Federal Action on Opioids

The growing number of overdoses and deaths caused by opioids (powerful pain relieving drugs) is a national public health crisis. The Minister of Health has made combatting this crisis a top priority.

The Government of Canada is taking a leadership role by using all of its available tools. We are working with provinces, territories and other partners across the country to take a collaborative approach to the crisis. On November 18 and 19, 2016, the Minister of Health brought together health partners to commit to joint action. The Joint Statement of Action to Address the Opioid Crisis outlines the combined commitment of over 30 partner organizations to respond to this crisis. The statement was created as a result of the Opioid Conference and Summit.

What is the opioid crisis?

The opioid crisis can be linked to the rapid rise in rates of drug overdoses and death involving both:

  • Prescription opioids; and
  • Increasingly toxic illegal drugs due to the increased presence of powerful illegal substances, such as fentanyl, a drug 50-100 times more potent than morphine.

Anyone who uses drugs can be at risk of an overdose, including those who:

  • are struggling with an addiction
  • use drugs occasionally in a recreational context
  • are trying an illegal drug for the first time
  • are not strictly following their health care professionals’ instructions

What is the Government of Canada doing about the opioid crisis?

Under the Joint Statement of Action to Address the Opioid Crisis, Health Canada committed to take new action across the Health Portfolio.

The Health Portfolio’s actions to address the opioid crisis complement the Government of Canada’s overall approach to drug policy, which is:

  • collaborative
  • compassionate
  • comprehensive
  • evidence-based

These values are reflected in our Canadian Drugs and Substances Strategy. Led by the Minister of Health, this strategy is a balanced and health-focused approach to drug policy, involving:

  • a strong foundation in evidence
  • the restoration of harm reduction
  • prevention
  • treatment
  • enforcement

The Government of Canada is committed to taking action on Canada’s opioid crisis through a targeted public health emergency response and through:

  1. Prevention
  2. Treatment
  3. Harm reduction
  4. Enforcement

Actions in these areas will be supported by a strong evidence base.

We will publish quarterly reports on progress implementing these Federal Action on Opioids and undertake new measures to respond to the crisis as they are identified.


To prevent problematic opioid use, we will:

  • better inform Canadians about the risks of opioids
  • support better prescribing practices
  • reduce easy access to unnecessary opioids
Action Progress Next steps
Amend regulations to allow for mandatory:
  • warning stickers on all opioids outlining their risks
  • information handouts for patients receiving prescribed opioids

November 15-16, 2016: A Scientific Advisory Panel was held to make recommendations on the content of warning stickers and information handouts.

February 17, 2017: The Record of Proceedings of the Scientific Advisory Panel was published online.
Spring 2017: We will propose amendments to the Food and Drug Regulations for pre-publication in the Canada Gazette, Part I.
Implement an evidence-informed public education campaign about problematic substance use. November 2016: A teen testimonial-style video campaign was launched, which shares stories of young Canadians and their families affected by problematic prescription drug use and addiction.

Summer/Fall 2017: New marketing tactics and outreach efforts are in development including events for teens and parents and patients; topic-related videos; and a mix of traditional and digital advertising. Messaging will focus on prevention and harm reduction and will be tailored for specific audience needs. Campaign materials will highlight the risks of opioids misuse, addiction and overdose prevention. Promoting Canada’s new Good Samaritan Drug Overdose Law is also included in the planned outreach activities.

Ongoing: We will continue to implement the public education campaign using a variety of outreach channels, including social media, experiential marketing, traditional and new media marketing activities and web-based communications.
Continue to promote best practices and national approaches through the Federal/Provincial/Territorial Prescription Monitoring Program Network. Ongoing: The Federal/Provincial/Territorial Prescription Monitoring Program Network will continue to assess the feasibility of mandating the programs in Canada and develop standard data indicators for programs.

