Author: rb809rb

Ontario’s medical regulator is proposing sweeping changes to prescribing safer supply drugs, The Canadian Press has learned.

The College of Physicians and Surgeons of Ontario is looking to clamp down on the practice and is set to hold a board of directors meeting next week to decide on the proposed changes.

Safer supply refers to prescribing medications as an alternative to opioids obtained on the streets to those who are at high risk of overdose.

The most common form of safer supply is hydromorphone, a powerful opioid often prescribed for pain but significantly less potent than fentanyl and its derivatives that dominate the illicit drug supply chain. Fentanyl is often found laced with other drugs such as benzodiazepines, a depressant, and xylazine, often used to tranquilize animals. 

One change the regulator has proposed in a document tucked away on its website is that “physicians must only prescribe safer supply medications in conjunction with opioid agonist therapy.” The therapy uses medications such as methadone to treat opioid addiction.

The college is also proposing an eight-week time limit for physicians to prescribe safer supply, and mandating that it be consumed in front of health-care professionals. 

The regulator previously made changes to its drug prescription policy in May that mandated physicians to perform an in-person assessment before prescribing narcotics for safer supply, as well as making it mandatory for doctors to offer opioid agonist therapy before prescribing safer supply drugs and perform follow-ups every three months.

The rationale behind the new proposed changes centres largely on diversion of patients’ prescription pills to the black market.

“The proposed amendments build on targeted changes introduced in May and respond to ongoing concerns about the diversion of safer supply medication and the resulting risks to patients and communities,” Mickey Cirak, spokesperson for the College of Physicians and Surgeons of Ontario, wrote in an email.

“In response, the college has proposed amendments intended to strengthen oversight of safer supply prescribing and enhance safeguards related to physician prescribing practices, consistent with its role as Ontario’s medical regulator.”

WATCH | Fifth Estate dives into Canada’s opioid crisis:

Canada’s opioid crisis has led to the deaths of tens of thousands of people, costing the health and justice systems billions. Many health providers say there were solutions that could have helped. We reveal how politics got in the way.

Health minister supports changes

The college said it has consulted with a broad range of people and organizations, including physicians, municipalities and health-care partners, as well as the office of Ontario’s chief medical officer of health, Dr. Kieran Moore.

Moore’s office did not respond to a request for comment or an interview. Moore has never granted The Canadian Press an interview about the province’s opioids crisis, despite more than a dozen requests since he took the role in 2021.

The College of Physicians and Surgeons said the initiative to change safer-supply prescription rules is its own and did not come from the provincial government.

WATCH | Ontario ends funding for supervised drug consumption sites:

Moss Park drug consumption sites to close as Ontario ends funding

Two supervised drug consumption sites in Moss Park received letters on Friday from the Ontario Ministry of Health saying that their provincial funding will end in 90 days. CBC’s Ali Chiasson spoke to advocates who are concerned this could lead to more open drug use in the area.

Cirak said the college also received feedback from doctors with expertise in addiction medicine.

The proposal has the support of Health Minister Sylvia Jones.

“Our government does not and will never support the distribution of illegal drugs, including the illicit use of hydromorphone masked as ‘safer supply,’” said Satnam Grewal, a spokesperson for Jones.

“We welcome any action from Ontario’s 27 regulatory colleges who set standards and obligations for health-care professionals, including the College of Physicians and Surgeons of Ontario, to crack down on the predatory prescribing of addictive drugs.”

Changes ‘dangerous’: harm reduction worker

Ontario has moved to an abstinence-based model under Premier Doug Ford in its approach to the ongoing opioid crisis. The province closed provincially funded supervised consumption sites and passed a law banning them within 200 metres of schools and daycares. 

The province has since opened 29 homelessness and addiction recovery treatment hubs, which the government calls HART hubs. It has spent more than $500 million on that plan, which offers primary and mental health care, addiction services and peer supports. 

Word of the proposed changes has reached some people who depend on safer supply, said Lorraine Lam, an organizer with the Shelter and Housing Justice Network and a longtime harm reduction worker. 

