Canada's provinces and territories plan to set up a national narcotics monitoring network that would provide the first comprehensive snapshot of the number of opioids doctors are prescribing to their patients.
The creation of the network was among a series of pledges made over the weekend, following a two-day summit in Ottawa on an opioid crisis whose consequences are reflected in the growing rates of addiction, overdoses and deaths across the country.
"We are absolutely committed to work in co-ordination in order that lives will be saved and that Canadians will be better educated on how opioids can be used appropriately," federal Health Minister Jane Philpott said at a news conference, where she was flanked by several of her provincial counterparts.
A "Joint Statement of Action to Address the Opioid Crisis" released by Health Canada at the conclusion of the conference tacitly acknowledges that policy makers are playing catch up on an epidemic that began two decades ago and that has worsened since 2012 with the arrival of bootleg fentanyl in many communities. Canada is the world's second largest per capita user of prescription opioids.
"We recognize that this is just the beginning," says the document, which outlines several areas where Ottawa and the provinces plan to collaborate, including gathering pan-Canadian figures on the number of emergency department visits and deaths due to opioid overdoses, and making harm-reduction measures, such as the addiction-treatment drug Suboxone, more widely available.
The narcotics monitoring system would allow policy makers to better manage what many at the summit called a public health emergency – physicians and pharmacists could check to see whether patients are obtaining drugs from multiple providers and regulators could identify prolific prescribers.
"Not having real-time surveillance in this crisis is like trying to plug holes of a sinking ship in the dark, not only with respect to opioid prescribing but even more importantly with respect to drug-use trends, drug-related harms and deaths," said Hakique Virani, an Edmonton-based public health and addiction-medicine specialist.
The opioid summit – the first of its kind in Canada – signals the federal government's resolve to address the problem. But major barriers remain, said Meldon Kahan, medical director of the substance use service program at Women's College Hospital in Toronto. "They are just starting to take steps that are quite timid but are not keeping up with the extent of the crisis," Dr. Kahan said.
An investigation by The Globe and Mail found that Ottawa and the provinces have failed to take adequate steps to address the roots of the problem: the over-prescribing of prescription painkillers. The practice dates back two decades, to when doctors began prescribing opioids to relieve moderate to severe pain as pharmaceutical companies promoted their benefits. In 2015, doctors wrote one prescription for every two Canadians.
Many provinces have no real-time monitoring systems for tracking patients who are double doctoring, and who is prescribing what to whom. In Ontario, every prescription filled by a pharmacist goes through a monitoring system, but only pharmacists, and not physicians, have access to it.
During the summit, several provinces made a commitment to improve their monitoring of prescription drugs. New Brunswick plans to set up a program that will provide alerts in real time to physicians and pharmacists to help them identify patients who may be at risk of addiction.
Newfoundland and Labrador plans to have a monitoring program for prescription painkillers up and running by the end of 2017.
Saskatchewan already has a prescription review program that allows authorized health-care professionals to electronically view current and past prescriptions of residents in the province. To reduce the abuse and diversion of opioids, the province will provide funding to its College of Physicians and Surgeons to operate the program.
Ontario is planning to provide physicians with reports showing how their opioid prescribing compares to that of their peers and to best practices. Pharmacists in Ontario already have access to that information.
"Every pharmacist in every town is aware of who the big prescribers are," said Tom McAnulty, a pharmacist in St. Catharines, Ont. "I can run a report on my screen and see how many scripts doctors write."
British Columbia, which has borne the brunt of the opioid crisis with 622 overdose deaths in the first 10 months of this year alone, has the most comprehensive narcotics surveillance system in Canada.
PharmaNet provides pharmacists, hospital emergency departments, community health centres and regulatory colleges with up-to-the-minute information about all prescription medications dispensed anywhere in British Columbia.