October 2017

It’s been a busy autumn so far at the Hamilton Niagara Haldimand Brant Local Health Integration Network, with the Patient and Family Advisory Council now up and running, continuing our Heroes in the Home caregiver recognition celebrations across the LHIN and bringing proposals forward to our Board related to community investment funding.

While all this is happening, there is one issue that’s been making headlines for the past several months across Ontario and Canada. You’ve probably been hearing a lot about the opioid crisis gripping communities across the country, including those in the HNHB LHIN. Whether the source is the news media, local and provincial politicians, activists or health care professionals sounding the alarm, the heavy toll of opioid addiction is becoming more evident. I want to focus, today, on how the LHIN is responding and what is happening locally regarding caring for people who are living with an addiction.

Opioids are a class of drugs that include some prescription medications such as oxycodone (OxyContin), morphine, codeine and others that act on the body’s nervous system to relieve pain. Also included in this class of drugs are heroin and synthetic opioids such as fentanyl and carfentanyl – all of which are chemically related.

Opioid pain relievers prescribed by a doctor are generally safe when taken over a short period of time, but even short term use can lead to dependence because, in addition to relieving pain, these drugs also produce a feeling of euphoria. Other opioid side effects can include suppressed breathing and racing heart rate to the point of respiratory failure at high doses. Taking opioids in either a higher dosage or a different way than prescribed can lead to addiction, overdose and even death.

In recent years, the number of opioid related overdoses and deaths has reached staggering levels in our communities. A recent report by the Canadian Institute for Health Information (CIHI) found Brantford had one of the country's worst rates for opioid-poisoning hospitalizations. In Hamilton, the number of Emergency Department visits for people experiencing an opioid overdose are among the highest in the province. There are a number of factors contributing to the opioid crisis, including widespread availability of both prescription and illicit opioids. For many years, opioids have been prescribed broadly to treat moderate to severe acute and chronic pain. It was believed that these medications were safer and less likely to lead to opioid dependence, especially considering the slow-release formulations of the drug oxycodone. New evidence shows that opioids are significantly more addictive than originally thought, which has prompted a review of opioid prescription guidelines.

Under new stricter guidelines, physicians are encouraged to avoid prescribing opioids as a first-line treatment for chronic, non-cancer pain and to reduce prescribed dosages among patients whose pain cannot be controlled with non-opioid alternatives. In many cases, prescribed dosages among people already taking opioids have also been incrementally reduced or discontinued altogether.

While there have been positive developments – reducing dosages and a move to tamper-resistant versions of oxycodone designed to prevent misuse – those already dependent on or misusing opioids are increasingly resorting to street drugs to manage their addictions.

The growing black-market availability of powerful synthetic opioids like fentanyl and carfentanyl has added a deadly new twist to the crisis. These potent drugs are being sought out by those already dependent on opioids and are also being cut into other illicit drugs like cocaine, heroin and methamphetamine. The unpredictable quality of street drugs – in combination with the fact that many drug users are unknowingly ingesting opioids – has caused a dramatic spike in hospital emergency department visits and deaths linked to overdose. These spikes are being seen across the province and, in particular, within our own LHIN.

The HNHB LHIN continues to pay close attention to the opioid crisis and we are working closely with the Ministry of Health and Long-Term Care along with public health agencies and our health system partners at the local level to roll-out strategies and solutions to combat the opioid crisis. These include public education campaigns for at-risk groups, exploring the possibility of harm-reduction strategies such as the introduction of supervised injection sites in select communities, and also, making Nalaxone – the anti-overdose treatment – available to first-responders, pharmacies, and in community settings to opioid users and their loved ones.

At the provincial level we are looking forward to learning more about the work to be carried out by the recently established Opioid Emergency Task Force. These front-line workers and people with lived experience will help strengthen the province's coordinated response to the opioid crisis.

The Task Force will ensure those closest to the crisis are providing critical insight about what is happening on the ground to support the province's coordinated response to the crisis and address new challenges as they arise.

On August 29, 2017, the Ontario government announced $222-million in new funding to fight the opioid crisis; and in late September it was confirmed that $21-million of that funding is being made available immediately in our region to help community-based addiction organizations. Working with our health service providers, funding proposals to ‘put boots on the ground’ have been reviewed and put forward to the HNHB LHIN board for consideration at its October 25 meeting. I will share further details about the funding when the decisions have been finalized.

Given the severity of the problem, I expect to see a continued focus on the opioid crisis at the provincial level and across the HNHB LHIN. As the local health care system response evolves, I am committed to keeping you informed about the latest strategies and solutions to be implemented across our LHIN; in the meantime, information about the provincial response and initiatives underway is available.

If you or your organization would like to be featured in a future blog or share a patient story in one of our Voices in the Community videos, you can reach us through our office. You can also connect with us over social media via our Twitter handle -@HNHB_LHINgage or on Facebook at facebook.com/HNHBLHIN. Your feedback and questions are always welcome.