The Network will also continue to share information and make links among partners on related initiatives, including:

Ongoing: The 2017-2018 workplan focuses on:

  • Privacy challenges
  • Prescription monitoring program profiles
  • Prescription monitoring data indicators
  • Stakeholder engagement and partnerships
Share information on prescribing practices with provincial and territorial regulatory and licensing bodies. This information will be obtained from Health Canada's compliance and enforcement activities in pharmacies. We are working with partners, including the Federal/Provincial/Territorial Prescription Monitoring Program Network to identify opportunities for collaboration. Winter/Spring 2017: Identify opportunities to assist provincial and territorial authorities by filling information gaps.
Engage with health professional licensing and regulatory bodies, to increase awareness of the First Nations and Inuit Health Branch's Non-Insured Health Benefits Program's (NIHB):

Ongoing: The NIHB program shares information and discusses new initiatives and decisions related to the Program’s Problematic Prescription Drug Use initiatives. 2017-18: Planned engagement with various regulatory bodies to discuss emerging issues and coordinate responses to problematic prescription drug use. 
Determine whether new contraindications are necessary for approved opioids (via the Canadian Product Monograph) to help practitioners make prescribing decisions. March 24, 2017: The Scientific Advisory Panel met to advise on the labelling of approved opioids (with a focus on examining information on contraindications). June 2017: A Record of Proceedings containing the Panel’s recommendations will be finalized and posted online.

*Revised Commitment*

Amend regulations to enable the Minister of Health to impose terms and conditions on opioid authorizations in order to require pharmaceutical companies to develop and implement risk management plans to identify, monitor, and or mitigate risks associated with opioid use.

Updated from:

Amend regulations to require manufacturers to develop and implement Risk Management Plans for opioid medications. They would be required to identify, characterize, prevent or minimize risks related to opioids.

November 15-16, 2016: A Scientific Advisory Panel was held to discuss and make recommendations on the Risk Management Plans, including which opioid products should be a priority.

February 17, 2017: The Record of Proceedings of the Scientific Advisory Panel was published online.

Spring 2017: The Minister will propose amendments to the Food and Drug Regulations for pre-publication in the Canada Gazette, Part I.

*Delayed to allow for further consultation*

Consider amending regulations to require a prescription for low-dose codeine products.

Information is being gathered from partners and stakeholders to assess risks and benefits, including from partners in Manitoba.

As of February 1, 2016: The Manitoba College of Pharmacists requires a prescription for low-dose codeine products from a:

  • physician
  • nurse practitioner
  • dentist
  • pharmacist

Summer 2017: Consultation will begin to identify potential risks and benefits and to gather available evidence to support analysis.

*Delayed to allow the consultation to take place at the same time as the related consultation on handling and destruction of unserviceable stock*

Update guidance to pharmacies on the destruction of consumer-returned prescription drugs. This will support and encourage them to accept returns while minimizing the risks of diversion to illegal markets and problematic use.

May 2017: Draft guidance to be shared with targeted stakeholders for consultation. 

Spring/Summer 2017: Publish and disseminate final guidance to community pharmacies, incorporating feedback obtained through consultation process.


To support better treatment options for patients, we will:

  • facilitate access to treatments for pain and opioid use disorder
  • promote collaboration and knowledge sharing on innovative approaches to treatment and rehabilitation
Action Progress Next steps
Review submissions for non-opioid pain relievers more quickly. No submissions have been received by Health Canada for review to date.  


Amend regulations to enable access to diacetylmorphine (pharmaceutical grade heroin) through Health Canada's Special Access Programme.
May 14, 2016: A notice to interested parties published in the Canada Gazette, Part I.

September 7, 2016: Final regulatory amendments approved and published in the Canada Gazette, Part II.
This action has been completed.
Support access to medication-assisted treatments that are not available on the Canadian market for opioid use disorder through Health Canada's Special Access Programme.

January 6, 2017: The Minister of Health wrote to her provincial and territorial colleagues, encouraging them to contact Health Canada's Chief Medical Advisor to discuss:

  • anticipated treatment needs
  • any factors they feel may affect timely access to and the implementation of treatment options

Ongoing: Continue to work with provincial and territorial health officials to identify treatment needs.

