Changes to prescribing safer supply drugs approved by Ontario medical regulator

Ontario’s medical regulator approved significant changes Tuesday to the way doctors prescribe safer supply drugs, in an effort to reduce the amount of opioids making their way to the streets.

The College of Physicians and Surgeons of Ontario’s board of directors will soon implement several changes to the practice of prescribing safer supply, which are medications given to people at high risk of overdose as an alternative to illicit opioids.

The board met Tuesday and passed a motion to enact the changes following a discussion on the proposals.

The college will make it mandatory for physicians to prescribe safer supply medications only in conjunction with opioid agonist therapy. The therapy uses medications such as Suboxone and methadone to treat opioid addiction.

“We are just here to protect the public and we’re here to ensure that the public is safe,” said Dr. Patrick Safieh, the board’s chair, near the end of the meeting.

“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 most common form of safer supply is hydromorphone, a powerful opioid often prescribed for pain but significantly less potent than fentanyl and its derivatives that dominate the illicit drug supply chain.

Patients will now have to take the safer supply medications in front of health-care professionals, rather than take the pills home.

The college will not go ahead with an eight-week time limit for physicians to prescribe safer supply to patients it had previously considered.

Police forces in Ontario have said that diversion of patients’ prescription hydromorphone to the black market is occurring, Safieh said.

The board heard from Dr. Anil Chopra, the college’s associate registrar, who said they have also received information from governments, Addiction Medicine Canada, the addictions section of the Ontario Medical Association and from public health officers that diversion of hydromorphone to the streets is occurring.

Chopra, Safieh and others agreed there is no data available to properly quantify where the hydromorphone on the street is coming from, but said at least part of it is from safer supply prescriptions.

Board member Peter Wiesner said he was concerned that the policy will not work for everyone, citing information sent in by the Ontario Drug Policy Research Network that shows 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?” he asked.

“We need to find, I think, some exemptions for the 12 per cent.”

He said the new policy will have an outsized effect on those living in rural Ontario who are not close to a pharmacy. Another concern he raised are for those people who are employed who are using safer supply drugs. Those people may have difficulties getting to a pharmacy every day to take their medicine if they are not allowed to take some home with them.

Safieh said the college will monitor the changes and make adjustments down the road if necessary.

The office of Health Minister Sylvia Jones has previously said she supports the changes.