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Province to de-list high-dose opioids

TORONTO—Ontario will be the first province to stop paying for high doses of long-acting opioids as part of a push to reduce the “growing problem” of addiction to the pain-killers in the province.

The Ministry of Health said that in January, 2017, high doses of the pain-killers will be removed from the Ontario Drug Benefit Formulary, which covers the cost of drugs for people who are 65 or older, live in a long-term care home, receive social assistance, or have high drug costs relative to their income.

It’s a decision that Dr. David Juurlink, head of the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, said is a “good move” on the government’s part because it may discourage doctors from prescribing unnecessarily-high doses of the drugs.

“We’re starting to see doctors prescribe them somewhat less regularly, but they are still used very, very often,” Juurlink noted.

“And, I think, too often.”

The affected drugs include 200-mg tablets of morphine, 24-g and 30-mg capsules of hydromorphone, and 75-microgram per hour and 100-microgram per hour patches of fentanyl.

But the change doesn’t affect lower doses of the drugs, which the ministry said actually can be more effective than high doses.

Ontario’s health minister said in a written statement that de-listing the drugs is an “important first step” in limiting high doses of opioids, which he noted are linked to overdose deaths.

Dr. Tara Gomes, who works at St. Michael’s Hospital and is a principal researcher for the Ontario Drug Policy Research Network, said these high doses of opioids can get people addicted—and even cause an overdose—with just one use.

Gomes was the lead author of a 2014 study that found Ontario dispensed the most high-dose oxycodone and fentanyl in the country per capita between 2006 and 2011.

The study showed that across the country, the rate of dispensing high-dose opioids rose 23 percent over the same period.

Juurlink, who also was an author on the study, said opioid addiction reaches beyond just Ontario and Canada.

He noted the over-prescription of high doses of the drugs is “a North American issue.”

Prescribing high doses of the drugs is particularly problematic because drug addicts, and people looking to “make a buck” by selling their prescriptions, are more likely to look for higher concentrations, Juurlink said.

But he noted there are some legitimate uses for high doses, like in end-of-life care.

“I’ve heard grumblings [about the announcement], mostly from the palliative care communities,” Juurlink said.

But he noted doctors who need to prescribe a higher dose can instruct their patients to scale up the number of pills they take.

He said the same could be done for patients who don’t necessarily need high doses, but that this move may encourage doctors think critically about why they prescribe such high dosages.

And Gomes noted the high dosages still will be available in the province.

They just won’t be refunded to patients under the Ontario Drug Benefit Formulary, so patients will have to pay out-of-pocket or use insurance to buy them.

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