Reducing Regulatory Barriers to Accessing Treatment, and New Funding for Innovative Projects
The opioid crisis is a national public health crisis that continues to devastate individuals, families and communities.
As part of the efforts to address this crisis, the Government of Canada has announced new actions to improve access to treatment and new funding for innovative projects:
Regulatory amendments to accessing methadone as a treatment
Methadone is commonly used to treat opioid use disorder in Canada. To prescribe, administer, sell or provide methadone, health care providers must apply for an exemption from the Narcotic Control Regulations. This exemption can be sought directly from Health Canada or through the relevant provincial or territorial licensing authority, which in turn makes a recommendation to Health Canada on behalf of the practitioner. This special exemption requirement is unique to methadone and does not apply to other opioids such as:
- high-strength pain relievers such as controlled-release oxycodone and fentanyl
- buprenorphine, a drug used to treat opioid use disorder.
These regulatory amendments, which were published on March 21 and come into effect 60 days after the Canada Gazette, Part II publication, will remove this unique requirement and allow health care providers to administer methadone treatment without needing to apply for an exemption from federal law. The objective of these regulatory amendments is to help Canadians have greater access to a continuum of treatment options for opioid use disorder and to enable more doctors, such as family physicians, to prescribe methadone.
Regulatory amendments to accessing diacetylmorphine as a treatment
As with other opioids, prescription diacetylmorphine has traditionally been used to treat pain. In Canada, diacetylmorphine, or pharmaceutical-grade heroin, can also be used when a patient with opioid use disorder has not responded to other forms of treatment, such as methadone or the combination of buprenorphine and naloxone.
Diacetylmorphine has specific regulatory controls that restrict its administration to hospital settings. Therefore, someone who is receiving treatment with diacetylmorphine must go to a hospital to receive it, which could mean having to return to the hospital multiple times a day. This could make it difficult for an individual to carry on with normal everyday activities such as having a job.
The regulatory amendments, which were published in the Canada Gazette, Part II on March 21 and come into effect 60 days after publication, will allow health care providers to provide this treatment outside a hospital setting and will make diacetylmorphine-assisted treatment more accessible to patients. The amendments will also allow nurse practitioners to prescribe diacetylmorphine if they are permitted to do so under the laws of their province or territory. These changes will allow diacetylmorphine-assisted therapy to be offered by doctors and nurse practitioners in a wider range of treatment facilities, such as substance use disorder clinics.
National clinical management guidelines for opioid use disorder
The Canadian Research Initiative in Substance Misuse (CRISM)—a national network of researchers, service providers, policy makers, and people with lived experience—received funding from the Canadian Institutes of Health Research (CIHR) to develop a national guideline for the clinical management of opioid use disorder (“the Guideline”).
The Guideline delivers a comprehensive set of recommendations to health care providers for managing opioid use disorder. It recommends primary care-led approaches, focusing on oral medications, with buprenorphine-naloxone as the preferred first-line treatment.
The Guideline was developed through an extensive consultation process with experts and people with lived and living experience. It was published in the Canadian Medical Association Journal on March 5.
Funding for a drug-checking pilot project in Toronto
Through the Substance Use and Addictions Program (SUAP), the federal government will provide more than $2 million to St. Michael’s Hospital for a pilot project to test drug-checking services at three supervised consumption sites in Toronto: The Works at Toronto Public Health; Parkdale Queen West Community Health Centre (Queen West site); and South Riverdale Community Health Centre.
The pilot project will test drug samples using mass spectrometry technology, and will include a study on how to optimize its use for timely and reliable results. This project will also look at how information on what is in the tested drugs will affect the behaviour of those who use drugs, including choosing to use less of a substance if it’s found to contain high levels of a contaminant.
Funding for a drug-checking pilot project in British Columbia
Through SUAP, the federal government will provide almost $3 million to the British Columbia Centre on Substance Use for a pilot project to test drug-checking services in three locations in the BC region.
This pilot project will include Fourier-transform infrared (FTIR) spectrometers and additional laboratory analytic testing in Vancouver and Surrey. Fentanyl test strips will be used in the Surrey and Nelson supervised consumption sites. This project will also look at whether people who use drugs will use these services and how these practices could be applied across Canada.
Funding for the British Columbia (BC) Centre for Disease Control for a pilot project on safer alternatives for people who use drugs
Through SUAP, the federal government will provide almost $1.5 million to the BC Centre for Disease Control to fund a pilot project that will provide a safer alternative to illegal opioids, hydromorphone (Dilaudid), to people who use drugs. The goal of this project is to reduce overdose deaths in individuals at high risk due to their use of illegal opioids by providing a safer alternative. This pilot project will connect high-risk users who are not currently accessing conventional harm reduction and treatment services to health and social supports. These supports will include counselling, health services and treatment for substance use disorder.
