Ontario to stop paying for higher-strength opioid painkillers

Ontario will stop paying for higher-strength opioid medications through its Ontario Drug Benefit (ODB) program next January as part of its strategy to address the growing problem of addiction to the painkillers.

Opioidssuch asfentanylandmorphineare often prescribed to patients with chronic pain, but can often lead toaddiction and overdose deaths.

• CDC urges U.S. doctors to limit opioid prescriptions

• Fentanyl and other opioids for chronic pain put patients on a dangerous slope

To help fight what it calls the "growing problem of opioid addiction in Ontario," the province's Ministry of Health and Long-Term Care announced last week that it would stop paying forthe following higher-strength long-actingopioidsfrom itsODB drug formulary as of January 2017:

• Morphine, 200 mg tablets.
• Hydromorphone, 24 mg and 30 mg capsules.
• Fentanyl, 75 mcg/hr and 100 mcg/hr patches.

The provincewill also delist50 mg tablets of Meperidine, also known as Demerol.

The ministry said it was giving six months notice of the funding changesto give patients time to consult with their doctors aboutchanges that may be required to their drug treatment plan.

"Physicians should initiate this discussion as soon as possible with any patients affected by these changes," the ministry advises in a notice on its website.

Ontario's drug benefit plan pays the cost ofmany prescription drugsfor those 65 and over as well as for those on assistance.

Lower doses better for patients

The Ontario government's action followed its establishment of a "pain subcommittee"to carry outa review of narcotics prescribed for pain management.

"The subcommittee indicated that lower opioid doses may improve patient outcomes," the ministry said in a statement. "Since many patients on high doses may be considered 'opioid failures,' tapering or withdrawing opioid treatment may result in improved mood, pain and function, with less sedation, fatigue, constipation, etc."

• Opioids tied to 1 in 8 deaths in young adults, Ontario study shows

Deaths linked to opioid use in Canada have soared in recent years.

A 2014 study found that opioids were related to one in eight deaths among young people in Ontario.

Rates of opioid-related death in the province increased by 242 per centbetween 1991 and 2010, rising from 12.2 deaths per million in 1991 (127 deaths annually) to 41.6 deaths per million in 2010 (550 deaths annually).

More recently, British Columbia declared a public health emergency in April after a dramatic increase in the number of overdose deaths from opioidslikefentanyl.

Of the 201 overdose deaths recorded in B.C. in the first three months of 2016, 64 involved fentanyl, according to the province's medical officer of health.