The College of Physicians and Surgeons of Ontario approved changes requiring opioid agonist therapy for safer supply prescriptions and mandating supervised dosing to reduce diversion.
Ontario’s medical regulator has approved significant changes to the prescribing of safer supply drugs, aiming to reduce the amount of opioids entering the illicit market. The College of Physicians and Surgeons of Ontario’s board of directors passed a motion on Tuesday to implement new protocols for medications given to individuals at high risk of overdose as an alternative to illicit opioids.
Under the new rules, physicians must prescribe safer supply medications only in conjunction with opioid agonist therapy. This therapy utilizes medications such as Suboxone and methadone to treat opioid addiction. Additionally, patients will no longer be permitted to take the pills home; they must consume the medications in front of health-care professionals.
The most common form of safer supply is hydromorphone, a powerful opioid prescribed for pain. While significantly less potent than fentanyl and its derivatives that dominate the illicit drug supply, authorities have raised concerns about its diversion.
Dr. Patrick Safieh, the board’s chair, stated the primary goal is public safety. “We are just here to protect the public and we’re here to ensure that the public is safe,” Safieh said. “So we’re trying to prevent diversion as much as possible and at the same time, ensuring that those that do require safer supply are taking (opioid agonist therapy) so that eventually no one is on this and needs this, that’s the purpose.”
The board heard from Dr. Anil Chopra, the college’s associate registrar, who noted that information from governments, Addiction Medicine Canada, the addictions section of the Ontario Medical Association, and public health officers indicates that diversion of hydromorphone to the streets is occurring. Police forces in Ontario have also reported that diversion of patients’ prescription hydromorphone to the black market is happening, according to Safieh.
However, Chopra, Safieh, and other board members agreed that there is no data available to properly quantify the source of street hydromorphone, though they acknowledged at least part of it comes from safer supply prescriptions.
The college decided not to proceed with a previously considered eight-week time limit for physicians to prescribe safer supply to patients. Board member Peter Wiesner expressed concern that the new policy might not work for all patients. He cited information from the Ontario Drug Policy Research Network showing that more than 87 per cent of patients on safer supply are also on opioid agonist therapy.
“But what about the 12 per cent that it doesn’t work for?” Wiesner asked. “We need to find, I think, some exemptions for the 12 per cent.”
Wiesner highlighted that the policy could have an outsized effect on individuals in rural Ontario who are not close to a pharmacy. He also raised concerns for employed patients who may face difficulties traveling to a pharmacy daily if they cannot take medication home.
Safieh indicated that the college will monitor the changes and make adjustments if necessary. The office of Health Minister Sylvia Jones has previously stated that she supports the changes.
Sources
This article was drafted with AI assistance and checked against the sources above. Company claims are reported as claims. Cover image is AI-generated.
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