Pubdate: Mon, 04 Jul 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Authors: Karen Howlett & Patrick White
Page: A1

MINISTRIES' TURF WAR STALLS DISTRIBUTION OF NALOXONE TO PRISONS

A turf battle between provincial ministries has stalled efforts to
distribute the opioid antidote naloxone to prisons in Ontario, further
limiting access to the lifesaving drug for people at high risk of 
overdosing.

For three years, public-health doctors have called on the province to
distribute take-home naloxone kits to prisons for newly released
inmates, who can be in particular danger from opioids. More recently,
they have urged the province to provide naloxone kits through hospital
emergency departments, which have had a 72-per-cent increase in visits
due to opioid overdoses in the past decade, according to figures
obtained by The Globe and Mail.

As of last month, the Ministry of Health had no plans to expand its
program for public-health units, which restricts distribution of the
take-home kits to needle-exchange sites, spokesman David Jensen said.
That has left the ministry in charge of correctional services to
improvise a solution for inmates leaving prison.

"This is a failed program," said Meldon Kahan, medical director of the
Substance Use Service at Women's College Hospital in Toronto. "They
are not reaching the people who really need it."

The Health Ministry's stand shows the gaps in the Ontario government's
response to an opioid crisis sweeping the nation, and puts the
province increasingly out of step with other regions in responding to
a surge in overdose deaths linked to illicit fentanyl. A recent Globe
investigation found that traffickers can easily order the highly
potent, low-cost drug online from overseas and have guaranteed
shipments to Canada.

The American Heart Association's 2015 cardiovascular care guidelines
say patients treated for an overdose in emergency rooms and inmates
released from prison are among the groups that benefit most from
naloxone. British Columbia, Alberta and Saskatchewan provide take-home
kits to patients treated in hospital for opioid overdoses. Alberta
hands out kits to inmates upon release, and British Columbia launched
a pilot program 10 months ago at two correctional centres with plans
to expand it province-wide.

The response in Ontario has been more muted. Health Minister Eric
Hoskins announced in May that Ontario would join B.C. and Alberta in
setting up a separate naloxone program for pharmacies, providing the
kits free of charge and over the counter without a prescription. But
barriers to access remain, especially in rural and Northern Ontario,
where pharmacies are few and far between.

Under Ontario's naloxone program for municipal public-health units,
only clinics that hand out clean needles to addicts can give the
first-aid treatment, which reverses the symptoms of an overdose in
minutes, to members of the public to take home. The shortcoming has
led to grassroots efforts to circumvent the rules.

A plan to distribute naloxone to released prison inmates ground to a
halt over the past six months in a jurisdictional row between
officials with the Ministry of Community Safety and Correctional
Services and the Ministry of Health, multiple public health sources
have told The Globe and Mail.

The rift between the two ministries dates back to at least Jan. 11,
when the correctional ministry's senior medical consultant, Lori
Kiefer, wrote to the province's regional medical officers of health
proposing a take-home naloxone program for all Ontario inmates
returning to the community.

In a letter obtained by The Globe, she asked medical officers in
regions with a correctional facility to develop "a common protocol and
explore means by which to deliver a program for this population at
risk."

When word of Dr. Kiefer's plan reached the Ministry of Health
department that is responsible for naloxone distribution in Ontario,
staff there refused to take action on it, complaining that corrections
staff had overstepped their authority, according to those familiar
with the discussions.

"There was 100-per-cent uptake on the part of public health to do
this," said Rosana Salvaterra, medical officer of health for
Peterborough, Ont. "My understanding is that bureaucrats working
within their respective ministries have shut this initiative right
down."

The corrections ministry refused a request to speak with Dr. Kiefer.
"It's important to know that we are in the early stages of looking at
the delivery of Take Home Naloxone kits in a correctional setting,"
spokesman Andrew Morrison said, without elaborating on when any such
program might be launched.

Mr. Jensen confirmed that the Health Ministry would not provide the
kits to Correctional Services. He said it was told it could go ahead
on its own and "purchase and distribute naloxone to inmates as they
see fit."

Instead of different ministries working in silos, Dr. Salvaterra said,
the government should set up a provincially co-ordinated naloxone
program. Pamela Leece, a resident in the public health and preventive
medicine program at the University of Toronto, said it makes more
sense to deal with naloxone in prisons as a health issue rather than a
corrections issue. "There's a high-risk population that needs
intervention," Dr. Leece said.

Dr. Kiefer's initiative was based in part on a recent research paper
she co-wrote, which found that an Ontario inmate's chance of dying by
an overdose spikes to 56 times the national average in the two weeks
after release.

"If we're interested in reducing deaths from overdose, it just makes
sense to deliver programs in places where people who use drugs spend
time," said Fiona Kouyoumdjian, a prison physician and lead author of
the study. "Given the state of our justice system, those people tend
to be concentrated in our correctional facilities."

Several communities in Ontario, including Peterborough and Waterloo
Region, are attempting to buy naloxone on their own and make it a
staple of hospital emergency departments. Dr. Kahan is making the drug
available in hospitals in seven communities as part of a project he is
spearheading that integrates treatment for opioid addiction and
primary care.

Kieran Michael Moore, associate medical officer of health for KFL&A
Public Health, an agency representing Kingston and neighbouring
communities, said it is crucial for him to be able to provide naloxone
kits in a region that houses 10,000 inmates.

"This is not rocket science," he said. "We don't know why it hasn't
quickly come to fruition."
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MAP posted-by: Matt