*Delayed to streamline with the Canadian Research Initiative in Substance Misuse (CRISM) national treatment guidelines consultation process*

Consult on special exemption requirement for methadone prescribing. This consultation will determine whether the requirement poses an unnecessary barrier to access to treatment.
Canadian Institutes of Health Research (CIHR) is funding the Canadian Research Initiative in Substance Misuse (CRISM) to develop a national guideline for medication-assisted treatment of opioid use disorder.

February 7, 2017: British Columbia's new Guideline for the Clinical Management of Opioid Use Disorder was published (funded in part by CIHR-CRISM).

April 2017: Health Canada and CRISM researchers are working together to develop a methadone consultation process.

Spring/Summer 2017: Consultation with experts and stakeholders who are involved in the design and delivery of methadone treatment programs will be held to identify:

  • any barriers to access posed by the current regulatory regime
  • options to remove those barriers

Summer 2017: National treatment guidelines for opioid use disorder to be released.

Winter 2017: Final report on the outcomes of the methadone consultations to be released
Improve access to buprenorphine/naloxone (that is Suboxone® and its generic formulations) treatment in rural and remote First Nations communities. We will do this by taking steps to ensure that the supports are in place to safely store, handle and undertake the daily witnessing of the medication. Ongoing: In 2013, the First Nations and Inuit Health Branch (FNIHB) added buprenorphine/naloxone to their Nursing Station Formulary. This addition accommodates the unforeseen realities (like weather delays) of delivering client-specific medications to remote First Nation communities. This act also ensures communities using the drug as part of approved community-based opioid addiction treatment programs can continue treatment without interruption.

Spring 2017: Initiate a scan of the availability of, and accessibility to buprenorphine/naloxone and methadone for treatment in order to identify the current range of infrastructure, jurisdictional and regulatory differences and community interest.

Fall 2017: Work with regions to identify challenges and opportunities for communities to access buprenorphine/naloxone, recognizing the importance of holistic, wrap-around treatment programs. A number of sites will be selected to expand local access to treatment programs based on Budget 2017 investments.
Bring together experts and policy makers for a focussed discussion on treatment of opioid use disorder. The discussion will include topics such as:
  • the current evidence base on best practices for opioid addiction treatment
  • knowledge gaps barriers for the implementation of best practices
Health Canada and the Canadian Institutes of Health Research are working with partners to plan the treatment symposium. Fall 2017: Host a treatment symposium.
Work with the Canadian Agency for Drugs and Technologies in Health (CADTH) to fill knowledge gaps on treatment options by helping to disseminate their reports.

September 2, 2016: CADTH published a report summarizing the existing scientific information comparing two medications used to treat opioid dependence: methadone and buprenorphine/naloxone.

The report has been shared with CADTH's Formulary Working Group to support federal, provincial, and territorial decisions to include buprenorphine/naloxone in publicly funded drug plans.

November 19, 2016: In the Joint Statement of Action to Address the Opioid Crisis, CADTH committed to analyze:

  • the international literature to identify best practices for pain management interventions (drug and non-drug)
  • the treatment of opioid addiction.

CADTH will provide evidence-based recommendations and decision-support tools that will inform and guide patients, clinicians and policy-makers on these interventions and treatments.

March 2017: CADTH has established a cross-functional opioid working group to identify, lead, and coordinate efforts to fulfill CADTH's commitment.

CADTH is also identifying and pursuing partnerships with various external organizations to collaborate on related activities and deliverables.

CADTH has developed an opioid evidence bundle and an evidence bundle on pain management on its website.
November 2017: CADTH to complete their recommendations and decision-support tools.

Collaborate with the Non-Insured Health Benefits Program (NIHB) and other public drug plans on initiatives for plan-based problematic prescription drug use to:

  • increase innovation
  • prevent the shifting of costs and problems from one payer to another
Ongoing: The Canadian Agency For Drugs And Technologies In Health (CADTH) Drug Policy Advisory Committee has created a working group to facilitate communications between public drug plans. This group will share information and coordinate actions related to problematic prescription drug use. NIHB participates in this working group.

The NIHB Program gets advice from its Drugs and Therapeutics Committee meetings on problematic prescription drug use initiatives. Other federal public plans are welcome to attend these meetings.
2017-18: Continued participation in review of opioid prescribing guidelines, opioid addiction treatment guidelines, and evidence review as part of Drug Policy Advisory Committee.