Funding for the BC Centre for Disease Control to develop peer support programs
Through SUAP, the federal government will provide almost $300,000 to the BC Centre for Disease Control to develop peer support programs for those with lived and living experience and who are working in overdose response environments. Peers and peer worker programs play a large role in persuading people who use drugs to seek help from health and social services. Evidence has shown that peers of people who use drugs are usually the first responders in an overdose situation, and these experiences can cause a significant amount of trauma for them.
This funding will go towards developing, implementing and evaluating two different peer-developed and peer-led programs to support peers who are working in overdose response environments.
Funding for Canadian Academy of Geriatric Psychiatry to develop guidelines, tools and resources to address substance use disorders in older adults
Through SUAP, the federal government will provide more than $960,000 to the Canadian Academy of Geriatric Psychiatry to develop guidelines, tools and resources to address substance use disorders in older adults. The project will develop four national guidelines for older adults focused on alcohol, opioids, benzodiazepines and cannabis.
The effects of aging on the body can result in an increased use of prescribed medications such as opioids and benzodiazepines, and can increase an individual’s sensitivity to these drugs. This makes older adults vulnerable to problematic substance use and its negative effects. The four national guidelines will consider the unique social, biological, pharmacological and psychological circumstances of older adults and focus on best practices.
Funding for Manitoba Health, Seniors and Active Living to increase the availability and delivery of opioid replacement therapy services
Through SUAP, the federal government will provide more than $2 million to the Manitoba Health, Seniors and Active Living to increase the availability and delivery of opioid replacement therapy services. The initiative aims to ensure that opioid replacement therapy prescribers in all areas of the province would receive consistent information and training regarding opioid replacement therapy service. The funding will also help expand the availability of trained opioid replacement therapy prescribers across the province and offer consistent training to other health and social service providers who provide psycho-social-spiritual supports for persons with opioid dependence who access opioid replacement therapy.
Funding from the Canadian Institutes of Health Research (CIHR)
CIHR, the Government of Canada’s health research investment agency, is investing a further $8.95 million to support 10 cutting-edge opioid-related research projects, including:
- Research: Dr. Christophe Altier at the University of Calgary
- Amount: $975,000
- Project: Studying the modulation and transmission of pain signals in pursuit of better pain management
- Research: Dr. Nathalie Auger at the Centre hospitalier de l’Université de Montreal (CHUM)
- Amount: $309,000
- Project: Studying the outcomes of pregnant women who use opioids, and the outcomes of their children
- Research: Dr. Jane Buxton at the BC Centre for Disease Control
- Amount: $520,000
- Project: Studying patterns of opioid prescription in BC and its relation to opioid dependence, illegal drug use, overdose and death
- Research: Dr. Patricia Conrod at the Centre hospitalier universitaire Sainte-Justine (Montreal)
- Amount: $1,774,000
- Project: Studying illicit substance use prevention efforts for Canadian adolescents
- Research: Dr. Nadia Fairbairn at the University of British Columbia
- Amount: $585,000
- Project: Studying how slow-release oral morphine can be repurposed as a new oral alternative for treating opioid use disorder
- Research: Dr. Marc Olivier Martel at McGill University
- Amount: $302,000
- Project: Studying the factors responsible for opioid cravings in patients with chronic pain
- Research: Dr. Graciela Pineyro at the Centre hospitalier universitaire Sainte-Justine (Montreal)
- Amount: $929,000
- Project: Studying how to develop opioid painkillers without the customary serious side effects such as respiratory depression and constipation
- Research: Dr. Ana Miriam Velly at the Jewish General Hospital (Montreal)
- Amount: $141,000
- Project: Studying the possible link between opioid use and cancer risk
- Research: Dr. Zainab Samaan at McMaster University
- Amount: $1,110,000
- Project: Studying how one’s genetic makeup can affect the body’s response to methadone
- Research: Dr. Jean Shoveller at UBC
- Amount: $451,000
- Project: Studying interventions specifically to reduce overdose-related harms to women
CIHR is also investing $1.85 million to fund a further 22 knowledge synthesis grants. These grants were directly informed by knowledge users, enabling researchers to consolidate available evidence relevant to identified knowledge gaps and feed it back into the hands of service providers, community advocates and provincial, territorial and federal policy makers on the front lines of the opioid crisis.
For more information on federal actions on the opioid crisis, please visit Canada.ca/Opioids.
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