Under the new regulations, methadone prescriptions have increased, which may sound like good news at first. At the same time, some experts warn that methadone treatment has become a profitable business for some clinics. They provide limited counseling while prescribing methadone to many patents.

 

The number of patients taking methadone almost doubled in British Columbia between 2009 and 2017, and some 22,000 patients are in treatment at present. The number of patients also doubled in Alberta over a 4-year period, and some 8,200 patients are in treatment in 2018. Methadone prescriptions have also increased in Yukon, Quebec, Saskatchewan, and elsewhere. Opioid replacement treatment is a life-saver for many, but physicians warn that this should be a starting point to help patients recover and live meaningful lives. Counseling is essential to find the root of the problem which is what led to drug abuse and addiction. This can help patients build stable relationships, graduate from school or university, go back to work, etc. Counseling has an important role to play as patients are usually persons with lack of parental involvement, mental disorders, family history of drug abuse, and other risk factors. Psychological factors also have a role to play, including personality and eating disorders, anxiety, depression, sensation seeking, and others. Counseling has the goal of finding the reasons and factors that led to addiction, whether trauma, emotional abuse, or physical abuse that patients need help with as to overcome addiction. Many patients have also developed associated substance abuse disorders and regularly take cocaine and other narcotics. Alcohol abuse is also a serious problem. The role of treatment centers and clinics is to address these problems and needs.