*New Action*

Amend regulations to allow the importation of drugs for an urgent public health need (such as the opioid crisis) that have been authorized for sale in the United States, European Union or Switzerland, but that are not yet authorized in Canada.  The need for the drugs would be notified by Public Health Officials. The drugs would appear on a list, incorporated by reference into the Food and Drug Regulations and maintained by the Minister.
April 22, 2017: Regulatory proposal has been pre-published in the Canada Gazette, Part I.

By Summer 2017: The Minister will propose amendments to the Food and Drug Regulations for publication in the Canada Gazette, Part II.

Harm reduction

To support measures that reduce the negative consequences of problematic opioid use, we will support a range of tools and harm reduction measures for communities, including:

  • communicating results from laboratory testing
  • facilitating access to naloxone
  • reviewing supervised consumption site applications
Action Progress Next steps

Support the establishment of supervised consumption sites by:

  • proposing necessary amendments to the Controlled Drugs and Substances Act to remove any undue barriers introduced through the Respect for Communities Act
  • supporting applicants to complete the application process through proactive engagement
  • keeping the public up to date on the status of applications that have been submitted to Health Canada, including their stage in the review process

December 12, 2016: The Minister of Health and the Minister of Public Safety introduced Bill C-37  in the House of Commons. The proposed legislation would repeal the previous legislative regime for establishing supervised consumption sites. This legislation would streamline the application process to align it with the five factors set out by the Supreme Court of Canada, which includes community consultation.

December 12, 2016: The Minister of Health replaced the National Anti-Drug Strategy with the Canadian Drugs and Substances Strategy (CDSS). Led by the Minister of Health, the CDSS restores harm reduction as a key pillar of Canada's drug strategy alongside the existing pillars of prevention, treatment and enforcement.

February 2017: Began publishing status of applications online.

Winter/Spring 2017: Support the Government as Bill C-37 moves through Parliament.

Spring 2017 Royal Assent of Bill C-37: Implement new supervised consumption site application process.


Take steps to facilitate access to naloxone using federal levers.

March 22, 2016: Health Canada amended the Prescription Drug List to make naloxone available without a prescription.

July 6, 2016: The Minister of Health signed an emergency order to authorize the immediate importation and sale of NARCAN® nasal spray for use in the emergency treatment of opioid overdoses.

October 3, 2016: The Minister of Health announced that Health Canada had authorized NARCAN® nasal spray for non-prescription use, following an expedited review to allow the product on the Canadian market.

Ongoing: The First Nations and Inuit Health Branch (FNIHB) is providing naloxone nasal spray for remote and isolated communities through Nursing Stations to provide timely access to at-risk clients and their families, until the product is available at retail pharmacies. For remote and isolated communities, naloxone injection is listed as a “must stock” antidote to reverse the effect of opioid overdose in the Nursing Station Formulary. FNIHB is also working with existing provincial public health programs to distribute take-home naloxone injection kits to high-risk clients for opioid overdose.

The Royal Canadian Mounted Police has released a training course for naloxone nasal spray and distributes naloxone kits to members across the force.

This action has been completed.

Health Canada's Drug Analysis Service (DAS) will implement a new initiative for sharing real-time information about emerging, potent, illicit drugs with provincial and territorial health authorities, as well as their law enforcement clients.

December 2016: DAS launched its Drug Alerts initiative.

April 2017: DAS has issued drug alerts to about 65 health authorities. Examples of drugs included in these alerts are carfentanil, furfentanyl, W18 and U47700.

2017-18: Continue to support federal, provincial and territorial partners to address the opioid crisis by providing laboratory analysis services and by sharing information.


To address illegal drug production and distribution, we will use legislative and regulatory authorities to address the illegal drug supply.

Action Progress Next steps


Make regulatory changes to control fentanyl precursors under the Controlled Drugs and Substances Act and its Precursor Control Regulations.

September 3, 2016: A Notice to interested parties was published in the Canada Gazette, Part I.

