Pubdate: Wed, 18 May 2016
Source: Globe and Mail (Canada)
Page: A4
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Patrick White

ONTARIO LAGS ON NALOXONE ACCESSIBILITY

Bureaucratic tangles, such as a lengthy drug-reclassification 
process, hold up making overdose remedy available without prescription

A cheap, life-saving antidote to an affliction that kills more 
Ontarians than car crashes every year remains hard to obtain in the 
province despite mounting pressure from public health officials and 
moves by other provinces to broaden its availability.

The drug naloxone is a safe and powerful remedy to opioid overdoses, 
a rising public-health crisis owing to a wave of bootleg fentanyl 
across the country that claims a life in Ontario every 14 hours, 
according to one estimate. The problem is even worse in Alberta and 
British Columbia, where provincial governments are countering the 
epidemic in part by shipping naloxone to community pharmacies for 
distribution free of charge to anyone, even those without a prescription.

But in Ontario, where the fentanyl scourge has emerged more recently, 
the government is taking a far slower path toward mass distribution 
of the antidote.

"At the moment, it's cheaper and easier to get opioids than naloxone 
in Ontario," said Michael Parkinson, who has researched the problem 
extensively as community engagement co-ordinator with the Waterloo 
Region Crime Prevention Council. "It's scandalous."

The contrast in provincial approaches became more stark last 
Wednesday, when Alberta announced it was using a ministerial order to 
make free naloxone available through 600 pharmacies without a prescription.

Health Canada cleared the way for just such a policy in March, 
expediting changes to its drug regulations that permitted provinces 
to dispense naloxone without a prescription as long as it was "for 
emergency use."

The Ontario College of Pharmacists has notified the provincial 
government that pharmacists here would embrace a model similar to 
Alberta's, but the discussions have gone nowhere.

"We have communicated with the Ministry [of Health and Long-Term 
Care] saying that if you want to deliver through pharmacies, we would 
work with that," College registrar Marshall Moleschi said. "We see no 
barriers to that. They haven't said no."

In the meantime, the College is working to address the problem on its 
own. It has launched a drug-reclassification process that would 
permit pharmacists to dispense naloxone without a prescription by 
early July. But the reclassification process is prolonged by design, 
a safeguard against the hasty introduction of unknown drugs.

So far, the province has shown little inclination to circumvent that 
reclassification process.

People dealing first-hand with the opioid crisis would like to see 
the same sense of urgency in Ontario as the Western provinces. "We've 
been anxious to get more naloxone in the hands of our outreach 
workers and right now we're waiting," said Dennis Long, executive 
director of Breakaway Addiction Services in Toronto. "This is the 
largest outbreak of overdose deaths we've seen in many years."

A spokesman for the Ministry of Health and Long-Term Care said it 
already sends naloxone kits to authorized organizations throughout 
the province, including public-health units that manage 
needle-exchange programs and ministry-funded hepatitis C teams.

But according to Mr. Parkinson, the strict eligibility criteria has 
resulted in just 21 individual distribution points across Ontario.

"That number would be barely adequate to serve a city the size of 
Toronto, quite frankly," Mr. Long said.

"And there are some real hot spots around the province. There is a 
real problem in Sudbury and Thunder Bay around opiates."

A single dose of naloxone is $1.50, proving the barriers to wider 
distribution stem more from bureaucratic entanglements than financial concern.

Last month, more than 200 physicians and public-health officials 
signed a letter imploring the province to better prepare for a spike 
in overdoses linked to bootleg fentanyl. Signatories called for 
real-time surveillance of opioid overdoes, timely toxicology testing 
of drugs seized at crime scenes and broader distribution of naloxone.
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MAP posted-by: Jay Bergstrom