Press Release: Over 400 Providers and Researchers Call on Ontario to Fund An Essential Drug to Address the Opioid Crisis

410 care providers and researchers have signed an open letter to Minister of Health Christine Elliott and Premier Doug Ford asking that Ontario take urgent action to ensure access to high dose injectable hydromorphone, a drug described as essential for addressing the current opioid overdose crisis in Ontario.

“The current drug supply contains extremely potent and toxic drugs, such as fentanyl,” said Jessica Hales, a nurse practitioner who works in downtown Toronto with many people who use drugs. She added that “People frequently don’t know the composition or concentration of drugs that they are injecting. That’s why we refer to the current drug supply as being poisoned.” One solution is to establish programs that provide access to a safer supply of drugs. High dose injectable hydromorphone is a crucial component of such programs.

Hydromorphone is an evidence-based therapy for the treatment of people who use opioids. A 2016 Canadian study compared hydromorphone with prescription heroin, known as diacetylmorphine, in people who used opioids and had previously stopped taking other treatments (such as methadone). In both treatment groups, there was a significant and comparable drop in the use of street drugs. On the basis of this evidence, Health Canada recently approved supervised injectable hydromorphone for some people who use opioids.

“In the context of a crisis, when people are dying daily from opioid overdose, decreasing the use of drugs that people buy on the street has the potential to be life-saving,” said Ahmed Bayoumi, a physician and researcher in Toronto. “Hydromorphone is key”, he continued. “Prescription heroin isn’t available in Ontario and setting up new clinics to prescribe heroin will take too long. We can’t wait.”

“We could rapidly implement hydromorphone prescribing,” said Hales. “Clients want this. Prescribers are eager to deliver it. But it is not covered under the Ontario Public Drug Plan, which is how almost all of my clients access prescription drugs.”

One of the most significant barriers to injectable hydromorphone is cost. In British Columbia, where high dose hydromorphone is included in the public drug formulary, the price listed on the public formulary website is about 40 cents per milligram. In the hydromorphone study, the average dose was just over 250 milligram per day, for a cost of about $100/day per person. “That might seem like a lot,” said Bayoumi, “but it’s important to recognize that the cost is offset by avoiding expensive health and social consequences of drug use.” A 2018 cost-effectiveness analysis projected that hydromorphone prescribing for people similar to those in the study would result in cost savings of over $100,000 per person over their lifetime compared to methadone. As a major purchaser, the government of Ontario could also negotiate significant price discounts.

“We need a range of approaches to reverse the opioid overdose crisis, including injectable hydromorphone and other harm reduction initiatives,” said Hales. “Too many people have died. We need to act quickly.”

For more information, please contact:
Jessica Hales at 647-879-4493 or jessicahales85@gmail.com
Ahmed Bayoumi at 416-864-5438 or ahmed.bayoumi@utoronto.ca or on Twitter: @AMBayoumi

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