November 30, 2016: Final regulations were published in the Canada Gazette, Part II.

This action has been completed.

Propose legislative changes to control pill presses/encapsulators and other appropriate amendments to the Controlled Drugs and Substances Act.

December 12, 2016: the Minister of Health and the Minister of Public Safety introduced Bill C-37 in the House of Commons.

These changes will better equip both health and law enforcement officials to reduce the harms associated with drug and substance use in Canada. The proposed legislation would allow for import control of pill presses/encapsulators and the opening of small packages at the border through amendments to the:

Winter/Spring 2017: Support the Bill C-37 Parliamentary process.

Spring 2017 Royal Assent of Bill C-37: Implement pill press/encapsulator import registration scheme.

May 2017: Stakeholder and partner outreach.

Work with Public Safety and law enforcement partners to produce materials to educate law enforcement agents on their ability to investigate and press charges for offences under the Food and Drugs Act. This would be particularly for the sale of unauthorized drugs that have not yet been controlled under the Controlled Drugs and Substances Act.

March 2017: Project expanded to include potential new law enforcement tools under the Controlled Drugs and Substances Act.

Spring 2017: Consult with public safety and law enforcement partners on content on dissemination approach.

Spring 2017 Royal Assent of Bill C-37: Disseminate educational materials through law enforcement networks.

Public health emergency response

To ensure a public-health-focussed emergency response to the opioid crisis, we will support a cohesive national public health response across governments and stakeholders.

Action Progress Next steps
Provide public health leadership on the emergency response to the opioid crisis. February 2017: The Public Health Agency of Canada (PHAC) developed a public health emergency response plan for opioids. Ongoing: PHAC will continue to update and adjust key response activities as required.
Deliver effective public health communications in support of the emergency response to the opioid crisis.

2016/2017: PHAC and Health Canada will develop comprehensive opioid communications plans.

March 13, 2017: Statement from the Chief Public Health Officer was released addressing the important contributions of pharmacists to addressing the opioid crisis.

Summer 2017: Public communications on the risks associated with opioids.

Stakeholder engagement to enhance a multi-sectoral public health response to the crisis.

In collaboration with provinces and territories, explore opportunities for joint communications on the opioid crisis.

Provide surge capacity, mobilizations and support to other jurisdictions, as required.

2016: PHAC provided a total of 113 person-days of epidemiological assistance to two jurisdictions to assist with analysis and writing of monthly opioid overdose reports.

Winter/Spring 2017: PHAC received and approved requests from five jurisdictions for assistance relating to the opioid crisis response.

March 2017: PHAC purchased injectable and nasal spray naloxone for the National Emergency Strategic Stockpile to support provincial and territorial needs, as required.

Ongoing: Upon request, PHAC will mobilize mini-clinics and additional analytical support to assist provincial and territorial response efforts.

Summer 2017: Planning is underway to mobilize more epidemiologists to an additional four jurisdictions that have self-identified data/surveillance capacity gaps.
Engage provincial and territorial partners and other stakeholders to support a coordinated federal, provincial and territorial response.

November 19, 2016: The Council of Chief Medical Officers of Health (CCMOH) made a Joint Statement of Action commitment to:

  • exchanging and disseminating best practices and lessons learned from jurisdictions addressing the opioid crisis
  • providing evidence-based public health advice to the Public Health Network Council and Conference of Deputy Ministers of Health
  • providing support and input in the establishment of key metrics for comparable data collection and reporting across Canada

December 2016: Activation of the federal, provincial and territorial Special Advisory Committee (SAC) on the Epidemic of Opioid Overdoses, which meets bi-weekly. PHAC provides co-ordination and support. 

Spring 2017: In addition to sharing lessons learned and leveraging best practices, the SAC has advanced opioid data/surveillance plans and has held discussions on upstream prevention across jurisdictions, guidance on establishment of supervised consumption sites, and naloxone distribution/supply.

June 2017: PHAC is coordinating a Town Hall event at the Canadian Public Health Association (CPHA) Conference. The Chief Public Health Officer will moderate a session entitled “Moving Upstream: Primary Prevention and Canada's Opioids Crisis.”

