A look at Ontario's new prescription narcotics strategy

Source: CTV.ca, by Dr. Marla Shapiro


As a province, Ontario has the dubious distinction of having the highest use of prescription drugs containing narcotics in the world. In fact, between 1991 and 2009, the number of prescriptions in Ontario for oxycodone drugs alone rose by a whopping 900 per cent.

As a result, starting this month, there is a new Ontario Narcotics Strategy and I would not be surprised if other provinces followed this initiative.

The strategy wants to promote the proper use of controlled substances and make sure these medications are used properly.

The first question is what are these drugs? In broad strokes, they would include medications that are often used to relieve pain, such as acetaminophen and codeine and other pain narcotics listed below. Another class of medication would include those often used to treat ADD and ADHD, such as Ritalin. Medications in the benzodiazepine family are also considered controlled medications.

The strategy hopes to raise awareness of patients and physicians alike on the safe use of these drugs. However, with this new strategy, there will be monitoring of the prescribing and dispensing of these medications through a newly established provincial narcotics monitoring system.

In Ontario, since 2000, there has been a 41% increase in narcotic related deaths and a 5-fold increase in oxycodone -elated deaths. The strategy not only seeks to monitor and partner with physicians and pharmacists, but also to treat addictions.

The monitoring systems will establish a data base that will collect and store both prescribing information and the dispensing of these medications. (The monitoring system is still under development and will come into effect spring 2012). Through this monitoring, it will be easy to identify unusual trends as well as develop harm reduction strategies. It can establish who is double-doctoring, refill too soon and poly-pharmacy to name a few.

If you are a patient on these medications, when you ask for a prescription, it will have to be done in person. You will have to provide a valid form of identification both to the prescriber and the pharmacist. The prescriber will have to completely identify themselves with their College registration number. All of this information will have to be recorded on the prescription accurately.

So what happens with this information? Well, the ministry can now identify patterns of inappropriate or excessive use and implement a province wide system of alerts. It allows the ministry to share that information to regulatory colleges and law enforcement authorities. At present the ministry is working with the Narcotics Advisory panel to examine what kind of health information it could share with providers. Similarly a physician who appears to be practising in a manner that raises alarm could also have their information provided to the regulatory college.

Ontario's Narcotics Strategy includes exploring opportunities to provide additional support for the treatment of addiction. The ministry currently provides funding for a number of substance abuse treatment programs, including withdrawal management, community counselling and residential treatment and support services. Additional information on specific treatment programs can be accessed on the Ontario Ministry of Health website.