Access to life-saving injectable treatments for opioid use disorder in Canada still extremely limited

published on February 23, 2021

Despite regulatory changes to encourage prescribing of injectable treatments for opioid use disorder in the midst of a worsening national overdose crisis, fewer than 800 patients in Canada received the evidence-based, life-saving therapy, a new study published today in the Canadian Medical Association Journal (CMAJ) shows.

Researchers from the British Columbia Centre on Substance Use (BCCSU) and University of British Columbia (UBC) reviewed programs across Canada between September 2018 and March 2019 that offered injectable opioid agonist treatment (iOAT), which includes injectable hydromorphone and diacetylmorphine (also known as prescription heroin). They found only 12 clinics in total, all of which were located in major urban centres, and just 322 active clients on iOAT as of March 2019.

An updated survey of these services through to March 2020 found only minimal increases to 16 total programs nationally and 401 active clients, suggesting that few Canadians are able to access this therapy despite evidence demonstrating its effectiveness as a treatment for opioid use disorder.

“Injectable opioid agonist treatment can be a highly effective therapy, particularly for those who’ve not had success when offered traditional oral treatments,” says Dr. Nadia Fairbairn, lead author on the study. “But while this treatment has been proven to help safely stabilize patients and protect those at risk of overdose, access to this treatment is limited and has been slow to expand.”

More than 17,602 Canadians died of an opioid-related overdose between January 2016 and June 2020. Untreated opioid use disorder and a toxic illicit drug supply contaminated with fentanyl and other adulterants are key drivers of the opioid overdose crisis, which was declared a public health emergency in British Columbia in 2016.

This unprecedented public health emergency underscores the importance of developing comprehensive, evidence-based health services to address the harms related to untreated opioid use disorder. Clinical trials in Canada and internationally have demonstrated that iOAT is an evidence-based, high intensity, cost-effective treatment option for patients with opioid use disorder who have not benefitted from other treatments and those whose individual situations and needs indicate they may benefit from injectable opioid agonist treatment.

In May 2019, Health Canada approved injectable hydromorphone for use as a treatment for severe opioid use disorder in adults. In August 2020, the federal Minister of Health sent a letter to all provincial and territorial ministers of health urging them to increase access to these treatments. Diacetylmorphine was also added to the List of Drugs for an Urgent Public Health Need following a request by Canada’s Chief Public Health Officer, Dr. Theresa Tam.

In September 2019, the Canadian Research Initiative on Substance Misuse (CRISM) published clinical and operational guidelines to support the scale-up of the treatment. However, as today’s findings demonstrate, access to iOAT remains limited.

The scan found that entire regions of the country – the prairies (save for one site in each of Alberta’s two main cities), the Atlantic provinces, and the northern territories – had no programs. No programs existed in rural areas, and several major urban centres (including Montreal and Toronto) did not have any iOAT programs at the time of publication. In addition, these existing programs did not have the capacity to take on all eligible patients, reporting waitlists almost as long – if not longer – than the number of clients on the therapy.

Programs offering iOAT across Canada cited a number of factors that encumbered their ability to provide services, including a lack of capacity to accommodate more patients and lack of access to diacetylmorphine, one of two drugs used in iOAT and the preferred formulation for many people suffering from severe opioid use disorder. Currently, diacetylmorphine is produced abroad and imported into Canada, raising the cost and increasing the likelihood of problems with supply.

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