WATCH | ‘HART’ hubs replace supervised drug consumption sites:

Ontario opens homelessness and addiction hubs, replacing consumption sites

After passing a law closing numerous supervised consumption sites, the province opened nine of its HART hubs on Tuesday. But critics say Ontario’s new approach is off to a bumpy start. Shawn Jeffords explains.

“The changes are really dangerous and very destabilizing,” Lam said. 

“People are really, really scared and people are really, really anxious and very angry.”

She said some people using safer supply got jobs or returned to school and she’s worried what will happen to them when they’re cut off.

“The reality is people who are on safe supply are going to be de-prescribed really, really quickly, which will increase the chances of people turning to the street unregulated supply, which will then therefore increase the risk of overdoses and deaths,” Lam said.

The college’s board of directors is set to meet on Oct. 13, when it is expected to vote on the proposed changes.

Kenyan authorities on Tuesday confirmed the country’s first imported Ebola case from Congo, making Kenya the latest country affected by the fast-moving outbreak.

Health Minister Aden Duale said a Kenyan citizen who arrived in the country on Saturday from Congo, via its neighbour Uganda, had been isolated and treated at Nairobi Hospital, where he tested positive for the Ebola virus and died late Monday.

Ebola is highly contagious and spreads in the human population through contact with bodily fluids such as vomit, blood or semen, and with contaminated surfaces and materials, such as bedding and clothing.

The current outbreak was declared in mid-May, months after it had been spreading in a remote part of eastern Congo. At least 8,400 cases have been recorded, including more than 4,000 deaths, according to government data, making it the fastest-growing outbreak of the disease in history.

Kenya had never had an outbreak of Ebola, according to the Kenya Medical Research Institute. Dozens of contacts have either been identified or are being traced.

Duale said Kenya was well-prepared to respond to Ebola cases, having trained nearly 5,000 health workers across the country on prevention and management.

Kenya is the fourth country to record an Ebola case in the current outbreak.

Tracing of flight passengers begin

Uganda has recorded 20 cases and France one. Before Kenya reported its case, there had been no active cases outside Congo since Uganda declared its outbreak over in late August.

Health authorities in Kenya have placed the country’s border points on high alert and are monitoring for possible additional cases.

Kenya’s Health Minister Aden Duale holds a news conference in Nairobi on Tuesday, announcing the first case of Ebola in the country. (Monicah Mwangi/Reuters)

Duale said 28 contacts, including family members and health workers who cared for the patient, had been identified. Another 23 passengers who travelled on the same flight from Uganda were being traced.

He said the patient had been living in Congo for the past seven years and fell ill about a month ago. He was treated at various hospitals before travelling by road to Kampala, where he boarded a flight to Nairobi, arriving on Saturday afternoon.

The contacts will remain in isolation for 21 days and will be released after testing negative for the virus, the Health Ministry’s director, Patrick Amoth, said.

WATCH | Congo’s record Ebola outbreak :

Ebola outbreak now deadliest in Congo’s history

The Ebola outbreak in the Democratic Republic of Congo is officially the deadliest in the country’s history, and health officials worry the crisis will only get worse when children return to school.

The patient’s relatives later took him in a private vehicle to Nairobi Hospital, where he was immediately isolated. He will be buried within 24 hours in accordance with recommended public safety protocols.

The minister said Kenya had tested 267 samples at five laboratories across the country since May before this first case was detected.

Congo’s outbreaks ‘like fighting a megafire’

In Congo, where the outbreak has spread to seven provinces, conditions are difficult. Responders have faced attacks on health teams, misinformation about the virus, a failure by locals to report symptoms and rebel violence that has limited access to treatment centres.

While cases have slowed in Ituri province, the epicentre, the outbreak is spreading in emerging hot spots in North Kivu and South Kivu provinces.

“It is like fighting a megafire. Multiple outbreaks are developing at the same time, with varying intensity and in different locations,” Stephanie Hoffmann, with Doctors Without Borders, said in a statement. 

The World Health Organization has warned this could surpass the deadliest Ebola outbreak in history, which erupted more than a decade ago and killed some 11,000 people in West Africa.