Summer 2017: The SAC will continue with bi-weekly meetings to address urgent issues related to opioid overdoses and deaths, including further discussions to advance data/surveillance efforts.

Ongoing: PHAC will continue to provide leadership, support and coordination for discussions with provincial and territorial public health officials through the SAC. The SAC is also the key mechanism to support CCMOH commitments.

Enhance data, surveillance and research.

February 2017: An Opioids Overdose Surveillance Task Group (OOSTG) reporting to the SAC was created, with a mandate to address opioid data and surveillance needs.

April 2017: Federal, provincial, territorial agreement on case definitions for “opioid-related deaths” that all jurisdictions will implement for reporting purposes.

May 2017: First national estimate of apparent opioid-related deaths in Canada for 2016.

Summer 2017: The SAC will continue to focus on advancing opioid data and surveillance to inform response efforts:

  • implement systematic, quarterly reporting of overdose death surveillance;
  • explore models for national reporting of non-fatal overdoses, focusing first on emergency department visits;
  • coordinate planning for an epidemiological study to better understand substance use and misuse trajectories.

Strong evidence base

To improve the evidence base to support policy decisions, we will:

  • consult experts
  • support research on opioid use and harms
  • enhance data collection, monitoring and surveillance
Action Progress Next steps

Hold Scientific Advisory Panels to provide advice on:

  • warning sticker
  • patient handout
  • Risk Management Plans
  • potential contraindications/limitations to be added to approved opioids

November 15-16, 2016: the Scientific Advisory Panel met to discuss recommendations on the:

  • content of warning stickers
  • content of patient information handouts for dispensed opioids
  • approach to requiring Risk Management Plans for opioids

February 17, 2017: The Record of Proceedings of the November 2016 Scientific Advisory Panel was published online.

March 24, 2017: The Scientific Advisory Panel met to discuss labelling of opioids.
June 2017: A Record of Proceedings containing the March 2017 Panel's recommendations will be developed and posted online.
Host a Best Brains Exchange on how to develop a Canadian Drugs Observatory. October 3, 2016: Health Canada and the Canadian Institutes of Health Research co-hosted the Best Brains Exchange. Through this exchange we gathered advice on how to develop a Canadian Drugs Observatory. Winter/Spring 2017: Issue a contract for a feasibility study and a business case for the creation of a Canadian Drugs Observatory (CDO).
Support the Canadian Institute for Health Information (CIHI) with their efforts to improve data collection, monitoring and surveillance on opioid use and harms.

2014: CIHI received funding to coordinate a pan-Canadian approach for the monitoring and surveillance of prescription drugs. In the Joint Statement of Action to Address the Opioid Crisis, CIHI commits to continuing this work on a priority basis and sets concrete milestones for 2017 and 2018.

March 1, 2017:
CIHI hosted a meeting of provincial and territorial chief coroners and medical examiners to continue its work to:

  • establish a common definition for opioid-related death;
  • begin developing a plan to collect consistent data on opioid-related deaths.
March 2017: CIHI shared the pan-Canadian definition of ‘opioid-related death’ established on March 1st with the Special Advisory Committee sub-group responsible for coroner data collection. This definition will be used to collect provincial/territorial coroner data beginning in April 2017.

Summer 2017: Publish updated statistics for two key metrics: number of hospital admissions due to opioid poisoning; and, number of emergency department visits due to opioid poisoning.

August 2017: Collaborate with provincial and territorial chief coroners and medical examiners to release recommendations for the investigation and reporting of drug-related deaths.

November 2017: Develop key metrics on the prevalence, consumption and harms of problematic opioid use and publicly report on an ongoing basis.

November 2018: Publicly report the number of opioid-related deaths, on an ongoing basis.
Support a synthesis grant aiming to review the current literature and increase our knowledge related to the harms associated with opioids in Canada.   June 2017: Launch a funding opportunity through the Canadian Institutes of Health Research.
Support new research projects on gender implications related to opioids.   June 2017: Launch a funding opportunity through the Canadian Institutes of Health Research.
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